The Royal Berkshire NHS Foundation Trust outpatient services transformation programme to improve quality and effectiveness of patient care.

Background: The Royal Berkshire NHS Foundation Trust outpatient services transformation programme is a strategic change programme delivered as a collaborative approach through the Berkshire West Integrated Care Partnership. The main aim of redesign is to improve capacity in clinics and improve patient experience. Methods: This was done through a best practice menu and 'how to' guides. This simplified and standardised the process for moving activity from face-to-face to virtual, maximising remote monitoring and moving clinics off the main acute site. Results: We have successfully implemented six different work streams to transform outpatient services. Referrals are now triaged and streamed. The number of patients reviewed virtually, on patient-initiated follow-up and seen closer to home has increased. Conclusion: The outpatient services transformation programme has resulted in improvements within the trust and the integrated care partnership. This programme supports the vision by the Royal College of Physicians and NHS England to modernise and transform outpatient services.

Mechanical degradation of drag reducing polymers in suspensions of blood cells and rigid particles.

Natural and synthetic soluble drag reducing polymers (DRP) have been shown to produce beneficial effects on blood circulation in various animal models and may represent a novel bioengineering way to treat cardiovascular disorders. These polymers are known to degrade when subjected to high shear stresses which could be a part of the process of their elimination from the vascular system. However, the relative rate of their degradation was not known especially in the presence of blood cells or particles. The hydrodynamic tests in this study demonstrated that DRP mechanical degradation was significantly increased by the presence of red blood cells (RBC) and even more so by the presence of rigid particles of similar size. Degradation rates increased with an increase in RBC or particle concentration. The natural DRP (derived from aloe) was shown to be much more resistant to flow-induced degradation than polyethylene oxide in the presence or absence of RBC.

Poly(N-vinylformamide)-A drag-reducing polymer for biomedical applications.

Water-soluble drag-reducing polymers (DRPs) were previously demonstrated to significantly increase blood flow, tissue perfusion, and tissue oxygenation when injected intravenously at nanomolar concentrations in various animal models. Turbulent flow drag-reducing ability was proven to be the most important factor defining the potential of polymers to favorably affect blood circulation. Several DRPs were applied in previous in vivo tests, but the search continues for suitable DRPs for biomedical applications. We demonstrated that poly(N-vinylformamide) (PNVF) with a molecular weight of 4.5 x 10(6) Da significantly reduced resistance to turbulent flow in a pipe and thus presents a DRP. We also found that the PNVF mechanical degradation is much slower than that of the most commonly used DRP, poly(ethylene oxide). PNVF is known to have low toxicity. Furthermore, our pilot in vivo study showed that PNVF had acceptable biocompatibility and hemodynamic effectiveness and thus could be considered as a DRP candidate for potential clinical use.

Matrix-assisted laser desorption/ionization mass spectrometry of discrete mass poly(butylene glutarate) oligomers.

The mass dependency of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) response has been studied using equimolar mixtures of synthetic discrete mass poly(butylene glutarate) (PBG) oligomers of known structure having degrees of polymerization of 8, 16, 32, and 64. Mass discrimination observed was attributed to choice of matrix and detector saturation caused by higher laser intensity and inclusion of matrix ions in the MALDI spectra. Optimization of sample preparation and instrumental parameters provided uniform response over the mass ranged spanned by these four oligomers. The oligomer mixture was shown to serve as a model of more complex polymer distributions in the mass range 780-6000 Da, and application of the discrete mass oligomers as internal and calibration standards was demonstrated. Inclusion of PBG discrete mass oligomers as an internal standard in a quasi-equimolar mixture with polydispersed poly(butylene adipate) (PBA) indicated that some diminution of response occurred during the analysis of this mixture of materials. Reasons for differences in the corrected molecular weight averages of the polydispersed PBA obtained from measurements using MALDI and GPC were studied using individual discrete mass oligomers as calibration standards for GPC. The data indicated that differences in hydrodynamic volumes of PBG oligomers and PEG standards at similar masses resulted in an overestimation by GPC of the molecular weight averages of the PBA distribution.