Nutrition and hydration

These resources from NHS Improvement on using nutrition and hydration to reduce the incidence of pressure ulcers and promote good wound healing, include evidence and recommendations for assessment and action when assessing an individual’s risk of developing a pressure ulcer; five top tips to prevent pressure ulcers; and three case studies.

NIHR Signal Biological therapies for psoriasis do not increase serious infection risk

People with psoriasis who take an immune-modulating treatment are no more likely to get serious infections than people taking standard therapies.inf




There are fears that these biological therapies raise the risk of serious infections and this has discouraged their use. They are recommended by NICE for moderate to severe psoriasis. Previous studies have reached conflicting conclusions, making it hard to advise on the true risk.




This study used a large database of people with psoriasis from the UK and Ireland. It compared serious infection risk of the biological therapies (etanercept, adalimumab or ustekinumab) with non-biological therapies, after accounting for factors such as other illnesses. It found none of the biological therapies studied had a higher risk of infection compared to non-biological therapies or compared to each other.




From the NIHR Dissemination Centre

High impact change model: managing transfers of care

This change model, developed by the Local Government Association with the Association of Directors of Adult Social Services, outlines a practical approach to managing patient flow and hospital discharge. It identifies eight system changes that will have the greatest impact on reducing delayed discharge. The resource supplements the model by bringing together examples of work being undertaken across the country, for each of the eight system changes.

Hepatic amyloidosis: a cause of rapidly progressive jaundice

BMJ Case Reports 2018; doi:10.1136/bcr-2017-222942

An 83-year-old man presented with an acute history of weight loss and jaundice. He had a history of type 2 diabetes mellitus and hypertension. He consumed 30 units of alcohol per week. 

UHCW Research: Benjamin Disney and Veena Shinde

Speech and language delay in children: a case to learn from

Br J Gen Pract 2018; 68 (666): 47-48. DOI: https://doi.org/10.3399/bjgp17X694373 

Speech and language delay in children is a common presentation to primary care either directly to the GP or through the health visitor, affecting approximately 6% of pre-school children. Young children, particularly those with speech delay, can be difficult to examine. Differentiation between an isolated pathology and those with concurrent global developmental delay is crucial. This article presents an example of a common case, considers the learning points, and highlights management principles.

UHCW Research: Nicola Wooles and Emma Hoskison

Reward to improve staff retention

A case study from NHS Employers shows how Sandwell and West Birmingham Hospitals NHS Trust used reward strategically to improve staff retention and reduce spending on temporary and agency staff.

Novel application of three-dimensional technologies in a case of dismemberment

Forensic Sci Int. 2016 Dec 2;270:139-145. doi: 10.1016/j.forsciint.2016.11.040. [Epub ahead of print]

This case study reports the novel application of three-dimensional technologies such as micro-CT and 3D printing to the forensic investigation of a complex case of dismemberment. Micro-CT was successfully employed to virtually align severed skeletal elements found in different locations, analyse tool marks created during the dismemberment process, and virtually dissect a charred piece of evidence. High resolution 3D prints of the burnt human bone contained within were created for physical visualisation to assist the investigation team. Micro-CT as a forensic radiological method provided vital information and the basis for visualisation both during the investigation and in the subsequent trial making it one of the first examples of such technology in a UK court.

UHCW Research: Brian A. Burnett

See also Corrigendum to "Novel application of three-dimensional technologies in a case of dismemberment" [Forensic Sci. Int. 270C (2017) 139-145].

Learning from deaths: case studies from trusts

NHS Improvement has put together a collection of case studies that show the range of activity that trusts are taking to implement the implement the requirements of Learning from Deaths, as well as the challenges they have faced and how they are seeking to overcome these.

Supporting staff retention with reward

In this NHS Employers' case study, Sandwell and West Birmingham Hospitals NHS Trust shares how they used their reward offer to improve staff retention, reduce agency and temporary staff spend and re-engaged the workforce.

New analysis shows impact of redesigning urgent and emergency care in Northumberland

The Health Foundation has published analysis examining the early impact of changes to A&E and urgent care services in Northumberland following the opening of the country’s first bespoke emergency hospital in Cramlington in 2015.

Retention: Showcasing Best Practice, Celebrating success and Looking to the Future

On 5 December 2017, NHS Employers hosted an event, Retention: Showcasing Best Practice, Celebrating success and Looking to the Future.

As part of the event, trusts presented on their key successes in the rollout of retention strategies to improve staff leaver and turnover rates. These included:

• Guy’s and St Thomas’ NHS Foundation Trust
• Cambridge University Hospitals NHS Foundation Trust
• Lincolnshire Partnership NHS Foundation Trust
• Blackpool Teaching Hospitals NHS Foundation Trust.

PO191 Diffuse psoriatic exacerbation following immunoglobulin administration

Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool

We report the first case of a widespread, exfoliative and erythematous psoriatic exacerbation following immunoglobulin administration. Serious dermatological complications should be considered in patients with pre-existing psoriasis prior to immunoglobulin administration.

UHCW Research: Fizzah Ali, Akram A Hosseini and Antony Thomas

PO199 An autoimmune cranial and peripheral polyneuropathy with myositis

Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool

A 69 year old man presented in 2006 with diplopia, facial weakness, bulbar dysfunction, profound sensory motor neuropathy (distally more than proximally), and hyporeflexia. Blood at the time did not reveal any major abnormalities. Electrophysiology confirmed severe sensory and motor axonal polyneuropathies. Sural nerve biopsy was non-specific, whereas muscle biopsy specifically showed peri-vascular inflammatory cells. Following significant improvement with intra-venous methylprednisolone, he returned to a functional independent life. More debilitating similar episodes recurred six and nine years later with involvement of cranial nerves 2–7, 9–12, accompanied by predominantly upper limb weakness and hyporeflexia. Post-contrast neural MR and CSF constituents remained normal (negative antiganglioside antibodies). Electrophysiology confirmed progressive axonal peripheral polyneuropathy. Liver biopsy ruled out cirrhosis/autoimmune hepatitis. In 2016, repeat Ro antibodies were positive, with3-year history of Raynaud’s phenomenon. Patient was treated with immunoglobulin, intravenous Methylprednisolone, followed by oral steroids. Subsequently, intravenous Cyclophosphamide then Mycophenolate with ongoing tapered steroids resulted in good response, despite persistent muscle wasting without fasciculations.

UHCW Research: Akram A Hosseini, Fizzah Ali, Shirish Dubey, and Antony Thomas

PO108 Susac syndrome: a case for early, aggressive and sustained treatment

Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool

We report a case of Susac syndrome, initially suspected to be multiple sclerosis, and advocate diagnostic caution and high suspicion. We describe a successful therapeutic approach comprising corticosteroids, intra-venous immunoglobulin and cyclophosphamide for encephalopathic relapse of Susac syndrome.

UHCW Research: Fizzah Ali, Akram A Hosseini and Antony Thomas

PO179 Aggressive disseminated intracranial anaplastic astrocytoma

Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool

A 21-year-old male immigrant from Afghanistan presented with seizures 2 years previously. MRI brain was suggestive of a possible low-grade glioma affecting the right temporal lobe. After 2 years, he re-presented with symptoms of headache, intermittent pyrexia, raised intracranial pressure (opening pressure of >42 cm/H2O) requiring ventriculoperitoneal shunt to preserve his vision. MRI head revealed slight progression in appearance within the right medial temporal lobe and extension into the right cerebral peduncle with enhancement of the basal meninges as well as 7th and 8th nerve complexes. CSF consistently showed two-digit lymphocytes, with raised protein and moderately reduced glucose ratio. Large CSF samples for cytology and flow-cytometry, Acid-Fast-Bacilli, and IgG subtypes remained negative. He had lymphopaenia. CT body/PET scans revealed no lymphadenopathy. Originally, tuberculosis was considered and quadruple anti-tuberculosis therapy was given along with oral Prednisolone. His first negative tuberculosis culture after 6 weeks coincided with increasing widespread leptomeningeal spread into the intradural spinal cord. Brain biopsy from the basal leptomeninges and temporal lobe confirmed anaplastic astrocytoma.

UHCW Research: Akram A Hosseini, Fizzah Ali and Holger Allroggen

Sharing best practice from clinical leaders in urgent and emergency care

The CQC has worked with senior clinical, nursing and managerial leaders from emergency departments at 17 hospital trusts across the country to develop a best practice resource for all NHS acute trusts.

A regressing spindle cell tumour of Reed

BMJ Case Reports 2017; doi:10.1136/bcr-2017-222002

Spindle cell tumour of Reed is a benign melanocytic naevus which usually presents as a deeply pigmented mole. It is more commonly found on the lower extremities of young girls. It is an uncommon naevus but its incidence and prevalence are not known. A Reed naevus typically goes through a rapid initial growth phrase before stabilising in size and then regresses over time. Awareness of Reed naevus has been demonstrated to be low, even among dermatology doctors.

UHCW Research: Simon Tso, William Hunt and Joanna E Gach

Significant improvement in response to the GLP1-agonist 'Liraglutide' following change in injection site

Endocrine Abstracts (2017) 50 EP054 DOI:10.1530/endoabs.50.EP054

Variability in treatment response with respect to GLP1 agents is well-accepted but incompletely understood. In a specialist GLP-1 clinic at UHCW, we describe a case of improved therapeutic response following change in injection site. Currently, advice is injection in the abdomen or thigh.

A 61 year old man was commenced on Liraglutide 1.2 mg subcutaneous OD injection, in 2013. Previously managed with glimepiride 4 mg and metformin 1 g BD, with suboptimal HbA1c of 93 mmol/mol, weight 111.4 kg.

This case highlights, therefore, anecdotal evidence suggesting site-specific efficacy with relation to liraglutide, and further work should focus on this and its potential mechanisms, including site-specific differences in absorption.

UHCW Research: Daniel Border, Wendy Clayton, Tom Barber & Harpal Randeva

Transportation and the role of hospitals

This report from the American Hospital Association explores the role of hospitals and health systems in addressing patient transport issues. It includes four case studies on hospitals and health systems in the US and their interventions to reduce transportation barriers in their communities.

New case study on how to run a successful recruitment fair

NHS Employers has published a new case study focusing on how Sandwell and West Birmingham Hospitals NHS Trust successfully ran a recruitment day to increase its nursing and health care assistant workforce.

The study looks at how the trust targeted nurses wanting to return to practice in the NHS, as well as more traditional groups such as nurses in training. The organisation reached out to experienced nurses working outside of the NHS through a variety of communications channels to secure over 160 attendees at their event. They interviewed 110 people leading to 95 job offers to both registered nurses and healthcare assistants.