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NIHR BRC Education and Training Fund Call Information Sheet open call

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NIHR Biomedical Research Centre (BRC) Southampton in Association with Southampton Academy of Research (SoAR) Education, Training & Career Development Fund Call From November 2020 to February 2021 For NIHR Biomedical Research Centre (BRC) Southampton in association with Southampton Academy of Research (SoAR) Table of Contents Information on the Fund .................................................................................. 2 The purpose of fund: ....................................................................................... 2 Criteria for scoring will include: ........................................................................ 4 Terms and Conditions: .................................................................................... 4 Claiming Procedures: ...................................................................................... 5  University Hospital of Southampton employees: (as indicated by your payslip) ................................................................................................ 5  Students and Honorary contract holders or external examiners/invigilators (If you are not receiving a salary from UoS or UHS) ................................................................................................... 5  University of Southampton Employees: (as indicated by your payslip) 5 1 For NIHR Biomedical Research Centre (BRC) Southampton in association with Southampton Academy of Research (SoAR) Education, Training & Career Development Fund Call Information on the Fund The NIHR Biomedical Research Centre (BRC) Southampton in Association with Southampton Academy of Research (SoAR) are pleased to announce the first Open call for the Education, Training & Career Development Fund Call. Applications for funding will be welcomed, reviewed and awarded from November 2020 to February 2021 as funding is needed. The scheme has a limited budget set aside for the financial year 1st April 2020 – 31st March 2021, awards are therefore competitive. Terms and Conditions apply. Deadline for applications: 9th February 2021 at 23:00hrs Email applications and supporting documents to: SoAR@uhs.nhs.uk Please direct any queries to the BRC academic career development leads: K.Mitchell@soton.ac.uk For Cross-cutting Themes (Data Science, Microbial Science and Behavioural Science) and other healthcare professionals M.Johnson@soton.ac.uk For Nutrition Theme K.Staples@soton.ac.uk For Respiratory & Critical Care Theme The purpose of fund:  Offer funds of up to £750 to enable BRC aligned junior investigators and research staff to access training, education and career development opportunities (This includes both research delivery staff and researchers)  Encourage and support BRC aligned junior investigators to disseminate their research  Raise the profile of the achievements of BRC aligned junior investigators The BRC Southampton Education, Training & Career Development Fund will support training of individuals undertaking research into respiratory diseases, critical care, or nutritional aspects of health and disease. The research should be aligned with, but does not necessarily have to be directly funded by, the respiratory and critical care theme, nutrition theme or one of the cross-cutting themes (Behavioural Science, Microbial Science and Data Science). The fund primarily aims to support the training needs of researchers in the early phases of their career, or research support staff with training and development needs. Awards will consist of a maximum of £750. 2 For NIHR Biomedical Research Centre (BRC) Southampton in association with Southampton Academy of Research (SoAR) NB. Those who have a BRC funded fellowship which includes provisions made for training and development will not be prioritised for allocation of these funds. In exceptional cases the fund will support senior staff with respect to training and development where needs cannot be met elsewhere (e.g. NHS Consultants invited to present BRC-supported research at international meetings). For presentations, affiliation to, and funding from, the BRC must be acknowledged. Applicants must be staff or students of University of Southampton or University Hospital Southampton NHS Foundation Trust.  In addition to the award you will be required to provide feedback on how this funding opportunity has impacted your learning and development. (A feedback form will be sent after your claim has been processed) Examples of support include: Conference and event fees, travel to other centres and short course fees. Conference fees will only be awarded to presenting authors (evidence of abstract acceptance required). On this occasion we will also support funding towards:  one university module fee, as a part or whole contribution  Open access fees. We will not support: Research which falls outside the remit of the BRC, salaries, projects consumables or equipment, mandatory training and development, stipends, living expenses and university fees for higher degree registration, expenses which can be accessed from other sources (e.g. NIHR funded SPARC or IVSA schemes see below). Individuals who have alternative access to funds e.g. NIHR Academy members by virtue of having been awarded an NIHR Southampton BRC studentship /fellowship who already have a budget for training as part of their studentship/ fellowship, those eligible to apply for funding via NIHR trainee fund. Please see links to examples of alternative funding For NIHR funded Academic Clinical Fellows and Clinical Lecturers: http://www.southampton.ac.uk/medicine/research/clinical_academic_training/funding_for_tr ainees.page? UoS staff member, student or UoS visitor access holders: https://www.researchprofessional.com/sso/login?service=https://www.researchprofessional. com/0/ 3 For NIHR Biomedical Research Centre (BRC) Southampton in association with Southampton Academy of Research (SoAR) The applications will be scored by a panel comprising of:  Two NIHR BRC academic career development leads (Karl Staples, Mark Johnson or Kay Mitchell) Criteria for scoring will include:  Importance of the award to the individual for their education, training or career development.  Relevance of the individual’s research or research support to the BRC.  Previous successful applications are welcome although this will be taken into account when scoring/allocating awards. Terms and Conditions:  Funding is subject to availability  Funding is awarded on a first come-first served basis  Any funding not claimed before Monday 15th March 2021 will be reallocated  Applicants will be notified of the outcome of their application approximately 14 working days after submission.  Funding for education and training will be prioritised over open access fees  Open access fees will only be awarded once in a five year period,  Applicants need to approach librarians to ensure they are not eligible for OA fees from elsewhere first  Requests for courses and conferences will take priority over open access fees 4 For NIHR Biomedical Research Centre (BRC) Southampton in association with Southampton Academy of Research (SoAR) Claiming Procedures: Please note: all claims will be paid retrospectively. You will receive a guide on our claiming procedures if/when you are issued with a successful letter. University Hospital of Southampton employees: (as indicated by your payslip) You will be required to submit your claim via the ESR Portal. Your claim will be processed by your line manager and funds taken from their Cost Centre initially. SoAR will then arrange for an interdepartmental transfer to put the money back into your Line manager’s Cost Centre. Please ensure that you have spoken to your line manager prior to application. You will be awarded a BRC Training and Education Fund allocation letter as proof, if successful.  Students and Honorary contract holders or external examiners/invigilators (If you are not receiving a salary from UoS or UHS) You will be required to complete a BACS form. The form must be returned to our finance department  University of Southampton Employees: (as indicated by your payslip) Once you are ready to claim please contact Mike Blackman via email and cc in SoAR. Mike Blackman- mjb3@soton.ac.uk Admin Team- SOAR@uhs.nhs.uk You will be required to claim via Businessworld Portal by using an Agresso code which will be set up for you, for this particular award. Please note: We strongly advise that you to contact the finance department before making any purchases. All bookings related to travel and accommodation must be made through Clarity. Finance ext: 27094 or Purchasing team ext: 25328 5
Url
/Media/Southampton-Clinical-Research/SoAR/NIHR-BRC-Education-and-Training-Fund-Call-Information-Sheet-open-call.pdf

Southampton PTC - Approved chemotherapy regimens 9 June 2020

Description
Appendix B: SOUTHAMPTON PAEDIATRIC ONCOLOGY PRINCIPAL TREATMENT CENTRE List of Approved Chemotherapy Regimens Updated 9th June 2020 Review Date: June 2021 Agreements 1 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Position Head Of Chemotherapy Service Name Dr Juliet Gray Organisation UHS Date agreed 19/2/2019 Disease / Indication LEUKAEMIA Acute lymphoblastic leukaemia: First line therapy Paediatric Chemotherapy Group Regimen / protocol Approved chemotherapy regimens Routes administration of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG As per UKALL 2011 Oral / IV bolus, IV infusion/ IM / s.c./ intrathecal Oral 6MP / MTX I V vincristine IV/s.c bolus Cytarabine IM asparaginase IV Daunorubicin and Doxorubicin (Level 2 only) IV/s.c bolus Cytarabine Oral 6MP / MTX 2 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication Relapse / 2nd line therapy Regimen / protocol Routes administration of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG As per UKALL R3 Interim Oral / IV bolus, IV Oral 6MP / MTX / TG IV/s.c Cytarabine guidance infusion / IM/ s.c./ IV vincristine Oral 6MP / MTX /6TG intrathecal IV/s.c Cytarabine IM asparaginase Blinatumomab Iv infusion Nlearabine as per CCLG IV infusion UKALL 2019 interim guidelines Philadelphia positive Infants Acute Myeloid Leukaemia First line therapy Relapse / 2nd line therapy Interim recommendations for Ph +ve children, June 2014 As per Interfant 2006 : CCLG Guidelines 2016 Myechild 01 UK Guidelines for relapsed AML (2010) Azacitidine NICE TA218 Oral / IV bolus, IV infusion / IM/ s.c./ intrathecal Oral / IV bolus, IV infusion / IM/ s.c./ intrathecal IV Infusion / IV bolus/ intrathecal IV Infusion / IV bolus/ intrathecal IV infusion SC bolus Oral 6MP / MTX /imatinib IV vincristine IV/s.c Cytarabine IM asparaginase Oral 6MP / MTX/6TG IV vincristine IV/s.c Cytarabine IM asparaginase IV/s.c Cytarabine Oral 6MP / MTX /imatinib / 6TG IV/s.c: Cytarabine Oral 6MP / MTX /6TG In children with Downs Syndrome CCLG guidelines (March IV infusion/ IV bolus 2014) 3 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication APML Regimen / protocol Routes administration of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG Guidelines for standard risk IV infusion/ IV bolus / children with APL (SR-ICC oral APL Study 02) Oral ATRA Chronic Myeloid Leukaemia Leukaemia Working Group Oral / iv bolus / iv Oral hydroxyurea Oral hyroxyurea / imatinib guidelines infusion /imatinib APLASTIC ANAEMIA CCLG recommendations for the management of CML in children and young people up to the age of 18years (Dec 2014) BSH Diagnosis and Management of Aplastic Anaemia, updated 2017 Iv infusion LYMPHOMA T cell and pre-B Lymphoma Burkitts / Large B cell lymphoma Initial therapy As per UKALL 2011 Oral / IV bolus, IV IV vincristine infusion/ IM / s.c./ IV /s.c. cytarabine intrathecal Oral 6MP/MTX As per Inter-B-NHL Ritux IV infusion / iv bolus / 2010 oral / intrathecal Oral 6MP / MTX IV /s.c cytarabine Relapse / second line therapy CCLG B-cell guidelines 2003 R-ICE NHL IV infusion / iv bolus / oral / intrathecal 4 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication Regimen / protocol Routes administration of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG Anaplastic large cell lymphoma Initial therapy Relapse CCLG guidelines (June 2009) As per ALCL relapse NHL 2006 01 IV infusion/ iv bolus / oral / intrathecal IV infusion/ iv bolus / oral / intrathecal IV Vinblastine Primary Mediastinal B cell Dose-adjusted R-EPOCH IV infusion/ iv bolus / Lymphoma oral / intrathecal Inter-B-NHL Ritux 2010 Hodgkin’s (classical) First line therapy CCLG interim (July 2013) guidelines Oral / IV bolus / IV infusion IV vincristine Oral prednisolone IV Cyclophosphamide (Level 2 only) Oral prednisolone Relapse / second line therapy EURONET PHL C2 trial As per guidelines EuroNet-PH1: ABVD IEP BEAM within Oral / IV bolus / IV infusion Iv bolus / infusion / oral IV vincristine Oral prednisolone IV Cyclophosphamide (Level 2 only) IV doxorubicin (Level 2 only) IV Vinblastine Oral prednisolone 5 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication Regimen / protocol Routes administration of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG Hodgkin’s (lymphocyte predominant) As per Euronet LP-1 study Iv bolus / infusion /oral iv vinblastine, Oral prednisolone oral prednisolone SOLID TUMOURS Ewings sarcoma Initial therapy As per Euro Ewings 2012 Iv bolus / iv infusion Or CCLG Flow sheet Oct 2019 Relapse / second line therapies As per CCLG flowsheet Iv infusion / oral (Aug 2017) rEECur: Oral temozolomide Oral temozolomide IV irinotecan (level 2 only) Irinotecan / temozolomide rEECur Germ Cell Tumours Initial therapy Relapsed disease TreoMel CCLG Interim guidelines for the treatment of germ cell tumours in children and adolescents (Jun 2018) Guidelines within GC III Iv infusion / bolus Iv infusion / bolus 6 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication HLH Hepatoblastoma Initial therapy (standard risk) Initial therapy (high risk) Hepatocellular carcinoma Langerhans Cell Histiocytosis Initial disease Refractory disease Nasopharyngeal carcinoma Regimen / protocol As per HLH 2004 Routes of Drugs that can be Drugs that can to be Approved by administration given in POSCU given in Community SPCG IV bolus / infusion CCLG Treatment Iv infusion guidelines for hepatoblastoma PHiTT protocol CCLG Treatment guidelines for hepatoblastoma IV infusion PHiTT protocol As per SIOPEL 5 IV infusion /oral Oral thalidomide PHiTT protocol IV infusion / IV bolus, Oral sorafenib PO Oral thalidomide Oral Sorafenib LCH IV Iv bolus /oral Iv vinblastine CCLG Guidelines for LCH 2010 – currently being updated As per LCH-S 2005 Iv infusion / iv bolus / Iv vinblastine oral Oral MP /MTX Oral 6MP / MTX Oral MP /MTX 7 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication Initial treatment Neuroblastoma Initial therapy: Stage IV / High risk Intermediate and low risk Neuroblastoma Relapse / second line therapy Regimen / protocol CCLG guidelines for nasopharyngeal carcinoma 2013 Routes administration Iv infusion of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG IM Interferon IM interferon HR-NBL-1-SIOPEN CCLG guidelines for High Risk Neuroblastoma (Mar 2019) As per CCLG guidelines for low and intermediate risk neuroblastoma Feb 2020 CCLG guidelines for relapsed and refractory neuroblastoma Iv infusion, iv bolus, oral, s/c Iv bolus / infusion Iv infusion Oral cis-retinoic acid Oral cis-retinoic acid As per BEACON trial Irinotecan + temozolomide Iv infusion / oral (as per CCLG guidelines) Cyclophosphamide and topotecan as per CCLG guidelines Topotecan + temozolomide (as per CCLG guidelines) Oral etoposide (as per CCLG guidelines) Iv infusion / oral oral Oral temozolomide Oral temozolomide IV Irinotecan (Level 2 only) Oral temozolomide Oral etoposide Oral temozolomide Oral etoposide 8 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication Regimen / protocol Routes administration of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG Oral temozolomide (as per oral Oral temozolomide CCLG guidelines) Dinituximab beta as per NICE guidance Topotecan,Vincristine and IV Infusion / IV bolus Doxorubicin as per CCLG Guideline HD-ICE, MD-ICE or LD-ICE as per CCLG guideline Hu3F8 as per YmAbs study IV infusion s/c GMCSF IV hu3F8 GM-CSF Non-rhabdomyosarcoma soft tissue EpSSG NRSTS 2005 IV bolus, iv infusion sarcoma protocol (STS 2006 03) Iv vincristine Iv actinomycin Osteosarcoma: Initial therapy Relapse / rescue therapy: Pancreatoblastoma CCLG flowsheet Oct 2019 Iv infusion Mifamurtide as per NICE Iv infusion TA Ifosamide /etoposide High dose MTX Gemcitabine/ Docetaxel Iv infusion Iv infusion IV infusion CCLG guidelines (2003) Iv infusion Iv mifamurtide Retinoblastoma 9 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication Regimen / protocol Routes administration of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG Initial therapy Initial therapy enucleation after unilateral CCLG guidelines (2008) CCLG Guideline for management of children with intraocular retinoblastoma II Second line chemo Jan 2008 CCLG Guidelines for the management of children with advanced unilateral retinoblastoma following primary enucleation May 2018 IV bolus / infusion IV bolus / infusion IV bolus / IV infusion Rhabdomyosarcoma Initial therapy (localised) Initial therapy (metastatic) As per RMS 2005 As per guidelines within RMS 2005 and CCLG guidelines (Nov 2013) Iv bolus / iv infusion / oral Iv bolus / iv infusion IV vincristine IV actinomycin Iv vinorelbine Oral cyclophosphamide IV vincristine Oral cyclophosphamide Relapsed disease EpSSG Phase II committee IV bolus/ IV infusion Relapsed RMS and CCLG guidelines (Aug 2013) 10 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication Wilms’ tumour / Clear Cell Sarcoma Kidney Regimen / protocol CCLG Renal tumour clinical management guidelines Jan 2020 Routes administration Iv bolus/infusion of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG Iv vincristine / actinomycin Iv doxorubicin (level 2) IV irinotecan (level 2) Relapsed disease TVD As per UK W-R Iv infusion IV infusion / iv bolus Iv vincrisitne actinomycin Iv doxorubicin (level 2) CNS TUMOURS Low grade glioma First line therapy Second line therapies: As per Low grade glioma 2 IV bolus, iv infusion protocol Weekly vinblastine IV bolus Vinilo trial IV bolus and oral Weekly vinblastine IV bolus IV vincristine, IV carboplatin (level 2 only) Iv vinblastine (PTC only) IV vinblastine Oral Nilotinib High grade glioma CCLG guidelines Oral Oral temozolomide Oral temozolomide Infant high grade glioma European study guidelines 11 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication DIPG Regimen / protocol BIOMEDE trial Routes administration Oral of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG Oral dasatinib, oral everolimus, oral erlotinib Medulloblastoma Standard risk High risk Infants (≤ 3 years) Relapse / refractory CCLG guidelines (Jan 2019) CCLG guidelines (Jan 2015) CCLG interim guidelines March 2019 Oral etoposide then consideration of autograft IV bolus / infusion / oral IV infusion / bolus / oral IV infusion / bolus IV infusion / oral IV vincristine Oral lomustine IV vincristine Oral etoposide Oral lomustine Oral etoposide Ependymoma Standard risk CCLG Interim guidelines for recurrent Medulloblastoma Dec 2018 CCLG guidelines IV infusion Infants Ependymoma II trial IV bolus / IV infusion UKCCSG Baby Brain IV infusion / bolus protocol (CNS 2007 09) CCLG Infant medulloblastoma – interim guidance Jan 2019 Headstart II SIOP Ependymoma II trial IV infusion / bolus and PO Oral valproate 12 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 Disease / Indication ATRT CPC Germ cells tumours Pinealoblastoma > 3 yrs of age Regimen / protocol Routes administration of Drugs that can be Drugs that can to be Approved by given in POSCU given in Community SPCG EURHAB protocol Iv infusion / bolus / intraventricular CCLG guidelines ( May 2011) As per SIOP CPT 2009 IV infusion / IV bolus / study Intraventricular As per GCT II study IV infusion CCLG guidelines (Sept 2013) EMERGENCY REGIMENS EMPIRICAL High count leukaemia Spinal cord compression Iv daunorubicin +/- vinc +/- Iv infusion / bolus steroid Carbo / etoposide Iv infusion Other soft tissue mass requiring urgent treatment Susoected Burkitt’s lymphoma Vincristine/Dactinomycin/ Cyclophosphamide IV cyclophosphamide, vincristine and oral prednisolone IV bolus/ IV Infusion IV infusion. Bolus and oral PALLIATIVE Oral etoposide Oral Oral etoposide 13 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020 14 SOUTHAMPTON PAEDIATRIC ONCOLOGY AND HAEMATOLOGY PRINCIPAL TREATMENT CENTRE List of approved chemotherapy regimens – VERSION 2.0 9th June 2020
Url
/Media/UHS-website-2019/Docs/PaediatricOncology/Southampton-PTC-Approved-chemotherapy-regimens-9-June-2020.pdf

How do we deal with patient consultations over DNACPR

Description
Auto Generated Title On these pages I discuss the clinical law on which our nursing and medical staff rely when caring for our patients. Mr Robert Wheeler, director, department of clinical law As you will know, following the Court of Appeal’s judgement in Tracey v Cambridge NHSFT & Ors [201] EWCA Civ 822, the court found that: the clinician has a duty to consult the patient in relation to DNACPR "unless he or she thinks that the patient will be distressed by being consulted and that that distress might cause the patient physical or psychological harm". Given the importance of this case, it is laid out below for you to read. Please bear in mind that the patient must be consulted; this requirement could be met by the provision of a printed sheet, such as appears at the end of this bulletin. On 5 February 2011, Mrs Tracey was diagnosed with lung cancer with an estimated life expectancy of nine months. On 19 February, she sustained a serious cervical fracture after a major road accident. She was admitted to the Hospital and transferred to the neurocritical care unit under the care of a consultant neurosurgeon. Because she had chronic respiratory problems she was placed on a ventilator, but did not respond to treatment for her chest infection. On 23 and 25 February, efforts were made to wean her from the ventilator, but these were unsuccessful. On 26 February, her treatment was reviewed by a consultant intensivist and on 27 February by a consultant oncologist. The intensivist and oncologist decided that Mrs Tracey should be taken off the ventilator. The question arose as to what would happen if she suffered a cardiorespiratory arrest. On 27 February, a DNACPR notice was completed. Mrs Tracey was successfully weaned from the ventilator and her condition appeared to improve. The circumstances in which this DNACPR notice came to be completed and placed in her notes lie at the heart of these proceedings. When one of her daughters discovered that the notice had been made, she was horrified and registered her objections. As a result, the notice was removed and cancelled on 2 March. Mrs Tracey’s condition deteriorated and she died at 10.38am on 7 March. The claim against the Trust was that it, amongst other things, breached Mrs Tracey’s rights because in imposing the notice, it failed to: adequately consult Mrs Tracey or members of her family notify her of the decision to impose the notice offer her a second opinion. The court found that Mrs Tracey did wish to be consulted about any DNACPR notice that the clinicians were contemplating completing and placing in her notes. Was it inappropriate to consult in relation to the notice on the facts of this case? The Trust submitted that the intensivist was entitled in the exercise of his clinical judgment to decide not to consult Mrs Tracey on the grounds that: he believed that CPR would be futile he knew that it would cause her distress to be involved in a discussion as to whether she should be resuscitated in the event of a cardiorespiratory arrest. Further, the Trust submitted that it was inappropriate to involve the patient if the clinician formed the view that CPR would be futile, even if he considered that involvement was unlikely to cause the patient harm. The court rejected this submission for two reasons. First, a decision to deprive the patient of potentially life-saving treatment is of a different order of significance for the patient from a decision to deprive him or her of other kinds of treatment. It calls for particularly convincing justification. The presumption should be that the patient is entitled to know that such an important clinical decision has been taken. The fact that the clinician considers that CPR will not work means that the patient cannot require him to provide it. It does not, however, mean that the patient is not entitled to know that the clinical decision has been taken. Secondly, if the patient is not told that the clinician has made a DNACPR decision, he will be deprived of the opportunity of seeking a second opinion, which may be desirable form the patient’s perspective. In terms of avoiding distress to a patient, the court made two findings that clinicians may not agree with. Firstly, that a belief that it would cause distress to the patient to discuss the issue is unlikely to be sufficient, without more, to make it inappropriate to involve her. The distress must be likely to cause the patient a degree of harm. It was accepted that if the intensivist had given evidence that he did not discuss CPR with her because he thought that she would be distressed and that this might cause her harm, the court would have been most unlikely to interfere with his clinical judgment. In that event, the court would have concluded that the clinician was entitled to decide that it was inappropriate to involve her in the process. The difficulty in this case is that the intensivist gave no such evidence. The court therefore found that the Trust had violated Mrs Tracey’s right to respect for her private life in failing to involve her in the process which led to the DNACPR notice. The court was nevertheless concerned by a ‘well-balanced and powerful representation from the Resuscitation Council (RC), expressing the fear that a judgment which states (or implies) that there is a presumption that, save in exceptional cases, every DNACPR decision must be made after consultation with the patient would seriously hamper the ability of health care professionals to provide individualised and compassionate care for vulnerable people towards the end of their lives’. The RC made the further point that in recent years there has been a reduction of inappropriate and unsuccessful attempts at CPR and that a judgment requiring consultation with a patient save in exceptional circumstances would be likely to reverse that process. In suggesting the following formulation, the court hoped that the RC concerns would be largely met: The clinician has a duty to consult the patient in relation to DNACPR “unless he or she thinks that the patient will be distressed by being consulted and that that distress might cause the patient physical or psychological harm". It must be emphasised that the court is insisting only that we consult before making this decision. Explicitly, the court leaves the decision whether the DNACPR should be imposed to the doctor. Our obligation to engage or consult with the patient may be met in a variety of ways. Oral discussion is one; but if you feel that the patient in front of you would find a written note of explanation more helpful, allowing them more time to consider their response (and subsequent questions) than an oral approach, then the following note, signed by the consultant in charge of the patient’s care might be appropriate. It should also be noted that the decision in Tracey did not specify consultation with the relatives, in circumstances when the patient lacked capacity. However, given the lower likelihood of causing harm or distress to adults accompanying the patient, consulting them before coming to your decision over whether or not to order DNACPR is plainly good practice. Here is a suggested patient information leaflet, to be handed to competent patients who you feel may prefer a written approach to the subject of DNACPR orders. Clearly, this can be modified according to departmental requirements, as long as the fundamental offer further to consult on an order, is conserved. The words in this leaflet are a draft. If you have suggestions for their improvement, please let me know and I’ll resend an amended form. Hospital, department, patient ID Date & Time Dear Mrs/Mr ... You will understand that some patients may unexpectedly become very seriously ill whilst in hospital. Sometimes, doctors will need to decide quickly whether their patient will be helped by ‘resuscitation’ of their heart and lungs. Resuscitation involves pressing on the chest to try and restore the heartbeat, so is sometimes used if a person’s heart beat stops. If you would like your nurse or doctor to discuss this further with you; and particularly if you have already decided what you would like to happen to you if your heart should stop; please let us know, and we will sit down and talk about it. Consultant in charge of case to sign (not a photocopy of signature). Robert Wheeler Deptartment of clinical law
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/HealthProfessionals/Clinical-law-updates/HowdowedealwithpatientconsultationsoverDNACPR.aspx

Psoralen ultraviolet light A (PUVA) treatment - Bath or basin soak - patient information

Description
This factsheet explains what psoralen ultraviolet light A (PUVA) treatment is, how to prepare for it and the benefits and risks of the treatment.
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/Media/UHS-website-2019/Patientinformation/Skin/Psoralen-ultraviolet-light-A-PUVA-treatment-Bath-or-basin-soak-1369-PIL.pdf

Eating and drinking with a high output stoma - patient information

Description
This factsheet provides information on how to manage your high output stoma.
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/Media/UHS-website-2019/Patientinformation/Digestionandurinaryhealth/Eating-and-drinking-with-a-high-output-stoma-2412-PIL.pdf

Post-enucleation socket syndrome (PESS) - patient information

Description
This factsheet contains information about post-enucleation socket syndrome (PESS).
Url
/Media/UHS-website-2019/Patientinformation/Eyes/Post-enucleation-socket-syndrome-PESS-3169-PIL.pdf

Stereotactic vacuum assisted excision (VAE) of breast - patient information

Description
This leaflet explains more about having a stereotactic VAE of the breast, including the benefits, risks and any alternatives, and what you can expect when you come to hospital.
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/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Stereotactic-vacuum-assisted-excision-VAE-of-breast-2025-PIL.pdf

Polysomnography (PSG) and multiple sleep latency test (MSLT) - patient information

Description
This factsheet explains what a polysomnography (PSG) and multiple sleep latency test (MSLT) are, what the tests involve and how to prepare for them.
Url
/Media/UHS-website-2019/Patientinformation/Respiratory/Polysomnography-PSG-and-multiple-sleep-latency-test-MSLT-3807-PIL.pdf

Your non-invasive ventilation (NIV) device: A40 Pro - patient information

Description
This factsheet explains how to use and care for your A40 Pro non-invasive ventilation (NIV) device safely at home.
Url
/Media/UHS-website-2019/Patientinformation/Respiratory/Your-non-invasive-ventilation-NIV-device-A40-Pro-3631-PIL.pdf

Your non-invasive ventilation (NIV) device: Lumis 150 - patient information

Description
This factsheet explains how to use and care for your Lumis 150 non-invasive ventilation (NIV) device safely at home.
Url
/Media/UHS-website-2019/Patientinformation/Respiratory/Your-non-invasive-ventilation-NIV-device-Lumis-150-3630-PIL.pdf
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