• Reviewing studies with diverse designs: the development and evaluation of a new tool

      Sirriyeh, R. (See also Harrison, R.); Lawton, R.; Gardner, Peter H.; Armitage, Gerry R. (2012)
      RATIONALE, AIMS & OBJECTIVE: Tools for the assessment of the quality of research studies tend to be specific to a particular research design (e.g. randomized controlled trials, or qualitative interviews). This makes it difficult to assess the quality of a body of research that addresses the same or a similar research question but using different approaches. The aim of this paper is to describe the development and preliminary evaluation of a quality assessment tool that can be applied to a methodologically diverse set of research articles. METHODS: The 16-item quality assessment tool (QATSDD) was assessed to determine its reliability and validity when used by health services researchers in the disciplines of psychology, sociology and nursing. Qualitative feedback was also gathered from mixed-methods health researchers regarding the comprehension, content, perceived value and usability of the tool. RESULTS: Reference to existing widely used quality assessment tools and experts in systematic review confirmed that the components of the tool represented the construct of 'good research technique' being assessed. Face validity was subsequently established through feedback from a sample of nine health researchers. Inter-rater reliability was established through substantial agreement between three reviewers when applying the tool to a set of three research papers (kappa = 71.5%), and good to substantial agreement between their scores at time 1 and after a 6-week interval at time 2 confirmed test-retest reliability. CONCLUSIONS: The QATSDD shows good reliability and validity for use in the quality assessment of a diversity of studies, and may be an extremely useful tool for reviewers to standardize and increase the rigour of their assessments in reviews of the published papers which include qualitative and quantitative work.
    • RHAPSODY - Internet-based support for caregivers of people with young onset dementia: program design and methods of a pilot study

      Kurz, A.; Bakker, C.; Bohm, M.; Diehl-Schmid, J.; Dubois, B.; Ferreira, C.; Gage, H.; Graff, C.; Hergueta, T.; Jansen, S.; et al. (2016)
      Background: Young Onset Dementia (YOD), defined by first symptoms of cognitive or behavioral decline occurring before the age of 65 years, is relatively rare compared to dementia of later onset, but it is associated with diagnostic difficulty and heavy burden on affected individuals and their informal carers. Existing health and social care structures rarely meet the needs of YOD patients. Internet-based interventions are a novel format of delivering health-related education, counseling and support to this vulnerable yet underserved group. Methods: The RHAPSODY (Research to Assess Policies and Strategies for Dementia in the Young) project is a European initiative to improve care for people with YOD by providing an internet-based information and skill-building program for family carers. The e-learning program focuses on managing problem behaviors, dealing with role change, obtaining support and looking after oneself. It will be evaluated in a pilot study in three countries using a randomized unblinded design with a wait-list control group. Participants will be informal carers of people with dementia in Alzheimer’s disease or behavioral-variant Frontotemporal degeneration with an onset before the age of 65 years. The primary outcome will be caregiving self-efficacy after 6 weeks of program use. As secondary outcomes caregivers’ stress and burden, carer health-related quality of life, caring-related knowledge, patient problem behaviors and user satisfaction will be assessed. Program utilization will be monitored and a health-economic evaluation will also be performed. Conclusions: The RHAPSODY project will add to the evidence on the potential and limitations of a conveniently accessible, user-friendly and comprehensive internet-based intervention as an alternative for traditional forms of counseling and support in healthcare, aiming to optimize care and support for people with YOD and their informal caregivers.
    • Rising Ambulance Life-Threatening Call Demand in High and Low Socioeconomic Areas

      Portz, K.; Newell, Robert J.; Archibong, Uduak E. (2012)
      Ambulance service demand is increasing in the United Kingdom. A common speculative view makes a link between this rise in demand, deprivation, and certain medical conditions. This study explored factors infl uencing English ambulance service demand in two areas of differing socioeconomic status. Adopting a causal comparative design, the study compared the numbers of life-threatening calls that Yorkshire Ambulance Service receives and serves in two geographical areas within the Hull and East Riding area. The area of lower socioeconomic status generated signifi cantly more life-threatening calls than the area of higher socioeconomic status; these calls often supported younger patients (mean age 59 years versus 71 years) for breathing diffi culties (29% versus 14.5%) more commonly. Tackling inequality will require a whole-systems approach, effective leadership, and recognition of the benefi ts of understanding difference. A key relationship will entail engaging with seldom heard communities.
    • Risk factors for congenital anomaly in a multiethnic birth cohort: an analysis of the Born in Bradford study

      Sheridan, E.; Wright, J.; Small, Neil A.; Corry, P.C.; Oddie, S.J.; Whibley, C.; Petherick, E.S.; Malik, T.; Pawson, Nicole; McKinney, P.A.; et al. (2013)
      Background: Congenital anomalies are a leading cause of infant death and disability and their incidence varies between ethnic groups in the UK. Rates of infant death are highest in children of Pakistani origin, and congenital anomalies are the most common cause of death in children younger than 12 in this ethnic group. We investigated the incidence of congenital anomalies in a large multiethnic birth cohort to identify the causes of the excess of congenital anomalies in this community. Methods: We obtained questionnaire data from the mothers of children with one or more anomalies from the Born in Bradford study, a prospective birth cohort study of 13 776 babies and their families in which recruitment was undertaken between 2007 and 2011. Details of anomalies were prospectively reported to the study and we cross checked these details against medical records. We linked data for anomalies to maternal questionnaire and clinical data gathered as part of the Born in Bradford study. We calculated univariate and multivariate risk ratios (RRs) with 95% CIs for various maternal risk factors. Findings: Of 11 396 babies for whom questionnaire data were available, 386 (3%) had a congenital anomaly. Rates for congenital anomaly were 305·74 per 10 000 livebirths, compared with a national rate of 165·90 per 10 000. The risk was greater for mothers of Pakistani origin than for those of white British origin (univariate RR 1·96, 95% CI 1·56–2·46). Overall, 2013 (18%) babies were the offspring of first-cousin unions. These babies were mainly of Pakistani origin—1922 (37%) of 5127 babies of Pakistani origin had parents in first-cousin unions. Consanguinity was associated with a doubling of risk for congenital anomaly (multivariate RR 2·19, 95% CI 1·67–2·85); we noted no association with increasing deprivation. 31% of all anomalies in children of Pakistani origin could be attributed to consanguinity. We noted a similar increase in risk for mothers of white British origin older than 34 years (multivariate RR 1·83, 95% CI 1·14–3·00). Maternal education to degree level was protective (0·53, 95% CI 0·38–0·75), irrespective of ethnic origin. Interpretation: Consanguinity is a major risk factor for congenital anomaly. The risk remains even after adjustment for deprivation, and accounts for almost a third of anomalies in babies of Pakistani origin. High levels of educational attainment are associated with reduced risk in all ethnic groups. Our findings will be valuable in health promotion and public health, and to those commissioning antenatal, paediatric, and clinical genetic services. Sensitive advice about the risks should be provided to communities at increased risk, and to couples in consanguineous unions, to assist in reproductive decision making. Funding: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care programme.
    • Risk, Fitness to practice and Disabled Health Care Students.

      Walker, Stuart A.; Dearnley, Christine A.; Hargreaves J.; Walker, A. (2013)
      The United Kingdom Equality Act of 2010 poses challenges to regulators, educators, and employers to ensure that disabled people are not excluded from health care professions on the basis of their impairment. Professional bodies must also anticipate the needs of disabled people and facilitate inclusion. In this article, we discuss some of the current tensions that exist between U.K. antidiscrimination legislation and the professional and statutory regulatory bodies that govern registration of health and social care practitioners in the United Kingdom. We present research that used a mixed methods approach to explore the tensions between higher education and placement providers in the health sector. Disabled students and health professionals engaged in semistructured interviews, and a survey explored the knowledge, skills, and attitudes of professional staff from a range of disciplines and institutions. Findings suggest that the negative feelings disabled students report are also evident in responses from health care professionals. Notions of risk emerge as a key issue from the data. We discuss whether the risk is perceived or actual and develop models to challenge existing preconceptions about the risk posed by disabled students when training as health care professionals. Finally, we suggest that while work clearly needs to be done in this area, some of this work can be addressed through the development of an inclusive curriculum for all health care practitioners. This article proposes an educational model of risk with which to guide this process.
    • The role and experiences of responders attending the sudden or unexpected death of a child: a systematic review and meta-synthesis

      Tatterton, Michael J.; Scholes, Sarah L.; Henderson, S.; Croucher, Fiona; Gibson, Carla (2022-01)
      The infrequency of sudden deaths means that professionals have limited exposure, making it difficult to gain experience and feel confident in their role. This meta-synthesis aims to synthesise qualitative research on the experience of professionals responding to cases of sudden or unexpected death. A systematic literature search was conducted using Academic Search Complete, CINHAL, Embase, psycINFO, PubMed and Web of Science, identifying ten papers for inclusion. Studies were appraised and synthesized using the principles of meta‐synthesis. Four superordinate themes were identified: perceptions of role, experience on scene, approaches to coping, and barriers to support. Findings suggest the way responders perceive their role and their experience on scene affect the approach taken to tasks and coping strategies used. The complexity of experience is often not acknowledged by responders or their colleagues. Experiences are compounded by cumulative factors which were expressed by different professional groups and across settings. Several barriers relating to workforce culture within organisations were identified, alongside the implications these have on staff wellbeing and the impact on bereaved families.
    • Role emerging placements in undergraduate occupational therapy training: a case study

      Fitzgerald, Martin; Smith, A.K.; Rehman, N.; Taylor, M. (2017-10)
      Purpose: Role emerging placements in occupational therapy training are contributing to professional and workforce development because of their strong occupational focus and placement of students in emerging practice. This manuscript explores how one role emerging placement challenged and developed student theoretical and clinical skills, presented new ways of working at the recipient site and enhanced service delivery. Methods: The background to role emerging placements in occupational therapy is explored through the use of a case study which reflects on and analyses how the assessment and treatment of occupation enhanced service delivery at a local, no-traditional site is presented. Eight students in England developed and ran a psycho-education group to support the occupational needs of female service users who have experienced domestic abuse. Results: There was an overall increase in self-esteem scores and an expressed increase in knowledge and understanding by participants. Students reported developing a deeper understanding of occupation and the hosts identified the student’s clinical skills as unique contributors to service delivery. Conclusion: By focusing on occupation, role emerging placements draw on the roots of the profession and anchor its future to the theoretical foundations of its past. However, in order to employ occupational therapists, these organisations need to understand what the occupational therapy profession can offer them.
    • Role extension and role advancement - Is there a difference? A discussion paper

      Hardy, Maryann L.; Snaith, Beverly (2006-11)
      The terms ‘extended’ and ‘advanced’ practice are commonly used to describe clinical practitioner roles. However, these terms have not been clearly defined within the context of modern radiography practice despite their fundamental importance to establishing the 4 tier structure, implementing Agenda for Change and promoting a coherent clinical radiography career structure. This paper discusses the terms ‘extension’ and ‘advancement’ in relation to radiography practice and, using evidence from the debates of other health professions, attempts to offer some clarity to the terminology, presenting one interpretation of its possible application to the radiographer role in the United Kingdom.
    • The role of higher education in transforming the quality of dementia care: dementia studies at the University of Bradford

      Downs, Murna G.; Capstick, Andrea; Baldwin, P. Clive; Surr, Claire A.; Bruce, E. (2009)
      There is now widespread concern about the inadequate care and support provided to people with dementia from diagnosis to death. It is acknowledged that while there is a range of effective ways to care for and support people with dementia and their families from diagnosis to death, these have yet to become integral to practice. In England, for example, the National Dementia Strategy seeks to transform the quality of dementia care. One of the key components to transforming the quality of care is to ensure we have an informed and effective workforce. We argue here that in order to transform the quality of care we need to distinguish between the aims of training and education. Whilst there is a place for skills-based workplace training, Higher Education in dementia studies has a key role to play in the provision of specialist knowledge and skills in dementia care emphasizing as it does the development of critical thinking, reflection and action. In this paper we describe dementia studies at Bradford University available at both undergraduate and postgraduate levels. We outline their aims and learning outcomes, curricula, approach to teaching, learning and assessment. We describe the nature of students who study with us, noting their fit with the Higher Education Funding Council in England's agenda for widening participation in higher education. Higher Education in dementia studies has a unique role to play in equipping practitioners and professionals with the information, skills and attitudes to realize the potential for quality of life for people with dementia and their families.
    • The role of subjective social status in living well for carers of people with dementia: findings from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme

      Victor, C.R.; Rippon, I.; Quinn, Catherine; Martyr, A.; Clare, L. (2021-08)
      We investigated how carers of people with dementia evaluate their standing in their community and wider society, and if this is related to ‘living well’. We used baseline data from the Improving the experience of Dementia and Enhancing Active Life programme and found that carers rated their standing in society higher than in their local community. Higher evaluations of both were associated with enhanced life satisfaction, well-being and quality of life. Initiatives that increase support or engagement in the community or wider society may help to increase carers’ perceptions of their social status, enhancing their ability to ‘live well’.
    • Role redesign in the National Health Service: The effects on midwives' work and professional boundaries

      Prowse, Julie M.; Prowse, Peter J. (2008)
      This article examines the effects of role redesign on the work and professional boundaries of midwives employed in the National Health Service. It outlines midwives' views and experiences of attempts to change their skills and professional boundaries and, using the concept of closure, considers the implications for the midwifery profession. The findings show that role redesign is changing midwives' work and that the traditional emotional, social and caring skills associated with a midwife are being undermined by the growth in technical work. Importantly, midwives attempts to use closure have met with limited success and aspects of their work which they enjoy are being delegated to maternity support workers, while midwives' roles expand to include work traditionally performed by doctors. Midwives' concerns about the implications of work redesign for maternity care and their professional boundaries reflect the uncertainty surrounding the profession about the future role and skills of a midwife.
    • Science or art: risk and project management in healthcare

      Sheppy, B.; Zuliani, J.D.; McIntosh, Bryan (2012)
      Despite its rapid growth in recent literature, risks in project management have received limited critical attention when compared to Lean principles and total quality management. The aim of this article is to examine the ongoing dialogue within health services funders and providers concerning the relationship between project management and its relationship to hard and soft environmental risk factors. The failure of high profile projects and cost to the taxpayer is on the increase. This article argues that the lack of understanding in relation to a holistic assessment of project success factors contributes to increased risk of failure. It argues that greater emphasis is needed on placing risk relative to both operational and cultural factors, as opposed to the frequent use of prescriptive mechanistic methodologies. These changes have the potential not merely to improve the success rates of healthcare management projects, but health outcomes too.
    • The scope of carer effects and their inclusion in decision-making: A UK-based Delphi study

      Al-Janabi, H.; Efstathiou, N.; McLoughlin, C.; Calvert, M.; Oyebode, Jan R. (BMC, 2021-07)
      Background and objective: Health and social care may affect family carers’ health and wellbeing in addition to patients’ lives. It is recommended that such impacts (carer effects) are considered in decision-making. However, the scope of carer effects and range of decisions where carer effects should be considered is uncertain. This study aimed to identify (i) how different categories of healthcare and social care were perceived to impact on family carers and (ii) whether there was consensus about when carer effects should be formally considered in decision-making contexts. Methods: A Delphi study was conducted with 65 UK-based participants with expertise in dementia, mental health, and stroke. Participants considered two broad forms of ‘interventions’ (patient treatment and replacement care) and two broad forms of ‘organisational change’ (staffing and changes in timing/location of care). Participants assessed the likely impacts of health and social care on family carers and whether impacts should be considered in decision-making. The survey was conducted remotely at two time points. Results: Participants predicted widespread impacts from interventions and organisational changes on different domains of family carers’ lives, with ‘emotional health’ the most likely outcome to be affected. Patient treatment and replacement care services (‘interventions’) were associated with positive impacts across all domains. Conversely, timing/location changes and staffing changes (‘organisational changes’) were perceived to have mixed and negative impacts. There was widespread support (80-81%) for considering carer effects in research studies, funding decisions, and patient decision-making. Conclusion: This study highlights a perception that carer effects are widespread and important to consider in economic evaluation and decision-making. It highlights the particular need to measure and value effects on carers’ emotional health and the need to use a societal perspective to avoid cost shifting to family carers when introducing interventions and making organisational changes.
    • A scoping review to identify the techniques frequently used when analysing qualitative visual data

      Smith, S.K.; Mountain, Gail; Hawkins, R.J. (2016)
      Challenges were encountered when attempting to analyse video based data during a project exploring touch screen computer technology with people living with dementia. In order to inform the analytic process, a scoping review of published evidence was undertaken. Results of the scope illustrated the use of various techniques when analysing visual data, the most common of which was the transcription of video into text and analysed using conversation analysis. Three additional issues emerged in the course of the review. First, there is an absence of detail when describing the ethical implications involved when utilising visual methods in research. Second, limited priority is given to providing a clear rationale for utilising visual methods when audio or field notes may have been a viable alternative. Third, only 40% of reviewed articles clearly stated a chosen methodology. The conclusions of the review illustrate a lack of consistency across studies in the overall reporting of research methods and recommend that authors be explicit in their reporting of methodological issues across the research process.
    • A scoping review: Strategic workforce planning in health and social care

      Prowse, Julie M.; Sutton, Claire; Eyers, Emma; Montague, Jane; Faisal, Muhammad; Neagu, Daniel; Elshehaly, Mai; Randell, Rebecca (2022-04)
      Aim This aim of this scoping review was to undertake a detailed review of the pertinent literature examining strategic workforce planning in the health and social care sectors. The scoping review was tasked to address the following three questions: 1. How is strategic health and social care workforce planning currently undertaken? 2. What models, methods, and tools are available for supporting strategic health and social care workforce planning? 3. What are the most effective methods for strategic health and social care workforce planning? Methods The scoping review utilised the five-stage scoping review framework proposed by Arksey and O’Malley (2005). This includes identifying the research question; identifying relevant studies; study selection; charting the data and collating, summarizing, and reporting the results. The search included a range of databases and key search terms included “workforce” OR “human resource*” OR “personnel” OR “staff*”. Relevant documents were selected through initially screening titles and abstracts, followed by full text screening of potentially relevant documents. Results The search returned 6105 unique references. Based on title and abstract screening, 654 were identified as potentially relevant. Screening of full texts resulted in 115 items of literature being included in the synthesis. Both national and international literature covers strategic workforce planning, with all continents represented, but with a preponderance from high income nations. The emphasis in the literature is mainly on the healthcare workforce, with few items on social care. Medical and dental workforces are the predominate groups covered in the literature, although nursing and midwifery are also discussed. Other health and social care workers are less represented. A variety of categories of workforce planning methods are noted in the literature that range from determining the workforce using supply and demand, practitioner to population ratios, needs based approach, the utilisation of methods such as horizon scanning, modelling, and scenario planning, together with mathematical and statistical modelling. Several of the articles and websites include specific workforce planning models that are nationally and internationally recognised, e.g., the workload indicators of staffing needs (WISN), Star model and the Six Step Methodology. These models provide a series of steps to help with workforce planning and tend to take a more strategic view of the process. Some of the literature considers patient safety and quality in relation to safe staffing numbers and patient acuity. The health and social care policies reviewed include broad actions to address workforce planning, staff shortages or future service developments and advocate a mixture of developing new roles, different ways of working, flexibility, greater integrated working and enhanced used of digital technology. However, the policies generally do not include workforce models or guidance about how to achieve these measures. Overall, there is an absence in the literature of studies that evaluate what are the most effective methods for strategic health and social care planning. Recommendations The literature suggests the need for the implementation of a strategic approach to workforce planning, utilising a needs-based approach, including horizon scanning and scenarios. This could involve adoption of a recognised workforce planning model that incorporates the strategic elements required for workforce planning and a ‘one workforce’ approach across health and social care.
    • Screening prior to gadolinium based contrast agent administration: A UK survey of guideline implementation and adherence

      Snaith, Beverly; Harris, Martine A.; Clarke, R. (2016-12)
      Contrast agents are used to enhance imaging examinations, however in magnetic resonance imaging (MRI) there is an association with nephrogenic systemic fibrosis (NSF). The risk is small, but elevated in patients with impaired renal function and screening of patients is advised prior to administration. This study examines adherence of UK hospitals to guidance on the use of gadolinium based contrast agents (GBCA) in MRI. This was a prospective study utilising an electronic survey. The sample comprised NHS Trusts in the UK (n = 174). An invitation was sent to all MRI lead radiographers including a link to the survey. 17.6% indicated they had no written protocol for the GBCA administration within radiology. 41.2% check blood test results for all patients undergoing a contrast MRI, whereas 45.6% only check those patients with known renal dysfunction or are high-risk. Comorbidities which categorised patients as high-risk included diabetes, cardiac or vascular disease and age, however the cut off varied from 65 to 75 years old. Six sites indicated point-of-care (POC) creatinine testing would be carried out where bloods were unavailable, a further 12 had considered POC testing and dismissed it as an adjunct to the patient pathway, the most commonly cited reason being the cost. Within the UK there is no consistent approach to renal function assessment prior to GBCA administration despite international guidance. POC testing may have a role to play, but a lack of evaluation in radiology has led to concerns that it may constrain capacity and increase costs.
    • See me, not just the dementia - Understanding people's experiences of living in a care home.

      Commission for Social Care Inspection (CSCI); Brooker, Dawn J.R.; Surr, Claire A.; Scally, Andy J. (2008)
      This report looks at the experiences of people with dementia living in care homes in England, with a particular focus on whether their care offers dignity and respect. Most similar studies have relied on the views of carers, care staff and people in the early stages of dementia. This study examines directly the experiences of people including those with advanced dementia.
    • Selecting stimuli parameters for video quality studies based on perceptual similarity distances

      Kumcu, A.; Platisa, L.; Chen, H.; Gislason-Lee, Amber J.; Davies, A.G.; Schelkens, P.; Taeymans, Y.; Philips, W. (2015-03)
      This work presents a methodology to optimize the selection of multiple parameter levels of an image acquisition, degradation, or post-processing process applied to stimuli intended to be used in a subjective image or video quality assessment (QA) study. It is known that processing parameters (e.g. compression bit-rate) or techni- cal quality measures (e.g. peak signal-to-noise ratio, PSNR) are often non-linearly related to human quality judgment, and the model of either relationship may not be known in advance. Using these approaches to select parameter levels may lead to an inaccurate estimate of the relationship between the parameter and subjective quality judgments – the system’s quality model. To overcome this, we propose a method for modeling the rela- tionship between parameter levels and perceived quality distances using a paired comparison parameter selection procedure in which subjects judge the perceived similarity in quality. Our goal is to enable the selection of evenly sampled parameter levels within the considered quality range for use in a subjective QA study. This approach is tested on two applications: (1) selection of compression levels for laparoscopic surgery video QA study, and (2) selection of dose levels for an interventional X-ray QA study. Subjective scores, obtained from the follow-up single stimulus QA experiments conducted with expert subjects who evaluated the selected bit-rates and dose levels, were roughly equidistant in the perceptual quality space - as intended. These results suggest that a similarity judgment task can help select parameter values corresponding to desired subjective quality levels.
    • Self-efficacy, habit strength, health locus of control and response to the personalised nutrition Food4Me intervention study

      Stewart-Knox, Barbara; Rankin, A.; Bunting, B.P.; Frewer, L.J.; Celis-Morales, C.; Livingstone, K.M.; Fischer, A.R.H.; Poinhos, R.; Kuznesof, S.; Gibney, M.J.; et al. (Emerald, 2021)
      Purpose – Randomised controlled trials identify causal links between variables but not why an outcome has occurred. This analysis sought to determine how psychological factors assessed at baseline influenced response to personalised nutrition. Design/methodology/approach – Web-based, randomised, controlled trial (RCT) was conducted across seven European countries. Volunteers, both male and female, aged over 18 years were randomised to either a non-personalised (control) or a personalised (treatment) dietary advice condition. Linear mixed model analysis with fixed effects was used to compare associations between internal and external health locus of control (HLoC), nutrition self-efficacy (NS-E) and self-report habit index (S-RHI) at baseline (N 5 1444), with healthy eating index (HEI) and Mediterranean diet index (MDI) scores between conditions post-intervention (N 5 763). Findings – An increase in MDI scores was observed between baseline and six months in the treatment group which was associated with higher NS-E (p