Research Development

Staff Publications

 Small purple icon of a book with a magnifying glass on top  Staff Publications

Find out what your colleagues have been writing. This section features articles published by staff working for St Helens and Knowsley Teaching Hospitals and Halton, Knowsley and St Helens community staff.

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All publications by 'Hardy KJ'



Mersey and West Lancashire Teaching Hospitals NHS Trust – St Helens & Knowsley Staff

Mortality from diabetic kidney disease before and during the COVID pandemic

Background and aims We have previously published 5-and 10-year audits from our UK diabetes kidney clinic reporting outcomes comparable to those in landmark trials of diabetic kidney disease in broadly similar patients. This 2023 (20-year) audit again showed practice consistent with NICE, ADA and Kidney Disease Improving Global Outcomes guidelines, but..

Published: 04/09/2023
Authors: Lewis GA, Cardwell J, Hardy KJ

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A62 (P227) Risk of 12-month mortality following a severe inpatient hypoglycaemic event...

Aims At our Trust, all severe inpatient hypoglycaemic episodes in individuals with diabetes (defined as a hypoglycaemic episode requiring injectable treatment) are reported to NaDIA-Harms (National Diabetes Inpatient Audit). We conducted a detailed review of the care of all these events to improve patient safety. In this study, we assessed..

Published: 25/04/2023
Authors: Taylor J, Michaels S, Hatton DA, Caton K, Cardwell J, Hardy KJ, Strong AJ, Bujawansa S

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P303 Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life

Background National guidelines recognise the importance of individualising HbA1c targets. Many people with diabetes agree to have their targets re-evaluated in consultations in response to specific characteristics. Aims We aimed to evaluate the impact of relaxed or stretch HbA1c goals on subsequent HbA1c levels and health-related quality..

Published: 25/04/2023
Authors: McNulty S, Westall S, Narayanan RP, Irving G, Furlong NJ, Bujawansa S, Cardwell J, Hardy KJ

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P302 Glycated haemoglobin targets: The experiences and views of people with diabetes and diabetes healthcare professionals

Background National guidelines highlight the importance of individualising HbA1c targets. Little is known about the experiences of people with diabetes and diabetes healthcare professionals (HCPs) on the use of HbA1c targets. We explored the experiences of adults with diabetes and diabetes HCPs on the use of glycated haemoglobin..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty SJ, Bujawansa S, Cardwell J, Hardy KJ

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P300 Setting explicit glycated haemoglobin goals improves diabetes-related distress, self-efficacy and wellbeing

Background High levels of diabetes-related distress and low levels of self-efficacy and wellbeing are associated with poorer outcomes in people with diabetes. Aims We evaluated the impact of relaxed or stretch HbA1c targets on diabetes-related distress, self-efficacy and wellbeing in adults with type 1 or type 2 diabetes. Methods We randomised 50..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Balafshan T, Cardwell J, Hardy KJ

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Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes

Background The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated..

Published: 27/10/2022
Authors: Westall S, Narayanan RP, Irving G, Hardy KJ

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The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review

Background Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. Methods We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes...

Published: 20/04/2022
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Hardy KJ

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P244 Planning services for people with type 2 diabetes: Is incidence still increasing

Aims Government plans for integrated care systems and integrated care boards are a welcome move towards more joined-up diabetes care between the NHS and local authorities, between health and social care and between specialist, community and primary care services. To plan effectively, for example, structured education for all newly diagnosed..

Published: 23/03/2022
Authors: Westall S, Mitchell L, Cardwell J, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ, McNulty S

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P124 Covid-19 pandemic associated with three-fold increase in demand for diabetes specialist advice

Aims The covid-19 pandemic was associated with legally restricted public movement (lockdowns) and reduced access to face-to-face consultation for diabetes in primary and specialist care. The aim of this study was to assess the impact of the pandemic on requests for specialist telephone support. Methods Retrospective analysis of calls for..

Published: 23/03/2022
Authors: Archer N, Westall S, Cardwell J, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ, McNulty S

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P243 Digital diabetes care: How well equipped are patients and what do they think about it

Aims Covid-19 precipitated an abrupt shift to non-face-to-face (digital) consultation. Some believe that this was overdue and that digital is better for many patients. Our aim was to establish the extent to which people with diabetes were equipped to manage digital consultation and what they felt about it. Methods We..

Published: 23/03/2022
Authors: Westall S, Mitchell L, Cardwell J, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ, McNulty S

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P91 Top to toe examination: An audit to assess the documentation of a foot exam for those admitted to hospital under medicine with diabetes

Background 10% of people with diabetes will suffer from a diabetes foot condition at some point. Those with diabetes related foot disease have high morbidity and mortality rate. They are at higher risk of pressure ulcers and other diabetes related complications such as heart disease or stroke. Patients with neuropathy and..

Published: 23/03/2022
Authors: Sullivan H, Westall S, Furlong NJ, McNulty S, Balafshan T, Narayanan RP, Bujawansa S, Hardy KJ, Pendlebury H

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P143 Non-attendance at structured type 2 diabetes education increases with deprivation

Aims Inequalities exacerbate poor health outcomes in diabetes. Structured education in type 2 diabetes is the cornerstone of supported self-management, but many people with newly diagnosed type 2 diabetes in the UK are not offered structured education and non-attendance in those accepting an offer of structured education is high. The aim of..

Published: 23/03/2022
Authors: Cardwell J, Mitchell L, Westall S, McNulty S, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ

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P193 Therapeutic inertia: Do patients get to target dose after glucagon-like peptide-1 receptor agonist (GLP-1-RA) initiation

Aims A recent primary care database study (J Rachman, Eli Lilly & Co) suggests that only about half of UK patients initiated on subcutaneous semaglutide (Ozempic) reach target maintenance dose. To assess the extent to which these data represent UK practice, we audited semaglutide dose optimisation and metabolic outcomes in our..

Published: 23/03/2022
Authors: Cardwell J, Edon E, Westall S, McNulty S, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ

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Perspectives From a Regional Plastic Surgery Centre on Evidence for the Purported Link Between SGLT2 Inhibitors and Fournier's Gangrene

Introduction The recent report issued by the MHRA indicating an association of Sodium glucose linked transporter type 2 (SGLT2) Inhibitors with the contraction of Fournier's Gangrene (FG), has been drawn with insufficient supporting evidence and without an adequately powered study to make any meaningful assertions or recommendations. We aimed to look..

Published: 10/12/2021
Authors: Asmar O, Mandal A, Tridente A, Hardy KJ, Shokrollahi K

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A service evaluation to assess the dietary management of hospitalised patients with diabetes receiving enteral nutrition

Background There has been a big drive from the UK government and Diabetes UK to provide improved psychological care for patients with diabetes. In addition to the emotional burden of having diabetes, people with type 1 and type 2 diabetes have higher levels of anxiety and depression than the general population. We..

Published: 18/04/2021
Authors: Gallagher CG, Westall S, Langan E, Narayanan RP, McNulty S, Bujawansa S, Mitchell L, Archer N, Hardy KJ

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A5 (P240) Reduced exercise activity is associated with increased anxiety in type 1 but not type 2 diabetes

Aims Increased physical activity and a healthy lifestyle underpin efforts to prevent type 2 diabetes and are cornerstones in managing type 1 and type 2 diabetes. Not only is reduced activity associated with risk of weight gain and adverse metabolism, but it is also mooted to be associated with impaired psychological wellbeing. We..

Published: 14/04/2021
Authors: Westall S, Narayanan RP, Sullivan H, Bujawansa S, Furlong NJ, McNulty S, Cardwell J, Mitchell L, Jackson J, Hardy KJ

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P167 Perceived problems in diabetes do not correlate with levels of anxiety and depression in a validated structured diabetes education programme

Aims Diabetes-related distress, anxiety and depression are all highly prevalent in people with diabetes. The Problem Areas In Diabetes (PAID) and Hospital Anxiety and Depression Score (HADS) questionnaires can be used to measure these domains. We evaluated the impact of structured education on each of these. Method People with diabetes..

Published: 14/04/2021
Authors: Westall S, Narayanan RP, Langan E, Gallagher CG, Bujawansa S, McNulty SJ, Furlong NJ, Sullivan H, Hardy KJ

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P166 The impact of local, validated structured education programmes on self-care activities in people with diabetes

Background Better glycaemic control is exhibited in patients with higher self-care abilities. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire measures diabetes self-care activities. As part of a local, validated structured education programme, we measure the SDSCA scores before and after completing structured education. Scores are outputted as ‘number of..

Published: 14/04/2021
Authors: Furlong NJ, Westall S, Cardwell J, Jackson J, Cairns J, Mitchell L, Bujawansa S, McNulty S, Narayanan RP, Hardy KJ

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P252 The impact of a validated structured education programme on diabetes-related distress in patients with type 1 diabetes

Background and Aim People with type 1 diabetes experience varying degrees of the emotional burden of diabetes and its treatments. The Problem Areas in Diabetes (PAID) questionnaire can be used to evaluate this domain. As part of a local, validated structured education programme for people with type 1 diabetes, baseline and endpoint..

Published: 14/04/2021
Authors: Narayanan RP, Westall S, Sullivan H, Cardwell J, Langan E, Gallagher CG, Bujawansa S, McNulty S, Furlong NJ, Hardy KJ

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P164 The impact of a local, validated structured education programme on anxiety and depression in people with diabetes

Background People with type 1 and type 2 diabetes experience greater degrees of anxiety and depression than the general population. The Hospital Anxiety Depression Scale (HADS) can evaluate this. Scores ≥8 on HADS-A (anxiety) or HADS-D (depression) indicate potential cases of anxiety or depression. Methods As part of a validated structured education programme,..

Published: 14/04/2021
Authors: Narayanan RP, Westall S, Sullivan H, Cardwell J, Cairns J, Gallagher CG, Bujawansa S, McNulty S, Furlong NJ, Hardy KJ

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Evaluating the impact of a pharmacist-led prescribing feedback intervention

Background Prescribing errors are prevalent in hospital settings with provision of feedback recommended to support prescribing of doctors. Feedback on prescribing has been described as feasible and valued but limited by doctors, with pharmacists described as credible facilitators of prescribing feedback. Evidence supporting prescribing feedback has been limited to date...

Published: 16/12/2020
Authors: Lloyd M, O'Brien S, Hardy KJ, Furlong NJ

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The impact of local, validated structured education programmes on self-care activities in people with diabetes

Background and Aim Better glycaemic control is exhibited in patients with higher self‐care abilities. The Summary of Diabetes Self‐Care Activities (SDSCA) questionnaire measures diabetes self‐care activities. As part of a local, validated structured education programme, we measure the SDSCA scores before and after completing structured education. Scores..

Published: 07/10/2020
Authors: Furlong NJ, Westall S, Cardwell J, Jackson J, Cairns J, Mitchell L, Bujawansa S, McNulty S, Narayanan RP, Hardy KJ

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The impact of a validated structured education programme diabetes-related distress in patients with type 2 diabetes

Background and Aim Patients with type 2 diabetes experience varying degrees of the emotional burden of diabetes and its treatments. The Problem Areas in Diabetes (PAID) questionnaire can be used to evaluate this domain. As part of a local, validated structured education programme for people with type 2 diabetes, baseline and endpoint..

Published: 07/10/2020
Authors: Cardwell J, Bujawansa S, McNulty S, Furlong NJ, Narayanan RP, Jackson J, Mitchell L, Westall S, Hardy KJ

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The impact of a validated structured education programme on diabetes-related distress in patients with type 1 diabetes

Background and Aim People with type 1 diabetes experience varying degrees of the emotional burden of diabetes and its treatments. The Problem Areas in Diabetes (PAID) questionnaire can be used to evaluate this domain. As part of a local, validated structured education programme for people with type 1 diabetes, baseline and endpoint..

Published: 07/10/2020
Authors: Narayanan RP, Westall S, Sullivan H, Cardwell J, Langan E, Gallagher CG, Bujawansa S, McNulty S, Furlong NJ, Hardy KJ

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The impact of a validated structured education programme on anxiety and depression in patients with type 2 diabetes

Background There has been a big drive from the UK government and Diabetes UK to provide improved psychological care for patients with diabetes. People with type 2 diabetes experience greater degrees of anxiety and depression than the general population. The Hospital Anxiety and Depression Scale (HADS) questionnaire can evaluate this. As..

Published: 07/10/2020
Authors: Westall S, Jackson J, Mitchell L, Cairns J, Sullivan H, Bujawansa S, McNulty S, Furlong NJ, Narayanan RP, Hardy KJ

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Perceived problem areas in diabetes do not correlate with levels of anxiety and depression

Background and Aim Diabetes‐related distress, anxiety and depression are all highly prevalent in people with diabetes. The Problem Areas In Diabetes (PAID) and Hospital Anxiety and Depression Score (HADS) questionnaires can be used to measure these domains. We evaluated the impact of structured education on each of these. Methods..

Published: 07/10/2020
Authors: Westall S, Narayanan RP, Langan E, Gallagher CG, Bujawansa S, McNulty S, Furlong NJ, Cardwell J, Hardy KJ

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The impact of a validated structured education programme on anxiety and depression in patients with type 1 diabetes

Background and Aim People with type 1 diabetes experience greater degrees of anxiety and depression than the general population. The Hospital Anxiety and Depression Scale (HADS) questionnaire can evaluate this. As part of a local, validated structured education programme for people with type 1 diabetes, baseline and endpoint measurements of anxiety and..

Published: 07/10/2020
Authors: Sullivan H, Westall S, Jackson J, Cairns J, Cardwell J, Bujawansa S, McNulty S, Furlong NJ, Narayanan RP, Hardy KJ

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The impact of seven-day working by a diabetes specialist nurse (DSN) team within an acute hospital trust

Aim Inpatient Diabetes Specialist Nurse Cover nationally is varied. Post a successful NHS England Transformation funding bid the aim was to provide greater support for ward areas, reduce error rates and increase satisfaction rates through the implementation of seven‐day working and an emergency advice line led by a diabetes..

Published: 07/10/2020
Authors: Michaels S, Bujawansa S, Hardy KJ, Cardwell J, Milne R, Strong AJ, Lee C, Smith R

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Measuring inpatient diabetes related staff satisfaction using a SurveyMonkey questionnaire

Background We introduced seven‐day working and increased support for inpatients from the diabetes specialist nursing (DSN) Team in 2017. Previous surveys using hand‐delivered or postal questionnaires had resulted in low response rates. This year we used an online survey via SurveyMonkey® to measure inpatient diabetes related staff satisfaction. Aim..

Published: 07/10/2020
Authors: Milne R, Bujawansa S, Hardy KJ, Cardwell J, Michaels S, Smith R, Lee C

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Financial impact of improving diabetes‐related clinical outcomes

Background Our Trust received funding through the NHS Diabetes Transformation Programme to improve inpatient care and foot care. The monies received for inpatient care was used to increase the number of diabetes inpatient nurses by fivefold. We introduced extended weekday coverage (0,800–2,200), weekend cover and an emergency support line. The funding..

Published: 07/10/2020
Authors: Bujawansa S, Furlong NJ, Narayanan RP, Westall S, Cardwell J, Mitchell L, Michaels S, Hardy KJ

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Improved structured education uptake by systematising the offer

Aims In the UK, attendance at diabetes‐structured education is poor. Indeed, even evidence of a formal offer of structured education is sometimes lacking. Our aim was to improve education update by mailing a validated letter offering structured education to every person registered with diabetes in our borough. Methods With..

Published: 07/10/2020
Authors: Mitchell L, Cardwell J, Bujawansa S, Hardy KJ

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Exploring the impact of pharmacist-led feedback on prescribing behaviour: A qualitative study

Background Prescribing errors occur frequently in hospital settings. Interventions to influence prescribing behaviour are needed with feedback one potential intervention to improve prescribing practice. Doctors have reported a lack of feedback on their prescribing previously whilst the literature exploring the impact of feedback on prescribing behaviour is limited. Objectives To..

Published: 16/01/2019
Authors: Furlong NJ, Hardy KJ, Lloyd M

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Exploring hospital pharmacists’perceptions of their medication communication with prescribers

Abstract Prescribing errors are common and problematic in hospital settings in the UK. Pharmacists have been described as integral in the interception of prescribing errors, with effective medication communication between pharmacists and prescribers important to resolve and optimize prescribing outcomes. However, poor communication between healthcare professionals, including pharmacists and prescribers,..

Published: 16/05/2018
Authors: Furlong NJ, Hardy KJ, Lloyd M

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Exploring pharmacist experiences of delivering individualised prescribing error feedback in an acute hospital setting

​ Highlights • Delivery of prescribing error feedback is valued by hospital pharmacists and considered sustainable • Pharmacists report altered prescribing behaviour and improved prescribing following receipt of feedback • Pharmacists report greater team-work and prescriber communication following delivery of feedback • Delivering prescribing error feedback can improve the self-confidence and self-worth of pharmacists Lloyd,..

Published: 20/12/2017
Authors: Lloyd M, Furlong NJ, Hardy KJ, O'Brien S

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Exploring the impact of feedback on prescribing error rates

​ Background Prescribing errors are prevalent in hospital settings with feedback identified as one potential error reduction strategy. Hospital pharmacists work alongside prescribers at ward level and are credible facilitators of prescribing error feedback. A formalised programme of pharmacist-led prescribing error feedback was designed and implemented  Objective To determine the impact..

Published: 17/08/2017
Authors: Lloyd M, O'Brien S, Hardy KJ, Furlong NJ

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Effect of academic detailing on insulin prescribing: a before and after study

​Abstract Introduction and aims Insulin is a high risk medication with prescribing errors potentially compromising patient care. The aim of the study was to assess the impact of educational outreach on insulin prescribing in a hospital setting. Methods Insulin prescribing was prospectively audited over a four week period. Hospital pharmacists..

Published: 28/04/2017
Authors: Hart A, Lloyd M, Furlong NJ, Hardy KJ

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Diabetic kidney disease in routine clinical care

​ Aim To examine the impact of service re-design on management and 10-year outcomes in diabetic kidney disease in a real world setting. Methods We established a highly structured, nurse-led diabetic kidney clinic to deliver consistent evidence-based care processes (blood pressure control (BP), glycaemic control (HbA1c), renin-angiotensin-aldosterone (RAAS) blockade, lipid-lowering..

Published: 19/07/2016
Authors: Hardy KJ, O'Brien S

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Assessment of diabetes knowledge

​ Abstract In the UK, approximately 12–25% of all hospital inpatients have diabetes, although most are admitted for other health problems. People with diabetes often have a prolonged hospital stay compared to people without the condition, often as a result of suboptimal inpatient management of their diabetes. During in-depth interviews conducted in..

Published: 19/07/2016
Authors: Cardwell J, Hardy KJ

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Urinary proteomic profiling in severe obesity

​ Introduction Obstructive sleep apnoea (OSA) is common in obesity and is associated with cardiovascular and metabolic complications. Continuous positive airway pressure (CPAP) in OSA may lead to physiological changes reflected in the urinary proteome. The aim of this study was to characterise the urinary proteome in severely obese adult subjects..

Published: 19/07/2016
Authors: Hardy KJ

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Effect of CPAP on arterial stiffness

​ Background Obstructive sleep apnoea (OSA) may independently increase cardiovascular risk in obesity. Although there is evidence that arterial stiffness is altered in OSA, knowledge of these effects with continuous positive airway pressure (CPAP) in severe obesity (body mass index (BMI) ≥ 35 kg/m2) is limited. This study aimed to explore how..

Published: 19/07/2016
Authors: Hardy KJ

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Diabetes education through adult learning

​ Abstract Patient education is acknowledged to be the cornerstone of effective self-management in people with chronic conditions such as diabetes. While the effects of patient education in terms of biophysical endpoints such as HbA1c are well studied, its effects on quality of life (QOL) and other non-biophysical outcomes are..

Published: 19/07/2016
Authors: Cardwell J, Hardy KJ, O'Brien S

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Serum urate and obstructive sleep apnoea

​ Abstract Obstructive sleep apnoea (OSA) may increase the risk of hyperuricaemia and predispose to gout. The evidence for the effects of OSA on serum urate in severe obesity is limited. This study investigated whether OSA was associated with serum urate in severe obesity and whether continuous positive airway pressure (CPAP)..

Published: 19/07/2016
Authors: Hardy KJ

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A64 (P310) Outpatient parenteral antibiotic therapy (OPAT)

Aims  To determine the benefits of OPAT in diabetes foot infections. Methods This was a retrospective study of consecutively initiated OPAT in patients with diabetes foot infections. Patients initiated on OPAT in a multidisciplinary diabetes foot clinic and inpatients discharged from a diabetes inpatient ward between April 2011 and May 2013 and..

Published: 19/07/2016
Authors: , Hardy KJ, Keigan S, Lewis A,

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Obstructive sleep apnea

​ Abstract Obstructive sleep apnea is associated with obesity and metabolic syndrome, leading to greater cardiovascular risk. Severely obese patients with obstructive sleep apnea may still be at risk of adverse health outcomes, even without previous cardiovascular disease. Pulse wave analysis non-invasively measures peripheral pulse waveforms and derives measures of haemodynamic..

Published: 19/07/2016
Authors: Hardy KJ

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Obstructive sleep apnoea in obese women

​ Background Recent studies have highlighted an association between gout and obstructive sleep apnoea (OSA), reflecting shared risk factors with increasing body weight associated with gout and OSA. However, intermittent episodes of hypoxia in OSA may lead to purine breakdown and increase uric acid levels, potentially contributing to hyperuricaemia. This study..

Published: 19/07/2016
Authors: Hardy KJ

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Low dietary sodium

​ Abstract  In a meta-analysis that investigated the effects of dietary sodium restriction in diabetes nephropathy, although blood pressure fell, there were significant increases in plasma renin and aldosterone levels. In this article, we hypothesise that in diabetic nephropathy, ACE-I or ARB treatment attenuates any rise in RAS hormones that might..

Published: 19/07/2016
Authors: Hardy KJ, O'Brien S

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Urinary proteomics

​ Introduction Obstructive sleep apnoea (OSA) is a common complication of obesity and can have a substantial negative impact on a patient's quality of life and risk of cardiovascular disease. In this study, discovery profiling of urinary peptides was performed by capillary electrophoresis- mass spectrometry (CE-MS) in obese subjects with and..

Published: 19/07/2016
Authors: Hardy KJ

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Serum creatinine and estimated glomerular filtration rate

​ OBJECTIVE  Fasting is not routinely recommended for renal function tests, despite the known effects of cooked meat on creatinine. We therefore studied variation in creatinine and estimate glomerular filtration rate (eGFR) following a standardised cooked meat meal in 80 subjects: healthy volunteers, diabetes patients with chronic kidney disease (CKD) stages 1 & 2, 3A, 3..

Published: 19/07/2016
Authors: Hardy KJ, O'Brien S

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GLP-1 Treatment

​ Abstract Glucagon-like peptide 1 (GLP-1) agonist treatment in type 2 diabetes typically improves glycaemic control and results in weight loss. The National Institute for Health and Clinical Excellence (NICE) continuation criteria are that at six months patients must have achieved at least a 3% reduction in weight and an 11mmol/mol (1%) reduction in..

Published: 19/07/2016
Authors: Keigan S, Wessels L, O'Brien S, Hardy KJ

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Inpatients with Diabetes

​ Aim:  UK management of inpatients with diabetes is suboptimal. Previously, we found diabetes knowledge to be lacking amongst ward staff nurses. We hypothesised that final year student nurses should know about diabetes management and our aim was to test diabetes knowledge in such students to determine whether low knowledge amongst..

Published: 19/07/2016
Authors: O'Brien S, , Cardwell J, Hardy KJ

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Diabetes Foot Ulceration

​ Aims:  The presence of foot ulceration is associated with increased morbidity and mortality. This study aimed to determine the factors associated with mortality among patients with foot ulcers attending a multidisciplinary diabetes foot clinic. Methods:  All patients reviewed consecutively in a multidisciplinary diabetes foot clinic with new foot ulceration between 1..

Published: 19/07/2016
Authors: Hart-Pinto AD, Beeharry D, Hardy KJ,

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Recurrent Foot Ulceration

​ Aims:  To identify risk factors for recurrent foot ulceration (RFU) among people with diabetes attending a multidisciplinary diabetes foot clinic. Methods:  All consecutively reviewed patients in amultidisciplinary diabetes foot clinic with newfoot ulceration over an 18-month period were included in this retrospective, observational study. Patients with Charcot neuroarthropathy were excluded...

Published: 19/07/2016
Authors: Hart-Pinto AD, Beeharry D, Hardy KJ,

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Healthcare Assistants Lack the Knowledge

​ Aim:  Much healthcare for people with diabetes is delivered by healthcare assistants (HCAs). We interviewed inpatients with diabetes following discharge from hospital and they raised concerns about HCAs’ understanding of diabetes.Given the enhanced role of HCAs in recent years it is essential they know how to manage inpatients with..

Published: 19/07/2016
Authors: , Cardwell J, Hardy KJ, O'Brien S

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Inpatient Diabetes Care

​ Aim:  Inpatient diabetes care is a burden on NHS resources. National inpatient audits identify areas of poor management but do not provide insight into underlying causes to fix the problems. Our aim was to explore the experiences of inpatients with diabetes, identify reasons for mismanagement and investigate these further. Methods: ..

Published: 19/07/2016
Authors: O'Brien S, , Cardwell J, Hardy KJ

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Guidelines and Inpatient Diabetes Nurse Specialists

​ Aim:  Diabetes specialist nurses (DSNs) have a vital role in enabling people to self-manage and in supporting non-specialist staff. Our research has identified low diabetes knowledge amongst ward nurses and students, but this may not be problematic if DSNs bridge the gap. Here, we surveyed ward nurses to determine their ..

Published: 19/07/2016
Authors: Cardwell J, , Hardy KJ, O'Brien S

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Obstructive sleep apnoea

​ Introduction:  Obstructive sleep apnoea (OSA) is associated with obesity, hypertension and cardiovascular disease. Arterial stiffness has been proposed as a marker of cardiovascular disease risk. We determined whether severely obese patients with newly diagnosed OSA without previous cardiovascular disease have increased arterial stiffness compared with BMI-matched controls. Methods:  72 patients(35 females),..

Published: 19/07/2016
Authors: Hardy KJ

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Diabetic Medicine

​   Nair, S; Hardy, KJ; Wilding, JPH. (2012).  Reply to Camargo et al. Diabetic Medicine . 29 (8), 1086-87  

Published: 19/07/2016
Authors: Hardy KJ

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Metformin and alcohol

​ Overend, L; Hardy, K. (2012).  Metformin and alcohol . Practical Diabetes. 29 (6), 229-30  

Published: 19/07/2016
Authors: Overend L, Hardy KJ

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Management of Hyperglycaemia

​ Chandrasekara, H; Brough, C; Goenka, N; Somauroo, J and Hardy, K. (2012).  Management of hyperglycaemia in people with acute coronary syndromes (NICE Clinical Guideline 130): uncertainty persists . Practical Diabetes. 29 (1), 9-11

Published: 19/07/2016
Authors: Hardy KJ

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Insulin Errors

​ McNulty, SJ; Lewis, A; Hardy, KJ. (2010).  Reducing insulin errors . BMJ. 341 (7782), 1065.   

Published: 19/07/2016
Authors: Lewis A, Hardy KJ, McNulty SJ

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Glucagon-like peptide-1 analogues

​ A 58 year old woman attends a diabetes clinic with type 2 diabetes of seven years’ duration and no history of macrovascular disease. She is obese (body mass index 37), but says she eats a healthy diet and describes this. Her blood pressure is 134/78 mm Hg, and she has microalbuminuria, but normal renal..

Published: 19/07/2016
Authors: Hardy KJ

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Pump Advanced Carbohydrate Education programme

​ Abstract Enabling patients to have a say in the design and delivery of local health services is a key priority in the NHS. The St Helens and Knowsley Teaching Hospitals NHS Trust diabetes team aimed to set up a peer support group for people with type 1 diabetes to aid in..

Published: 19/07/2016
Authors: Cardwell J, Furlong NJ, Hardy KJ, Wessels L, O'Brien S

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St Helens Community Staff

P303 Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life

Background National guidelines recognise the importance of individualising HbA1c targets. Many people with diabetes agree to have their targets re-evaluated in consultations in response to specific characteristics. Aims We aimed to evaluate the impact of relaxed or stretch HbA1c goals on subsequent HbA1c levels and health-related quality..

Published: 25/04/2023
Authors: McNulty S, Westall S, Narayanan RP, Irving G, Furlong NJ, Bujawansa S, Cardwell J, Hardy KJ

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P302 Glycated haemoglobin targets: The experiences and views of people with diabetes and diabetes healthcare professionals

Background National guidelines highlight the importance of individualising HbA1c targets. Little is known about the experiences of people with diabetes and diabetes healthcare professionals (HCPs) on the use of HbA1c targets. We explored the experiences of adults with diabetes and diabetes HCPs on the use of glycated haemoglobin..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty SJ, Bujawansa S, Cardwell J, Hardy KJ

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P300 Setting explicit glycated haemoglobin goals improves diabetes-related distress, self-efficacy and wellbeing

Background High levels of diabetes-related distress and low levels of self-efficacy and wellbeing are associated with poorer outcomes in people with diabetes. Aims We evaluated the impact of relaxed or stretch HbA1c targets on diabetes-related distress, self-efficacy and wellbeing in adults with type 1 or type 2 diabetes. Methods We randomised 50..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Balafshan T, Cardwell J, Hardy KJ

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Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes

Background The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated..

Published: 27/10/2022
Authors: Westall S, Narayanan RP, Irving G, Hardy KJ

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The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review

Background Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. Methods We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes...

Published: 20/04/2022
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Hardy KJ

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Evaluating the impact of a pharmacist-led prescribing feedback intervention

Background Prescribing errors are prevalent in hospital settings with provision of feedback recommended to support prescribing of doctors. Feedback on prescribing has been described as feasible and valued but limited by doctors, with pharmacists described as credible facilitators of prescribing feedback. Evidence supporting prescribing feedback has been limited to date...

Published: 16/12/2020
Authors: Lloyd M, O'Brien S, Hardy KJ, Furlong NJ

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Exploring pharmacist experiences of delivering individualised prescribing error feedback in an acute hospital setting

​ Highlights • Delivery of prescribing error feedback is valued by hospital pharmacists and considered sustainable • Pharmacists report altered prescribing behaviour and improved prescribing following receipt of feedback • Pharmacists report greater team-work and prescriber communication following delivery of feedback • Delivering prescribing error feedback can improve the self-confidence and self-worth of pharmacists Lloyd,..

Published: 20/12/2017
Authors: Lloyd M, Furlong NJ, Hardy KJ, O'Brien S

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Exploring attitudes and opinions of pharmacists toward delivering prescribing error feedback

Background Prescribing error (PE) rates have been extensively reported in the literature. Various interventions at reducing PEs have been studied with some success, yet PEs continue to be a challenge for the health care system. Prescriber feedback has been proposed as one mechanism to reduce PEs in seminal studies. Pharmacists..

Published: 19/07/2016
Authors: Furlong NJ, Hardy KJ, Lloyd M, O'Brien S

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Formalized prescribing error feedback from hospital pharmacists

Abstract Doctors have reported a lack of awareness of their prescribing errors with lack of feedback considered a system failure. This article summarizes the views of hospital doctors about receiving formal prescribing error feedback from ward-based pharmacists. Lloyd, M; Watmough, SD; O'Brien, SV; Furlong, N; Hardy, K. (2015). Formalized prescribing error..

Published: 19/07/2016
Authors: Furlong NJ, Hardy KJ, Lloyd M, O'Brien S

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North West Boroughs Community Health Staff

The impact of a validated structured education programme on diabetes-related distress in patients with type 1 diabetes

Background and Aim People with type 1 diabetes experience varying degrees of the emotional burden of diabetes and its treatments. The Problem Areas in Diabetes (PAID) questionnaire can be used to evaluate this domain. As part of a local, validated structured education programme for people with type 1 diabetes, baseline and endpoint..

Published: 07/10/2020
Authors: Narayanan RP, Westall S, Sullivan H, Cardwell J, Langan E, Gallagher CG, Bujawansa S, McNulty S, Furlong NJ, Hardy KJ

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Perceived problem areas in diabetes do not correlate with levels of anxiety and depression

Background and Aim Diabetes‐related distress, anxiety and depression are all highly prevalent in people with diabetes. The Problem Areas In Diabetes (PAID) and Hospital Anxiety and Depression Score (HADS) questionnaires can be used to measure these domains. We evaluated the impact of structured education on each of these. Methods..

Published: 07/10/2020
Authors: Westall S, Narayanan RP, Langan E, Gallagher CG, Bujawansa S, McNulty S, Furlong NJ, Cardwell J, Hardy KJ

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