CVASC incorporates a number of multi-disciplinary team (MDT) delivered services as below aiming for “one-stop” consultations. There is close collaboration between two or more of the services to ensure a truly inter-disciplinary care for our patients.
This was established in October 2016. It is run by an ENT consultant (Mr Shashi Prasad) along with UHCW speech and language therapists (SALT) with gastroenterologist (Dr Jay Mannath) in an advisory role. There is at least one clinic per month. A detailed history is taken with the use of validated patient-reported outcome measures (PROMs) like the EAT-10 score and Sydney Swallowing Questionnaire. Besides routine ENT examination, optical imaging, oromotor evaluation of the oral phase of swallowing, objective measure of laryngo-pharyngeal reflux with the Reflux Finding Score (RFS) and Fibreoptic Endoscopic Evaluation of Swallowing (FEES) are undertaken. If appropriate, oesophageal manometry, transnasal oesophagoscopy and videofluroscopy are performed. Interventions advised include dietary modifications, swallowing exercises/therapy, endoscopic transnasal/transoral balloon dilatation, injection of botulinum toxin for neuromyomectomy, endoscopic stapling and endoscopic/microscopic laser surgery.
This was established in November 2016. It is run by an ENT consultant (Mr Shashi Prasad) along with community speech and language therapists (SALT). This are three such clinics per month. A detailed history of speaking and singing voice is taken with the use of validated patient-reported outcome measures like Reflux Symptom Index and Vocal Handicap Index-10. Besides routine ENT examination, optical imaging, perceptual assessment of the voice, objective measure of laryngo-pharyngeal reflux with the Reflux Finding Score, high-definition videostroboscopy and dynamic vocal assessment are undertaken. Interventions advised include improving vocal hygiene. Speech therapy, endoscopic transnasal/transoral balloon dilatation, injection of botulinum toxin for neuromyomectomy and endoscopic/microscopic laser phonosurgery.
This was established in December 2016. It is run by an ENT consultant (Mr Shashi Prasad) along with community speech and language therapists (SLT). Interventions are carried out under topical anaesthesia and include transcutaneous injections to improve the quality of voice under high-definition video endoscopic control. This is advantageous because of: better access in patients with trismus or anatomical constraints, the ability to perform procedures under a local anaesthetic which: helps in patients with medical co-morbidities that make a general anaesthetic challenging/impossible with less cardiopulmonary stress, circumventing issues surrounding availability of beds and theatre capacity; reduce waiting times; enabling ambulatory surgery (patients may be able to drive home and possibly get back to work right away); being quite safe; and being cost-effective vis-a-vis similar procedures carried out traditionally under a general anaesthetic.
This was set up in April 2018 envisaging partnership working between ENT (Mr Shashi Prasad) and Respiratory Sciences (Ms Joanna Shakespeare and Mr Edward Parkes). It seeks to evaluate patients with exercise induced laryngeal obstruction, typically seen in young athletic individuals and often misdiagnosed as either asthma or exercise-induced asthma. Aside from a detailed history, patients have a breath-by-breath gas analysis and ECG to assess physiological response to exercise and a continuous laryngeal examination (which is the gold standard test) entailing the insertion of a laryngoscope through the patient’s nose to monitor the upper airway during the performance of an incremental maximal exercise.
This was established in June 2018 with core members including ENT (Mr Shashi Prasad and Mr Natesh Basaviah), Respiratory Medicine (Prof David Parr and Dr Rosa Maria Ortiz-Comino) and Thoracic Surgery Surgery (Mr Antonio Martin-Ucar) consultants. There is a planned link to the soon-to-be launched MDT vasculitis service that has clinicians from Rheumatology and Nephrology. The service deals with pathologies and the management of conditions affecting the larynx and trachea. Conditions considered include: persistent and or progressive exertional dyspnoea and or stridor in patients with history of granulomatous disease, neck trauma, autoimmune conditions, prolonged intubation, neck or laryngo-tracheobronchial surgery; unexplained persistent and/or progressive exertional dyspnoea and or stridor especially in adult Caucasian women; “difficult-to-treat asthma” diagnosed in an adult; ineffective treatment for acute asthma or exacerbation of COPD; long-term tracheostomies with difficult or doubtful decannulation. Following the clinic consultation, patients are investigated as per standard evidence-based protocol, discussed in a MDT meeting and treatment undertaken incorporating the expertise of the relevant clinician (s) for a truly integrated and efficient “closer-to-home” care of patients. Formal meetings are held every month but there are regular discussions among members. Interventions range from endoscopic therapies like balloon dilatation, CO2/KTP laser and insertion of stents to open resection and anastomosis. Very few centres have such a comprehensive service for central airway diseases. It currently covers the catchment population of Coventry, Rugby and Warwickshire, with plans to expand.
The multi-disciplinary clinic was set up in June 2019. It provides a streamlined, multi-disciplinary approach to complex, chronic cough and has been established through a collaboration between the Ear, Nose and Throat Department ENT) and Respiratory Medicine. Consultants from the two specialities (Prof David Parr, Respiratory Medicine and Mr Shashi Prasad, ENT/Head and Neck Surgery) and specialist nurses are working in conjunction with Respiratory Physiology and Physiotherapy. UHCW is one of a minority of centres in the UK to boast this 'gold-standard' facility mirroring internationally accepted protocols. Appointments allow patients to have a joint specialist consultation and include detailed history, assessment of the upper airway using nasoendscopy, sputum testing and disease-specific patient-reported outcome measures.
This was set up in early 2020. It seeks to: manage complex tracheostomy care, streamline decannulation, facilitate early discharge, coordinate community care, reduce re-admission rates with tracheostomy-related complications, promote weaning in patients on non-invasive ventilation, monitor and audit tracheostomy care, provide advice and guidance as well as teach skills to members in the Trust providing tracheostomy care, link in with other centres and feed into the National Patient Safety programme. Members include consultants from Otolaryngology (Mr Shashi Prasad, Lead Clinician and Mr Natesh Basaviah), Critical Care and Respiratory Medicine (Dr Asad Ali); Speech and Language Therapists; Critical Care Outreach, Specialist Physiotherapists, Head and Neck Clinical Nurse Specialists, members of the Non-Invasive Ventilation team and Specialist Dietician. A series of protocols, clinical operating/standard operating procedures and a database have been developed.
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