Cardiff and Vale University Health Board (CAVUHB) (Welsh: Bwrdd Iechyd Prifysgol Caerdydd a'r Fro) is the local health board of NHS Wales for Cardiff and Vale of Glamorgan, in the south-east of Wales. Formed on 1 October 2009 through the amalgamation of three NHS organisations in the Cardiff and Vale of Glamorgan area. The three organisations amalgamated were: Cardiff and Vale NHS Trust, employing 12,000 staff and previously responsibility for hospital services in the Cardiff and Vale of Glamorgan area; Cardiff Local Health Board; and Vale of Glamorgan Local Health Board both responsible for GP, Dental, Optical and pharmacy services. The headquarters of the Board is in the University Hospital of Wales, in Cardiff. Cardiff and Vale University Health Board is the operational name of Cardiff and Vale Local Health Board.The Board supports a population of around 445,000 people living in Cardiff and the Vale of Glamorgan. It oversees seventeen health centres, public health and community care services and also has a range of specialist services used by the whole of Wales, including renal, paediatric, neurology and bone marrow transplantation.As of June 2020, Charles Janczewski is the chairman of the Board. Its current Interim Chief Executive is Prof Stuart Walker.The board is one of the first organisations in the UK to make wifi available in its hospitals, on the basis that enables patients to stay in touch with their family and friends, and improves the way it interacts with patients.
Background Testing for HIV, linkage to treatment, and access to pre-exposure prophylaxis (PrEP) (medication that reduces the risk of acquiring HIV) is essential for early HIV diagnosis, treatment, and prevention. General practice could play a key role in maximising HIV testing opportunities and supporting access to PrEP. Aim To develop an intervention for general practice to increase HIV testing and facilitate access to PrEP. Design and setting This was a person-based approach (PBA) intervention development study using the capability, opportunity, motivation, behaviour model in South West England. Method A scoping review and semistructured interviews with healthcare professionals (HCPs) and local organisation representatives with an interest in HIV prevention/health care were conducted to understand the challenges and find potential solutions to increase HIV testing and facilitate access to PrEP in general practice. Intervention development used focus groups with HCPs and the public. Purposive sampling ensured diversity of practices and participants. Data were analysed using the PBA table of planning and the collaborative and intensive pragmatic qualitative approach. Results Barriers identified included lack of clinician knowledge of HIV and PrEP, concern about stretched resources, and a lack of systematic testing methods. Proposed strategies included simpler testing approaches to normalise testing and reduce HIV stigma. The intervention developed consists of: education, a prompt to test, simplified and standardised testing, PrEP signposting processes, patient information, and practice champions. Conclusion Research is needed to explore the feasibility and the effectiveness of this multicomponent intervention to increase testing and access to PrEP within general practice. Funding barriers also need to be addressed.
Postpartum haemorrhage (PPH) is common, affecting an estimated 13% of women having vaginal birth and 31% of women having caesarean birth. Successful management of PPH requires early and accurate diagnosis and effective treatment. A systematic review found that subjective visual estimation of blood loss misses 52% of PPH diagnoses at vaginal birth (pooled sensitivity 48%, 95% CI 44-53), and probably more at caesarean birth. The WHO-International Federation of Gynecology and Obstetrics-International Confederation of Midwives consolidated guidelines on PPH therefore recommend objective quantification of blood loss with products such as a calibrated blood collection drape. When supported by a robust implementation strategy and a first-response treatment bundle, objective measurement of blood loss and monitoring of vital signs has been shown to diagnose PPH accurately and early, and improve clinical outcomes. Refractory PPH can progress to life-threatening PPH, which should be managed by a multidisciplinary team providing aggressive resuscitation and targeted treatment. Saving the life of a woman with excessive postpartum bleeding is a race against time. The six delays to avoid are: (1) in the diagnosis (by use of objective cumulative blood loss measurement and early trigger criteria), (2) in the first-response treatment (by authorising midwives to administer all components of a standardised bundle of interventions), (3) in the escalation (by use of explicit escalation criteria and red flags), (4) in the use of temporising measures (eg, non-pneumatic anti-shock garment), (5) in the identification and targeted management of any specific causes of bleeding, and (6) in the provision of blood and blood products. Quick actions to avoid these delays can mean the difference between life and death for a woman with PPH.
Background:Rib fractures (RFx) increase morbidity, mortality, and resource utilization. This retrospective study aimed to evaluate the effectiveness of a novel RFx treatment protocol (RFTP) on patient outcomes. Study design:We included 3679 RFx patients admitted to a single level 1 trauma center between January 2011 and October 2018. The RFTP, launched as a computer physician order entry on October 25, 2016, included an escalating multimodal pain management, a standardized nursing assessment with interventions, and an atelectasis and mucus clearance regimen. Patients' characteristics and outcomes before and after the protocol were compared. Propensity score matching analysis was used to account for differences in baseline characteristics between groups. Intention-to-treat and protocol analyses were done. Outcome measures included mortality, length of stay (LOS), pulmonary complications, rapid response activations, and elevation in level of care. Results:There were 2393 and 1286 patients treated in the pre-protocol and post-protocol time periods, respectively. Adherence rate to the RFTP was 53.3%. Multivariate adjustment showed a significant reduction in hospital LOS by 1.4 days (95% CI 0.71 to 2.02), a significant decrease in the odds of requiring mechanical ventilation (OR 0.77, 95% CI 0.58 to 1.00) and rapid responses (OR 0.55, 95% CI 0.42 to 0.72). Comparison of the matched samples also showed a significant decrease in LOS (14.7 days vs 11.2 days, p<0.001), rapid responses (17.7% vs 12.8%, p=0.010), and mortality (10.7% vs 6.5%) in those treated using the RFTP in the post-protocol period. These findings were mostly substantiated on per-protocol analyses. Conclusion:The RFx protocol was associated with significant improvements in the LOS and a reduction in rapid responses required. In a severely morbid matched sample, the RFTP was also associated with reduced mortality. Multidisciplinary protocolized care of patients with RFx is associated with better outcomes. Level of evidence:Level III evidence (retrospective cohort study).
Postpartum hemorrhage (PPH) remains the leading cause of pregnancy-related mortality worldwide. Regardless of initiating cause, continued bleeding may progress to a systemic coagulopathy. This coagulopathy may be further complicated by profound fibrinolytic activation progressing to systemic hyperfibrinolysis, a condition that we have termed acute obstetric coagulopathy (AOC). Patients with placental abruption or amniotic fluid embolism are among those at highest risk for AOC. In response to the unmet need for a rapid method to detect fibrinolytic activation in this scenario, we developed a novel assay that we have termed the Fibrinolytic Activity Screening Test (FAST). This assay measures endogenously generated plasmin activity in plasma within 5 minutes. Its high sensitivity for the detection of in vivo fibrinolytic activation was confirmed by strong correlation with elevated plasmin-antiplasmin (PAP) complex levels. We analyzed archived plasma samples from 33 women with PPH and 20 pregnant women just prior to elective Cesarean section. Of the 33 subjects with PPH, 12 had PAP complexes >25,000 ng/mL, thereby meeting criteria for the diagnosis of AOC. Plasmin activity measured by the FAST assay differentiated AOC from non-AOC PPH (p=0.0007) and from pregnant non-PPH control groups (p<0.0001), and was strongly correlated with both PAP complexes and D-dimer levels. Among subjects with PPH in whom viscoelastic whole blood testing (ROTEM) was performed, none of the 18 without AOC or 9 of those with AOC had evidence of ROTEM-defined hyperfibrinolysis. The FAST assay is a rapid tool to detect activation of fibrinolysis associated with AOC in women after delivery.
OBJECTIVE:Across several clinical specialties, research-active hospitals deliver higher-quality care and achieve better patient outcomes. To date, these associations have primarily been demonstrated using hospital-reported metrics, with limited insight from the patient perspective. This study evaluated, for the first time, the association between research activity within UK inflammatory bowel disease (IBD) hospital services and adult patient-reported quality of care. METHODS:A cross-sectional analysis was conducted using 2023 national IBD UK benchmarking Patient and Service Survey data linked with research recruitment metrics from the National Institute for Health and Care Research Central Portfolio Management System (CPMS) between 2020 and 2022. Patient-reported high-quality care in the preceding 12 months was defined as a response of 'good', 'very good' or 'excellent' on a five-point Likert scale. Research activity was measured by the number of participants recruited to CPMS-registered IBD studies managed by gastroenterology. Associations were assessed using Spearman's correlation and multivariate regression, adjusting for service-level factors. RESULTS:Recruitment data from 32 391 research participants across 176 IBD services were aligned with 11 454 care quality and 13 583 research opportunity patient responses. A positive correlation was observed between IBD service research recruitment volume and the proportion of patients reporting high-quality care (rₛ=0.19, p=0.013). This association remained significant after adjusting for tertiary status, service size, number of consultants and presence of an IBD leadership team (adjusted β (SE)=0.0008 (0.0004); p=0.029). Services recruiting to interventional studies demonstrated higher patient-reported care quality, while those offering research opportunities reported both higher care quality and greater research recruitment. CONCLUSION:IBD service research activity is positively associated with patient-reported care quality. Embedding research engagement within routine service delivery may improve patient experience and support quality improvement. The results have important implications for service design, workforce planning and national research policy.
