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New initiative to improve care for terminally ill patients

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The Welsh Ambulance Service has joined forces with Macmillan Cancer Support in Wales to launch a new initiative to improve the care delivered to terminally ill patients.

The collaboration, which launches this Dying Matters Awareness Week (10-16 May 2021), is designed to improve the training delivered to ambulance crews so they can provide the very best care for patients at the end of life.

The training will help to give staff a greater understanding of end of life care, supporting clinicians to better recognise when a patient is nearing end of their life, and improving communication and symptom management skills to prevent avoidable hospital admissions.

Ed O’Brian, Macmillan Paramedic and the Trust’s End of Life Care Lead, said: “The collaboration between Welsh Ambulance and Macmillan Cancer Support will bring huge benefits to patients and staff across Wales.

“Ambulance clinicians are often called to assist patients nearing the end of their life due to an advanced or terminal illness, so it’s vital they can do so having had the appropriate training and with the right support structure around them to deliver the best care.

Training is being provided to ambulance crews to help improve the care given to terminally ill patients (Image: Flickr)

“The network of support being developed as part of this project in conjunction with Palliative Care Wales is invaluable, such as the ability for an ambulance clinician anywhere in Wales to be able to contact a palliative medicine doctor 24/7 from the patient’s home to seek their advice and guidance in order to achieve the best outcome for the patient.

“The two-year project will also help us to identify why, where and when patients at the end of life are needing to access the ambulance service, so we can identify areas for further development across the health and care sector in Wales.”

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This is the latest in a series of initiatives between the Welsh Ambulance Service and Macmillan Cancer Support designed to improve the care that palliative patients receive.

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Richard Pugh, Head of Partnerships for Macmillan Cancer Support in Wales, said: “Macmillan is so very proud to be able to help fund this project through the fantastic and tireless support given by our fundraisers.

“This first-of-its-kind partnership means we can help people, and their loved ones, to spend their final days in the way they want.

“As people near the end of life, dignity and the knowledge that their final wishes have been met is the best comfort and gift we can give them.”

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Ambulance Service emergency contact centre (Image: Welsh Ambulance Service Trust)

In 2019, the Welsh Ambulance Service won an NHS Wales Award in the Delivering Person-Centred Services category for its End of Life Care Rapid Transport Service, as well as the Outstanding Contribution to Transforming Health and Care Award.

The End of Life Care Rapid Transport Service, delivered by the Trust’s Non-Emergency Patient Transport Service, works with teams across Wales to provide transport for terminally ill patients to their preferred place of death.

The enhanced service ensures patients and their families have minimal delays, helping to reduce any further distress and anxiety.

The dedicated service has made nearly 2,000 compassionate journeys since its introduction in 2017.

The Trust was also the first ambulance service in the UK to introduce ‘Just in Case’ medications to its frontline emergency vehicles, allowing paramedics to better manage the symptoms that may sometimes be experienced as terminally ill patients become more poorly.

Nikki Pease, Palliative Care Consultant at Velindre University NHS Trust, added: “Where and how people die matters.

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“This all-Wales collaborative project serves to ensure first class end of life care to all.”


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Schoolboy’s dental transformation inspires traumatised children

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A schoolboy who lost his front teeth and suffered serious facial injuries in a holiday water park accident has had his smile restored thanks to Swansea Bay University Health Board’s Community Dental Services team.

Louis Richards, 13, from Bridgend, smashed into a slide at a water park while on holiday with his family in Antalya, Turkey. 

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Louie after his dental transformation (Image: Swansea Bay NHS)

The impact forced three of his front teeth into his nasal cavity, knocking his nose sideways. He received emergency treatment in Turkey and flew back to the UK with a medical brace protecting his teeth. 

Now dramatic before-and-after pictures of Louis are being used to support other children who have suffered dental trauma.

Dr Rohini Mohan, Swansea Bay’s Clinical Lead for Community Dental Services successfully treated Louis at the Neath Port Talbot Resource Centre following the August 2019 incident – and gave him back a perfect smile. 

She took pictures of him before and after the procedure using a telemedicine app that enables dentists to take data-compliant photos of patients’ teeth. 

Dr Mohan said: “The pictures of Louis have been inspirational to show other children who have suffered a trauma that you can come through it. It helps their parents as well. The worst can happen, and you can still come out with a beautiful smile.

“Until they see it on the app, they don’t believe it’s possible.”

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Consultant Connect, the UK’s leading telemedicine provider to the NHS, launched the innovative app with Swansea Bay UHB in March 2021– making it the first region in the UK to trial it for community dentistry.

Hundreds of patients who are vulnerable because they live in remote areas, care homes or have physical or learning disabilities have been helped. 

More than 250 data-compliant photos have been sent on using the PhotoSAF function from dentists to consultants since the app was rolled out. 

Dental therapists on face-to-face appointments can seek advice from specialist consultants using the photo messaging function of the Consultant Connect App. The specialist can tell them whether the patient needs to be referred to see a consultant – or that the problem is minor and can be dealt with by the dentist on the scene.

This swift decision-making saves hospitals and orthodontic specialist sites from unnecessary referrals while also ensuring vulnerable patients with genuinely serious conditions are treated quickly. 

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The service has also been valuable in ensuring patient records and relevant medical documents are easily imported into a patient’s notes.

And it has enabled dentists in smaller clinics which don’t have specialist camera equipment to use the app to take pictures of successful treatments which can then inspire other patients, particularly children. 

Dr Mohan, Swansea Bay’s Clinical Lead for Community Dental Services (Image: Swansea Bay NHS)

Dr Mohan added: “I don’t know what we would do without it now. It’s been a life saver for us, a game-changer. We all count ourselves lucky that we’ve been the first area in the country to use this service in dentistry.

“It’s provided better outcomes to vulnerable patients because the right decisions are made quicker. And it’s been immensely beneficial to take pictures of treatments which can then be shown to other patients.” 

Jonathan Patrick, CEO of Consultant Connect, said: “We’re delighted to be giving such a successful service to dentists, to consultants and ultimately to patients in Swansea Bay. These are challenging times in the health service, and we want to give all patients in Wales the best outcomes possible.”

How it works

Sue Davies, Lead Dental Therapist for the Dental Transformation Programme, Swansea Bay UHB, works three days a week carrying out dental checks on some of Swansea’s 2,500 care home residents.

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Sue Davies, Lead Dental Therapist for the Dental Transformation Programme (Image: Swansea Bay NHDS)

She checks for lesions inside a patient’s mouth. If she finds any, she will use the Consultant Connect PhotoSAF function to take a picture of the lesion. 

She then types in the patient’s NHS number which links the photos to the patient’s records. She can add in notes using a Dictaphone feature or by typing them in. The photos are then saved to the secure cloud – and not to Sue’s phone. 

The photos can then be sent to a clinical lead, such as Dr Rohini Mohan, to check if they need to be referred to the maxillofacial unit in Swansea.

Photos can also be used as a reference point to check if an ulcer is improving or getting worse. 

Sue also checks areas around a patient’s nose and mouth for anything suspicious and if she finds anything of concern also sends on.

And she uses Consultant Connect to print out pictures of patients with poor oral hygiene to help with training and to show to care home managers to make sure they are aware of the issues.

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She said: “The Consultant Connect App is great. I get reassurance from a consultant that I’ve made the right decision and we’re saving time and money. I would definitely recommend Consultant Connect to other dental care professionals.”

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Morriston burns team gives surgeons a helping hand with emergency training

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Surgeons around the UK could be getting hands-on training for a life and limb-saving emergency procedure using a simulator created in Swansea.

 A team at Morriston Hospital has developed a realistic silicone arm to teach a procedure called an emergency escharotomy.

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Severe injuries such as a deep burn to a limb can cause tissue to swell to the point where blood cannot easily flow past the injury.

The skin acts like a tight bandage, preventing the area around the injury from expanding to accommodate the swelling.

This tourniquet-like effect leads to the compression of the blood vessels, muscle, tissues and nerves below.

It’s known as compartment syndrome, requiring an emergency escharotomy – cutting into the skin and the tissues beneath, allowing them to spread open to relieve this build-up of pressure.

Because time is critical, the procedure sometimes has to be carried out before the patient can be transferred to a hospital with burns facilities, by surgeons who may not have had previous escharotomy experience.

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The idea for the simulator came from a team of consultants in Morriston Hospital including consultant burns, plastic and reconstructive surgeon Jonathan Cubitt.

“The aim is to improve the knowledge of general surgeons who may be working in a peripheral hospital and might have to do this procedure when a patient comes in,” he said. 

“It’s a procedure that can save lives and limbs but traditionally it has not been particularly well taught.

“Current trauma courses focus on the indications and theory of escharotomy but without being able to demonstrate the procedure in practical terms.

“You can draw pictures and show where you cut but most general surgeons will not get the hands-on operating theatre experience you need to know how to do it properly.

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 “What we have done is create a very high-fidelity training simulator to improve the skills of non-plastic surgeons so they can carry out this procedure with confidence.”

Mr Cubitt (centre) with his Morriston colleagues Ian Pallister and Sarah Hemington-Gorse (Image: Swansea Bay NHS)

Through the Royal College of Surgeons, Mr Cubitt successfully applied for a grant from the Blond McIndoe Research Foundation (BMRF).

This UK-based charity funds ground-breaking research, nationally and globally, into techniques and technologies that will repair, restore and regenerate tissue and reduce debilitating scarring.

To develop the training arm, Mr Cubitt worked with Morriston Hospital colleagues including burns and plastics consultant Sarah Hemington-Gorse and trauma consultant Ian Pallister, who has previously created a number of realistic injury simulators.

“It has a reusable inner arm with skeleton, fat and muscle, along with air bladders to help simulate the pressure change when you cut it, and a replaceable sleeve,” said Mr Cubitt.

“You can cut through this sleeve down to the fat to simulate the operation and it is really realistic.”

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The simulator also features a fingertip that turns pink to demonstrate reperfusion – the restoration of blood flow.

Mr Cubitt and his colleagues have since held workshops into the feasibility of a comprehensive education package to teach upper limb escharotomy.

It involved 34 plastic and non-plastic surgeons, and an evaluation showed there was increase in confidence in performing an escharotomy.

 “Looking forward we aim to develop further models for lower limb and chest escharotomy and possibly even tracheostomy so that we would be able to run a comprehensive emergency burns surgery course.” said Mr Cubitt.

“Our aim is to improve emergency burns care education in the UK and globally.”

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Mr Cubitt was invited to a BMRF event in London to highlight the innovative research being carried out with the foundation’s support.

He had the opportunity to explain the training simulator to guests including the BMRF’s Royal Patron, the Princess Royal.

“She was very interested in our simulator and interested in the possible global implications for training and improving emergency burns care,” said Mr Cubitt.

Mr Cubitt demonstrating the simulator to HRGH The Princess Royal (Image:Blond McIndoe Research Foundation)

(Lead image: Swansea Bay NHS)

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Look out for a loved one this Blue Monday say Samaritans Cymru

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Today marks Blue Monday, supposedly the most difficult day of the year, but the leading suicide prevention charity says feeling low can happen on any day of the year and that we need to be aware of how the pandemic is increasing those feelings amongst many of us.

As pandemic uncertainties continue, Samaritans Cymru is encouraging people to get their mugs out and share a drink with a friend, neighbour or colleague who may be struggling to cope. 

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Although winter is thought to be one of the harder seasons with dark days and frosty nights, Samaritans volunteers hear similar concerns all year round from those that contact the charity. The main concerns include mental health and illness (46%), family (34%) and loneliness (28%)*. 

National treasure Dame Julie Walters joins faces from TV and comedy, including James Acaster and Keith Lemon, and talented artists across the UK to encourage people to have a cuppa and a chat with someone they care about for Samaritans Brew Monday. 

Samaritans Ambassador Dame Julie Walters thinks people can really make a difference to someone’s day just by asking if they are OK. She said: “People go through a range of emotions throughout the year so the idea of feeling blue on one day is a load of rubbish. I’ve had my fair share of blue days and have found solace in speaking to loved ones over a glass of something or two. 

“It is a simple action that can go a long way, particularly now when so many people continue to feel isolated and lonely. It doesn’t have to be Monday, or a cuppa, connecting with someone at any time during the year shows them you are there and ready to listen.” 

Talented artists who have experience of mental health struggles, including Cardiff-based Nathan Wyburn of Britain’s Got Talent fame,  have also lent their paintbrushes and pencils by creating uplifting illustrations that share a message of connection with others over a cup of something and a catch up. 

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Nathan Wyburn has had his own mental health struggles and anxiety which at times stalled his creativity, but he credits the power of talking in his recovery. Nathan is known for creating art with food, including portraits of Mariah Carey and Tim Peake, so for Brew Monday Nathan created an uplifting portrait showing two people connecting, made with coffee and biscuits. Nathan said: 

“Having suffered with anxiety, panic attacks and bouts of depression for many years, I know first-hand how difficult it can be to do anything in those moments, let alone talk – but take it from me, once you open up about how you’re feeling, it can be life-changing. I’m so proud to be supporting Brew Monday and really hope my coffee art catches someone’s eye and makes them think to pick up the phone to a friend. You never know just how much a simple conversation could help someone.”  

Samaritans Cymru continues to highlight how the pandemic has widened inequalities in Wales in order to tackle the prevalence of suicide. Living in poverty, job insecurity and loneliness and isolation are all social issues which have risen during the pandemic but it is important to recognize these are all risk factors for suicide. Reaching out to those around us and asking how they are over a cup of tea or coffee, could actually be a lifesaver, 

With support from Network Rail, Transport for Wales and the wider rail industry, Samaritans will have a presence at train stations across Wales throughout January, supporting key workers and those who are travelling, providing tea bags and tips on how to be a better listener, along with their helpline details.

Bethan Jelfs, People & Change Director at Transport for Wales said: “We’re proud to once again be supporting Samaritans’ Brew Monday campaign at stations across Wales to help spread the message that it is important everyone reaches out to check on family and friends and also takes time to look after their own mental health.  With almost two years of Covid-related restrictions, which has impacted on some people more than others, this vital awareness campaign is needed more than ever.”

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Krista Sexton, Head of Operational Risk at Network Rail added: “We’re proud to support Samaritans’ Brew Monday campaign as it provides a simple but effective way for us to reach out to our railway colleagues and loved ones who might be needing a little extra support. The past two years, during the pandemic, have been difficult on many people’s mental health but, we know, not everybody always wants to share their concerns. 

This poignant campaign reminds us to stop and listen and encourage those struggling to open up and have a chat over a cup of tea.” 

Lead image: Samaritans volunteer has a virtual catch up for Brew Monday. (Image: Abbie Trayler-Smith)

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