• Does coping mediate the relationship between familism and caregiver outcomes?

      Parveen, Sahdia; Morrison, V.; Robinson, C.A. (2014-03)
      Objectives: The sociocultural model of stress and coping, which despite receiving support from several studies conducted with diverse ethnic groups, has yet to be tested longitudinally or used within the context of positive caregiver outcomes. The aim of the current study was to test a specific component of the model, which posits that caregiver coping will be influenced by the cultural value of familism (feelings of solidarity and loyalty among family members), which will in turn affect caregiver outcomes. Method: A questionnaire was completed by 123 family caregivers in the UK assessing familism, use of coping strategies, caregiver gains, anxiety and depression at three time points over nine months. Results: Mediation analysis followed guidelines proposed by Baron and Kenny. Religious coping and positive reframing at time 2 (T2) were found to significantly mediate between familism values at time 1 (T1) and caregiver gains at time 3 (T3). Behavioural disengagement at T2 was found to mediate between familism at T1 and caregiver depression atT3. Additionally familism was found to be positively associated with both negative and positive aspects of caregiving. Conclusion: Our longitudinal findings suggest that interventions and services acknowledging caregiver values and the associated coping responses may prove beneficial.
    • Does head extension and flexion increase postural instability in elderly subjects when visual information is kept constant?

      Buckley, John G.; Anand, Vijay; Scally, Andy J.; Elliott, David B. (2005)
      The present study determined the effects of flexing and extending the head on the postural stability and mean anterior-posterior (A-P) center of mass (CM) position during upright stance in the elderly. To ensure visual input to stability was not a confounding variable, visual information was kept as constant as possible for all head positions. Twelve healthy elderly subjects (72.3±4.7 years) were asked to stand stationary on a single force-platform. Postural stability (assessed using the rms A-P excursion of the center of pressure (CP)) was determined for standing with the head erect, and with the head flexed and extended. The vestibular contribution to postural stability becomes increasingly important under challenging conditions, so to highlight the effects of vestibular system input, measurements of postural stability under conditions where visual and somatosensory inputs were disrupted were included. Changes in the mean A-P CM position when tilting the head were assessed by determining changes in the mean A-P location of the CP from standing with the head erect. Compared to standing with the head erect and looking straight ahead, postural stability was reduced when the head was flexed or extended (P<0.01). Changes in mean A-P CM position were only significant when standing with the head flexed (P<0.05). This suggests that increases in postural instability with the head tilted from the erect position may be in part due to mechanical perturbation rather than solely vestibular disruption.
    • Does radiography advanced practice improve patient outcomes and health service quality? A systematic review

      Hardy, Maryann L.; Johnson, Louise; Sharples, Rachael; Boynes, Stephen; Irving, Donna (2016)
      Objectives To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Methods Using the World Health Organisation definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs and data were systematically extracted using electronic data extraction proforma. Results 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n=7) focussing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The papers were generally considered to be of low to moderate quality with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No papers reported data relating to time to diagnosis, time to recovery or patient mortality. Conclusions Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. Advances in knowledge This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality. Powered by
    • Does size matter? The benefits and challenges of voluntary sector partnerships in dementia service provision for South Asian communities in England

      Blakey, Heather; Parveen, Sahdia; Oyebode, Jan R. (2016-07-01)
      In response to the need for improved access to dementia services for minority ethnic communities, the Alzheimer’s Society piloted, in 2014, the Information Programme for South Asian Families (IPSAF), an adapted version of its existing course for carers. It delivered this in partnership with local black and minority ethnic community and faith organisations, a new approach for the Alzheimer’s Society. In most cases, the partnerships formed were strong and effective, and have given rise to ongoing plans for joint working that bring benefits to both the local organisations and the Alzheimer’s Society. However, the current realities of UK voluntary and community sector dynamics raise questions of ownership and issues around how to establish genuine partnerships. In this article, we reflect on what the IPSAF experience indicates about the potential for equitable partnerships between small and large organisations, and draw out lessons for building effective, mutually beneficial relationships.
    • Does telehealth monitoring identify exacerbations of chronic pulmonary disease and reduce hospitalisations? An analysis of systems data

      Kargiannakis, M.; Fitzsimmons, D.A.; Bentley, C.L.; Mountain, Gail (2017-03-22)
      Background: The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD. Objective: The aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission. Methods: A total of 23 participants received a telehealth-supported intervention. This paper reports on the analysis of data from a telehealth monitoring system that captured data from two sources: (1) data uploaded both manually and using Bluetooth peripheral devices by the 23 participants and (2) clinical records entered as nursing notes by the clinicians. Rules embedded in the telehealth monitoring system triggered system alerts to be reviewed by remote clinicians who determined whether clinical intervention was required. We also analyzed data on the frequency and length (bed days) of hospital admissions, frequency of hospital Accident and Emergency visits that did not lead to hospital admission, and frequency and type of community health care service contacts—other than the COPD discharge service—for all participants for the duration of the intervention and 6 months postintervention. Results: Patients generated 512 alerts, 451 of which occurred during the first 42 days that all participants used the equipment. Patients generated fewer alerts over time with typically seven alerts per day within the first 10 days and four alerts per day thereafter. They also had three times more days without alerts than with alerts. Alerts were most commonly triggered by reports of being more tired, having difficulty with self-care, and blood pressure being out of range. During the 8-week intervention, and for 6-month follow-up, eight of the 23 patients were hospitalized. Hospital readmission rates (2/23, 9%) in the first 28 days of service were lower than the 20% UK norm. Conclusions: It seems that the clinical team can identify exacerbations based on both an increase in alerts and the types of system-generated alerts as evidenced by their efforts to provided treatment interventions. There was some indication that telehealth monitoring potentially delayed hospitalizations until after patients had been discharged from the service. We suggest that telehealth-supported care can fulfill an important role in enabling patients with COPD to better manage their condition and remain out of hospital, but adequate resourcing and timely response to alerts is a critical factor in supporting patients to remain at home.
    • Does the anatomical position of the motorcyclist impact venous return?

      Lindsay, E.; Vowden, Peter; Vowden, Kath (2013)
      While most motorcyclists focus on the maintenance of their motorcycle and personal safety equipment, recent research has highlighted the impact of motorcycling on lowerlimb health. This article underlines the importance of regular health checks to recognise early warning signs of venous disease and how health promotion initiatives linked to preventative strategies may help to minimise the risk of developing venous leg ulcers in this difficult-to-reach population.
    • Does the use of additional x-ray beam filtration during cine acquisition reduce clinical image quality and effective dose in cardiac interventional imaging?

      Davies, A.G.; Gislason-Lee, Amber J.; Cowen, A.R.; Kengyelics, S.M.; Lupton, M.; Moore, J.; Sivananthan, M. (2014-12)
      The impact of spectral filtration in digital (‘cine’) acquisition was investigated using a flat panel cardiac interventional X-ray imaging system. A 0.1-mm copper (Cu) and 1.0-mm aluminium (Al) filter added to the standard acquisition mode created the filtered mode for comparison. Image sequences of 35 patients were acquired, a double-blind subjective image quality assessment was completed and dose–area product (DAP) rates were calculated. Entrance surface dose (ESD) and effective dose (E) rates were determined for 20- and 30-cm phantoms. Phantom ESD fell by 28 and 41 % and E by 1 and 0.7 %, for the 20- and 30-cm phantoms, respectively, when using the filtration. Patient DAP rates fell by 43 % with no statistically significant difference in clinical image quality. Adding 0.1-mm Cu and 1.0-mm Al filtration in acquisition substantially reduces patient ESD and DAP, with no significant change in E or clinical image quality.
    • Dog bite injuries: can the old dog be taught new tricks?

      Lightowler, Bryan; Pape, Hilary (2017-10)
      Dog bite injuries are a common cause of patient presentation to NHS emergency departments (EDs) and minor injuries units, and are generally associated with a low level of acuity, despite an inherent capacity for significant soft tissue damage to be inflicted by canine jaws capable of exerting terrific bite forces. Anatomical sites for injury correlate to victim age, with hand and wrist injuries predominating in the adult population. The most common complication is infection secondary to inoculation of oral flora, with the hands being particularly vulnerable due to their anatomy. Injuries to structures such as tendons can be discreet, and retained foreign bodies can easily be overlooked. Wound care has a propensity to attract a disproportionately high level of malpractice actions, and approaches to the management of dog bite injuries have largely been empirical, which may render the practitioner particularly exposed. In response to increasing pressures on healthcare systems, paramedics with extended scopes of practice, including wound care and suturing, are being utilised to assess, manage, treat, and either refer or discharge patients with apparently minor injuries, in strategies aimed at reducing hospital admissions. This article adopts a case study format to examine and evaluate treatment modalities and the current evidence base informing best practice in terms of dog bite injuries from the perspective of a paramedic practitioner, with critical reflection on the decision making process and complexities of such episodes of care in the pre-hospital setting.
    • Doing visual archaeology: archive images and participatory film-making

      Capstick, Andrea; Ludwin, Katherine (2015)
      Visual sociology often relies for its content on researcher-created or participant-created images. In this article we discuss our use of existing local history archive images in a participatory film-making project with ten people living in residential dementia care in the Northern UK. We draw on the concept of archaeology in two ways: first, as used by Foucault (1972), who contends that archaeology is a metaphor for exploring traces left by the past in order to understand the present. Secondly, in a more obvious sense–many of the most salient cultural references for our participants related to public buildings and local landmarks that had been demolished, repurposed, or dramatically changed in appearance since their youth.
    • Domestic Violence and Health Care: Opening Pandora¿s Box ¿ Challenges and Dilemmas

      Lavis, Victoria J.; Horrocks, Christine; Kelly, Nancy; Barker, V. (Sage, 2005-08)
      In this article we take a critical stance toward the rational progressive narrative surrounding the integration of domestic violence within health care. Whilst changes in recent UK policy and practice have resulted in several tangible benefits, it is argued that there may be hidden dilemmas and challenges. We suggest that the medical model of care and its discursive practices position women as individually accountable for domestic violence-related symptoms and injuries. This may not only be ineffective in terms of service provision but could also have the potential to reduce the political significance of domestic violence as an issue of concern for all women. Furthermore, it is argued that the use of specific metaphors enables practitioners to distance themselves from interactions that may prove to be less comfortable and provide less than certain outcomes. Our analysis explores the possibilities for change that might currently be available. This would appear to involve a consideration of alternative discourses and the reformulation of power relations and subject positions in health care.
    • Dose assessment of digital tomosynthesis in pediatric imaging

      Gislason-Lee, Amber J.; Elbakri, I.A.; Reed, M. (2009-03)
      We investigated the potential for digital tomosynthesis (DT) to reduce pediatric x-ray dose while maintaining image quality. We utilized the DT feature (VolumeRadTM) on the GE DefiniumTM 8000 flat panel system installed in the Winnipeg Children’s Hospital. Facial bones, cervical spine, thoracic spine, and knee of children aged 5, 10, and 15 years were represented by acrylic phantoms for DT dose measurements. Effective dose was estimated for DT and for corresponding digital radiography (DR) and computed tomography (CT) patient image sets. Anthropomorphic phantoms of selected body parts were imaged by DR, DT, and CT. Pediatric radiologists rated visualization of selected anatomic features in these images. Dose and image quality comparisons between DR, DT, and CT determined the usefulness of tomosynthesis for pediatric imaging. CT effective dose was highest; total DR effective dose was not always lowest – depending how many projections were in the DR image set. For the cervical spine, DT dose was close to and occasionally lower than DR dose. Expert radiologists rated visibility of the central facial complex in a skull phantom as better than DR and comparable to CT. Digital tomosynthesis has a significantly lower dose than CT. This study has demonstrated DT shows promise to replace CT for some facial bones and spinal diagnoses. Other clinical applications will be evaluated in the future.
    • Dose optimization in cardiac x-ray imaging

      Gislason-Lee, Amber J.; McMillan, C.; Cowen, A.R.; Davies, A.G. (2013-09)
      Purpose: The aim of this research was to optimize x-ray image quality to dose ratios in the cardiac catheterization laboratory. This study examined independently the effects of peak x-ray tube voltage (kVp), copper (Cu), and gadolinium (Gd) x-ray beam filtration on the image quality to radiation dose balance for adult patient sizes. Methods: Image sequences of polymethyl methacrylate (PMMA) phantoms representing two adult patient sizes were captured using a modern flat panel detector based x-ray imaging system. Tin and copper test details were used to simulate iodine-based contrast medium and stents/guide wires respectively, which are used in clinical procedures. Noise measurement for a flat field image and test detail contrast were used to calculate the contrast to noise ratio (CNR). Entrance surface dose (ESD) and effective dose measurements were obtained to calculate the figure of merit (FOM), CNR2/dose. This FOM determined the dose efficiency of x-ray spectra investigated. Images were captured with 0.0, 0.1, 0.25, 0.4, and 0.9 mm Cu filtration and with a range of gadolinium oxysulphide (Gd2O2S) filtration. Results: Optimum x-ray spectra were the same for the tin and copper test details. Lower peak tube voltages were generally favored. For the 20 cm phantom, using 2 Lanex Fast Back Gd2O2S screens as x-ray filtration at 65 kVp provided the highest FOM considering ESD and effective dose. Considering ESD, this FOM was only marginally larger than that from using 0.4 mm Cu at 65 kVp. For the 30 cm phantom, using 0.25 mm copper filtration at 80 kVp was most optimal; considering effective dose the FOM was highest with no filtration at 65 kVp. Conclusions: These settings, adjusted for x-ray tube loading limits and clinically acceptable image quality, should provide a useful option for optimizing patient dose to image quality in cardiac x-ray imaging. The same optimal x-ray beam spectra were found for both the tin and copper details, suggesting that iodine contrast based imaging and visualization of interventional devices could potentially be optimized for dose using similar x-ray beam spectra.
    • Dose optimization in pediatric cardiac x-ray imaging

      Gislason-Lee, Amber J.; Davies, A.G.; Cowen, A.R. (2010-10)
      Purpose: The aim of this research was to explore x-ray beam parameters with intent to optimize pediatric x-ray settings in the cardiac catheterization laboratory. This study examined the effects of peak x-ray tube voltage kVp and of copper Cu x-ray beam filtration independently on the image quality to dose balance for pediatric patient sizes. The impact of antiscatter grid removal on the image quality to dose balance was also investigated. Methods: Image sequences of polymethyl methacrylate phantoms approximating chest sizes typical of pediatric patients were captured using a modern flat-panel receptor based x-ray imaging system. Tin was used to simulate iodine-based contrast medium used in clinical procedures. Measurements of tin detail contrast and flat field image noise provided the contrast to noise ratio. Entrance surface dose ESD and effective dose E measurements were obtained to calculate the figure of merit FOM , CNR2 / dose, which evaluated the dose efficiency of the x-ray parameters investigated. The kVp, tube current mA , and pulse duration were set manually by overriding the system’s automatic dose control mechanisms. Images were captured with 0, 0.1, 0.25, 0.4, and 0.9 mm added Cu filtration, for 50, 55, 60, 65, and 70 kVp with the antiscatter grid in place, and then with it removed. Results: For a given phantom thickness, as the Cu filter thickness was increased, lower kVp was favored. Examining kVp alone, lower values were generally favored, more so for thinner phantoms. Considering ESD, the 8.5 cm phantom had the highest FOM at 50 kVp using 0.4 mm of Cu filtration. The 12 cm phantom had the highest FOM at 55 kVp using 0.9 mm Cu, and the 16 cm phantom had highest FOM at 55 kVp using 0.4 mm Cu. With regard to E, the 8.5 and 12 cm phantoms had the highest FOM at 50 kVp using 0.4 mm of Cu filtration, and the 16 cm phantom had the highest FOM at 50 kVp using 0.25 mm Cu. Antiscatter grid removal improved the FOM for a given set of x-ray conditions. Under aforesaid optimal settings, the 8.5 cm phantom FOM improved by 24% and 33% for ESD and E, respectively. Corresponding improvements were 26% and 24% for the 12 cm phantom and 6% and 15% for the 16 cm phantom. Conclusions: For pediatric patients, using 0.25–0.9 mm Cu filtration in the x-ray beam while maintaining 50–55 kVp, depending on patient size, provided optimal x-ray image quality to dose ratios. These settings, adjusted for x-ray tube loading limits and clinically acceptable image quality, should provide a useful strategy for optimizing iodine contrast agent based cardiac x-ray imaging. Removing the antiscatter grid improved the FOM for the 8.5 and 12 cm phantoms, therefore grid removal is recommended for younger children. Improvement for the 16 cm phantom declined into the estimated margin of error for the FOM; the need for grid removal for older children would depend on practical feasibility in the clinical environment.
    • Double checking medicines: defence against error or contributory factor?

      Armitage, Gerry R. (2008)
      RATIONALE AND AIM: The double checking of medicines in health care is a contestable procedure. It occupies an obvious position in health care practice and is understood to be an effective defence against medication error but the process is variable and the outcomes have not been exposed to testing. This paper presents an appraisal of the process using data from part of a larger study on the contributory factors in medication errors and their reporting. METHODS: Previous research studies are reviewed; data are analysed from a review of 991 drug error reports and a subsequent series of 40 in-depth interviews with health professionals in an acute hospital in northern England. RESULTS: The incident reports showed that errors occurred despite double checking but that action taken did not appear to investigate the checking process. Most interview participants (34) talked extensively about double checking but believed the process to be inconsistent. Four key categories were apparent: deference to authority, reduction of responsibility, automatic processing and lack of time. Solutions to the problems were also offered, which are discussed with several recommendations. CONCLUSIONS: Double checking medicines should be a selective and systematic procedure informed by key principles and encompassing certain behaviours. Psychological research may be instructive in reducing checking errors but the aviation industry may also have a part to play in increasing error wisdom and reducing risk.
    • Double contrast barium enema. eLearning module

      Culpan, Gary (2013)
      This session considers the double contrast barium enema examination (DCBE) in investigation of bowel pathology and discusses its place alongside other imaging modalities and alternative investigations. Tips on equipment use, technique and reporting will be offered.
    • Drawn from life: Cocreating narrative and graphic vignettes of lived experience with people affected by dementia

      Capstick, Andrea; Dennison, Alison; Oyebode, Jan R.; Healy, Lesley; Surr, Claire A.; Parveen, Sahdia; Sass, C.; Drury, Michelle (Wiley, 2021)
      Background: The growing literature on Patient and Public Involvement and Engagement (PPIE) and dementia identifies specific problems related to the influence involvement has on research outcomes, over-reliance on family members as proxies, and lack of representation of seldom-heard groups. Adaptations to the PPIE process are therefore needed in order to make possible the involvement of a broader spectrum of people living with dementia. Objective: To adapt the PPIE process in order to make participation in co-creation by people living with dementia accessible and meaningful across a spectrum of cognitive abilities. Design: Narrative elicitation, informal conversation, and observation were used to co-create three vignettes based on PPIE group members’ personal experience of dementia services. Each vignette was produced in both narrative and graphic formats. Participants: Nine people living with dementia and five family members. Results: Using enhanced methods and outreach it was possible to adapt the PPIE process so that not only family members and people with milder cognitive difficulties could participate, but also those with more pronounced cognitive problems whose voices are less often heard. Conclusions: Making creative adaptations is vital in PPIE involving people living with dementia if we wish to develop inclusive forms of PPIE practice. This may, however, raise new ethical issues, which are briefly discussed.
    • Drop jump landing knee valgus angle; normative data in a physically active population

      Herrington, L.C.; Munro, Allan G. (2009)
      Objective Establish normative values for knee valgus angle during drop jump and step landings. Design Observational. Setting University biomechanics laboratory. Participants 100 physically active asymptomatic individuals (50 male, 50 female) aged 18–28 years old. Main outcome measures Knee valgus angle during drop jump and step landings. Results There were no differences between genders during the step landing task (p < 0.12) but there were differences during the drop jump landing task (p < 0.048). Both males and females showed no significant differences between sides for either of the tasks (p > 0.05) or between the valgus angle generated for either of the tasks (p > 0.05). Conclusion It would appear in order to be regarded as an average “normal” performance during a drop jump landing task knee valgus angle should be symmetrical and in the range of 7–13° for females and 3–8° for males. For a unilateral step landing task knee valgus angle should be symmetrical and in the range of 5–12° for females and 1–9° for males.
    • Drug errors, qualitative research and some reflections on ethics.

      Armitage, Gerry R. (2005)
      Observational methods as part of a qualitative approach have been specifically employed in the study of drug error and have undeniable strengths. This position paper will examine some recent research raising a number of ethical, and tangentially, methodological issues concerning the qualitative study of drug errors within United Kingdom National Health Service hospitals. Reflections on the views and ethical conduct of other qualitative researchers are provided to contextualize the discussion. Background.¿ The impact of a drug error, and any resultant adverse event can be significant. The human and financial costs are considerable. Establishing an accurate estimation of the frequency of adverse event and reporting rates has been difficult; additionally, methodological weaknesses in medical error research have sometimes caused further difficulties. Unsurprisingly, observational studies and for that matter, a whole range of other methods are now being considered in the quest to establish both understanding and predictability in relation to medical error. Relevance to clinical practice.¿ It is argued here that any participants in medical error research should be treated in a way that takes account of the prevailing culture of health care and, in the United Kingdom, the current ethos of government policy on medical error. This requires gaining informed consent, promoting transparency in method, and providing the opportunity for participants to learn. Effective error researchers can clearly increase the available knowledge in this critical area but ethical considerations and their chosen methods should show an appropriate level of respect for their participants. Carefully implemented qualitative approaches can help realize such respect.
    • Dualities of dementia illness narratives and their role in a narrative economy

      Hillman, A.; Jones, I.R.; Quinn, Catherine; Nelis, S.M.; Clare, L. (2018-06)
      The concept of 'narrative economies' has recently been proposed as a set of exchange relationships that, through biography and story-telling, facilitate access to resources and act as a source of value. We utilise this concept to inform our analysis of 18 qualitative interviews with five people with dementia and four informal carers. Our participants are members of a pre-existing group of dementia advocates, representing the voices of those living with the condition. There are a growing number of people in the early stages of dementia - like our participants - being called upon to account for their experience, as a means of developing a politicised 'collective illness identity'. These interviews present an opportunity to study a group of people who are actively involved in speaking as, and for, people with dementia. Four themes emerged from the data: becoming a voice of or for people with dementia; biographical reinforcement; responsibilisation; and resistance. These themes illustrate the ways in which people with dementia participate in their own identity construction and, as representatives of those living with dementia, they also illustrate the ways in which illness narratives produce material and symbolic value.