• 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.
    • Just an observation or tool for labour?

      Whitney, Elizabeth J. (2015-06)
    • Justice, Care and the Welfare State by Daniel Engster [Book review]

      Powell, Catherine (2016)
      Justice, Care and the Welfare State’ presents a justice theory to guide welfare policies across Western societies. As the author highlights “the main value of this book is to provide some insight into how Western welfare states can be reformed to better promote justice under contemporary social and economic conditions” (p.3).
    • Key sources of operational inefficiency in the PSC

      Papalexi, M.; Bamford, D.; Breen, Liz (2020-06-17)
      Purpose: This study explores the downstream Pharmaceutical Supply Chain (PSC) and provides insight to the delivery process of medicines and associated operational inefficiencies. Design/methodology/approach: An exploratory, qualitative approach was adopted to examine PSC inefficiency within two European contexts: the UK and Greece. Data was gathered through interviews and a thematic analysis conducted to analyse the data and identify challenges faced by both supply chains. Findings: The medicines delivery system needs to be enhanced in terms of quality, visibility, speed and cost in order to perform effectively. The findings demonstrated that although the healthcare supply chains in the two European contexts have different operational structures, the results are in concordance with each other. Financial, communication, waste and complexity issues were the major concerns. Research limitations/implications: To our knowledge this is the first study to examine aspects of the medicines supply chain via a cross-case analysis in the UK and Greece and extends the body of knowledge. A broader sample of responses is warranted to further validate these findings. Practical implications: The study outputs can inform pharmacies’ strategic to instigate targeted improvement interventions. The implications of which may be extrapolated further to other European healthcare organisations. Originality/value: This research contributes to the academic literature by adding further theoretical insights to supply chain strategy development, especially those that have been characterised as highly complex. The study identifies 4 key areas of intervention needed within this supply chain (in both countries) to promote higher level efficiencies and effectiveness.
    • Knowledge, attitudes and practices towards blood donation in Barbados

      Atherley, A.E.; Taylor, C.G.; Whittington, A.; Jonker, Cornelis (2016-12)
      Background: The World Health Organization (WHO) recommends 100% blood should be from voluntary non-remunerated donors (VNRD) yet the majority of blood donations (75%) in Barbados are family/replacement donations. Increasing VNRD is paramount to achieving a safe, reliable blood supply and understanding the population is a strategy suggested by the WHO to inform donor recruitment and education. Objective: To obtain information to devise strategies for a voluntary donor mobilization campaign in Barbados. Methods: Participants in Barbados (n=429) completed a self-administered questionnaire in 2014. The questionnaire comprised 31 questions including demographics (age, sex, highest educational attainment) and blood donation-related knowledge, attitudes and practices. Analysis of variance, t-test and linear regression were used to analyse data. Results: Fifty-three per cent (n=219) of participants had previously donated blood; only 23.9% of these had donated within the past two years and almost half were family/replacement donors only. Knowledge deficits included blood donation requirements, deferral factors and maximum yearly donations. Most participants (79%) were willing to donate with more information. Participants with higher educational attainment and previous donors had higher total knowledge and attitude scores (p<0.01). Single, female, and younger participants were less likely to donate blood (p<0.05). Conclusion: Barbados can likely increase voluntary blood donation rates by addressing knowledge deficits through education campaigns and increasing awareness of the need for donation.
    • Lack of attentional retraining effects in cigarette smokers attempting cessation: a proof of concept double-blind randomised controlled trial

      Begh, R.; Mulville, Jacqui.; Shiffman, S.; Ferguson, S.G.; Nichols, L.; Mohammed, Mohammed A.; Holder, R.L.; Sutton, S.; Aveyard, P. (2015-04-01)
      Observational studies have shown that attentional bias for smoking-related cues is associated with increased craving and relapse. Laboratory experiments have shown that manipulating attentional bias may change craving. Interventions to reduce attentional bias could reduce relapse in smokers seeking to quit. We report a clinical trial of attentional retraining in treatment-seeking smokers. This was a double-blind randomised controlled trial that took place in UK smoking cessation clinics. Smokers interested in quitting were randomised to five weekly sessions of attentional retraining (N=60) or placebo training (N = 58) using a modified visual probe task from one week prior to quit day. Both groups received 21 mg nicotine patches (from quit day onwards) and behavioural support. Primary outcomes included change in attentional bias reaction times four weeks after quit day on the visual probe task and craving measured weekly using the Mood and Physical Symptoms Scale. Secondary outcomes were changes in withdrawal symptoms, time to first lapse and prolonged abstinence. No attentional bias towards smoking cues was found in the sample at baseline (mean difference = 3 ms, 95% CI = -2, 9). Post-training bias was not significantly lower in the retraining group compared with the placebo group (mean difference = -9 ms, 95% CI = -20, 2). There was no difference between groups in change in craving (p = 0.89) and prolonged abstinence at four weeks (risk ratio = 1.00, 95% CI = 0.70, 1.43). Taken with one other trial, there appears to be no effect from clinic-based attentional retraining using the visual probe task. Attentional retraining conducted out of clinic may prove more effective. CLINICAL TRIAL REGISTRATION: UK Clinical Trials ISRCTN 54375405.
    • Larval debridement therapy: vascular wound management

      Tweedle, B.; Vig, S.; Vowden, Kath; Tyrer, J. (2014)
      Lower limb ulcers (LLU) are a common manifestation of long-standing vascular disease and may be exacerbated by trauma or dependency. Ulcers can be grouped according to the underlying aetiology with approximately 76% due to venous disease, 22% due to arterial and 5% occurring as a complication of diabetes. In up to 20% of patients there is some crossover where a mixed picture is present.
    • Leading in Health Care: challenging boundaries and future potential

      Hardy, Maryann L.; Snaith, Beverly; Henwood, S. (2014)
    • Lean management in the NHS: fad or panacea

      McIntosh, Bryan; Cookson, G. (2012)
      Lean principles emerged in the Japanese manufacturing industry after the Second World War. Lean management focuses on improving product quality while eliminating waste—primarily through process redesign and the integration of employees, management, suppliers and customers into the quality management process. The NHS is under significant pressure to improve productivity while maintaining or improving service quality, at the same time as service demand increases. The Quality, Innovation, Productivity and Prevention (QIPP) programme’s primary concern is to ensure that financial resources are used to bring maximum benefit and quality of care to patients (Department of Health, 2010). Lean management could therefore offer a panacea for the NHS, although its applicability to the health service sector is contested. This article investigates whether lean management is merely a fad or whether it could alleviate the pressure the NHS faces. While specific clinical processes may easily adopt lean processes and practices, healthcare organisations will need a paradigm shift in their management philosophy to adopt lean more widely. The promise of lean management remains elusive but could be harnessed by willing organisations.
    • The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database

      Ward, S.T.; Hancox, A.; Mohammed, Mohammed A.; Ismail, T.; Griffiths, E.A.; Valori, R.; Dunckley, P. (2017-06)
      Objective: The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. Design: OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy ( JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable. Results: Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. Conclusions: There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate
    • Learning from mistakes: What leagues won’t do

      McIntosh, Bryan; Pascoe, P. (2016-04)
      In March, the Department of Health (DH) released the Learning from Mistakes League, in which NHS organisations are ranked by levels of openness and transparency (DH, 2016). While a welcome first step toward the centralised and open promotion of learning since the publication of the Francis and Berwick reports three years earlier, unfortunately, the league can be considered misleading for a number of reasons.
    • Letter re: Comparison of acetabular and femoral morphologies on hip, pelvic, and lumbar radiographs (Yun et al.)

      Snaith, Beverly; Flintham, K. (2018)
      We read with interest the recent article by Yun et al. [1] comparing acetabular and hip measurements across pelvis, hip and lumbar spine radiographs. The authors assert that lumbar radiographs can be utilised in place of routine pelvis radiographs for these measurements. The example lumbar spine radiograph (figure 2) appears to be an abdominal image, with a contrast urogram. Indeed, standard texts [2,3] confirm that the anteroposterior lumbar spine radiograph should not include any coverage of the hips as appropriate collimation should limit the anatomy to T12 superiorly, lower sacrum inferiorly and the sacroiliac joints laterally, which would exclude the hip joints. Thus assessing any hip measurements on an appropriately collimated lumbar spine radiograph should not be possible. This is further compounded by the description of the centring point within their study (iliac crest), which varies from the internationally recognised standard of lower costal margin/L3 [2,3].