• Components of impactful dementia training for general hospital staff: a collective case study

      Surr, Claire A.; Sass, C.; Burnley, N.; Drury, Michelle; Smith, S.J.; Parveen, Sahdia; Burden, S.; Oyebode, Jan R. (2020)
      Background and objectives: People with dementia occupy around one quarter of general hospital beds, with concerns consistently raised about care quality. Improving workforce knowledge, skills and attitudes is a mechanism for addressing this. However little is known about effective ways of training healthcare staff about dementia. This study aimed to understand models of dementia training most likely to lead to improved practice and better care experiences for people with dementia, and to understand barriers and facilitators to implementation. Method: A collective case study was conducted in three National Health Service Acute Hospital Trusts in England. Multiple data sources were used including interviews with training leads/facilitators, ward managers and staff who had attended training; satisfaction surveys with patients with dementia and/or carers; and observations of care using Dementia Care Mapping. Results: Interactive face-to-face training designed for general hospital staff was valued. Simulation and experiential learning methods were felt to be beneficial by some staff and stressful and distressing by others. Skilled delivery by an experienced and enthusiastic facilitator was identified as important. Staff identified learning and practice changes made following their training. However, observations revealed not all staff had the knowledge, attitudes and skills needed to deliver good care. Patient and carer satisfaction with care was mixed. A major barrier to training implementation was lack of resources. Supportive managers, organisational culture and strong leadership were key facilitators. Conclusion: Dementia training can lead to improved care practices. There are a range of key barriers and facilitators to implementation that must be considered.
    • Comprehensive assessment of patient image quality and radiation dose in latest generation cardiac x-ray equipment for percutaneous coronary interventions

      Gislason-Lee, Amber J.; Keeble, C.; Egleston, D.; Bexon, J.; Kenyelics, S.M.; Davies, A.G. (2017)
      This study aimed to determine whether a reduction in radiation dose was found for percutaneous coronary interventional (PCI) patients using a cardiac interventional x-ray system with state-of-the-art image enhancement and x-ray optimization, compared to the current generation x-ray system, and to determine the corresponding impact on clinical image quality. Patient procedure dose area product (DAP) and fluoroscopy duration of 131 PCI patient cases from each x-ray system were compared using a Wilcoxon test on median values. Significant reductions in patient dose (p ≪ 0.001) were found for the new system with no significant change in fluoroscopy duration (p ¼ 0.2); procedure DAP reduced by 64%, fluoroscopy DAP by 51%, and “cine” acquisition DAP by 76%. The image quality of 15 patient angiograms from each x-ray system (30 total) was scored by 75 clinical professionals on a continuous scale for the ability to determine the presence and severity of stenotic lesions; image quality scores were analyzed using a two-sample t -test. Image quality was reduced by 9% (p ≪ 0.01) for the new x-ray system. This demonstrates a substantial reduction in patient dose, from acquisition more than fluoroscopy imaging, with slightly reduced image quality, for the new x-ray system compared to the current generation system.
    • A Comprehensive Model of Factors Associated with Capability to "live Well" for Family Caregivers of People Living with Mild-to-Moderate Dementia: Findings from the IDEAL Study

      Clare, L.; Wu, Y.-T.; Quinn, Catherine; Jones, I.R.; Victor, C.R.; Nelis, S.M.; Martyr, A.; Litherland, R.; Pickett, J.A.; Hindle, J.V.; et al. (2019)
      Understanding key influences on outcomes for caregivers of people with dementia is hampered by inconsistent conceptualization and measurement of outcomes and limited evidence about the relative impact of different variables. We aimed to address these issues. We analyzed data from 1283 caregivers of community-dwelling individuals with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life cohort study. We generated a “living well” latent factor from measures of quality of life, satisfaction with life, and well-being. We used structural equation modelling to derive latent variables for 7 domains reflecting caregivers’ perceptions of their personal resources and experiences, and to examine the associations with caregivers’ perceptions of their capability to “live well.” The domain of psychological characteristics and psychological health was most strongly related to living well [2.53; 95% confidence interval (CI), 2.08-2.97], followed by physical fitness and physical health (1.48; 95% CI, 1.04-1.91) and experiencing caregiving (1.34; 95% CI, 0.99-1.70). Social capitals, assets and resources (0.68; 95% CI, 0.35-1.00) and relationship with the person with dementia (−0.22; 95% CI, −0.41 to −0.03) had smaller, significant associations. Social location (0.28; 95% CI, −0.33 to 0.89) and managing everyday life with dementia (0.06; 95% CI, −0.15 to 0.28) were not significantly associated with living well. These findings demonstrate the importance of supporting caregivers’ psychological and physical health and their ability to develop and maintain positive coping strategies, as well as enabling them to maintain vital social capitals, assets and resources.
    • A comprehensive model of factors associated with subjective perceptions of "living well" with dementia: findings from the IDEAL study

      Clare, L.; Wu, Y-T.; Jones, I.R.; Victor, C.R.; Nelis, S.M.; Martyr, A.; Quinn, Catherine; Litherland, R.; Pickett, J.A.; Hindle, J.V.; et al. (2019-01)
      Introduction: We aimed to better understand what predicts the capability to “live well” with dementia by identifying the relative contribution of life domains associated with the subjective experience of living well. Methods: We analyzed data from 1547 individuals with mild-to-moderate dementia in the IDEAL cohort. We generated a “living well” latent factor from measures of quality of life, satisfaction with life, and well-being. We used multivariate modeling to identify variables related to living well measures and structural equation modeling to derive latent variables for 5 life domains and to examine the associations of these domains with living well. Results: All 5 domains were individually associated with living well. When modeled together, the psychological characteristics and psychological health domain was the only independent predictor of living well [effect size, 3.55; 95% confidence interval (CI): 2.93-4.17], and effect sizes were smaller for physical fitness and physical health (1.23, 95% CI: −0.10 to 2.58), social capitals, assets and resources (0.67; 95% CI: −0.04 to 1.38), managing everyday life with dementia (0.33; 95% CI: −0.06 to 0.71), and social location (0.08; 95% CI: −2.10 to 2.26). Discussion: Psychological resources, and the social, environmental, and physical factors that underpin positive psychological states, are potentially important targets for interventions and initiatives that aim to improve the experience of living with dementia.
    • Compression therapy for venous ulcers.

      Vowden, Kath; Vowden, Peter (2008)
    • Computer based simulation in CT and MRI radiography education: Current role and future opportunities

      Chaka, Brian; Hardy, Maryann L. (2021-05)
      Objective: The use of Computer-based simulation (CBS), a form of simulation which utilises digital and web based platforms, is widely acknowledged in healthcare education. This literature review explores the current evidence relating to CBS activities in supporting radiographer education in CT and MRI. Key findings: Journal articles published between 2010 and 2020 were reviewed (n ¼ 663). The content was evaluated and summarised with the following headings; current utility, overview of CBS types, knowledge acquisition and evaluation, and student perspective. CBS utility in CT and MRI radiography education is limited. Its current use is for pre-registration education, and the interfaces used vary in design but are predominantly used as a preclinical learning tool to support the training of geometric scan planning, image acquisition and reconstruction, and associated technical skills. CBS was positively acknowledged by student radiographers; based on its inherent flexibility, self-paced learning and the ability to practice in a safe environment. Nonetheless, the educational validation of CBS in CT and MRI education pertaining to knowledge and skill acquisition has not been fully assessed through rigorous academic assessments and metrics. Conclusion: The current use of CBS in CT and MRI education is limited. The development of software programmes with functionality and capability that correlates with current clinical practice is imperative; and to enable more research in CBS utility to be undertaken to establish the efficacy of this pedagogical approach. Implications for practice: Due to limited placement opportunities, the use of simulation is increasing and evolving; in line with the approach to design and deliver high quality Simulation Based Education (SBE) in Diagnostic Radiography education. The continued development, utility and evaluation of CBS interfaces to support student radiographers at pre and post registration level is therefore essential.
    • Computer-aided National Early Warning Score to predict the risk of sepsis following emergency medical admission to hospital: a model development and external validation study

      Faisal, Muhammad; Richardson, D.; Scally, Andy J.; Howes, R.; Beatson, K.; Speed, K.; Mohammad, Mohammad A. (2019-04-08)
      Background: In English hospitals, the patient’s vital signs are monitored and summarised into a National Early Warning Score (NEWS). NEWS is more accurate than the quick sepsis related organ failure assessment (qSOFA) score at identifying patients with sepsis. We investigate the extent to which the accuracy of the NEWS is enhanced by developing computer-aided NEWS (cNEWS) models. We compared three cNEWS models (M0=NEWS alone; M1=M0 + age + sex; M2=M1 + subcomponents of NEWS + diastolic blood pressure) to predict the risk of sepsis. Methods: All adult emergency medical admissions discharged over 24-months from two acute hospitals (YH–York Hospital for model development; NH–Northern Lincolnshire and Goole Hospital for external model validation). We used a validated Canadian method for defining sepsis from administrative hospital data. Findings: The prevalence of sepsis was lower in YH (4.5%=1596/35807) than NH (8.5%=2983/35161). The c-statistic increased across models (YH: M0: 0.705, M1:0.763, M2:0.777; NH:M0: 0.708, M1:0.777, M2:0.791). At NEWS 5+, sensitivity increased (YH: 47.24% vs 50.56% vs 52.69%; NH: 37.91% vs 43.35% vs 48.07%)., the positive likelihood ratio increased (YH: 2.77 vs 2.99 vs 3.06; NH: 3.18 vs 3.32 vs 3.45) and the positive predictive value increased (YH: 11.44% vs 12.24% vs 12.49%; NH: 22.75% vs 23.55% vs 24.21%). Interpretation: From the three cNEWS models, Model M2 is the most accurate. Since it places no additional data collection burden on clinicians and can be automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
    • A concept analysis of the term migrant women in the context of pregnancy

      Balaam, M-C.; Haith-Cooper, Melanie; Parízková, A.; Weckend, M.J.; Fleming, V.; Roosalu, T.; Vržina, S.S. (2017)
      Aim - This paper explores the concept of migrant women as used in European healthcare literature in context of pregnancy to provide a clearer understanding of the concept for use in research and service delivery. Methods- Walker and Avant's method of concept analysis. Results - The literature demonstrates ambiguity around the concept; most papers do not provide an explicit or detailed definition of the concept. They include the basic idea that women have moved from an identifiable region/country to the country in which the research is undertaken but fail to acknowledge adequately the heterogeneity of migrant women. The paper provides a definition of the concept as a descriptive theory and argues that research must include a clear definition of the migrant specific demographics of the women. This should include country/region of origin and host, status within the legal system of host country, type of migration experience, and length of residence. Conclusion - There is a need for a more systematic conceptualization of the idea of migrant women within European literature related to pregnancy experiences and outcomes to reflect the heterogeneity of this concept. To this end, the schema suggested in this paper should be adopted in future research.
    • The concept of spiritual care in mental health nursing

      Greasley, Peter; Chiu, L.F.; Gartland, M. (2001)
      In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing. Background. The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care. Methods. A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing. Results. According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person¿s sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the `mechanics of nursing¿. Conclusions. The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care.
    • Concordance with clinical practice guidelines for dementia in general practice

      Wilcock, J.; Iliffe, S.; Turner, S.; Bryans, M.; O'Carroll, R.; Keady, J.; Levin, E.; Downs, Murna G. (2009)
      BACKGROUND: Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care. AIM: To determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia. Design: Unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK. METHODS: Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated. RESULTS: We reviewed 450 records of patients aged 75 and over with a diagnosis of dementia and found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing. DISCUSSION: The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records.
    • Confidence Intervals and Sample Size Calculations for Studies of Film-reading Performance

      Scally, Andy J.; Brealey, S. (2003)
      The relaxation of restrictions on the type of professions that can report films has resulted in radiographers and other healthcare professionals becoming increasingly involved in image interpretation in areas such as mammography, ultrasound and plain-film radiography. Little attention, however, has been given to sample size determinations concerning film-reading performance characteristics such as sensitivity, specificity and accuracy. Illustrated with hypothetical examples, this paper begins by considering standard errors and confidence intervals for performance characteristics and then discusses methods for determining sample size for studies of film-reading performance. Used appropriately, these approaches should result in studies that produce estimates of film-reading performance with adequate precision and enable investigators to optimize the sample size in their studies for the question they seek to answer.
    • The Conforming, The Innovating and The Connecting Teacher: A qualitative study of why teachers in lower secondary school adopt physically active learning

      Øystein, L.; Tjomsland, H.E.; Leirhaug, P.E.; McKenna, J.; Quaramby, T.; Bartholomew, J.; Jenssen, E.S.; Daly-Smith, Andrew; Resaland, G.K. (2021-09)
      This paper explores why teachers adopt physically active learning (PAL). Data were collected through ‘go-alongs’ supplemented by individual interviews with 13 teachers in seven Norwegian lower secondary schools. Data were then analysed thematically. Results indicated that as well as to enhance their teaching and pupils' learning, teachers adopt PAL to adhere to school policy (The Conforming Teacher), to be an innovative educator (The Innovating Teacher), and, because it matches past positive personal experiences (The Connecting Teacher). The findings can be used to shape PAL teacher training programs to increase the likelihood of adoption.
    • Confronting mortality: faith and meaning across cultures

      Paulson, S.; Kellehear, Allan; Kripal, J.J.; Leary, L. (2014)
      Despite advances in technology and medicine, death itself remains an immutable certainty. Indeed, the acceptance and understanding of our mortality are among the enduring metaphysical challenges that have confronted human beings from the beginning of time. How have we sought to cope with the inevitability of our mortality? How do various cultural and social representations of mortality shape and influence the way in which we understand and approach death? To what extent do personal beliefs and convictions about the meaning of life or the notion of an afterlife affect how we perceive and experience the process of death and dying? Steve Paulson, executive producer and host of To the Best of Our Knowledge, moderated a discussion on death, dying, and what lies beyond that included psychologist Lani Leary, professor of philosophy and religion Jeffrey J. Kripal, and sociologist Allan Kellehear. The following is an edited transcript of the discussion that occurred February 5, 7:00-8:30 pm, at the New York Academy of Sciences in New York City.
    • Consanguinity, genetics and definitions of kinship in the UK Pakistani Population

      Bittles, A.H.; Small, Neil A. (2016-11)
      Consanguineous marriage is a controversial topic in many Western societies, with attention mainly focused on the health of immigrant communities from Asia and Africa. In the UK consanguinity is especially prevalent in the Pakistani community which now numbers over 1.1 million. Less attention has been paid to the influence of hereditary population stratification within Pakistani communities. In particular, biraderi (literally brotherhood) membership which denotes male lineages that largely govern marriage partner choice and hence the transmission of disease genes. The various roles played by biraderi and their relationship to other socio-occupational and kinship terms, such as caste, quom and zat, are often overlooked in health-based studies. The interchangeable use of these different kinship terms without rigorous definition can create identity uncertainty and hinders inter-study comparisons. Where feasible, standardization of terminology would be both desirable and beneficial, with biraderi the preferred default term to identify specific social and genetic relationships within the Pakistani diaspora.
    • Consensus guidance for the use of debridement techniques in the UK.

      Gray, D.; Acton, C.; Chadwick, P.; Fumarola, S.; Leaper, D.J.; Morris, C.; Stang, D.; Vowden, Kath; Vowden, Peter; Young, T. (2011)
    • Consensus Views on Advance Care Planning for Dementia: A Delphi Study

      Sinclair, J.B.; Oyebode, Jan R.; Owens, R.G. (2016-03)
      The uptake of advance care planning (ACP) is particularly low among people with dementia. This may reflect barriers to communication between professionals, patients and families in the face of lack of consensus about the process. This study aimed to methodically investigate consensus views of how ACP should be explained and carried out with people with dementia. A three-round Delphi study explored views of how and when ACP should be addressed, what should be covered, who should be involved and why rates of ACP are low. Seventeen participants took part comprising family members, old age psychiatrists and policy makers. Thirty-two items reached consensus. The panel agreed on 11 different areas for discussion. They concurred that ACP was best addressed after the person has come to terms with the diagnosis when the individual feels ready to do so. There was a consensus view that the process should be couched in terms of ‘certain possibilities’. Consensus items emphasised personal choice and autonomy, while also prioritising the need to discuss financial aspects and to include spouses. There was no consensus that professionals should be involved, although the panel viewed them as carrying some responsibility for low uptake. It is suggested that ACP should include general discussion of values as well as coverage of specific points. Professionals need to offer discussion and information on ACP, but also make clear that the patient has the right to choose whether to pursue ACP or not.
    • "The Constant State of Becoming”: Power, Identity, and Discomfort on the Anti-Oppressive Learning Journey

      Hart, Andrew; Montague, Jane (2015-02-24)
      The development of a clear personal and professional identity – ‘knowing oneself’ – is frequently cited as a key factor in supporting anti-oppressive practice. In the field of health and social care, work placements are a major vehicle for equipping students to become anti-oppressive practitioners committed to making effective diversity interventions in a range of organizational settings. This article highlights some of the tensions inherent in the formation of such an identity and pays particular attention to issues such as discomfort, power inequalities, the discursive production of the self and ways in which educational and workplace organizational settings can simultaneously promote and inhibit such identity development. The article concludes that the discomfort experienced by students as part of this learning process is not only inevitable but necessary to becoming an anti-oppressive practitioner, and that the narrative process offers ways of empowering both students and service users to challenge oppression.
    • Context matters: Problematizing the policy‐practice interface in the enactment of gender equality action plans in universities

      Ní Laoire, C.; Linehan, C.; Archibong, Uduak E.; Picardi, I.; Udén, M. (John Wiley & Sons Ltd, 2021-03)
      This study argues for recognition of the constitutive role of context in shaping the dynamics of the policy‐practice interface in the field of gender equality in universities. Using a comparative and reflective case‐study approach, we draw on our experiences, as action‐researchers, of developing and implementing Gender Equality Action Plans (GEAPs) in four universities in four different European countries and we explore the role of national and local context in the mediation and translation of the GEAP model. Drawing on the concepts of gendered organizations, dialogic organizational change, and policy mobilities, we argue for the need to be critical of approaches to gender equality in higher education (HE) that presume policy measures and good practice models transfer unproblematically to different HE organizations in different international contexts; instead, we draw attention to the contingent ways in which uneven gender relations articulate and manifest in different contexts, shaping possibilities for, and obstacles to, gender equality intervention. Thus, we argue that context plays a crucial constitutive role in the interpretation, enactment, and impact of gender equality policy in HE.
    • Context sensitive cardiac x-ray imaging: a machine vision approach to x-ray dose control

      Kengyelics, S.M.; Gislason-Lee, Amber J.; Keeble, C.; Magee, D.R.; Davies, A.G. (2015-09)
      Modern cardiac x-ray imaging systems regulate their radiation output based on the thickness of the patient to maintain an acceptable signal at the input of the x-ray detector. This approach does not account for the context of the examination or the content of the image displayed. We have developed a machine vision algorithm that detects iodine-filled blood vessels and fits an idealized vessel model with the key parameters of contrast, diameter, and linear attenuation coefficient. The spatio-temporal distribution of the linear attenuation coefficient samples, when appropriately arranged, can be described by a simple linear relationship, despite the complexity of scene information. The algorithm was tested on static anthropomorphic chest phantom images under different radiographic factors and 60 dynamic clinical image sequences. It was found to be robust and sensitive to changes in vessel contrast resulting from variations in system parameters. The machine vision algorithm has the potential of extracting real-time context sensitive information that may be used for augmenting existing dose control strategies.