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 'McNulty S'



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

P281 Impact of pre-pregnancy counselling on HbA1c level and pregnancy outcomes in women with pre-existing diabetes

Aims The aim of our study was to assess uptake of pre-pregnancy counselling and its impact on HbA1c level. We looked to establish whether lower HbA1c levels and counselling improved outcomes in pregnant women with pre-existing diabetes. Methods Electronic record of all pregnant women with pre-existing diabetes booked..

Published: 25/04/2023
Authors: Collings S, Christian S, Pankaja S, McNulty S, Davies H, Milne R, Gallagher CG, Bujawansa S

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P280 Impact of introducing an intensive support package alongside continuous glucose monitoring on neonatal outcomes and...

Aims The National Diabetes in Pregnancy Audit in 2020 demonstrated that the percentage increase of women with type 1 diabetes under our service achieving an HbA1c

Published: 25/04/2023
Authors: Milne R, McNulty S, Pankaja S, Davies H, Gallagher CG, Christian S, Bujawansa S

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P277 Patient and public involvement (PPI) exploring the experiences of women with gestational diabetes...

Aim Gestational Diabetes (GDM) affects 1 in 23 UK pregnancies and can lead to adverse maternal & neonatal outcomes. PPI empowers those affected by a condition to influence future care. The aim of this project was to explore the experiences of GDM care for a group of women and their partners attending a..

Published: 25/04/2023
Authors: Gallagher CG, Christian S, Pankaja S, McNulty S, Davies H, Milne R, Bujawansa S

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P137 Follow up screening for diabetes after gestational diabetes 2019 versus 2022

Aims NICE guidelines for screening state that all GDM patients should be screened for diabetes at 6 to 12 weeks postpartum. Previous published data have given a national rate of less than 20% [1]. Our previously published data showed a 45% follow up [2]. We re-reviewed our screening rate after the interventions of: discussion with and..

Published: 25/04/2023
Authors: McNulty S, Milne R, Gallagher CG, Pankaja S, Christian S, Davies H, 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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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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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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P169 Service evaluation to determine the reason for increased gestational diabetes (GDM) referrals following SARS-CoV-2 pandemic

Aims England and Wales report on average, 700,000 annual pregnancies. From these 5% are complicated with hyperglycaemia with 87.5% of these Gestational diabetes (GDM). Pregnant women living with obesity are at higher risk of developing GDM. There is a linear relationship between glucose and adverse pregnancy outcomes. We noted a marked increase in..

Published: 23/03/2022
Authors: Gallagher CG, Milne R, Davies H, McNulty S, Pankaja S, Bujawansa 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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P145 Service evaluation examining the understanding of breastfeeding among women with diabetes

Aims Breastfeeding is beneficial for a mother, baby and society. Enhancing breastfeeding rates has potential to save lives and drive improvements in public health. Breastfed babies have a lower risk of developing childhood-onset diabetes. On average breastfeeding rates in St Helens are between 26.5% and 31.6% at 6-8 weeks. The aim of..

Published: 23/03/2022
Authors: Gallagher CG, Bujawansa S, Milne R, Michaels S, McNulty S, Westall S

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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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Acute urinary retention in a 27-year-old male secondary to benign prostatic hyperplasia

Introduction Benign prostatic hyperplasia (BPH) is common in the ageing male. Clinical manifestations like retention impact on a patient’s quality of life. Alterations in androgen activity at the androgen receptor complex level in the prostate contribute to prostatic hyperplasia with the highest incidence occurring in males in their 70’s...

Published: 19/05/2021
Authors: Napier-Hemy TP, Floyd Jr MS, McNulty S, Omar A, Mistry R, Gana HB

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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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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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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

Read More

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

Read More

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

Read More

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

Read More

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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Impact of the introduction of National Institute for Health and Care Excellence (NICE) guideline NG3

​ Aims NICE updated its guidance on diabetes in pregnancy in February 2015. The changes included recommending cut-off values for diagnosing gestational diabetes (GDM) and lowering the target pre-prandial glucose levels from

Published: 19/07/2016
Authors: Bujawansa S, McNulty S, Wilkinson P, Michaels S, Pankaja 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

Read More

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

Read More

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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Knowsley Community Staff

Primary Care Management of Patients

​ Aims:  Evidence-based management of patients with IGR is essential in reducing the incidence of Type 2 diabetes. The estimated adult prevalence of IGR is 2.3%. Without intervention, the majority of IGR patients are likely to develop Type 2 diabetes within five–10 years. A clinical audit was conducted to identify current practice in the..

Published: 19/07/2016
Authors: Conrad D, McNulty S

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Halton Community Staff

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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

Read More

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

Read More