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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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 |
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 |
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 |
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 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 |
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 |
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 |
Aims To explore the impact of a prescribing feedback intervention on insulin prescribing. Methods This was a mixed-methods study in a hospital setting. An insulin prescribing feedback intervention was delivered verbally and in writing to twelve doctors. Insulin prescribing error frequency was compared to ten doctors who had not received..
Published: | 13/03/2021 |
Authors: | Lloyd M, Bennett N, Wilkinson A, Furlong NJ, Cardwell J, Michaels S |
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 |
Aim To evaluate the views of doctors and nurses on the delivery and use of a safe insulin tips (SIPS) educational programme. Methods Twelve SIPS were developed covering key areas of safe insulin use by a multi‐professional collaboration of patients and healthcare professionals. Individual SIPs were emailed weekly over 12..
Published: | 07/10/2020 |
Authors: | Lloyd M, Michaels S, Cardwell J, Furlong NJ |
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 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 |
Aims NICE guideline NG17 recommend individual care plans agreed with the person with type 1 diabetes (PWT1D), reviewed annually and to include diabetes education provision. Where and how this education should be delivered is up for debate. A group was established in Merseyside to look at education offered to PWT1..
Published: | 07/10/2020 |
Authors: | Strong AJ, Cardwell J |
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 The aim of this research was to explore the impact of pharmacist‐led feedback on insulin prescribing. Methods This study was undertaken in a large UK teaching hospital. Ward pharmacists were trained in the delivery of prescribing feedback. Definitions of insulin prescribing errors were based on the National Diabetes..
Published: | 26/06/2019 |
Authors: | Bennett N, Cardwell J, Furlong NJ, Hart A, Lloyd M, Michaels S |
Aims To evaluate the use of multiprofessional high‐fidelity simulation to educate nurses and healthcare assistants on the management of hypoglycaemia and diabetic ketoacidosis. Methods A simulation‐based training event was developed by a multidisciplinary team. Nurses and healthcare assistants on two hospital wards were invited to participate. Effectiveness of..
Published: | 26/06/2019 |
Authors: | Cardwell J, Furlong NJ, Hart A, Lloyd M, Michaels S, Rowson M |
Aims The aim of this research was to explore the impact of feedback on insulin prescribing behaviour. Method(s) Doctors that had received feedback on their insulin prescribing were invited to participate in the study. Semi-structured interviews were used to explore the potential impact of feedback on their insulin prescribing...
Published: | 26/06/2019 |
Authors: | Bennett N, Cardwell J, Furlong NJ, Hart A, Lloyd M, Michaels S |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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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 |