• Diagnostic radiographer advanced clinical practice in the United Kingdom - A national cross-sectional survey

      Woznitza, N.; Pittock, L.; Elliott, J.; Snaith, Beverly (2021-07-28)
      To survey the diagnostic radiography workforce in the United Kingdom (UK) at an organisational level to ascertain the scope of advanced practice and compliance with Health Education England standards for multiprofessional advanced clinical practice (ACP). 174 diagnostic imaging departments were invited to participate in a cross-sectional electronic survey focused upon advanced level practice and their educational and accreditation expectations (October-December 2019). Breast imaging, computed tomography, fluoroscopy, interventional radiology, lithotripsy, magnetic resonance imaging and projectional radiography were included. A total of 97 responses were received, of which 79 were eligible for inclusion (45%). Respondents reported advanced-level practice roles across all imaging modalities, which included clinical reporting, procedural-based and combined roles. Radiograph and mammogram reporting were most prevalent (95 and 67% of Trusts), with fluoroscopy the most frequent procedure-only role (25%). Only 39% of trusts required adherence to the four pillars of ACP within job descriptions, and only 12% requiring a full Masters qualification. Diagnostic radiographer reporting and procedure-based roles in the NHS are varied and widespread. However, inconsistencies in fulfilment against the expected standards for advanced practice exist. Realignment of advanced-level roles to delineate enhanced and advanced clinical practice may ensure consistency between roles and professions. A requirement for accreditation as an advanced (clinical) practitioner with adherence to advanced practice requirements could therefore provide value to accreditation for both individual practitioners and Trusts. Within the UK, diagnostic radiographer roles previously self-identified as advanced-level practice may be termed enhanced practice when not adhering to expected ACP standards.
    • Diet and physical activity in pregnancy: a study exploring women's beliefs and behaviours

      Chana, R.; Haith-Cooper, Melanie (2019-05-02)
      Being obese or gaining excessive weight during pregnancy can increase health risks for mother and baby. Adopting a healthy diet and increasing physical activity reduces these risks and has long-term health benefits for women. Despite this, women do not always maintain a healthy lifestyle during pregnancy. Aim To explore the factors that encouraged and prevented a diverse group of women to maintain a healthy lifestyle during pregnancy. Methods A total of 12 women participated in semi-structured qualitative interviews, underpinned by the theory of planned behaviour. Interviews were audio recorded, transcribed verbatim then subject to deductive thematic analysis. Findings Four themes emerged: women's knowledge of a healthy lifestyle, sociocultural influences, physical health and health professional support. These influenced women's intentions and actual behaviours during pregnancy. Conclusions Enhanced health professional advice may motivate women to adopt a healthy lifestyle during pregnancy. This could be through new means such as health technology.
    • Dietitian-led education program to improve phosphate control in a single-center hemodialysis population.

      Reddy, V.; Symes, F.; Sethi, N.; Scally, Andy J.; Scott, J.; Mumtaz, R.; Stoves, J. (2009)
      Objective We sought to analyze the effect of a structured, dietitian-led education program on patients' general knowledge of phosphate and phosphate binders, and its impact on serum phosphate concentrations in a single-center hemodialysis population. Design We compared subjects before and after intervention. Setting This study involved two dialysis units operated by a single center. Patients One hundred and fifteen hemodialysis patients consented to participate in this study (54% male; mean age, 61.1 years; 32% Asian). Patients acted as their own controls. One hundred and eight patients completed the study. Intervention All patients completed a questionnaire to assess their knowledge of phosphate and phosphate-binder therapy. Small group teaching sessions were then delivered to patients by a single dietitian, with the aid of a hospital interpreter as required. Patients also received information booklets or audio cassettes translated into Urdu. A second identical questionnaire was completed a month later. Main Outcome Measures Outcome measures involved pre-education and posteducation knowledge scores, monthly measurements of serum phosphate, calcium, and mean Kt/V, and parathyroid hormone concentrations every 3 months during the 5 month run-in period and subsequent 5-month study period. Results The education program significantly improved patients' general knowledge of phosphate and of phosphate-binders (P < .001), especially in patients with a low pretest score and those of South Asian origin. This result was associated with a significant reduction in serum phosphate in patients with hyperphosphatemia (P = .032). Conclusions These findings suggest that a combination of educational initiatives is effective in enhancing patients' knowledge of phosphate and phosphate-binders, and consequently in improving serum phosphate levels in patients with hyperphosphatemia.
    • Digital life storytelling and dementia: linear narratives or lines of flight?

      Capstick, Andrea; Ludwin, Katherine (2015-09-17)
      Digital storytelling using a standard software package such as Photostory 3 can work to impose a linear format on a slideshow of visual images. By contrast the forms of self-expression adopted by people who have a diagnosis of dementia can often be digressive, circuitous and rhizomatic, corresponding more closely to Deleuze and Guattari’s concept of ‘lines of flight’. Preparatory to completing digital stories with ten people with a diagnosis of dementia who were living in a long-term social care environment, we used both linear (visual narrative) and non-linear (collaging) storyboarding techniques. This presentation draws on examples of both, together with extracts from one completed digital life story, to highlight why we need to avoid linear form dictating digital storytelling practice.
    • Disabled People, Effective Practitioners: Enabling a Health Care Workforce that Better Reflects Society

      Dearnley, Christine A.; Elliott, J.; Hargreaves, J.; Morris, S.; Walker, L.; Walker, Stuart A.; Arnold, C. (2010)
    • Disproportionality in NHS Disciplinary Proceedings

      Archibong, Uduak E.; Kline, R.; Eshareturi, Cyril; McIntosh, Bryan (2019-04-01)
      This article investigates the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings. The study involved an in-depth knowledge review and analysis of literature on the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings from 2008 to 2017, as well as semi-structured interviews with 15 key stakeholders. Participants were stakeholders from both primary and secondary care and included equality and diversity leads, human resource professionals, NHS service managers, representatives of trade unions and health professional regulatory council representatives. The knowledge review indicates that to date, black, Asian and minority ethnic staff are disproportionately represented in NHS disciplinary proceedings. Evidence gathered demonstrates the continuation of inappropriate individual disciplinary action and failure to address organisational shortcomings against black, Asian and minority ethnic members of staff. Overall, six factors were identified as underpinning the disproportionate representation of black minority ethnic staff in disciplinaries: closed culture and climate; subjective attitudes and behaviour; inconclusive disciplinary data; unfair decision making; poor disciplinary support; and disciplinary policy misapplication.
    • Disrupting disproportionality proceedings: The recommendations

      Archibong, Uduak E.; Kline, R.; Eshareturi, Cyril; McIntosh, Bryan (2019-06-02)
      An in-depth knowledge review and analysis of literature on the involvement of Black and Minority Ethnic (BAME) staff in NHS disciplinary proceedings from 2008 to 2017 as did 15 semi-structured interviews with key stakeholders. The research findings indicate that BME staff are disproportionately represented in NHS disciplinary proceedings, there is a continuation of inappropriate individual disciplinary action and a failure to address organisational shortcomings. Six factors emerged: closed culture and climate; subjective attitudes and behaviour; inconclusive disciplinary data; unfair decision making; poor disciplinary support and disciplinary policy mis-application were all identified as underpinning the disproportionate representation of BME staff in disciplinary procedures. Disciplinary policy needs streamlining and greater clarity needs to be achieved regarding the difference between disciplinary, capability and performance issues and to this respect we make several recommendations.
    • Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes

      Supuk, Elvira; Alderson, Alison J.; Davey, Christopher J.; Green, Clare; Litvin, Norman; Scally, Andy J.; Elliott, David B. (2016-03)
      Purpose To determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors. Methods Self-reported dizziness and falls were determined in 287 patients (mean age of 76.5 ± 6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Six-month falls rates were determined using self-reported retrospective data. Results The number of patients with dizziness reduced significantly after cataract surgery (52% vs 38%; χ2 = 19.14, p < 0.001), but the reduction in the number of patients who fell in the 6-months post surgery was not significant (23% vs 20%; χ2 = 0.87, p = 0.35). Dizziness improved after first eye surgery (49% vs 33%, p = 0.01) and surgery on both eyes (58% vs 35%, p < 0.001), but not after second eye surgery (52% vs 45%, p = 0.68). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. Conclusions Dizziness is significantly reduced by first (or both) eye cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery.
    • Do animals bite more during a full moon? Retrospective observational analysis.

      Bhattacharjee, C.; Bradley, P.; Smith, M.; Scally, Andy J.; Wilson, B.J. (2000)
      Objective: To test the hypothesis that the incidence of animal bites increases at the time of a full moon. Design: Retrospective observational analysis. Setting: Accident and emergency department at a general hospital in an English city. Subjects: 1621 consecutive patients, irrespective of age and sex. Main outcome measures: Number of patients who attended an accident and emergency department during 1997 to 1999 after being bitten by an animal. The number of bites in each day was compared with the lunar phase in each month. Results: The incidence of animal bites rose significantly at the time of a full moon. With the period of the full moon as the reference period, the incidence rate ratio of the bites for all other periods of the lunar cycle was significantly lower (P <0.001). Conclusions: The full moon is associated with a significant increase in animal bites to humans.
    • Do physiotherapy staff record treatment time accurately? An observational study

      Bagley, Pamela J.; Hudson, M.; Green, J.R.; Forster, A.; Young, J. (2009)
      OBJECTIVE: To assess the reliability of duration of treatment time measured by physiotherapy staff in early-stage stroke patients. DESIGN: Comparison of physiotherapy staff's recording of treatment sessions and video recording. SETTING: Rehabilitation stroke unit in a general hospital. SUBJECTS: Thirty-nine stroke patients without trunk control or who were unable to stand with an erect trunk without the support of two therapists recruited to a randomized trial evaluating the Oswestry Standing Frame. Twenty-six physiotherapy staff who were involved in patient treatment. MAIN MEASURES: Contemporaneous recording by physiotherapy staff of treatment time (in minutes) compared with video recording. STATISTICAL ANALYSIS: Intraclass correlation with 95% confidence interval and the Bland and Altman method for assessing agreement by calculating the mean difference (standard deviation; 95% confidence interval), reliability coefficient and 95% limits of agreement for the differences between the measurements. RESULTS: The mean duration (standard deviation, SD) of treatment time recorded by physiotherapy staff was 32 (11) minutes compared with 25 (9) minutes as evidenced in the video recording. The mean difference (SD) was -6 (9) minutes (95% confidence interval (CI) -9 to -3). The reliability coefficient was 18 minutes and the 95% limits of agreement were -24 to 12 minutes. Intraclass correlation coefficient for agreement between the two methods was 0.50 (95% CI 0.12 to 0.73). CONCLUSIONS: Physiotherapy staff's recording of duration of treatment time was not reliable and was systematically greater than the video recording.
    • Do psychosocial interventions have an impact on maternal perception of perinatal depression?

      Firth, Amanda; Haith-Cooper, Melanie; Egan, Dominic (2016-12)
      Poor perinatal mental health, in particular depression, affects at least 10% of new mothers in the UK. Current best practice recommends the use of talking therapies or medication, however, many women choose not to use medication or are deterred from accessing NHS services for example due to immigration status. Those who can access NHS treatment often face a long waiting list to see a clinician or therapist. Untreated perinatal depression impacts on the health and wellbeing of mothers and babies, consequently it is essential that alternative psychosocial interventions delivered by non-clinicians are considered. A systematic review was conducted on seven quantitative studies examining the effect of psychosocial interventions in reducing maternal symptoms of depression. Interventions focused either on physical activity or peer support, measuring depression scores on a validated screening tool. The review concludes that antenatal group peer support may benefit women in the antenatal period and that postnatal peer telephone support may be helpful for primiparous women but further large scale research is required.
    • Do we need the health visitor in the clinic?

      Plews, Caroline M.C.; Bryar, R. (2002)
      Objectives: A review of the literature reveals little description of the advisory role of the health visitor in the child health clinic. This paper describes a study which examined content, clients' recall and value to the client of their discussion with the health visitor. Design: Descriptive study; non-participant observation; semi-structured interviews. Setting: One predominantly urban community Trust involving seven volunteer health visitors from seven different child health clinics. A total of 24 clinics were observed. Participants: One hundred clients attending seven child health clinics. Findings: Most mothers reported that speaking with the health visitor had been fairly or very important. Clients' discussion with the health visitors covered a wide range of child-centred issues and concerns. Mothers recalled 79% of all topics discussed during the clinic visit and initiated nearly 59%. Although weighing was considered an important reason for attending clinic by most mothers it did not preclude wanting to speak with the health visitor. However, some mothers did not wish to speak to the health visitor. Conclusion: The health visitor provided an advisory and support service for many of the attending mothers. Most clients reported valuing this intervention. This study support the notion that mothers do not attend the clinic simply for medical services or screening. Attention should be focused on research and development of services which reflect this consumer agenda. Consideration should be given to the appropriateness of health visitors weighing children.
    • Doctoral profile of the medical radiation sciences: a baseline for Australia and New Zealand

      Ekpo, E.U.; Snaith, Beverly; Harris, Martine A.; McEntee, M.F. (2017-09)
      Research is critical to evidence‐based practice, and the rapid developments in technology provide opportunities to innovate and improve practice. Little is known about the research profile of the medical radiation science (MRS) profession in Australia and New Zealand (NZ). This study provides a baseline of their doctoral activity. A cross‐sectional survey of MRS professionals in Australia and NZ holding a doctorate or undertaking doctoral studies, was performed using an online tool (Bristol Online Survey®, Bristol, UK). A chain‐referral sampling technique was adopted for data collection. An email invitation with a link to the survey was generated and distributed through email and social media. The survey contained questions related to participant demographics, doctoral status, qualification route, funding and employment. There were 63 responses to the survey comprising 50.8% diagnostic radiographers (DRs; n = 32), 23.8% radiation therapists (RTs; n = 15), with the remaining 25.4% (n = 16) equally split between sonographers and nuclear medicine technologists (NMTs). A total of 40 (63.5%) of respondents had completed their doctoral qualification. In NZ, only DRs held a doctoral award constituting 0.3% of DRs and 0.2% of the total registered MRS population. In Australia, there was a greater proportion of doctoral NMTs (n = 8/1098; 0.7%) than RTs (n = 15/2394; 0.6%) and DRs (n = 27/12,001; 0.2%). Similar to other countries, findings show a very small percentage of doctoral MRS professionals in Australia and NZ. Strategies to engage and support individuals in research, up to and beyond doctoral study, need to be embedded in practice.
    • Documentation in pressure ulcer prevention and management

      Vowden, Kath; Vowden, Peter (2015)
      Effective record keeping underpins service delivery and provides a record of the quality of care delivered. Pressure ulcer risk assessment, prevention strategy and pressure ulcer care provision are a key element in the nursing process and are correctly a focus area within the safety agenda. This article reviews issues related to the documentation of pressure ulcer risk assessment and prevention and asks whether the time is right to move towards a universal system of pressure ulcer care documentation, linked to reporting within the NHS.
    • Documentation of spinal red flags during physiotherapy assessment

      Cooney, F.; Graham, Claire; Jeffrey, Sarah; Hellawell, Michael (2017-12)
      The project was designed as a retrospective service evaluation using audit to assess the identification and documentation of red flags in initial assessment of patients with low back pain. Firstly, the documentation of 11 predetermined red flags was assessed. Secondly, the documentation of relevant additional information was assessed and finally, compliance with local policy to highlight positive red flag findings in the designated area on the paperwork was examined. The documentation for the majority of red flags was high, however, clear gaps were identified. Additionally, there was no evidence of further clinical consideration of positive red flags during the diagnostic process. Possible factors influencing red flag documentation are discussed and suggestions are provided to improve recording and response to clinical indicators of malignancy.
    • Does a more dynamic method of partial weight bearing instruction translate to improved protocols?

      Graham, Claire; Jeffrey, Sarah; Hellawell, Michael (2018-11-02)
      Background: Partial weight bearing protocols are commonly incorporated into rehabilitation to enhance recovery. Patients are often prescribed protocols that refer to a percentage of their body weight, such as 20% weight bearing, that should be placed through the healing limb during activities such as walking (gait). In order to achieve these partial weight baring protocols patients are usually provided with walking aids such as crutches. Accurate reproducibility of and compliance with these protocols could be considered essential to the rehabilitation process, however poor reproducibility of partial weight bearing protocols during crutch assisted gait using a current method of instruction has been shown. Aims: The aim of this study was to determine whether a more dynamic method of partial weight bearing protocol instruction, was more accurately reproduced. Methods: In total, 16 participants were randomly allocated to one of two groups and were taught 20% partial weight bearing using two different methods of instruction. A participant’s ability to reproduce their target load using crutch assisted gait was assessed using a force plate. Findings: The mean error for the static method of instruction was significantly greater than the more dynamic method. Conclusion: As seen previously, the static method of instruction of partial weight bearing protocols, using bathroom scales, does not seem to translate accurately to dynamic motion; however, the more dynamic method assessed in this study appears to result in more accurate reproducibility.