• 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.
    • Measuring the well-being of people with dementia living in formal care settings: the use of Dementia Care Mapping.

      Innes, C.; Surr, Claire A. (2001)
      Over the years there have been advances in the quality of care provision for people with dementia. How to measure the impact of care on the person with dementia has challenged researchers as, until recently, no evaluation tool offered a comprehensive overview of the behaviour patterns and well-being of persons with dementia. Dementia Care Mapping (DCM) is a tool used by care practitioners and researchers to capture both the process (behaviours) and outcome (well-being) of care and is therefore of use as a tool to evaluate quality of care. This study aims to assess, through DCM, the experience of dementia care provision in residential and nursing homes in two voluntary organizations in England. The data illustrates similarities in the well-being and behaviour patterns of 76 persons with dementia living in six care settings throughout England. Examples of instances when people with dementia were "put down" and when well-being was enhanced, are outlined. The homes in the study were meeting the physical care but not the broader psychosocial care needs of the observed residents. The action taken by the organizations as a result of the DCM evaluations is summarized.
    • The mechanics of landing when stepping down in unilateral lower-limb amputees

      Twigg, Peter C.; Jones, S.F.; Scally, Andy J.; Buckley, John G. (2006)
    • Medical Error: perspectives from Hospice Management.

      Sirriyeh, R. (See also Harrison, R.); Armitage, Gerry R.; Gardner, Peter H.; Lawton, R. (2010)
    • Medication-related risk factors and its association with repeated hospital admissions in frail elderly: A case control study

      Cheong, V-Lin; Sowter, Julie; Scally, Andy J.; Hamilton, N.; Ali, A.; Silcock, Jonathan (2020-09)
      Repeated hospital admissions are prevalent in older people. The role of medication in repeated hospital admissions has not been widely studied. The hypothesis that medication-related risk factors for initial hospital admissions were also associated with repeated hospital admissions was generated. To examine the association between medication-related risk factors and repeated hospital admissions in older people living with frailty. A retrospective case-control study was carried out with 200 patients aged ≥75 years with unplanned medical admissions into a large teaching hospital in England between January and December 2015. Demographic, clinical, and medication-related data were obtained from review of discharge summaries. Statistical comparisons were made between patients with 3 or more hospital admissions during the study period (cases) and those with 2 or fewer admissions (controls). Regressions were performed to establish independent predictors of repeated hospital admissions. Participants had a mean age of 83.8 years (SD 5.68) and 65.5% were female. There were 561 admission episodes across the sample, with the main reasons for admissions recorded as respiratory problems (25%) and falls (17%). Univariate logistic regression revealed five medication-related risks to be associated with repeated hospital admissions: Hyper-polypharmacy (defined as taking ≥10 medications) (OR 2.50, p < 0.005); prescription of potentially inappropriate medications (PIMs) (OR 1.89; p < 0.05); prescription of a diuretic (OR 1.87; p < 0.05); number of high risk medication (OR 1.29; p < 0.05) and the number of 'when required' medication (OR 1.20; p < 0.05). However, the effects of these risk factors became insignificant when comorbid disease was adjusted for in a multivariable model. Medication-related risk factors may play an important role in future repeated admission risk prediction models. The modifiable nature of medication-related risks factors highlights a real opportunity to improve health outcomes.
    • Medicine information sources used by nurses at the point of care.

      Ndosi, M.; Newell, Robert J. (01/09/2010)
      Aims: To identify sources of medicine information that nurses use while administering medicines.
    • Medicines Optimisation - extracting the last vestiges of value from your medicines

      Breen, Liz (2016-09)
      The concept of waste and how it can be reduced, recycled, refurbished or reused in its current form has been widely discussed in industry. The importance of waste reduction from an environmental and economic perspective has also heightened in both industry and within the research arena. Thus said, stringent steps have been taken to facilitate the collection of and capture residual value in waste items. This article explores this premise in relation to medicines waste as part of the wider medicines optimisation agenda.
    • Medicines Reconciliation Using a Shared Electronic Health Care Record.

      Moore, P.; Armitage, Gerry R.; Wright, J.; Dobrzanski, S.; Ansari, N.; Hammond, I.; Scally, Andy J. (2011)
      Objective: This study aimed to evaluate the use of a shared electronic primary health care record (EHR) to assist with medicines reconciliation in the hospital from admission to discharge. Methods: This is a prospective cross-sectional, comparison evaluation for 2 phases, in a short-term elderly admissions ward in the United Kingdom. In phase 1, full reconciliation of the medication history was attempted, using conventional methods, before accessing the EHR, and then the EHR was used to verify the reconciliation. In phase 2, the EHR was the initial method of retrieving the medication history-validated by conventional methods. Results: Where reconciliation was led by conventional methods, and before any access to the EHR was attempted, 28 (28%) of hospital prescriptions were found to contain errors. Of 99 prescriptions subsequently checked using the EHR, only 50 (50%) matched the EHR. Of the remainder, 25% of prescriptions contained errors when verified by the EHR. However, 26% of patients had an incorrect list of current medications on the EHR. Using the EHR as the primary method of reconciliation, 33 (32%) of 102 prescriptions matched the EHR. Of those that did not match, 39 (38%) of prescriptions were found to contain errors. Furthermore, 37 (36%) of patients had an incorrect list of current medications on the EHR. The most common error type on the discharge prescription was drug omission; and on the EHR, wrong drug. Common potentially serious errors were related to unidentified allergies and adverse drug reactions. Conclusions: The EHR can reduce medication errors. However, the EHR should be seen as one of a range of information sources for reconciliation; the primary source being the patient or their carer. Both primary care and hospital clinicians should have read-and-write access to the EHR to reduce errors at care transitions. We recommend further evaluation studies.
    • Meeting the health and social needs of pregnant asylum seekers; midwifery students perspectives. Part 1; Dominant discourses and midwifery students

      Haith-Cooper, Melanie; Bradshaw, Gwendolen (2013)
      Current literature has indicated a concern about standards of maternity care experienced by pregnant women who are seeking asylum. As the next generation of midwives, it is important that students are educated in a way that prepares them to effectively care for these women. To understand how this can be achieved, it is important to explore what asylum seeking means to midwifery students. This article is the first of three parts and reports on one objective from a wider doctorate study. It identifies dominant discourses that influenced the perceptions of a group of midwifery students' about the pregnant asylum seeking woman. The study was designed from a social constructivist perspective, with contextual knowledge being constructed by groups of people, influenced by underpinning dominant discourses, depending on their social, cultural and historical positions in the world. In a United Kingdom University setting, during year two of a pre-registration midwifery programme, eleven midwifery students participated in the study. Two focus group interviews using a problem based learning scenario as a trigger for discussion were conducted. In addition, three students were individually interviewed to explore issues in more depth and two students' written reflections on practice were used to generate data. Following a critical discourse analysis, dominant discourses were identified which appeared to influence the way in which asylum seekers were perceived. The findings suggested an underpinning ideology around the asylum seeker being different and of a criminal persuasion. Although the pregnant woman seeking asylum was considered as deserving of care, the same discourses appeared to influence the way in which she was constructed. However, as the study progressed, through reading alternative sources of literature, some students appeared to question these discourses. These findings have implications for midwifery education in encouraging students to challenge negative discourses and construct positive perceptions of asylum seeking.
    • Meeting the health and social needs of pregnant asylum seekers; midwifery students’ perspectives. Part 2; Dominant discourses and approaches to care

      Haith-Cooper, Melanie; Bradshaw, Gwendolen (2013)
      Pregnant women seeking asylum in the United Kingdom appear particularly vulnerable, having complex health and social care needs and could benefit from a woman centred approach to midwifery care. This article is the second of three parts and reports on the findings from one objective of a wider doctorate study. It focuses on exploring midwifery students' perceptions of how to approach the care of pregnant women seeking asylum. Although the design of the study is explored in article one, in this context, the data was subject to critical discourse analysis to meet this objective. Key words and phrases were highlighted which appeared to reveal power and ideology implicit in the language used when discussing midwifery care of the pregnant woman seeking asylum. Dominant discourses were identified which appeared to influence the way in which care was approached and the possible sources of these discourses critically analysed. The findings suggest an underpinning ideology around following policies and guidelines to meet the physical needs of the woman at the expense of her other holistic needs. Despite learning to adopt a woman centred approach in theory, once in practice some students appear to be socialised into (re)producing these dominant medical and managerial discourses with “midwifery discourse” being marginalised. In addition, some students appeared to have difficulty understanding how to adopt a woman centred approach and the importance of considering the woman's context and its impact on care. These findings have implications for midwifery educators and this article identifies that the recent Nursing and Midwifery Council requirement for students to undertake a caseloading activity could provide the opportunity for them to adopt a consistent woman centred approach in practice, rejecting dominant medical and managerial discourses. However, these discourses appear to influence midwives caring for women more widely and will be difficult to challenge.
    • Meeting the health and social needs of pregnant asylum seekers; midwifery students’ perspectives. Part 3; The pregnant woman within the global context; an inclusive model for midwifery education to address the needs of recently arrived migrant women in the UK

      Haith-Cooper, Melanie; Bradshaw, Gwendolen (2013)
      Aim to describe the conceptualisation and development of an inclusive educational model. The model is designed to facilitate pre-registration midwifery students' learning around the health and social care needs of pregnant women seeking asylum in the United Kingdom. Background current literature has identified a concern about the standard of maternity care experienced by asylum seeking women accessing maternity services in the United Kingdom. In response to this, a doctorate study was undertaken which focused on examining the way in which a group of midwifery students approached the provision of care for asylum seekers. This study revealed difficulties that these students had both in identifying these women's needs and also in the wider care issues in practice. Consequently, one of the recommendations was to ameliorate these difficulties through midwifery education. Methods the key findings from this study were used together with relevant supporting literature to construct “the pregnant woman within the global context” model for midwifery education. Results The model is designed to facilitate a holistic assessment of need rather than focusing on the physical assessment at the expense of other aspects of care. It incorporates wider factors, on a global level, which could impact on the health and social care needs of a pregnant woman seeking asylum. It also prompts students to consider the influence of dominant discourses on perceptions of asylum seek;ing and is designed to encourage students' to question these discourses. Recommendations this model can be used in midwifery education to prepare students in caring for pregnant women seeking asylum. It may be especially helpful when students have close contact with pregnant women seeking asylum, for example through caseloading. Further research is recommended to evaluate the effectiveness of this model in enhancing the care of asylum seeking women in the United Kingdom.
    • Membrane sweeping at term to promote spontaneous labour and reduce the likelihood of a formal induction of labour for postmaturity: a systematic review and meta-analysis

      Avsiyovski, H.; Haith-Cooper, Melanie; Scally, Andy J. (2019)
      The aim of this study was to evaluate the efficacy and the safety of membrane sweeping in promoting spontaneous labour and reducing a formal induction of labour for postmaturity. Based on articles published between 2005 and 2016, 12 electronic databases were searched. Relative risk (RR) and its 95% confidence interval (CI) were used as pooled statistics. A total of seven studies consisting of 2252 participants were selected for the review and meta-analysis. The results revealed that membrane sweeping is advantageous in promoting spontaneous labour (RR = 1.205, 95% CI: 1.133–1.282, p = <.001), and reducing the formal induction of labour for postmaturity (RR = 0.523, 95% CI: 0.409–0.669, p = <.001). The studies reported several varying outcomes for both maternal and foetal morbidities; meta-analyses were performed where possible on each of these and found there to be no statistically significant differences in outcome between the intervention and control groups.
    • Memories on film: digital storytelling with people in residential dementia care.

      Capstick, Andrea; Ludwin, Katherine (2015)
      Memories on film is the outcome of an 18-month study funded by the National Institute for Health Research’s School for Social Care Research. Based on the principles of Participatory Video (Milne et al 2012), the study used digital storytelling and co-production techniques to create short films with 10 participants in a Leeds dementia care facility. Choice of images and narrative content were decided by the participants, who were aged between 76 and 99 years, and had lived in Leeds for most if not all of their lives. Almost all of them decided to tell the story of their own early life and its defining events, and the participants’ own voices, both speaking and singing, feature on the soundtrack to their films. We made extensive use of local history websites, and archives such as Leodis, when putting the films together. We were particularly keen to find out whether the creation of digital stories with this group of people – who can experience isolation and marginalisation – would help to increase their social participation. As a result we are now interested, not only in discussing the film-making process and the study outcomes, but also in identifying opportunities to have the completed films hosted by other websites and community groups. The summative focus groups for the study identified a number of potential uses for the films, including inter-generational work with schools, staff development initiatives, and raising public awareness.
    • Metamemory and prospective memory in Parkinson's disease

      Smith, Sarah J.; Souchay, C.; Moulin, C.J.A. (2011)
      OBJECTIVE: Metamemory is integral for strategizing about memory intentions. This study investigated the prospective memory (PM) deficit in Parkinson's disease (PD) from a metamemory viewpoint, with the aim of examining whether metamemory deficits might contribute to PM deficits in PD. METHOD: Sixteen patients with PD and 16 healthy older adult controls completed a time-based PM task (initiating a key press at two specified times during an ongoing task), and an event-based PM task (initiating a key press in response to animal words during an ongoing task). To measure metamemory participants were asked to predict and postdict their memory performance before and after completing the tasks, as well as complete a self-report questionnaire regarding their everyday memory function. RESULTS: The PD group had no impairment, relative to controls, on the event-based task, but had prospective (initiating the key press) and retrospective (recalling the instructions) impairments on the time-based task. The PD group also had metamemory impairments on the time-based task; they were inaccurate at predicting their performance before doing the task but, became accurate when making postdictions. This suggests impaired metamemory knowledge but preserved metamemory monitoring. There were no group differences regarding PD patients' self-reported PM performance on the questionnaire. CONCLUSIONS: These results reinforce previous findings that PM impairments in PD are dependent on task type. Several accounts of PM failures in time-based tasks are presented, in particular, ways in which mnemonic and metacognitive deficits may contribute to the difficulties observed on the time-based task.