Research Development
Staff Publications
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Staff Publications
Research Development
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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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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
Aim Despite national initiatives to improve practice, the National Diabetes Inpatient Audit (NADIA) 2019 still reported high levels of medication and insulin errors. A quick reference insulin safety binder was produced to promote insulin safety and support registered nurses whilst undertaking medication rounds. The binder is an eye catching, easy to..
Published: | 23/03/2022 |
Authors: | Strong AJ, Michaels S, Cardwell J, Bujawansa S |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
Aim To screen members of the homeless community in St. Helens for diabetes, and offer advice, support, diabetic eye screening and diabetic foot screening for those with diabetes, following two diabetes-related deaths in this population in 2018. Method(s) The Teardrops Hub staff promoted the drop in service to their service..
Published: | 07/10/2020 |
Authors: | Pendlebury H, Bujawansa S, Cardwell J |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
Aims NICE guidelines for screening state that all GDM patients should be screened for diabetes at 6–12 weeks postpartum. Previous published data have given a national rate of less than 20%1. We reviewed our screening rate after the interventions of: discussion with the patient at first and last visit, written instructions to..
Published: | 07/10/2020 |
Authors: | McNulty SJ, Wilkinson P, Michaels S, Davies H, Sullivan H, Bujawansa S |
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 |
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 |
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 |
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 |
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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Aim To screen members of the homeless community in St. Helens for diabetes, and offer advice, support, diabetic eye screening and diabetic foot screening for those with diabetes, following two diabetes-related deaths in this population in 2018. Method(s) The Teardrops Hub staff promoted the drop in service to their service..
Published: | 07/10/2020 |
Authors: | Pendlebury H, Bujawansa S, Cardwell J |
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 |
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 |