• Severe neonatal hypernatraemia: a population based study

      Oddie, S.J.; Craven, V.; Deakin, K.; Westman, J.; Scally, Andy J. (2013)
      AIMS: To describe incidence, presentation, treatment and short term outcomes of severe neonatal hypernatraemia (SNH, sodium >/=160 mmol/l). METHODS: Prospective, population based surveillance study over 13 months using the British Paediatric Surveillance Unit. Cases were >33 weeks gestation at birth, fed breast or formula milk and <28 days of age at presentation. RESULTS: Of 62 cases of SNH reported (7, 95% CI 5.4 to 9.0 per 1 00 000 live births), 61 mothers had intended to achieve exclusive breast feeding. Infants presented at median day 6 (range 2-17) with median weight loss of 19.5% (range 8.9-30.9). 12 had jaundice and 57 weight loss as a presenting feature. 58 presented with weight loss >/=15%. 25 babies had not stooled in the 24 h prior to admission. Serum sodium fell by median 12.9 mmol/l per 24 h (range 0-30). No baby died, had seizures or coma or was treated with dialysis or a central line. At discharge, babies had regained 11% of initial birth weight after a median admission of 5 (range 2-14) days. 10 were exclusively breast fed on discharge from hospital. CONCLUSIONS: Neonatal hypernatraemia at this level, in this population, is strongly associated with weight loss. It occurs almost exclusively after attempts to initiate breast feeding, occurs uncommonly and does not appear to be associated with serious short term morbidities, beyond admission to hospital.
    • Sex and age differences in attitudes and intention to adopt personalised nutrition in a UK sample

      Stewart-Knox, Barbara; Poinhos, R.; Fischer, A.R.H.; Chaudhrey, M.; Rankin, A. (2022)
      There has been an increase in development of technologies that can deliver personalised dietary advice. Devising healthy, sustainable dietary plans will mean taking consideration of extrinsic factors such as individual social circumstances. The aim of this study was to identify societal groups more or less receptive to and likely to engage with digitally delivered personalised nutrition initiatives. Sample and Methods: Volunteers were recruited via a social research agency from within the UK. The resultant sample (N=1061) was 49% female, aged 18-65 years. Results: MANOVA (Tukey HSD applied) indicated that females and younger people (aged 18-29 years) had more favourable attitudes and were more likely to intend to adopt personalised nutrition. There were no differences in attitude toward or intention to adopt personalised nutrition between different education levels, income brackets or occupational groups. Conclusion: These results imply that females and younger people may be most likely to adopt personalised nutrition in the future. Initiatives to promote personalised nutrition should target males and older people.
    • Sexuality, Intimacy and Older Care Home Residents.

      Simpson, P.; Horne, Maria; Wilson, C.B.; Brown, L.; Dickinson, T.; Smith, S.; Torkington, K.; Tinkler, P. (2015)
      Over half a million people aged 65+ live in care homes (ONS 2011). Yet, sex, sexuality and intimacy and old people remain overlooked in social policy and professional practice (Hafford-Letchfield 2008). We explore narratives from a feasibility study based in Northwest England that consulted on the significance of researching sexuality and intimacy. We draw on narratives generated with two focus groups of professional carers (n = 16) and interviews with three residents, (two male and one female) and four female spouses (n = 7). All three types of stakeholders expressed concern about privacy and environmental impediments to intimacy (e.g. shortage of double rooms). However, distinct concerns were expressed by each group. Residents’ expressed scepticism that the topic was ‘too personal’, that old people were post-sexual or that sex/intimacy were part of range of needs and could be eclipsed by those relating to grand-parenting, avoiding isolation and personalization of care. Spouses emphasized the importance of intimacy over sex/sexuality as an indicator of the depth and longevity of a relationship but were concerned about unmet needs and loss of influence over their partners’ care. Obliged to meet a complex of legal, professional, ethical and interpersonal obligations, care staff articulated a need for guidance to help them support residents and their significant others. We conclude with practical recommendations that address barriers to enabling intimacy.
    • A SHARED study the benefits and costs of setting up a health research study involving lay coresearchers and how we overcame the challenges

      Mockford, C.; Murray, M.; Seers, K.; Oyebode, Jan R.; Grant, R.; Boex, S.; Staniszewska, S.; Diment, Y.; Leach, J.; Sharma, U.; et al. (2016-03-03)
      Background: Involving patients and the public in all stages of research has been the focus of the SHARED study. Patient and public involvement (PPI) is an important strategic priority for the Department of Health and funders such as the National Institute for Health Research. The aim of this paper is to describe the benefits, challenges and costs involved in setting up the research study with lay members as part of the research team. The study focused on developing service user-led recommendations for people with memory loss and their carers, on discharge from acute hospital to the community. Methods: This began with a discussion of an initial research idea with a lay group of carers and people living with dementia. Once funded, approval was sought from the Research Ethics Committee and NHS Trusts to conduct the research including the active involvement of lay co-researchers. Finally, to recruit, train and pay lay co-researchers in their role. Results: The benefits of PPI have included developing ideas which are important to people living with memory loss; support for PPI received from the funders and research ethics committee, high levels of interest from volunteer groups, and lasting enthusiasm from many of the co-researchers. Organisational challenges were met in the requirement for research passports and with payment methods for the co-researchers. Training was beneficial but incurred extra costs for repeated training days. Discussion: Overall the benefits outweighed the challenges which were overcome to varying degrees. The lay co-researchers gained membership of a study group and a beneficial partnership developed with the third sector. The biggest challenge was in overcoming the differences in approach to lay co-researchers between NHS Trusts. Organisational culture has been slow to incorporate PPI and this has not yet been fully addressed. It has the potential to delay the start of projects, affect recruitment time, incur extra research costs and disadvantage PPI.
    • Sharing a living room: Empathy, reverie and connection

      McVey, Lynn (2019-09)
      This paper examines what the originally psychoanalytic concept of reverie can add to non-psychoanalytic practitioners’ understandings of empathy. It uses case material from a study into UK therapists’ experiences of reverie, which centres on a single moment in a session, when an image of her own living room flashed suddenly through a therapist’s mind. Reverie – a capacity to contain the other’s unprocessed emotional experiencing - can offer a magnifying lens through which to view some forms of empathy, revealing the relational, embodied and imaginative materials from which they are constructed. The paper links shared experiencing like that found in reverie with simulative accounts of empathy, but does not claim this enables us to experience exactly what the other feels; rather, when approached sensitively, tentatively and with clients’ needs foremost, it can foster deep connection, enabling us, as it were, to enter others’ inner worlds – perhaps even their living rooms - and make ourselves at home there. Finally, practical ways to work empathically with reverie are suggested, which may interest therapists from a range of modalities, including humanistic approaches.
    • 'She's usually quicker than the calculator': financial management and decision-making in couples living with dementia

      Boyle, Geraldine (2013)
      This article explores how married couples managed their finances and made financial decisions when one spouse had dementia, drawing comparisons with the approaches used prior to the illness. More specifically, the article examines the role of social factors in influencing the involvement of people with dementia in financial management and decision-making, particularly whether a gender dynamic adopted earlier in a marriage similarly influenced a gendered approach following dementia. The research formed part of a larger study of everyday decision-making by couples living with dementia which explored the role of non-cognitive factors in influencing whether people with dementia were involved in decision-making processes. Twenty-one married couples living at home took part; the recently-diagnosed were excluded. Qualitative methods -including participant observation and interviews - were used to examine the couples' fiscal management and decision-making-processes, the perceptions of people with dementia and their spouses about their current financial abilities and whether any support provided by spouse-carers influenced their partners' financial capacity. The fieldwork was undertaken in the North of England between June 2010 and May 2011. Thematic analysis of the data showed that social factors influenced the perceived capacity of people with dementia and the financial practices adopted by the couples. In particular, gender influenced whether people with dementia were involved in financial decisions. The research demonstrated that non-cognitive factors need to be taken into account when assessing and facilitating the capacity of people with dementia. In addition, as people with dementia were somewhat marginalised in decisions about designating financial authority (Lasting Power of Attorney), spouse-carers may need guidance on how to undertake advance care planning and how to support their relatives with dementia in major decision-making, particularly when there are communication difficulties.
    • Shifting sands: The erosion of higher education provision

      Breen, Liz; McIntosh, Bryan (2016-07)
      This commentary considers changes to education in UK mental health nursing.
    • Should all women with pregnancy-related pelvic girdle pain be treated with exercise?

      Bromley, R.; Bagley, Pamela J. (2014-08)
      This paper presents the main findings of a systematic literature review that was undertaken to investigate whether physiotherapist-guided exercise is effective in reducing the severity of pregnancy-related pelvic girdle pain (PPGP). Seven electronic databases were systematically searched. Studies that met the inclusion criteria were assessed for methodological quality and internal validity. Five primary randomized controlled trials (RCTs) and one post-partum follow-up study were included in the review. The authors of all six studies incorporated advice and physiotherapist-guided exercise, either in a group setting or as part of an individualized exercise programme, into at least one of their intervention groups, with or without the addition of a pelvic support belt, acupuncture or other physiotherapy treatment modality. Two of the primary RCTs found that exercise and advice effectively reduced pre-partum PPGP. One study concluded that exercise had no additional value beyond simply supplying a pelvic support belt and advice. The results of another trial supported the use of physiotherapist-guided stabilization exercises for the treatment of post-partum PPGP. Yet another study did not find any differences between the intervention groups involved. The works included in this review all reported that PPGP reduced over time, regardless of the intervention used to treat it, suggesting that the greatest factor influencing the resolution of PPGP is time rather than exercise. The findings do not support the routine use of physiotherapist-guided exercise in the treatment of all women with PPGP. Advice, information and a non-elastic pelvic support belt should be offered to women with pre-partum PPGP, whereas patients with persistent symptoms of post-partum PPGP should receive individualized physiotherapist-guided exercise aimed at stabilizing the pelvic area as part of a wider package of physiotherapy treatment.
    • Should I stay or should I go now? Exploring Polish women's returns “home”

      Duda-Mikulin, Eva A. (2018-08)
      At a time when there are more people on the move than ever before, it is pivotal to explore people's motivations and experiences of return migration. Whilst motivations for migration are comparatively well explored, return migrants' experiences are less well-known and migrants' gender is rarely considered. This article addresses these gaps. It is based on qualitative research and in-depth interviews with 32 Polish women: 16 migrants and 16 return migrants. Considered through the lens of agency and structure, this research uncovers how fluid the process of migration has become; migration motivations and patterns are blurred and interlinked with one another while classic migration theories seem outdated. The study uses an “intersection of motivations” to show how inseparable migration-related motivations have become. This article contributes to the growing literature on East–West return migration and highlights women as migrants and the gendered nature of their mobility.
    • Should sports consider neuroimaging in the assessment of concussion?

      Beck, Jamie J.W. (2015-01-01)
      This article discusses the current evidence for the short- and long-term effects of concussion in sport and how occurrences of concussion should be managed. The article also considers the potential role of medical imaging in terms of assessing both acute and chronic head injuries. Greater awareness of when medical imaging could be used will aid the practitioner's understanding of its potential contribution while still maintaining the fundamental importance of clinical judgement.
    • Should we Standardise how Heart Rate is Measured?

      Mohee, K.; Khan, M.M.; Akeroyd, L.; Scally, Andy J.; Morley, C. (2014)
      Introduction There is increasing evidence that lowering HR in cardiovascular disease may be beneficial. Recent trials have documented heart rate (HR) using supine ECG and the NICE guideline for heart failure[1,2] suggests lowering HR below 75 bpm but without specifying how HR should be measured. There is no published data on how HR measured by supine ECG compares to “real world” measurement in the clinic or surgery and any discrepancy might lead to overzealous introduction of HR lowering treatment. Method HR was measured in 136 consecutive patients attending a new cardiology OP clinic. Three methods of measuring HR were compared in the following sequence: Supine HR measured by ECG “real world” measurement by the nurse using Dynamat (auto) Manually over 30 sec during examination (Dr). Patients with dysrhythmia were excluded. Findings HR measured using these 3 methods has been presented separately and has shown a significant difference with ECG HR slower on average by >6bpm vs. either auto or Dr Measurement. The table shows the number and % of patients where HR was either ≥ 70bpm (Shift evidence) or ≥ 75 bpm (Nice guidelines) measured by one or two methods but not all three. Conclusion Real world HR measurement is consistently higher than supine ECG HR and may therefore lead to over inclusive treatment according to guideline recommendations. The method used to measure HR should be defined both in clinical trials and in published guidelines. Supine ECG is suggested as the preferred method for documenting HR prior to initiating rate lowering therapy.
    • Sigmund Freud

      Small, Neil A. (2014)
    • Silence of a scream: application of the Silences Framework to provision of nurse-led interventions for ex-offenders

      Eshareturi, Cyril; Serrant-Green, L.; Galbraith, V.E.; Glynn, M. (2015-05-01)
      The Silences Framework and its underpinning concept of ‘Screaming Silences’ was originally presented with the invitation for further peer review and utilisation in other contexts in order to test its usefulness and enable critique by a wider audience. This paper reports the use of the framework in a study researching nurse-led interventions for released ex-offenders. Screaming Silences were situated in how an issue, as experienced by ex-offenders, screams out to them in relation to their health and its impact on their reality while remaining silent in the consciousness of society and the application of practice. In addressing these Screaming Silences, we associated the Silences Framework within marginal discourses as they are less prioritised by policy and frequently positioned as far removed from what society considers as normal. Screaming Silences were situated in the subjective experiences of ex-offenders known as the ‘listener’ and the social and personal context in which these experiences occurred. We affirmed that the framework is ideally suited for researching issues which are under-researched, silent from policy discourse and excluded from practice, as it is oriented towards exploring individual experiences by valuing individual interpretations of events.
    • The Silences Framework: a tool for exploring marginalised perspectives

      Eshareturi, Cyril (2017-03-31)
      The Silences Framework as a tool for exploring marginalised perspectives The Silences Framework was devised for use as a vehicle for exposing additional viewpoints in studies revolving around sensitive subjects and marginalised perspectives. Cyril’s presentation conveys the use of The Silences Framework in the provision of a nurse-led intervention for custodial community based ex-offenders. ‘Screaming Silences’ as exposed were located in the subjective experiences of ex-offenders known as the ‘listener’ and the social and personal context in which their experiences occurred. Crucially, The Silences Framework as used sought to acknowledge and redress the balance of power relating to ‘what and whose’ experience count in a research study. Epistemologically, the generation of knowledge using the framework necessitated an anti-essentialist perspective which was interpretive in nature. Thus, the intent was to arrive at what constitutes as truth from the lived experiences of the individuals researched. It is hoped that this presentation will facilitate understanding by unravelling the process of using The Silences Framework to underpin applied research and concurrently contribute to the wider use of the framework in research with other marginalised groups.
    • A simple framework for analysing the impact of economic growth on non-communicable diseases

      Cohen, I.K.; Ferretti, F.; McIntosh, Bryan (2015-05-13)
      Non-communicable diseases (NCDs) are currently the leading cause of death worldwide. In this paper, we examine the channels through which economic growth affects NCDs’ epidemiology. Following a production function approach, we develop a basic technique to break up the impact of economic growth on NCDs into three fundamental components: (1) a resource effect; (2) a behaviour effect; and (3) a knowledge effect. We demonstrate that each of these effects can be measured as the product of two elasticities, the output and income elasticity of the three leading factors influencing the frequency of NCDs in any population: health care, healthrelated behaviours and lifestyle, and medical knowledge.
    • A single-centre experience of implementing a rapid CXR reporting and CT access pathway for suspected lung cancer: Initial outcomes

      Hunter, R.; Wilkinson, Elaine; Snaith, Beverly (2022-05)
      Lung cancer remains a major cause of preventable death and early diagnosis is critical to improving survival chances. The chest X-ray (CXR) remains the most common initial investigation, but clinical pathways need to support timely diagnosis through, where necessary, escalation of abnormal findings to ensure priority reporting and early CT scan. This single-centre study included a retrospective evaluation of a rapid lung cancer CXR pathway in its first year of operation (May 2018-April 2019). The pathway was initially designed for primary care referrals but could also be used for any CXR demonstrating abnormal findings. A parallel cross-sectional survey of radiographers explored their understanding, adherence and concerns regarding their role in the pathway operation. Primary care referrals on the rapid diagnostic pathway were low (n = 51/21,980; 0.2%), with 11 (21.6%) requiring a CT scan. A further 333 primary care CXR were escalated by the examining radiographer, with 100 (30.0%) undergoing a CT scan. Overall, 64 of the CT scans (57.7%) were abnormal or demonstrated suspicious findings warranting further investigation. There were 39 confirmed primary lung carcinomas, most with advanced disease. Survey responses showed that most radiographers were familiar with the pathway but some expressed concerns regarding their responsibilities and limited knowledge of CXR pathologies. This baseline evaluation of the rapid lung cancer pathway demonstrated poor referral rates from primary care and identified the need for improved engagement. Radiographer escalation of abnormal findings is an effective adjunct but underlines the need for appropriate awareness, training, and ongoing support. Engagement of the multiprofessional team is critical in new pathway implementation. Rapid diagnostic pathways can enable early diagnosis and the radiographer has a key role to play in their success.
    • Six mechanisms behind carer wellbeing effects: A qualitative study of healthcare delivery

      Al-Janabi, H.; McLoughlin, C.; Oyebode, Jan R.; Efstathiou, N.; Calvert, M. (2019-08)
      Health and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic ‘IMPACT’. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients.
    • Skill maximisation: the future of healthcare

      McIntosh, Bryan; Sheppy, B. (2013)
      The NHS must increase productivity by 6% per annum if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. Given that staff costs are 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforces will need to be changed to meet these targets. Healthcare management will be greatly affected by these changes. We argue that skill maximisation (e.g. increasing the responsibilities of healthcare practitioners) is the key to increasing productivity and care quality. We argue that to increase output (represented by volumes of cases treated) and quality of care is not just necessary, but essential. We therefore argue that the key to addressing the future of healthcare is the maximisation of the use of human resource.