• Local diagnostic reference levels for skeletal surveys in suspected physical child abuse

      Mussmann, B.; Hardy, Maryann L.; Rajalingham, R.; Peters, D.; McFadden, S.; Abdi, A.J. (2021-05)
      Introduction: The purpose was to determine if an age based, local diagnostic reference level for paediatric skeletal surveys could be established using retrospective data. Methods: All children below two years of age referred for a primary skeletal survey as a result of suspected physical abuse during 2017 or 2018 (n ¼ 45) were retrospectively included from a large Danish university hospital. The skeletal survey protocol included a total of 33 images. Dose Area Product (DAP) and acquisition parameters for all images were recorded from the Picture Archival and Communication System (PACS) and effective dose was estimated. The 75th percentile for DAP was considered as the diagnostic reference level (DRL). Results: The 75th percentile for DAP was 314 mGy*cm2 , 520 mGy*cm2 and 779 mGy*cm2 for children <1 month, 1e11 months and 12 < 24 months of age respectively. However, only the age group 1e11 months had a sufficient number of children (n ¼ 27) to establish a local DRL. Thus, for the other groups the DAP result must be interpreted with caution. Effective dose was 0.19, 0.26 and 0.18 mSv for children <1, 1e11 months and 12 < 24 months of age respectively. Conclusion: For children between 1 and 11 months of age, a local diagnostic reference level of 520 mGy*cm2 was determined. This may be used as an initial benchmark for primary skeletal surveys as a result of suspected physical abuse for comparison and future discussion. Implications for practice: While the data presented reflects the results of a single department, the suggested diagnostic reference level may be used as a benchmark for other departments when auditing skeletal survey radiation dose.
    • Logical goal-setting frameworks for leprosy projects

      Ogbeiwi, Osahon (2020-05)
      Introduction: Goal setting is a fundamental practice in the effective management of healthcare services worldwide. This study investigated the extent to which leprosy goal formulation in Nigeria is logical and SMART. Method: Document review of baseline problems, goal statements and goal attainments for 2016 in six leprosy projects using a customised logical framework matrix. Results: A total of 15 main problems, 6 aims, 19 objectives and 42 indicators were found. The goals were problem-based and logically linked, with a pattern of a single aim per project, multiple objectives per aim, and multiple indicators per objective. Goal statements specified only impact in 5/6 aims, and only outcome and terminal timeframe in 17/19 (89.5%) objectives. Only one objective stated all four SMART components of outcome, indicator, target and timeframe. While three (7.1%) indicators and two (10.5%) objectives were measurable, no target was attainable. Discussion: Goal-setting frameworks for leprosy projects should be problem based and logical according to best practice. That most leprosy objectives were not completely SMART is similar to the reported structure of objectives published by other health organisations globally.
    • Long-Run Macroeconomic Determinants of Cancer Incidence

      Ferretti, F.; Jones, S.; McIntosh, Bryan (2013)
      Abstract: Background: Understanding how cancer incidence evolves during economic growth is useful for forecasting the economic impact of cancerous diseases, and for governing the process of resources allocation in planning health services. We analyse the relationship between economic growth and cancer incidence in order to describe and measure the influence of an increasing real per capita income on the overall rate of cancer incidence. Method:We test the relationship between real per capita income and the overall rate of cancer incidence with a cross-sectional analysis, using data from the World Bank and the World Health Organization databases, for 165 countries in 2008. We measure the elasticity of cancer incidence with respect to per capita income, and we decompose the elasticities coefficients into two components: age-effect and lifestyle-effect. Results: An Engel’s model, in a double-log quadratic specification, explains about half of the variations in the age-standardised rates and nearly two thirds of the variations in the incidence crude rates. All the elasticities of the crude rates are positive, but less than one. The income elasticity of the age-standardised rates are negative in lower income countries, and positive (around 0.25 and 0.32) in upper middle and high income countries, respectively. Conclusions:These results are used to develop a basic framework in order to explain how demand-side economic structural changes may affect the long run evolution of cancer incidence. At theoretical level, a J-Curve is a possible general model to represents, other things being equal, how economic growth influence cancer incidence.
    • The long-term (24-month) effect on health and well-being of the Lifestyle Matters community-based intervention in people aged 65 years and over: a qualitative study

      Chatters, R.; Roberts, J.; Mountain, Gail; Cook, S.; Windle, G.; Craig, C.; Sprange, K. (2017-09)
      Objectives To assess the long-term effect on health and well-being of the Lifestyle Matters programme. Design Qualitative study of a subset of intervention arm participants who participated in the Lifestyle Matters randomised controlled trial (RCT). Setting The intervention took place at community venues within two sites in the UK. Participants A purposeful sample of 13 participants aged between 66 and 88 years from the intervention arm of the RCT were interviewed at 24 months post randomisation. Interviews aimed to understand how participants had used their time in the preceding 2 years and whether the intervention had any impact on their lifestyle choices, participation in meaningful activities and well-being. Intervention Lifestyle Matters is a 4-month occupational therapy intervention, consisting of group and individual sessions, designed to enable community living older people to make positive lifestyle choices and participate in new or neglected activities through increasing self-efficacy. Results Interviews revealed that the majority of interviewed participants were reportedly active at 24 months, with daily routines and lifestyles not changing significantly over time. All participants raised some form of benefit from attending Lifestyle Matters, including an improved perspective on life, trying new hobbies and meeting new friends. A number of intervention participants spoke of adapting to their changing circumstances, but there were significant and lasting benefits for 2 of 13 intervention participants interviewed. Conclusion The majority of those who experienced the Lifestyle Matters intervention reported minor benefits and increases in self-efficacy, but they did not perceive that it significantly improved their health and well-being. The two participants who had experienced major benefits also reported having had life-changing events, suggesting that this intervention is most effective at the time when lifestyle has to be reconsidered if mental well-being is to be sustained.
    • Longitudinal trajectories of quality of life among people with mild-to-moderate dementia: a latent growth model approach with IDEAL cohort study data

      Clare, L.; Gamble, L.D.; Martyr, A.; Sabatini, S.; Nelis, S.M.; Quinn, Catherine; Pentecost, C.; Victor, C.; Jones, R.W.; Jones, I.R.; et al. (2022)
      Objectives: We aimed to examine change over time in self-rated quality of life (QoL) in people with mild-to-moderate dementia and identify sub-groups with distinct QoL trajectories. Method: We used data from people with mild-to-moderate dementia followed up at 12 and 24 months in the IDEAL cohort study (baseline n=1537). A latent growth model approach examined mean change over time in QoL, assessed with the QoL-AD scale, and investigated associations of baseline demographic, cognitive and psychological covariates with the intercept and slope of QoL. We employed growth mixture modelling to identify multiple growth trajectories. Results: Overall mean QoL scores were stable and no associations with change over time were observed. Four classes of QoL trajectories were identified: two with higher baseline QoL scores, labelled Stable (74.9%) and Declining (7.6%), and two with lower baseline QoL scores, labelled Stable Lower (13.7%) and Improving (3.8%). The Declining class had higher baseline levels of depression and loneliness, and lower levels of self-esteem and optimism, than the Stable class. The Stable Lower class was characterised by disadvantage related to social structure, poor physical health, functional disability, and low psychological well-being The Improving class was similar to the Stable Lower class but had lower cognitive test scores. Discussion: Understanding individual trajectories can contribute to personalised care planning. Efforts to prevent decline in perceived QoL should primarily target psychological well-being. Efforts to improve QoL for those with poorer QoL should additionally address functional impairment, isolation, and disadvantage related to social structure.
    • Machine vision image quality measurement in cardiac x-ray imaging

      Kengyelics, S.M.; Gislason-Lee, Amber J.; Keeble, C.; Magee, D.; Davies, A.G. (2015-03)
      The purpose of this work is to report on a machine vision approach for the automated measurement of x-ray image contrast of coronary arteries lled with iodine contrast media during interventional cardiac procedures. A machine vision algorithm was developed that creates a binary mask of the principal vessels of the coronary artery tree by thresholding a standard deviation map of the direction image of the cardiac scene derived using a Frangi lter. Using the mask, average contrast is calculated by tting a Gaussian model to the greyscale pro le orthogonal to the vessel centre line at a number of points along the vessel. The algorithm was applied to sections of single image frames from 30 left and 30 right coronary artery image sequences from di erent patients. Manual measurements of average contrast were also performed on the same images. A Bland-Altman analysis indicates good agreement between the two methods with 95% con dence intervals -0.046 to +0.048 with a mean bias of 0.001. The machine vision algorithm has the potential of providing real-time context sensitive information so that radiographic imaging control parameters could be adjusted on the basis of clinically relevant image content.
    • Maintaining Professional Identity and Role in the Modern Workplace

      Fitzgerald, Martin (2014)
      In the last decade, occupational therapists have faced new performance and commissioning demands from the state. These demands, such as Payment by Results (PbR) or funding tied to performance, have, on the face of it, improved service delivery and patient experience. However, they have also introduced new ways of working and new demands from management that have contributed to a crisis of identity, as therapists struggle to reconcile conflict- ing professional, managerial, and service demands with their day-to-day practice (Lloyd et al 2010). Professionals possess a unique and complex body of knowledge that cannot easily be appreciated and under- stood by those outside the profession. This body of knowledge, along with autonomy and self-regulation, are regarded as important aspects of professionalism and professional identity. However, it is now customary for occupational therapists to work as lone professionals within multi-disciplinary teams, often with professionals of other disciplines as their line or service managers, thereby experiencing differing local management and variant local practice.
    • Making patients better: a qualitative descriptive study of Registered Nurses reasons for working in surgical areas

      Mackintosh, Carolyn (2007)
      Little is known about the career decisions qualified nurses make, although it is clear that some areas of practice are more popular than others. This qualitative descriptive study considers one common area, surgery, and explores the motivation for decisions made by Registered Nurses (RNs) to work in this area. A sample of 16 RNs working within surgical areas participated in semi-structured interviews, using a thematic interview schedule. Findings were analysed using the framework suggested by Morse and Field. Analysis of findings indicates that all participants actively chose to work within surgery and that this was because of the pace and turnover of surgical work, personal satisfaction at the recovery of patients; the close links between this type of work; and participants' original aims when first entering nursing and participants' preference of surgery to other areas of nursing work. Participants actively rejected working in areas where patients were likely to suffer from chronic long-term conditions where recovery was unlikely and felt that these areas were likely to be depressing and unrewarding. These findings suggest that participants actively chose to work with 'healthy' patients in preference to those who may be considered 'ill', and this is closely linked to the identified need of participants to be able to 'make patients better'. Participants were reluctant to work in areas where they would be unlikely to achieve this aim.
    • A managed decline: Higher education provision

      Breen, Liz; McIntosh, Bryan (2016)
    • The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: A longitudinal cohort study

      White, N.; Leurent, B.; Lord, Kathryn; Scott, S.; Jones, L.; Sampson, E.L. (2017)
      Background: The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals. Method(s): A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave-AD scale), as well as documentation of pharmacological prescriptions and non-pharmacological management. Results: The overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p= 0.008). Nonpharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients’ admissions. Conclusions: Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.
    • Managers’ perspectives on promotion and professional development for black African nurses in the UK

      Likupe, G.; Baxter, C.; Jogi, M.; Archibong, Uduak E. (2014)
      An exploratory qualitative study design was adopted for this study and underpinned by Rex’s migrant workers framework (Rex, 1999). Semi-structured interviews were conducted with ten ward managers from four NHS trusts in the north-east of England to gain an insight into their experiences of working with black African nurses with regard to equal opportunities in accessing professional development and promotion. Managers reported that black African nurses experienced racism from patients, racism from colleagues, discrimination and lack of equal opportunities. A unique finding of the study was that managers stereotyped black African nurses as lacking motivation for professional development and promotion. The authors recommend that NHS ward managers receive training in implementing antidiscrimination policies and valuing equality and diversity.
    • Managing high viscosity exudate

      Vowden, Peter; Bond, E.; Meulenetre, F. (2015)
      Wound pain, odour and exudate have a major impact on patient quality of life. Understanding the management of these core components of wound healing is essential if patient outcomes are to be optimised. This paper discusses the role and types of exudate, the impact of high viscosity exudate on management and what to consider when selecting an appropriate dressing with the aim of restoring a satisfactory moist wound environment for healing.
    • Mapping the Offender Health Pathway - Challenges and Opportunities for Support Through Community Nursing

      Eshareturi, Cyril; Serrant-Green, L. (2016-06)
      The health needs of released offenders are significantly greater than those of the general population with a lack of equity existing between need and supply. Offender health indicates that they re-enter their communities with limited pre-release preparation for the continuity of access to healthcare once outside prison. This report relates the findings of a three year study commissioned by Burdett Trust to map the released offender health pathway towards identifying ‘touch points’ in the community for the delivery of a nurse led intervention.
    • Maximising the Potential of Longitudinal Cohorts for Research in Neurodegenerative Diseases: A Community Perspective

      Moody, Catherine L.; Mitchell, D.; Kiser, G.; Aarsland, D.; Berg, D.; Brayne, C.; Costa, A.; Ikram, M.A.; Mountain, Gail; Rohrer, J.D.; et al. (2017)
      Despite a wealth of activity across the globe in the area of longitudinal population cohorts, surprisingly little information is available on the natural biomedical history of a number of age-related neurodegenerative diseases (ND), and the scope for intervention studies based on these cohorts is only just beginning to be explored. The Joint Programming Initiative on Neurodegenerative Disease Research (JPND) recently developed a novel funding mechanism to rapidly mobilise scientists to address these issues from a broad, international community perspective. Ten expert Working Groups, bringing together a diverse range of community members and covering a wide ND landscape (Alzheimer’s, Parkinson’s, frontotemporal degeneration, amyotrophic lateral sclerosis, Lewy-body and vascular dementia) were formed to discuss and propose potential approaches to better exploiting and coordinating cohort studies. The purpose of this work is to highlight the novel funding process along with a broad overview of the guidelines and recommendations generated by the ten groups, which include investigations into multiple methodologies such as cognition/functional assessment, biomarkers and biobanking, imaging, health and social outcomes, and pre-symptomatic ND. All of these were published in reports that are now publicly available online.
    • Meaning making And Generativity In Children and Young people with Life limiting conditions (MAGICYL)

      Watts, L.; Rodriguez, A.; Tatterton, Michael J.; McSherry, W.; Smith, J. (2019-04-02)
    • Meaningful social interactions between older people in institutional care settings.

      Hubbard, G.; Tester, S.; Downs, Murna G. (2009-10-21)
      This paper is a contribution to the developing understanding of social relationships in institutional care settings. It focuses on two areas that have been neglected in research: the reasons for and types of social interaction in institutional settings, and the ways in which the context of people's lives shapes social interaction. The paper draws on ethnographic observations conducted in four care settings in Scotland using a symbolic interactionist perspective. It finds that residents communicate and interact, and that the personal, cultural and structural contexts frame social interaction and influence the ways that residents use humour, express sexuality, and show hostility. The paper concludes that residents create social interactions in which action is embedded, but do so within specific structural and cultural contexts. These contexts `control¿ resident action by establishing frameworks for the interpretation of meaning. At the same time, each facet of context is `controlled¿ by the ways in which residents actively take on the `role¿ of others, and project `self¿ and a `label¿.
    • Measuring parenting practices and family functioning with brief and simple instruments: Validation of the Spanish version of the PAFAS.

      Mejia, A.; Filus, A.; Calam, R.; Morawska, A.; Sanders, M.R. (2015-06)
      A set of instruments with different response formats is usually used to assess parenting practices in clinical settings and in research studies. These complex protocols can be problematic for parents with low-literacy levels. The Parenting and Family Adjustment Scales (PAFAS) is a brief, easy to read instrument that has been developed to address these concerns. The English version of this instrument suggested that it has good internal consistency (range from .70 to .96), as well as satisfactory construct and predictive validity. The aim of the present study was to explore the validity and reliability of the Spanish version of the PAFAS. A sample of 174 Spanish-speaking parents (85 % mothers; M = 37 years old; SD = 9.1) from Panama in Central America completed the instrument alongside the Parenting Scale and the Depression Anxiety Stress Scale (DASS-21). Psychometric evaluations revealed that the measure had satisfactory construct and concurrent validity as well as good internal consistency (values >.60 for all subscales) and test–retest reliability (ICC >.60 for all subscales). The PAFAS shows promise as a brief outcome measure to assess parenting practices and family functioning with Spanish-speaking parents. Potential uses of the measure and implications for further validation with diverse samples are discussed.