• "An invisible map" - maternal perceptions of hunger, satiation and 'enough' in the context of baby led and traditional complementary feeding practices

      McNally, Janet; Hugh-Jones, S.; Hetherington, M.M. (Elsevier, 2020-05)
      Mothers' responsiveness to hunger and fullness cues has been implicated in the development of infant over-weight, and baby led weaning (BLW) is argued to be one way to protect against overfeeding. Whilst studies have examined maternal perceptions of hunger, fullness and adequate intake to some degree in traditional weaning (TW) contexts, less is known about this in BLW. This study therefore aimed to understand and compare maternal perceptions of cues and intake in BLW and TW. Eleven mothers of infants (7–24m) participated in semi-structured interviews based on discussions of short videos featuring participants feeding their infants. Interviews were read and transcribed in full. Data were selected for coding which addressed mothers' perceptions of infant hunger, fullness and sufficient consumption and subsequently subjected to template analysis. A sample of data was coded to produce an initial template which was applied to all interviews and revised in an iterative process to produce a final template for interpreting findings. Mothers in the study were adept at recognising fullness cues and gauging feeding state. Both groups perceived similar hunger cues although TW mothers reported a wider range of fullness cues. Both groups used numerous strategies for judging the adequacy of their babies’ intake. These included the use of infant cues, however perceived adequacy of intake was also influenced by factors such as infant tiredness and maternal worries about over and under-eating. Findings have implications for the development of responsive feeding interventions while also highlighting the utility of video elicited interviews for understanding feeding interactions.
    • Involvement in meetings and events: Tips for good practice

      Mason, Clare; Quinn, Catherine; Andrews, Michael; Parveen, Sahdia; Litherland, R. (2020-11)
      When face-to-face meetings and events resume, there is likely to be a renewed commitment to involving people with dementia and carers. Clare Mason and colleagues reflect on what they have learnt from their own experience and provide some tips for good practice.
    • Involving minority ethnic communities and diverse experts by experience in dementia research: the Caregiving HOPE study

      Parveen, Sahdia; Barker, S.; Kaur, R.; Kerry, F.; Mitchell, W.; Happs, A.; Fry, Gary; Morrison, V.; Fortinsky, R.; Oyebode, Jan R. (2018-11)
      Patient and public involvement is imperative to ensure relevance of research. There is a growing literature on the theoretical underpinning on patient and public involvement including level and processes of involvement. The aim of this paper is to describe a person-centred and culturally sensitive approach to working with minority ethnic communities, involving carers, people living with dementia, members of the public and carer support workers, as used in the Caregiving HOPE study; and the influence of the approach on the study’s research processes and outcomes. Patient and public involvement members were considered experts by experience and involved with study conception, design, conduct and dissemination. The perspective of the experts by experience is also presented in this article. The level and nature of involvement was influenced by each individual’s needs and desires which changed over the course of the study. The approach had a significant impact on study outcomes as evidenced by successful recruitment and engagement at a national level, but was not without challenges with greater flexibility required and fuller consideration of financial and time costs required. Benefits of the approach included strong engagement, improved outcomes (successful recruitment of seldom heard groups) and meaningful relationships between researchers and experts by experience. A person-centred and culturally sensitive approach is required with patient and public involvement to ensure involvement is not detrimental to those involved, is meaningful and enjoyable and has a positive impact on the research.
    • Is 'Healthy Dying' a paradox? Revisiting an early Kastenbaum challenge

      Kellehear, Allan (2014)
      This article is a review of Robert Kastenbaum's 1979 essay entitled "Healthy dying: A paradoxical quest continues." It begins with a summary of the arguments and challenges in the original essay. This is followed by an evaluation of his original claims in the light of contemporary insights in modern public health history and empirical studies of near-death experiences and death bed visions. The recent development of health promotion in palliative care is described in relation to these developments and Kastenbaum's early question about the paradoxical quest for health while dying is again posed against this background. Given our modern understanding of "health" in current global health policy and debates, it is argued that "healthy dying" is no paradox. Instead, the pursuit of health at the end of life represents a realistic modern desire to compress morbidity, minimize unnecessary suffering, and enhance quality of life at this time.
    • Is a nurse consultant impact toolkit relevant and transferrable to the radiography profession? An evaluation project

      Snaith, Beverly; Williams, S.; Taylor, K.; Tsang, Y.; Kelly, J.; Woznitza, N. (2018-08)
      Introduction: Consultant posts were developed to strengthen strategic leadership whilst maintaining front line service responsibilities and clinical expertise. The nursing profession has attempted to develop tools to enable individuals to evaluate their own practice and consider relevant measurable outcomes. This study evaluated the feasibility of transferring such a nursing ‘toolkit’ to another health profession. Method: This evaluation was structured around a one-day workshop where a nurse consultant impact toolkit was appraised and tested within the context of consultant radiographic practice. The adapted toolkit was subsequently validated using a larger sample at a national meeting of consultant radiographers. Results: There was broad agreement that the tools could be adopted for use by radiographers although several themes emerged in relation to perceived gaps within the nursing template, confirming the initial exercise. This resulted in amendments to the original scope and a proposed new evaluation tool. Conclusion: The impact toolkit could help assess individual and collaborat ive role impact at a local and national level. The framework provides consultant radiographers with an opportunity to understand and highlight the contribution their roles have on patients, staff, their organisation and the wider profession.
    • Is a radiographer led immediate reporting service for emergency department referrals a cost effective initiative?

      Hardy, Maryann L.; Hutton, J.; Snaith, Beverly (2013-02)
      Demand for both Emergency Department (ED) and radiology services continues to increase across the UK while simultaneously, healthcare organisations are being asked to evaluate the quality of care provided and constrain service costs. National guidance on radiograph reporting times recommends ED radiographs are reported on day of patient attendance but in practice, delays in reporting persist. This study considers whether a radiographer led immediate reporting service for ED referrals could provide a cost-effective service improvement solution. A pragmatic multi-centre randomised controlled trial was undertaken. 1502 patients were recruited and randomly assigned to an immediate or delayed reporting arm and treated according to group assignment. Patient health gain was measured in terms of change in utilities derived from EQ-5D responses at baseline and 8 week follow-up. Resources used and the costs of an immediate reporting service were analysed at the patient level and compared to standard reporting practices. 1688 radiographic examinations were performed (1502 patients). 79 discordant radiographic interpretations were identified (n = 79/1688; 4.7%). Interpretive errors were significantly reduced within immediate reporting arm. No significant difference was noted in the relative improvement in patient perceived health status between the 2 arms of the study. The average cost saving per patient in the immediate reporting arm was £23.40. Radiographer led immediate reporting of ED radiographs is a cost-effective service development and its universal introduction could make a significant contribution to the current drive to increase service productivity within current budget constraints.
    • Is ethnic density associated with health in a context of social disadvantage? Findings from the Born in Bradford cohort.

      Uphoff, E.P.; Pickett, K.E.; Crouch, S.; Small, Neil A.; Wright, J. (2016)
      Objectives In this study we aimed to test the associations between area-level ethnic density and health for Pakistani and White British residents of Bradford, England. Design The sample consisted of 8610 mothers and infant taking part in the Born in Bradford cohort. Ethnic density was measured as the percentage of Pakistani, White British or South Asian residents living in a Lower Super Output Area. Health outcomes included birth weight, preterm birth and smoking during pregnancy. Associations between ethnic density and health were tested in multilevel regression models, adjusted for individual covariates and area deprivation. Results In the Pakistani sample, higher ethnic density was associated with lower birth weight (b -0.82, 95% CI -1.63; -0.02), and higher South Asian density was associated with a lower probability of smoking during pregnancy (OR 0.99, 95% CI 0.98; 1.00). Pakistani women in areas with 50-70% South Asian residents were less likely to smoke than those living in areas with less than 10% South Asian residents (OR 0.39, 95% CI 0.16;0.97). In the White British sample, neither birth weight nor preterm birth was associated with ethnic density. The probability of smoking during pregnancy was lower in areas with 10-29.99% compared to < 10% South Asian density (OR 0.79, 95% CI 0.64; 0.98). Conclusion In this sample, ethnic density was associated with lower odds of smoking during pregnancy but not with higher birth weight or lower odds of preterm birth. Possibly, high levels of social disadvantage inhibit positive effects of ethnic density on health.
    • Is food insecurity associated with maternal health among UK ethnic groups? An exploration of women in the BiB cohort

      Power, M.S.; Small, Neil A.; Doherty, B.; Stewart-Knox, Barbara; Pickett, K.E. (2018)
      Food insecurity is a determinant of maternal health; however, research on the health impact of food insecurity among mothers of varying ethnicities is under-developed. We assessed the association of food insecurity and health among white British and Pakistani mothers. Data from the Born in Bradford cohort were matched with data on food insecurity and self-reported health from the nested BiB1000 study (N= 1280). Food insecurity was associated with elevated odds of fair/poor health among white British mothers but not Pakistani mothers. Adjusting for financial security, the association between food insecurity and poor health was not significant among either white British or Pakistani mothers.
    • Is magnetic resonance imaging a viable alternative to ultrasound as the primary imaging modality in the diagnosis of paediatric appendicitis? A systematic review

      Ogunmefun, G.; Hardy, Maryann L.; Boynes, Stephen (2016)
      Background: Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention in paediatric patients. Ultrasound is generally the diagnostic imaging modality of choice, followed by CT, where paediatric appendicitis is suspected. However, high operator dependency and diagnostic restrictions related to anatomical and clinical presentation may limit consistency of application. This paper explores whether MRI is a viable alternative to ultrasound as the primary imaging modality. Method: A systematic review of the literature was undertaken. A search of Medline, Cinahl, PubMed Central and Google Scholar was undertaken supplemented by a review of reference lists, author searching and review of NICE evidence base for existing guidelines. Included studies were assessed for bias using the QUADAS-2 quality assessment tool and data were extracted systematically using a purposefully designed electronic data extraction proforma. Results: Seven studies were included in final review. The age range of participants extended from 0 to 19 years. Only one study with a patient age range of 0e14 used sedation. Sensitivity estimates from the included studies ranged from 92% to 100% while specificity ranged from 89% to 100%. A significant variation in the number and type of sequences was noted between the studies. Conclusion: MRI offers high sensitivity and specificity comparable to contrast enhanced CT and greater than ultrasound as reported in the literature. Where accessibility is not a restriction, MRI is a viable alternative to ultrasound in the assessment and diagnosis of paediatric appendicitis. Clinical practice recommendations have been provided to facilitate the translation of evidence into practice.
    • Is midwifery knowledge a relevant construct in contemporary practice? A report on international Delphi survey

      MacVane Phipps, Fiona E. (2013)
      Is midwifery knowledge a relevant construct for contemporary practice? In other words, is it useful to think about the things midwives know and the skills they possess in terms of midwifery knowledge? Or, in an era of interprofessional practice, clinical governance and risk management, have midwives lost whatever was unique to their profession about how to help women give birth?
    • Is objective and accurate cognitive assessment across the menstrual cycle possible? A feasibility study

      Farrar, D.; Neill, Joanna C.; Scally, Andy J.; Tuffnell, D.J.; Marshall, Kay M. (2015-01-08)
      OBJECTIVES: Variation in plasma hormone levels influences the neurobiology of brain regions involved in cognition and emotion processing. Fluctuations in hormone levels across the menstrual cycle could therefore alter cognitive performance and wellbeing; reports have provided conflicting results, however. The aim of this study was to assess whether objective assessment of cognitive performance and self-reported wellbeing during the follicular and luteal phases of the menstrual cycle is feasible and investigate the possible reasons for variation in effects previously reported. METHODS: The Cambridge Neuropsychological Test Automated Battery and Edinburgh Postnatal Depression Scale were used to assess the cognitive performance and wellbeing of 12 women. Data were analysed by self-reported and hormone-estimated phases of the menstrual cycle. RESULTS: Recruitment to the study and assessment of cognition and wellbeing was without issue. Plasma hormone and peptide estimation showed substantial individual variation and suggests inaccuracy in self-reported menstrual phase estimation. CONCLUSION: Objective assessment of cognitive performance and self-assessed wellbeing across the menstrual cycle is feasible. Grouping data by hormonal profile rather by self-reported phase estimation may influence phase-mediated results. Future studies should use plasma hormone and peptide profiles to estimate cycle phase and group data for analyses.
    • Is practice placement capacity helping the NHS to recruit healthcare professionals?

      Hellawell, Michael; Graham, Claire; O'Brien, Caroline (2018-04-04)
      Practice placements are a fundamental aspect of preparing students for working in the NHS and will influence where, and in what specialities, students work. Additionally, NHS leaders now consider the issues of recruitment and retention of NHS staff to be as serious as concerns over funding. NHS Providers have outlined the issues although there appears to be little, or no, consideration in terms of plans required for the most immediate future workforce. It is hypothesised that there is link between student healthcare placement capacity and workforce gaps. The policy of increasing training places and of funding practice placements may have a positive effect on practice placement provision and if so contribute to increasing the NHS workforce, but without further detail this impact remains unknown. Along with most aspects of service delivery, planning practice placements using the best available evidence will ensure that the impact on service delivery is minimised while maximising the experience for the next generation of NHS employees.
    • Is the 12-item General Health Questionnaire (GHQ-12) confounded by scoring method in individuals with facial disfigurement?

      Martin, C.R.; Newell, Robert J. (2005)
      The GHQ-12 has been recommended as a reliable screening instrument for psychological distress in all clinical groups. The usefulness of the GHQ-12 was evaluated in individuals with significant facial disfigurement by examination of the impact of alternative scoring methods on case detection rates. The type of scoring method used had a significant impact on the relative prevalence of `cases'. However, examination of the receiver operating characteristics (ROC) of the alternative scoring methods revealed a good fit between methods. The use of the GHQ-12 as a screening instrument to determine psychological distress in individuals with facial disfigurement may be enhanced by inclusion of an appearance-specific measure in the screening schedule and by the adoption of one scoring method; the GHQ method.
    • Is There a Relationship Between Landing, Cutting, and Pivoting Tasks in Terms of the Characteristics of Dynamic Valgus?

      Jones, P.A.; Herrington, L.C.; Munro, Allan G.; Graham-Smith, P. (2014)
      Background: Anterior cruciate ligament (ACL) injuries are a major problem among female athletes. Screening for the risk of ACL injuries tends to focus on landing tasks, which may be limited in sports where changing direction is the main action involved in noncontact ACL injuries such as soccer. Purpose: To investigate whether there is a relationship between single-legged landing (SLL), cutting (90° cuts), and pivoting (180° turns) in terms of the characteristics of dynamic valgus. Study Design: Controlled laboratory study. Methods: Twenty female soccer players (mean ± SD: age, 21.0 ± 3.9 years; height, 1.65 ± 0.08 m; mass, 58.4 ± 6.4 kg) performed a minimum of 6 trials of SLL from a 0.3-m drop height and cutting and pivoting all on the right leg. Kinematics and kinetics were calculated from 3-dimensional motion analysis. Results: Strong correlations were found for peak knee abduction angles between tasks (R = 0.63-0.86, P < .01), whereas only moderate correlations between SLL and cutting (R = 0.46, P < .05), cutting and pivoting (R = 0.56, P < .05), and SLL and pivoting (R = 0.43, P > .05) were found between tasks for peak knee abduction moments. Conclusion: The results suggest that female athletes who exhibit poor SLL mechanics perform the same during various changing direction tasks. Clinical Relevance: The results support the use of existing screening tests that involve landing tasks to identify at-risk athletes for noncontact ACL injuries.
    • Issues affecting supply of palliative medicines into community pharmacy: A qualitative study of community pharmacist and pharmaceutical wholesaler/distributor perspectives

      Campling, N.; Breen, Liz; Miller, E.; Birtwistle, J.; Richardson, A.; Bennett, M.; Latter, S. (Elsevier, 2022-06)
      ackground Patient access to medicines in the community at end-of-life (pertaining to the last year of life) is vital for symptom control. Supply of such medicines is known to be problematic, but despite this, studies have failed to examine the issues affecting community pharmacy access to palliative medicines. Objective To identify community pharmacists' and pharmaceutical wholesalers'/distributors' views on supply chain processes and challenges in providing access to medicines during the last year of life, to characterise supply in this UK context. Methods Qualitative design, with telephone interviews analysed using Framework Analysis. Coding frames were developed iteratively with data analysed separately and then triangulated to examine differences in perspectives. Findings Thirty-two interviews (24 community pharmacists and 8 wholesalers/distributors) were conducted. To ensure appropriate palliative medicines were available despite occasional shortages, community pharmacists worked tirelessly. They navigated a challenging interface with wholesalers/distributors, the Drug Tariff to ensure reimbursement, and multiple systems. IT infrastructures and logistics provided by wholesalers/distributors were often helpful to supply into community pharmacies resulting in same or next day deliveries. However, the inability of manufacturers to predict operational issues or accurately forecast demand led wholesalers/distributors to encounter shortages with manufactured stock levels, reducing timely access to medicines. Conclusions The study identifies for the first time how palliative medicines supply into community pharmacy, can be improved. A conceptual model was developed, illustrating how influencing factors affect responsiveness and speed of medicines access for patients. Work is required to strengthen this supply chain via effective relationship-building and information-sharing, to prevent patients facing disruptions in access to palliative medicines at end-of-life.
    • Item hierarchy-based analysis of the Rivermead Mobility Index resulted in improved interpretation and enabled faster scoring in patients undergoing rehabilitation after stroke

      Roorda, L.D.; Green, J.R.; Houwink, A.; Bagley, Pamela J.; Smith, J.; Molenaar, I.W.; Geurts, A.C. (2012)
      OBJECTIVE: To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke. DESIGN: Cohort study. SETTING: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom. PARTICIPANTS: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy-based start-and-stop rules was checked in a second group of patients (n=237; mean age +/- SD, 60.0+/-11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules. RESULTS: The RMI had good fit of the double monotonicity model (coefficient H(T)=.87). The interpretation of the total score improved. Item hierarchy-based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules. CONCLUSIONS: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI.
    • The journey effect: how travel affects the experiences of mental health in-patient service-users and their families

      Heyman, B.; Lavendar, E.; Islam, Shahid; Adey, A.; Ramsey, T.; Taffs, N.; Xplore Service-user and Carer Research Group (2015-07)
      The qualitative study presented in this paper explored the perspectives of serviceusers, family members and staff about the impact of travel issues on the lives of mental health in-patients and carers. This topic was chosen because it was prioritised by members of Xplore, a service-user and carer research group, and has received little research attention. Travel problems were a significant issue for many service-users and carers, bound-up with mental health issues and the recovery experience. Travel facilitation through the funding of taxis and the provision of guides was greatly appreciated. A few service-users and carers positively valued distancing from their previous home environment. The meaning of travel issues could only be understood in the context of individuals’ wider lives and relationships. The significance of the findings is discussed in relation to the social model of disability.
    • Journeying through Dementia, a community-based self-management intervention for people aged 65 years and over: a feasibility study to inform a future trial

      Sprange, K.; Mountain, Gail; Shortland, K.; Craig, C.; Blackburn, D.; Bowie, P.; Harkness, K.; Spencer, M. (2015-11-30)
      Background: A study to determine the feasibility of conducting a future population-based trial into a selfmanagement intervention for community-living adults with early stage dementia included evaluation of intervention content and modes of delivery, staffing requirements, recruitment methods and the utility and usability of patient reported outcomes. Methods: Participants identified through memory clinics in one city took part in an intervention called ‘Journeying through Dementia’. The 12-week programme incorporating four individual sessions with one of the facilitators encourages participants to engage in discussion and activities related to health and well-being positioning them as the expert enabling long-term behavioural change. Participants (n = 10) and their nominated carers (n = 7) were all asked to complete selected outcomes at baseline, 8 weeks (participants only) and post intervention and invited to comment on their usability. All participants and carers were qualitatively interviewed before intervention delivery about their expectations and participants; nominated carers and facilitators were all interviewed after cessation about their experiences. Results: The manualised intervention and modes of delivery proved acceptable to participants and carers. Reported benefits included increased confidence and self-efficacy, engagement in new or lapsed activities and reengagement in fun and friendships. People with dementia and carers were able to self-complete all outcome measures, but time required to complete the measures is a key factor. Strategies for recruitment need to include direct contact within 24–48 h post invitation to the study. Analysis of data on the primary outcome did not reveal any trends. Facilitators found the training and support to be appropriate and helpful. Conclusions: The tailored intervention reportedly met the needs of all participants. The study confirmed the need for careful identification and application of patient-reported outcome measures. Outcomes to measure some dimensions of reported benefit are not available.