Latest news for the TB Service North Central London.
The SHUB launches bespoke TB Clinical Noting in Electronic Patient Records
A HUGE thank you to Mithun Deb (Systems Specialist, Whittington Health) for his skill and patience in developing a bespoke Clinical Noting template in the Electronic Patient Record (Medway) with Dr Helen Booth (Clinical lead, SHUB/UCLH) . Thanks to Lusha Kellgren (TB Specialist Nurse SHUB) who did much of the user testing. At the NCL TB Service South Hub@Whittington aka the SHUB.
- All TB nursing documentation is now captured on the Electronic Patient Record
- It is a multidisciplinary template
- It can generate letters
- Can be used to extract information to improve patient care
One good patient outcome from COVID lockdown?
A keen footballer attended A&E with problems swallowing, neck pain. Due to lockdown restrictions they had not been able to play football……..which was perhaps a good thing as they had an unstable spine from TB causing bone destruction of C5-7 cervical vertebrae (pictured) putting them at risk of spinal cord damage. They have now completed TB treatment, have no neurological damage…and are back playing football!
- Spinal TB is site of disease in 4.6% cases in England Tuberculosis in England: annual report - GOV.UK (http://www.gov.uk/)
- Length of preceding symptoms range from 4 to 11 months. Usually, patients seek advice only when there is severe pain, marked deformity, or neurological symptoms
- Incidence of neurological deficit varies from 23 to 76%. In cervical spinal tuberculosis these are pain, weakness, and numbness of the upper and lower extremities, eventually progressing to tetraplegia.
Continuing the Football, COVID and TB theme
In May, Maddy Wickers (TB Outreach Worker, pictured front row far left) played in the REAL North London football derby of Whittington Hospital vs North Middlesex Hospital at the Tottenham Hotspur Stadium.
Daniel Levy, Chairman, Tottenham Hotspur, said: “The staff at our local hospitals are true heroes who we owe a great deal to and the Club and AIA are honoured to provide this special opportunity as a ‘thank you’ for their hard work throughout the pandemic.
The score: North Middlesex 4, Whittington Hospital 3
North Central London TB Service responds to COVID-19
Not everything is COVID-19
London Ambulance Service report form emergency call – possible COVID
Chest Xray showed infection in the top of the left lung- ‘indeterminate for COVID-19 ‘
Diagnosis: Patient with known HIV presenting with sputum smear positive pulmonary TB
- In 2018 2.9% of people with TB in London were co-infected with HIV
- There has been a significant decline in the number and proportion of TB patients with HIV since 2004 https://pubmed.ncbi.nlm.nih.gov/29879977/
- In the majority of these patients, TB is now diagnosed in those already known to be HIV positive.
Congratulations to Abigail Izzard who has now started her new role is as the clinical support worker on the Royal Free site.
A recent patient at the South Hub presented with back pain and was found to have spinal, pleural and pulmonary involvement
- Nearly a third of patients with pulmonary disease have TB in at least one other site i.e. multifocal disease
- Spinal involvement occurs in 3.2% of cases
- Well done to Meena Middleton (TB nurse specialist South Hub) and Dr Peter Mills (South Hub) who have developed a guideline on how to refer to, and present such cases at the neurosurgical spinal multidisciplinary meetings
Congratulations to Lusha KellgrenCongratulations to Lusha Kellgren (TB nurse lead, South Hub) who was recognised for her Outstanding Contribution to clinical care at the Whittington International Nurses Day award ceremony.
Congratulations to Peter MackenziePeter Mackenzie (TB nurse specialist, North Middlesex) recently took delivery of a “NHS Rainbow Badge” .
He writes ‘wearing the badge carries a responsibility and opportunity to send a message of inclusion, and can play a valuable part in reducing stigma and inequality. It is a way for staff to show that the organisation is an open, non-judgmental and inclusive place for people that identify as LGBT+.’
It was with great sadness to hear that Dr Ken Citron has recently died (pictured right) with the 'new' mobile XRay unit launched outside Houses of Parliament as part of Collaborative Tuberculosis Strategy for England 2015-2020.
- His life in relation to the history of tuberculosis is on our TB NCL website
- In 1995 he published a report, Out of the Shadow (attached), which found TB rates of 2% in homeless people in Camden and Westminster - the highest ever recorded among this risk group in the UK
- Homelessness remains a social risk factor in 4.7% of our patients with TB, two thirds of which are homeless during their TB care (annual report link above)
Steve Hitchins, Chair of Whittington Health NHS Trust from 2014 until June this year, sadly passed away unexpectedly recently. He was always hugely supportive of the North Central London TB service.
Professor Mahdad Noursedeghi (South Hub/UCL) and colleagues published that the presence of a blood gene transcriptional 'signature' in people who had been in contact with someone with TB, had a positive predictive value of 50% and a negative predictive value of 99.3% for progression to active tuberculosis within 90 days. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz252/5421263
It is great news that the recruitment target of >100 volunteers has been achieved for a follow up study to further understand how and why immune response to TB differs between people
The team have said farewell to the following staff recently:
- Esme Sicat (TB nurse specialist) North Middlesex who to be a senior nurse at the Lister Hospital
- Mary Pike (NCL Admin, North Middlesex) retired after many years with the service
- Louis Menson Evans (HCA, South Hub) left to study to be an associate physician
- Thomas Randal (Lead TB nurse, North Middlesex) returned to Denmark
We wish them all the best for the future and hope they keep in touch!
Thomas and Mary pictured at one of the leaving do’s
Another Note of Thanks
Launch of revamped North Central London TB Service website
I am pleased to announce the revamped North Central London TB Service website.
It includes information on TB, the services we offer and web based self-referral forms.
Many thanks to Richard Megroff and the IT team at Whittington health for helping to design this.
Focus on TB in prisons
Amanda McCormack (TB nurse specialist South Hub/prison liaison lead) featured with one of our current patients on National Prison Radio, as part of a campaign launched on World TB day, to raise awareness about TB amongst people that live and work in prisons.
Well done to the prison health care team headed up by Dr Deyaa Al Kurdi who made the early diagnosis on this prisoner by sending sputum samples even before a chest Xray (right)!
Rates of active TB in places of prescribed detention in the UK are high compared with the general population. They have high rates of loss to follow-up care and poor treatment outcomes.
Screening for TB: new entrants, mobile Xray units and incidents
Following a successful trial, driven by Chantelle Khan (TB Administrative Support, North Middlesex) and Jennifer DeKoningh (Network Co ordinator), the NCL TB Network will be undertaking New Entrant TB screening. This is a key intervention of the Collaborative TB Strategy for England 2015–2020
Recently an asymptomatic 15 year old boy, screened in the Unaccompanied asylum seeking young person infection screening clinic at UCLH had a chest X-ray which revealed a very small shadow in the top of the left lung (pictured).
Induced sputum at the South Hub confirmed isoniazid resistant TB - screening identifies both latent and active TB cases.
Dr Jonnie Cohen (South Hub/UCLH), presented the results of a national survey on clinical practice at the British Association for Paediatric TB In Manchester in February. This will inform the paediatric TB national guideline under development.
At the conference Lusha Kellgren (TB nurse lead South Hub) found the lecture theatre named after her grandfather - the first Professor of Rheumatology in the UK.
He established the Mobile Field Survey Unit in 1954 to undertake clinical and radiological surveys of rheumatism in miners - has some similarity to the Mobile Xray Unit still used to screen for TB in UK!
Belated congratulations to Narinder Boparai (NCL TB Network Screening Lead, pictured left) who presented a poster at the Winter British Thoracic Society meeting on the excellent work she has done on standardising TB incident management across the North Central London TB Network.
There were 148 incidents reported in one year: 43.2% were in a healthcare settings highlighting the importance of healthcare workers to be alert to the possibility of TB.
"today I have been discharged from the TB service after one year of regular visits ... I feel I would like to say good bye to all and really thank you to all nurses and admin team: you have been so nice and friendly all the time … Being a doctor myself I know how difficult is to keep a smile all the time even on busy days, and I am grateful for this."
Welcome to Abigail Izzard the new network TB outreach worker, Drs Natalie Prevatt (Consultant ID Paediatrician), Li-An Brown and Kate David (SpRs ID/Micro) who have joined the South Hub/Whittington team
Comings and goings
Angelita Solamalai (pictured) retired after 15 years as TB lead nurse at the RFH. We wish her all the best for the future.
Welcome to Josiane Dos Santos and Madeleine Wickers our new outreach worker and TB Case worker.
- Huge congratulations to Lusha Kellgren (Lead Nurse, South Hub) who has qualified as a non-medical independent prescriber. Professor Rob Miller (South Hub/CNWL) was her Designated Medical Practitioner
- Amanda McCormack (TB nurse specialist, South Hub) is one of only 70 nurses across London selected for the Florence Nightingale leadership programme. NHS England and NHS Improvement are funding the programme in recognition of the contribution of nurses/midwives across the 70 years of the NHS and to develop future leaders of healthcare in the capital. Go Amanda! https://florence-nightingale-foundation.org.uk/nhs-70-leadership-programme/
- Trevor Hart (Outreach coordinator) successfully completed The Whittington Health I.CARE Leadership Programme. Pictured right receiving his certificate from Siobhan Harrington (Chief Executive, Whittington Health)
Congratulations to Steve Morris-Jones
Congratulations to Steve Morris-Jones (Microbiology South Hub/UCLH) and his family (pictured) who successfully cycled the 875miles from Land’s End to John O’Groats and raised >£3000 for TB Alert, https://www.justgiving.com/fundraising/gingermojo-LEJOG
TB Alert, a UK based charity which works to tackle TB in the UK and the developing world was founded by Ken Citron and others. In the attached document he forwarded, he reflects on his life in relation to tuberculosis including having pulmonary TB himself which was cured with rest, relaxation, good food and sea air in Broadstairs!
TB and the NHS 70th birthday
Jacqui White (Sector Lead Nurse) cuts the cake at the NHS TB Tea party at the South Hub which welcomed current and past TB colleagues, friends, family, patients and other health care professionals.
Amanda McCormack (TB nurse specialist, South Hub) was named as one of 70 Whittington Health Heroes. She received a special commemorative NHS 10p coin released by The Royal Mint.
It was an opportunity to reflect on huge advances in TB outcomes in the last 70 years.
Recent death of Professor Denny Mitchison
It is with great sadness that we heard of the recent death of Professor Denny Mitchison. He was involved in key advances in the last 70 years:
- First ever randomised placebo control trial:
Continuing the research theme - congratulations to Maddy Noursadeghi (UCL/South Hub) who has been promoted to Professor at UCL. https://www.ucl.ac.uk/infection-immunity/people/professor-mahdad-noursadeghi
Continuing to spread our expertise
The North Middlesex team hosted a TB training session for health care professionals and 3rd sector workers. Thomas Rendal (TB nurse lead, N Mid) in action (left).
NCL TB sector has welcomed the first student nurses on rotation from Middlesex University. Well done to Peter McKenzie (TB nurse specialists N Mid) for organising
A thank you present from a patient who now remembers his care!
60 year old found collapsed in the street with complete memory loss. He did not know who he was or where he lived.
- He had extensive pulmonary TB (left)
- His profound memory loss was diagnosed as Korsakoff syndrome secondary to heavy alcohol use
- After thiamine (vitamin B1) supplements, successfully completing TB treatment and a lot of detective work he made a great recovery, knows who he is and is in supported accommodation!
- 4% of patients with TB in London misuse alcohol
- It is the highest social risk factor for TB to be diagnosed at the time of a hospital admission
We wish all the best to Maria McEwan (TB nurse specialist S Hub) and Astrid Grindlaye (Outreach worker) in their new (not completely) unrelated) posts.
Welcome to Maddie Wickers (TB outreach Care worker), Zandile Maseko (research nurse), Damien Ming and James Milburn (ID/micro SPR Whittington/South Hub).
World TB day events
' Nothing to fear'
Health care professionals and 3rd sector workers were invited to an excellent session organised by Trevor Hart (Outreach worker) with support from Astrid Grindlay (Outreach worker), Jacqui White (lead nurse) and Jennifer DeKoningh (lead admin).
Steve Hitchins, Whittington Health chairman, was a welcome audience member
Left to Right Sue Wilders (Social Care team leader), Trevor and Josie (ex patient).
Stephen Lawn Memorial Lecture
Steve worked at, and was supportive of the NCL TB service -South Hub.
He is best known for his work on HIV TB in South Africa. This was a moving meeting celebrating the recent findings of the STAMP study on rapid urine testing for disseminated TB in HIV positive patients which he set up
Steve, 3rd from left at South Hub 1st anniversary party
Focus on paediatric TB
Meena Middleton (TB nurse specialist South Hub, committee member for the “British Association for Paediatric Tuberculosis") attended the 2nd International Meeting on childhood tuberculosis in Vilnius, Lithuania.
A highlight was a debate on bedaquiline /delamanid dispersible tablets (not currently licensed for <18 year olds) replacing injectable agents in childhood MDR-TB
Developments and opportunities following the service restructure were outlined at December NCL TB network meeting.. The dedication and skills of the team was illustrated by North Middlesex having 43 years of specialist TB nursing experience between them!
TB doesn't stop for Christmas and value of spot sputums
Patient on anti-TNF alpha treatment for ankylosing spondylitis, attended A&E with persistent cough.
Referred that day to South Hub . Spot sputum smear +ve.
Recent paper co-authored by Drs Mike Brown (South Hub/UCLH) and Marc Lipman (RFH) reported that Spot Sputums as good as Early Morning Sputums – research already in clinical practice https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0947-9
Whittington PALS passed on lovely patient feedback
Wellcome £1.6 million research grant
Congratulations to Mahdad Noursadeghi (UCL/South Hub) who has been awarded this research grant. He writes:
I aim to test whether our individual risk of tuberculosis disease may be due to differences in the way our immune systems respond to infection and that these differences are genetically inherited.
We will measure the activity of immune genes at the site of a skin test for TB as a model for how the immune system functions at the site of real disease. We will then link differences in immune responses between people with the infection with differences in their genetic code and the likelihood of their infection progressing to disease. These studies will reveal how and why some people develop the disease while others control the infection.
The findings will help us target preventive therapies to those who need them most and to develop better vaccines or new treatment for TB aimed at improving immunity.
TB nurse specialists' CPD!
- The National PHE BCG Vaccination Training Programme took place at the South Hub in September covering competency framework, maintaining the vaccine ‘cold chain’ and using the unlicensed Intervax BCG vaccine currently available:
- Click here for InterVax BCG vaccine factsheet
- Congratulations to Jacqui Barrett (TB nurse specialist, Edgware) who passed the nurse prescribing course at Whittington Hospital. Pictured with her FP10 prescription pad.
Lovely message from a patient at the South Hub
‘To the wonderful team at the TB Clinic. Thank you for everything. If every cloud has a silver lining then you were definitely mine, Take care and till we meet again!’