• "I Don't Think of It As An Illness": Illness Representations in Mild to Moderate Dementia

      Clare, L.; Quinn, Catherine; Jones, I.R.; Woods, R.T. (2016-02-27)
      The self-regulatory model proposes that illness representations influence adjustment and coping in chronic conditions. Better understanding of the illness representations held by people with dementia could help with targeting information and support so as to optimize adjustment and coping. In this mixed-methods study of illness representations among people with mild to moderate Alzheimer’s, vascular, or mixed dementia we aimed to clarify the nature of the representations held, to determine whether specific profiles can be identified based on perceptions of the identity and cause of the condition, and to examine associations between these profiles and other participant characteristics. Data were collected in the second wave of the Memory Impairment and Dementia Awareness Study (MIDAS). Sixty-four people with dementia, who had been told their diagnosis at a memory clinic, completed interviews and responded to questionnaires. In each case a carer was also interviewed. Cluster analysis based on responses about identity and cause identified three profiles. ‘Illness’ cluster participants saw themselves as living with an illness and used diagnostic labels, ‘ageing’ cluster participants did not use diagnostic labels and viewed their difficulties as related to ageing, and ‘no problem’ cluster participants considered that they did not have any difficulties. ‘Illness’ cluster participants had better cognition and better awareness, but lower mood, and perceived more practical consequences, than ‘ageing’ cluster participants. Holding an ‘illness’ model may not be advantageous. Rather than encouraging adoption of such a model, it may be preferable to target information and select interventions in line with the person’s representation profile.
    • "I just keep thinking that I don't want to rely on people." a qualitative study of how people living with dementia achieve and maintain independence at home: stakeholder perspectives

      Rapaport, P.; Burton, A.; Leverton, M.; Herat-Gunaratne, R.; Beresford-Dent, Jules; Lord, Kathryn; Downs, Murna G.; Boex, S.; Horsley, R.; Giebel, C.; et al. (2020-01)
      BACKGROUND: Most people living with dementia want to remain in their own homes, supported by family and paid carers. Care at home often breaks down, necessitating transition to a care home and existing interventions are limited. To inform the development of psychosocial interventions to enable people with dementia to live well for longer at home, we qualitatively explored the views of people living with dementia, family carers and health and social care professionals, on how to achieve and maintain independence at home and what impedes this. METHODS: We conducted an inductive thematic analysis of qualitative interviews with 11 people living with dementia, 19 professionals and 22 family carers in England. RESULTS: We identified four overarching themes: being in a safe and familiar environment, enabling not disabling care, maintaining relationships and community connectedness, and getting the right support. For people living with dementia, the realities of staying active were complex: there was a tension between accepting support that enabled independence and a feeling that in doing so they were accepting dependency. Their and professionals' accounts prioritised autonomy and 'living well with dementia', while family carers prioritised avoiding harm. Professionals promoted positive risk-taking and facilitating independence, whereas family carers often felt they were left holding this risk. DISCUSSION: Psychosocial interventions must accommodate tensions between positive risk-taking and avoiding harm, facilitating autonomy and providing support. They should be adaptive and collaborative, combining self-management with flexible support. Compassionate implementation of rights-based dementia care must consider the emotional burden for family carers of supporting someone to live positively with risk.
    • ‘I no longer feel alone’: meeting the needs of bereaved grandparents through a children’s hospice support group

      Tatterton, Michael J.; Lyon, J.A. (2020)
      Background: Children’s hospices provide a range of family-centred care services, including bereavement support. Not all hospices provide specific services for grandparents. Aim: To explore how a hospice-based bereavement support group supported grandparents in their grief following the death of a grandchild. Methods: Grandparents attending a group were invited to complete an anonymous questionnaire. Questionnaires from eight groups, run between 2015 and 2019 were collated and interpreted to identify themes. Findings: 121 grandparents attended the groups; 113 returned the questionnaires (93% response). Three central themes were identified: environment and space, being with people who understand, and the opportunity to hear the stories of others. Grandparents valued hearing the stories of others, providing an opportunity to reflect on the experience of others. Conclusion: Grandparents felt supported and validated by the group. The facilitated sessions increased coping and resilience of participants, enabling grandparents to support their partner, adult children and surviving grandchildren more effectively.
    • I'm wondering now if I'm the only person who remembers: using film and narrative biography to resist amnesia in dementia studies.

      Capstick, Andrea (2008)
      This study is grounded in my concerns, as a HE lecturer in Dementia Studies, about the difficulties practitioner-students face in writing reflectively about their work with people who have dementia. I introduced a short fiction film, Ex Memoria, into the curriculum, initially as a means of ascertaining whether the use of an arts-based approach would facilitate greater reflection among students more familiar with biomedical perspectives on dementia. The film attempts to convey the experiences of a woman with dementia, a Polish-Jewish refugee from wartime Poland, now living in a London care home. Twenty two students completed either coursework assignments or reviews based on the film. The findings suggest that the psychosocial perspective which underpins the Dementia Studies programme, and has been widely promoted as a corrective to the biomedical ¿standard paradigm¿ (Kitwood, 1997), itself contributes to the ahistorical and depoliticized positioning of people with dementia, their families, and professional caregivers. In conclusion I argue that the psychologisation of dementia has contributed to its academic marginalisation. A broader, more transdisciplinary approach is required; one which sets dementia in the context of 20th century history, and thus avoids the social amnesia (Jacoby, 1996) currently affecting dementia studies.
    • Identification of Stage-Specific Breast Markers using Quantitative Proteomics

      Shaheed, Sadr-ul; Rustogi, Nitin; Scally, Andy J.; Wilson, J.; Thygesen, H.; Loizidou, M.A.; Hadjisavvas, A.; Hanby, A.; Speirs, V.; Loadman, Paul M.; et al. (2013)
      Matched healthy and diseased tissues from breast cancer patients were analyzed by quantitative proteomics. By comparing proteomic profiles of fibroadenoma (benign tumors, three patients), DCIS (noninvasive cancer, three patients), and invasive ductal carcinoma (four patients), we identified protein alterations that correlated with breast cancer progression. Three 8-plex iTRAQ experiments generated an average of 826 protein identifications, of which 402 were common. After excluding those originating from blood, 59 proteins were significantly changed in tumor compared with normal tissues, with the majority associated with invasive carcinomas. Bioinformatics analysis identified relationships between proteins in this subset including roles in redox regulation, lipid transport, protein folding, and proteasomal degradation, with a substantial number increased in expression due to Myc oncogene activation. Three target proteins, cofilin-1 and p23 (increased in invasive carcinoma) and membrane copper amine oxidase 3 (decreased in invasive carcinoma), were subjected to further validation. All three were observed in phenotype-specific breast cancer cell lines, normal (nontransformed) breast cell lines, and primary breast epithelial cells by Western blotting, but only cofilin-1 and p23 were detected by multiple reaction monitoring mass spectrometry analysis. All three proteins were detected by both analytical approaches in matched tissue biopsies emulating the response observed with proteomics analysis. Tissue microarray analysis (361 patients) indicated cofilin-1 staining positively correlating with tumor grade and p23 staining with ER positive status; both therefore merit further investigation as potential biomarkers.
    • Illness representations in caregivers of people with dementia

      Quinn, Catherine; Jones, I.R.; Clare, L. (2017-05)
      Illness representations shape responses to illness experienced by the self or by others. The illness representations held by family members of those with long-term conditions such as dementia influence their understanding of what is happening to the person and how they respond and provide support. The aim of this study is to explore components of illness representations (label, cause, control and timeline) in caregivers of people with dementia. This was an exploratory study; the data reported came from the Memory Impairment and Dementia Awareness Study (MIDAS). Data from semi-structured interviews with 50 caregivers of people with dementia were analysed using content analysis. The majority of caregivers gave accounts that appeared to endorse a medical/diagnostic label, although many used different terms interchangeably. Caregivers differentiated between direct causes and contributory factors, but the predominant explanation was that dementia had a biological cause. Other perceived causes were hereditary factors, ageing, lifestyle, life events and environmental factors. A limited number of caregivers were able to identify things that people with dementia could do to help manage the condition, while others thought nothing could be done. There were varying views about the efficacy of medication. In terms of timeline, there was considerable uncertainty about how dementia would progress over time. The extent of uncertainty about the cause, timeline and controllability of dementia indicated that caregivers need information on these areas. Tailored information and support taking account of caregivers' existing representations may be most beneficial.
    • Illusion or delusion - Lean management in the health sector

      McIntosh, Bryan; Cohen, I.K.; Sheppy, B. (2014)
      Purpose: There has been considerable interest in implementing practices imported from manufacturing into healthcare as a solution to rising healthcare spending and disappointing patient safety indicators. One approach attracting particular interest is Lean management, which is explored in this article. Design/methodology/approach: The exploratory research focuses on Lean management in the health sector. It is based on extensive secondary data and it is a practical in implication. Data provided both background and context. Findings: Despite widespread enthusiasm about Lean management’s potential, evidence about its contribution to higher performance is inconsistent. Research limitations/implications: Major Lean operations management and human resource management concepts, including just-in-time (JIT), total quality management (TQM) and total productive maintenance (TPM) are explored. Practical implications: This article contributes to the healthcare organizational management literature by showing that although Lean management seems to have the potential to improve organizational performance; it is far from a panacea for underperforming hospitals. The article informs policy-making by suggesting that a progressive managerial philosophy has a stronger impact on healthcare performance than adopting practices from any particular managerial approach. Originality/value: A critical evaluation on Lean’s impact on informing healthcare policy is presented, which contributes to healthcare organisational management literature by showing that even though Lean management in healthcare appears to have the potential to improve performance; there remain problems with its application.
    • Image quality based x-ray dose control in cardiac imaging

      Davies, A.G.; Kengyelics, S.M.; Gislason-Lee, Amber J. (2015-03)
      An automated closed-loop dose control system balances the radiation dose delivered to patients and the quality of images produced in cardiac x-ray imaging systems. Using computer simulations, this study compared two designs of automatic x-ray dose control in terms of the radiation dose and quality of images produced. The first design, commonly in x-ray systems today, maintained a constant dose rate at the image receptor. The second design maintained a constant image quality in the output images. A computer model represented patients as a polymethylmetacrylate phantom (which has similar x-ray attenuation to soft tissue), containing a detail representative of an artery filled with contrast medium. The model predicted the entrance surface dose to the phantom and contrast to noise ratio of the detail as an index of image quality. Results showed that for the constant dose control system, phantom dose increased substantially with phantom size (x5 increase between 20 cm and 30 cm thick phantom), yet the image quality decreased by 43% for the same thicknesses. For the constant quality control, phantom dose increased at a greater rate with phantom thickness (>x10 increase between 20 cm and 30 cm phantom). Image quality based dose control could tailor the x-ray output to just achieve the quality required, which would reduce dose to patients where the current dose control produces images of too high quality. However, maintaining higher levels of image quality for large patients would result in a significant dose increase over current practice.
    • Imaging the cervical spine following rugby related injury

      Beck, Jamie J.W. (2016-05)
      Rugby Union and Rugby League are popular sports with high participation across the world. The high impact nature of the sport results in a high proportion of injuries. Rugby has an association with cervical spine injury which has potentially catastrophic consequences for the patient. Anecdotal evidence suggests that radiographers find it challenging to visualise the cervicothoracic junction on the lateral supine cervical spine projection in broad shouldered athletes. This paper intends to analyse the risk factors for cervical spine injuries in rugby and discuss the imaging strategy in respect to radiography and CT scanning in high risk patient groups such as rugby players who are suspected of suffering a cervical spine injury.
    • The immobilisation and restraint of paediatric patients during plain film radiographic examinations

      Graham, P.; Hardy, Maryann L. (2004-02)
      Purpose: The immobilisation and restraint of children to facilitate radiographic examination is a controversial issue that has been relatively ignored by radiography research. The aim of this study was to begin to fill this gap by providing a description of restraint used in a limited number of clinical sites in order to highlight any perceived need for training, policies or guidelines in the use of child immobilisation and restraint. Methods: A cross-sectional survey design using a postal questionnaire was adopted. One hundred and sixty-seven questionnaires were distributed to radiographers employed within six hospital Trusts. Results: A response rate of 83.2% (n=139/167) was achieved. Ninety-three percent (93.5%, n=130/139) of respondents indicated that restraining techniques were used although only 19.2% (n=25/130) had received specific training in safe restraining techniques and 7.9% (n=11/139) in distraction techniques as an alternative to restraint. A need for further guidance and support for clinical staff was evident with 73.3% (n=74/101) of respondents identifying a need for specific guidelines and 84.6% (n=110/130) indicating that further training opportunities were required. Conclusions: The use of restraint in paediatric plain film radiography is an apparently widespread practice and support for clinical radiographers through the development of training opportunities and practice guidelines are seen as essential in order to promote high quality paediatric radiography practices.
    • Immunohistochemical analysis of NAD(P)H:quinone oxidoreductase and NADPH cytochrome P450 reductase in human superficial bladder tumours: Relationship between tumour enzymology and clinical outcome following intravesical mitomycin C therapy

      Basu, Saurajyoti; Brown, John E.; Flannigan, G. Michael; Gill, Jason H.; Loadman, Paul M.; Naylor, Brian; Scally, Andy J.; Seargent, Jill M.; Shah, Tariq K.; Puri, Rajiv; et al. (2004)
      A central theme within the concept of enzyme-directed bioreductive drug development is the potential to predict tumour response based on the profiling of enzymes involved in the bioreductive activation process. Mitomycin C (MMC) is the prototypical bioreductive drug that is reduced to active intermediates by several reductases including NAD(P)H:quinone oxidoreductase (NQO1) and NADPH cytochrome P450 reductase (P450R). The purpose of our study was to determine whether NQO1 and P450R protein expression in a panel of low-grade, human superficial bladder tumours correlates with clinical response to MMC. A retrospective clinical study was conducted in which the response to MMC of 92 bladder cancer patients was compared to the immunohistochemical expression of NQO1 and P450R protein in archived paraffin-embedded bladder tumour specimens. A broad spectrum of NQO1 protein levels exists in bladder tumours between individual patients, ranging from intense to no immunohistochemical staining. In contrast, levels of P450R were similar with most tumours having moderate to high levels. All patients were chemotherapy naïve prior to receiving MMC and clinical response was defined as the time to first recurrence. A poor correlation exists between clinical response and NQO1, P450R or the expression patterns of various combinations of the 2 proteins. The results of our study demonstrate that the clinical response of superficial bladder cancers to MMC cannot be predicted on the basis of NQO1 and/or P450R protein expression and suggest that other factors (other reductases or post DNA damage events) have a significant bearing on tumour response.
    • The impact of a new public health approach to end-of-life care: A systematic review

      Sallnow, L.; Richardson, H.; Murray, S.A.; Kellehear, Allan (2016-02-12)
      Background: Communities play an increasingly significant role in their own health and social care, and evidence demonstrates the positive impact of this work on a range of health outcomes. Interest is building regarding the application of the principles of the new public health approach to those facing the end of life and their families and communities. Aim: To review the evidence relating to the impact of a new public health approach to end-of-life care, specifically as this applies to efforts to strengthen community action. Design: A systematic review employing narrative synthesis. Both meta-ethnography and the use of descriptive statistics supported analysis. Data sources: Eight databases (AMED, ASSIA, BiblioMap, CINAHL, Cochrane Reviews, EMBASE, MEDLINE and PsycINFO) were searched from the earliest record to March 2015 using set eligibility criteria. Results: Eight articles were included in the analysis. Three main themes emerged from the meta-ethnography: making a practical difference, individual learning and personal growth and developing community capacity. The quantitative findings mapped to the meta-ethnography and demonstrated that engaging communities can lead to improved outcomes for carers such as decreased fatigue or isolation, increase in size of caring networks and that wider social networks can influence factors such as place of death and involvement of palliative care services. Conclusion: Evidence exists for the impact of community engagement in end-of-life care. Impact assessment should be an integral part of future initiatives and policy makers should recognise that these approaches can influence complex issues such as carer support, community capacity, wellbeing and social isolation.
    • Impact of a person-centred dementia care training programme on hospital staff attitudes, role efficacy and perceptions of caring for people with dementia: A repeated measures study

      Surr, Claire A.; Smith, Sarah J.; Crossland, Jo; Robins, Jan (2016-01)
      People with dementia occupy up to one quarter of acute hospital beds. However, the quality of care delivered to this patient group is of national concern. Staff working in acute hospitals report lack of knowledge, skills and confidence in caring for people with dementia. There is limited evidence about the most effective approaches to supporting acute hospital staff to deliver more person-centred care. This study aimed to evaluate the efficacy of a specialist training programme for acute hospital staff regarding improving attitudes, satisfaction and feelings of caring efficacy, in provision of care to people with dementia. A repeated measures design, with measures completed immediately prior to commencing training (T1), after completion of Foundation level training (T2: 4–6 weeks post-baseline), and following Intermediate level training (T3: 3–4 months post-baseline). All participants received the 3.5 day Person-centred Care Training for Acute Hospitals (PCTAH) programme, comprised of two levels, Foundation (0.5 day) and Intermediate (3 days), delivered over a 3–4 months period. Staff demographics and previous exposure to dementia training were collected via a questionnaire. Staff attitudes were measured using the Approaches to Dementia Questionnaire (ADQ), satisfaction in caring for people with dementia was captured using the Staff Experiences of Working with Demented Residents questionnaire (SEWDR) and perceived caring efficacy was measured using the Caring Efficacy Scale (CES). The training programme was effective in producing a significant positive change on all three outcome measures following intermediate training compared to baseline. A significant positive effect was found on the ADQ between baseline and after completion of Foundation level training, but not for either of the other measures. Training acute hospital staff in Intermediate level person-centred dementia care is effective in producing significant improvements in attitudes towards and satisfaction in caring for people with dementia and feelings of caring efficacy. Foundation level training is effective in changing attitudes but does not seem to be sufficient to bring about change in satisfaction or caring efficacy. Keywords
    • Impact of a specialist mental health pharmacy team on medicines optimisation in primary care for patients on a severe mental illness register: a pilot study

      Raynsford, Justine; Dada, C.; Stansfield, D.; Cullen, T. (2020)
      Objective Medication arrangements for patients with severe mental illness (SMI), including schizophrenia and bipolar disorder, can be complex. Some have shared care between primary and secondary services while others have little specialist input. This study investigated the contribution a specialist mental health clinical pharmacy team could make to medicines optimisation for patients on the SMI register in primary care. Research shows that specialist mental health pharmacists improve care in inpatient settings. However, little is known about their potential impact in primary care. Method Five general practice surgeries were allocated half a day per week of a specialist pharmacist and technician for 12 months. The technician reviewed primary and secondary care records for discrepancies. Records were audited for high-dose or multiple antipsychotics, physical health monitoring and adherence. Issues were referred to the pharmacist for review. Surgery staff were encouraged to refer psychotropic medication queries to the team. Interventions were recorded and graded. Results 316/472 patients on the SMI register were prescribed antipsychotics or mood stabilisers. 23 (7%) records were updated with missing clozapine and depot information. Interventions by the pharmacist included clarifying discharge information (12/104), reviewing high-dose and multiple antipsychotic prescribing (18/104), correcting errors (10/104), investigating adherence issues (16/104), following up missing health checks (22/104) and answering queries from surgery staff (23/104). Five out of six interventions possibly preventing hospital admission were for referral of non-adherent patients. Conclusion The pharmacy team found a variety of issues including incomplete medicines reconciliation, adherence issues, poor communication, drug errors and the need for specialist advice. The expertise of the team enabled timely resolution of issues and bridges were built between primary and secondary care.
    • The impact of an enhanced assessment tool on students’ experience of being assessed in clinical practice: a focus group study

      Haigh, Jacquelyn; Dearnley, Christine A.; Meddings, Fiona S. (2007-04)
      As part of a CETL funded project (ALPS 2006) 29 student midwives and their link lecturers were given an electronic version of a clinical portfolio on hand held computers (PDAs). These devices were used during an eight week clinical practice placement to record tripartite assessment interviews and to facilitate grading of the placement. Three focus groups conducted at the end of the placement explored the concept of clinical practice assessment and the impact of the electronic portfolio on the students’ experience of clinical practice and its assessment. Data was analysed from an activity theory perspective in that the electronic assessment tool was viewed as an artefact mediating situated knowing about student assessment in a particular socio-historical context. Findings suggest that students perceive clinical assessment as contested with different assessors having different understandings of it. However the electronic devise facilitated changes to the assessment tool. These changes promoted a shared understanding of the assessment process which was pragmatic and acceptable to students and clinicians. The significance of this study is that it highlights the role of assessment tools in creating a shared understanding of the assessment process rather than simply articulating that understanding.
    • Impact of body part thickness on AP pelvis radiographic image quality and effective dose

      Alzyoud, K.; Hogg, P.; Snaith, Beverly; Flintham, K.; England, A. (2018-10-03)
      Introduction: Within medical imaging variations in patient size can generate challenges, especially when selecting appropriate acquisition parameters. This experiment sought to evaluate the impact of increasing body part thickness on image quality (IQ) and effective dose (E) and identify optimum exposure parameters. Methods: An anthropomorphic pelvis phantom was imaged with additional layers (1e15 cm) of animal fat as a proxy for increasing body thickness. Acquisitions used the automatic exposure control (AEC), 100 cm source to image distance (SID) and a range of tube potentials (70e110 kVp). IQ was evaluated physically and perceptually. E was estimated using PCXMC software. Results: For all tube potentials, signal to noise ratio (SNR) and contrast to noise ratio (CNR) deceased as body part thickness increased. 70 kVp produced the highest SNR (46.6e22.6); CNR (42.8e17.6). Visual grading showed that the highest IQ scores were achieved using 70 and 75 kVp. As thickness increases, E increased exponentially (r ¼ 0.96; p < 0.001). Correlations were found between visual and physical IQ (SNR r ¼ 0.97, p < 0.001; CNR r ¼ 0.98, p < 0.001). Conclusion: To achieve an optimal IQ across the range of thicknesses, lower kVp settings were most effective. This is at variance with professional practice as there is a tendency for radiographers to increase kVp as thickness increases. Dose reductions were experienced at higher kVp settings and are a valid method for optimisation when imaging larger patients.