• 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.
    • 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.
    • Method of Micro-Sampling Human Dentine Collagen for Stable Isotope Analysis

      Curtis, Mandi J.; Beaumont, Julia; Elamin, F.; Wilson, Andrew S.; Koon, Hannah E.C. (2022-07-15)
      Sampling of dentine for stable carbon (δ13 C) and nitrogen (δ15 N) isotope ratios in the direction of tooth growth allows the study of temporal changes to the diet and physiological stress of an individual during tooth formation. Current methods of sampling permanent teeth using 1mm increments provide temporal resolution of six - nine months at best depending on the tooth chosen. While this gives sufficient sample sizes for reliable analysis by mass spectrometry, sectioning the dentine across the incremental structures results in a rolling average of the isotope ratios. A novel method of incremental dentine collagen sampling has been developed to decrease the collagen increment size to 0.35mm along the incremental structures thus reducing averaging and improving the temporal resolution of short-term changes within the δ13 C and δ15 N values. This study presents data for a MicroMill-assisted sampling method that allows for sampling at 0.35mm width x 1mm depth increments following the incremental growth pattern of dentine. A NewWave MicroMill was used to sample the demineralised dentine section of modern donated human third molars from Sudan and compared to data from the same teeth using the 1mm incremental sectioning method 2 from Beaumont et al. (2013). The δ13 C and δ15 N isotopic data showed an increased temporal resolution, with each increment providing data for two-four months of dentine formation. The data show the potential of this method for studying dietary reconstruction, nutritional stress, and physiological change with greater temporal resolution potentially to seasonal level and with less attenuation of the δ13 C and δ15 N values than was previously possible from human dentine.
    • Methodological approaches to evaluating the practice of radiographers¿ interpretation of images: A review.

      Brealey, S.; Scally, Andy J. (2008)
      Recent initiatives to modernise the National Health Service describe how improving pay structures and staff working lives can be achieved in the form of advanced practitioner and consultant posts. Role development in Radiography represents a fundamental change to professional practice of radiographers and is subject to the provisions of the statutory and professional codes of conduct which govern such practice. In Diagnostic Radiography the response to Government initiatives has led to a change in practice so that radiographers in these new posts provide reports for a variety of imaging modalities. At the same time as there have been changes in the practice of Radiography, the discipline of evidence-based medicine has emerged. Changes in clinical practice should be underpinned by evidence from research. The purpose of this paper is to discuss the methodological approaches used to conduct research that evaluates one of the most salient areas of development in Radiography practice, that is the role of radiographers as advanced or consultant practitioners when interpreting plain radiographs. We begin by discussing what an evaluation is and two broad approaches for conducting health services research, and then appraise the evidence about radiographer reporting in the context of these methods of evaluation. We then suggest future considerations about the methodological approaches to evaluating radiographer reporting practice and identify where there are evidence gaps and the need for further research to inform evidence-based Radiography.
    • Methodological Challenges of Researching Positive Action Measures

      Archibong, Uduak E.; Darr, Aliya; Eferakorho, Jite; Scally, Andy J.; Atkin, K.; Baxter, C.; Johnson, M.R.D.; Bell, M.; Waddington, L.; Wladasch, K.; et al. (2009)
      This paper highlights some ofthe methodological challenges which have arisen in collecting data for an international study on positive action measures. It will describe strategies employed to encourage participation in the study from as wide a range of organisations and individuals using a mixed method approach. The paper will also discuss the methodological and sensitive issues related to this type of research in organisations and strategies adopted by the research team to ameliorate any problems that have arisen whilst maintaining trustworthiness and rigour in the study.
    • Methodological standards in radiographer plain film reading performance studies.

      Brealey, S.; Scally, Andy J.; Thomas, N. (2002)
      The objectives of this paper are to raise awareness of the methodological standards that can affect the quality of radiographer plain-film reading performance studies and to determine the frequency with which these standards are fulfilled. Multiple search methods identified 30 such studies from between 1971 and the end of June 1999. The percentage of studies that fulfilled criteria for the 10 methodological standards were as follows. (1) Performance of a sample size calculation, 3%; (2) definition of a normal and abnormal report, 97%; (3) description of the sequence of events through which films passed before reporting, 94%; (4) analysis of individual groups of observers within a combination of groups, 50% (5) appropriate choice of reference standard, 80%; (6) appropriate choice of arbiter, 57%; (7) appropriate use of a control, 22%; (8) analysis of pertinent clinical subgroups, e.g. body areas, patient type, 44%; (9) availability of data for re-calculation, 59%; and (10) presentation of indeterminate results, 69%. These findings indicate variation in the application of the methodological standards to studies of radiographer's film reading performance. Careful consideration of these standards is an essential component of study quality and hence the validity of the evidence base used to underpin radiographic reporting policy.
    • Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation findings from the IDEAL programme

      Collins, R.; Hunt, A.; Quinn, Catherine; Martyr, A.; Pentecost, C.; Clare, L. (2022)
      Objectives Dementia can affect language processing and production, making communication more difficult. This creates challenges for including the person’s perspective in research and service evaluation. This study aims to identify methods, tools and approaches that could facilitate meaningful communication with people with moderate-to-severe dementia and support the inclusion of their perspectives. Methods This qualitative study was conducted as part of the IDEAL programme and involved in-depth, semi-structured interviews with 17 dementia research and/or care professionals with expertise in communication. Transcripts were analysed using framework analysis. Findings Three main themes each with sub-themes were identified: (1) Awareness, knowledge and experience; (2) Communication approach and (3) Personalization. A person-centred orientation based on getting to know the participant and developing a bi-directional exchange formed the fundamental context for effective communication. Building on this foundation, an approach using pictures, photographs or objects that are meaningful to the person and appropriate for that person’s preferences and ability could help to facilitate conversations. The findings were integrated into a diagram illustrating how the topics covered by the themes interrelate to facilitate communication. Conclusions Useful skills and approaches were identified to help researchers engage and work with people with moderate-to-severe dementia and ensure their perspective is included. These covered getting to know the participant, using a variety of tangible tools and interactional techniques and considering the environment and context of the conversation.
    • Methods for the analysis of ordinal response data in medical image quality assessment

      Keeble, C.; Baxter, P.D.; Gislason-Lee, Amber J.; Treadgold, L.A.; Davies, A.G. (2016-04)
      The assessment of image quality in medical imaging often requires observers to rate images for some metric or detectability task. These subjective results are used in optimization, radiation dose reduction or system comparison studies and may be compared to objective measures from a computer vision algorithm performing the same task. One popular scoring approach is to use a Likert scale, then assign consecutive numbers to the categories. The mean of these response values is then taken and used for comparison with the objective or second subjective response. Agreement is often assessed using correlation coefficients. We highlight a number of weaknesses in this common approach, including inappropriate analyses of ordinal data and the inability to properly account for correlations caused by repeated images or observers. We suggest alternative data collection and analysis techniques such as amendments to the scale and multilevel proportional odds models. We detail the suitability of each approach depending upon the data structure and demonstrate each method using a medical imaging example. Whilst others have raised some of these issues, we evaluated the entire study from data collection to analysis, suggested sources for software and further reading, and provided a checklist plus flowchart for use with any ordinal data. We hope that raised awareness of the limitations of the current approaches will encourage greater method consideration and the utilization of a more appropriate analysis. More accurate comparisons between measures in medical imaging will lead to a more robust contribution to the imaging literature and ultimately improved patient care.