• Mourning

      Small, Neil A. (2014)
    • Moving and handling and managing physiological deterioration of deceased children in hospice cool rooms: practice guidelines for care after death

      Tatterton, Michael J.; Honour, A.; Billington, D.; Kirkby, L.; Lyon, J.A.; Lyon, N.; Gaskin, G. (2021)
      Children’s hospices provide a range of services for babies, children and young people who have life-shortening conditions, including care after death in specialist ‘cool bedrooms’. Caring for children after death is a challenging area of hospice care, with variation seen within, and between organisations. The study aims to identify current practices and to produce guidelines that promote safe practice in moving and handling and managing physiological deterioration of children after death. An electronic questionnaire was sent to all 54 British children’s hospices; 33 responded (=62% of hospices). Variation in the way in which children’s hospices delivered care after death was identified, in terms of the length of stay, care provision and equipment used, owing to demands of individual families and the experience and confidence of practitioners. Internal variation in practice can lead to practitioner anxiety, and risk-taking when providing care, particularly in the presence of family members. Practice recommendations have been made that reflect the practical demands of caring for a child’s body after death; these have been split into two parts: moving and handling considerations and managing physiological deterioration. These recommendations should be used to support the development of policy and practice, allowing organisations to standardise staff expectations and to support practitioners when caring for children after death.
    • Moving and handling children after death: an inductive thematic analysis of the factors that influence decision-making by children’s hospice staff

      Tatterton, Michael J.; Honour, A.; Kirby, L.; Billington, D. (Lippincott Wolters Kluwer, 2022-02)
      Hospices for children and adolescents in the United Kingdom provide care to the bodies of deceased children, in specially-designed chilled bedrooms called ‘cool rooms’. In an effort to develop resources to support hospice practitioners to provide this specialist area of care, the study aimed to identify the factors that influence decision-making when moving and handling children’s bodies after death in a hospice cool bedroom. An internet-based survey was sent to all practitioners employed by one children’s hospice. A total of 94.9% of eligible staff responded (n=56). An inductive approach to thematic analysis was undertaken, using a six-phase methodological framework. Three core themes were identified that inform practitioners’ perception of appropriateness of moving and handling decisions: care of the body, stages of care, and method of handling. The complexity of decision-making and variation in practice was identified. Practitioners relied on both analytical and initiative decision-making, with more experienced practitioners using an intuitive approach. Evidence-based policy and training influence the perception of appropriateness, and the decisions and behaviour of practitioners. The development of a policy and education framework would support practitioners in caring for children’s bodies after death, standardising expectations and measures of competence in relation to moving and handling tasks.
    • Moving towards culturally competent dementia care, Have we been barking up the wrong tree?

      Mackenzie, Jennifer; Bartlett, Ruth L.; Downs, Murna G. (2005)
      In the UK it is established that health and social care services for people with dementia from black and minority ethnic communities need to move towards providing evidence-based culturally appropriate care. At present, however, the evidence base available to guide professionals working with people with dementia from diverse ethnic and cultural groups is limited, and beliefs about dementia and the type of treatment and support needed have received little attention. Consequently this creates problems for service providers faced with appropriately supporting people with dementia and their families from black and minority ethnic communities.
    • Music-assisted systematic desensitization for the reduction of craving in response to drug-conditioned cues: A pilot study

      Stamou, Vasileios; Chatzoudi, T.; Stamou, L.; Romo, L.; Graziani, P. (2016-11)
      Recent research addressing the use of music to support the needs of people receiving treatment for drug addiction has led to the development and implementation of music-assisted therapeutic interventions. We hypothesized that two different music modalities combined with systematic desensitization can counter-condition drug-related cues and significantly reduce the associated craving responses. We further examined the effect of the two treatments on cognitive and psychopathological components of addiction. Twenty-four individuals experiencing drug addiction were randomly assigned to one of the three study groups, namely systematic desensitization (SD) combined with listening to New Age meditation music improvised live on Tibetan bowls (IMT), systematic desensitization combined with listening to relaxing New Age music recorded in individual MP3 devices (NIMT), or a control group that received no additional therapeutic intervention (CTR). Participants in the two treatment groups received six sessions in addition to their standard treatment during a period of three weeks. Evaluation took place at baseline, post-treatment and one month after the end of treatment. Results showed that IMT and NIMT combined with SD significantly reduced craving in response to external drug-conditioned cues, while IMT appeared to be slightly more effective than NIMT in altering permissive thoughts on drug and alcohol use, depression symptoms and everyday life craving reactivity. Further investigation as to the role of music-assisted systematic desensitization as a therapeutic intervention for drug addiction treatment is warranted.
    • Muslims and Community Cohesion in Bradford: Factors contributing to community cohesion, as it affects recently arrived migrants and established Muslim communities

      Samad, A. Yunas (2010)
      This study examined factors that either enhance or undermine community cohesion in areas with established Muslim communities and into which Muslim migrants have recently arrived. It explores ethnic and religious interaction; kinship and friendship networks; political and civic participation; community and people's feelings of belonging to Britain; and local policy-maker' and practitioners' views.
    • NAD(P)H:Quinone oxidoreductase-1 C609T polymorphism analysis in human superficial bladder cancers: relationship of genotype status to NQO1 phenotype and clinical response to Mitomycin C.

      Basu, Saurajyoti; Brown, John E.; Flannigan, G. Michael; Gill, Jason H.; Loadman, Paul M.; Martin, Sandie W.; Naylor, Brian; Puri, Rajiv; Scally, Andy J.; Seargent, Jill M.; et al. (2004)
      NAD(P)H:Quinone oxidoreductase-1 (NQO1) has been implicated in the bioreductive activation of the clinically active anticancer drug Mitomycin C (MMC) and a polymorphic variant of NQO1 which lacks functional enzyme activity (NQO1*2) has been linked with poor survival in patients treated with MMC. The relationship between NQO1 activity and cellular response to MMC is however controversial and the aim of this study was to determine whether the response of bladder cancer patients to MMC can be forecast on the basis of NQO1*2 genotype status. Genomic DNA was extracted from formalin-fixed, paraffin-embedded tissue from 148 patients with low to intermediate grade (G1/G2) superficial (Ta/T1) bladder cancers and NQO1*2 genotype status determined by PCR-RFLP. NQO1*2 genotype status was retrospectively compared with clinical response to intravesical administered MMC with the primary end-point being time to first recurrence. NQO1 phenotype was determined by immunohistochemistry. Of the 148 patients genotyped, 85 (57.4%) were NQO1*1 (wild-type), 59 (39.8%) were NQO1*1/*2 (heterozygotes) and 4 (2.7%) were NQO1*2/*2. No NQO1 protein expression was detected in NQO1*2/*2 tumours. A broad spectrum of NQO1 protein expression existed in tumours genotyped as NQO1*1 and NQO1*1/*2 although tumours with NQO1*1 typically expressed higher NQO1 protein. A poor correlation existed between NQO1*2 genotype status and clinical response to MMC. The results of this retrospective study suggest that tailoring MMC therapy to individual patients with superficial bladder cancer on the basis of NQO1 genotype status is unlikely to be of clinical benefit.
    • The National Early Warning Score and its subcomponents recorded within ±24 hours of emergency medical admission are poor predictors of hospital-acquired acute kidney injury

      Faisal, Muhammad; Scally, Andy J.; Elgaali, M.A.; Richardson, D.; Beatson, K.; Mohammed, Mohammed A. (2018-02-01)
      Background: Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. Aim: To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. We report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity.
    • The Nature of Contemporary Dying: Obsessions, Distortions, Challenges

      Kellehear, Allan (2016)
      This article makes critical observations about the popular examination of dying and its care, identifies the key challenges to modern dying, and argues for a public health approach to end-of life care. Only by adopting a global and non-clinical perspective on the human experience of dying can we address people’s concerns where these arise—in their own homes and workplaces—and to offer alternatives to the more radical choices offered by modern medicine.
    • Near-peer teaching and exam results: the acceptability, impact, and assessment outcomes of a novel biological sciences revision programme taught by senior medical students

      Mann, J.; Protty, M.B.; Duffy, J.; Mohammed, Mohammed A.; Wiskin, C. (2014)
      Near-peer teaching is becoming increasingly popular as a learning methodology. We report the development of a novel near-peer biological sciences revision course and its acceptability and impact on student confidence and exam performance. A cross-sectional analysis of tutee-completed evaluation forms before and after each session was performed, providing demographic details, quality scores, and self-rating of confidence in the topic taught on a 0 to 100 mm visual analogue scale (VAS). The confidence data was examined using analysis of means. Exam performance was examined by analysis of variance and canonical correlation analysis. Thirty-eight sessions were delivered to an average of 69.9 (±27.1) years 1 and 2 medical students per session generating 2656 adequately completed forms. There was a mean VAS gain of 19.1 (5.3 to 27.3) in self-reported confidence. Looking at relationship between attendance and exam scores, only two topics showed significant association between number of sessions attended and exam performance, fewer than hypothesised. The present study demonstrates that near-peer teaching for biological sciences is feasible and is associated with improved self-reported confidence in the sessions taught. The outcome data, showing significant effect for only a small number of items, demonstrates the difficulty of outcome related research.
    • A necessary change: the transfer of care from hospital to community.

      McIntosh, Bryan (2012)
      The National Health Service (NHS) in England must improve productivity by 6% per annum if projected savings of £21 billion are to be attained by 2014, while simultaneously improving or at least maintaining the quality of care (Department of Health (DH), 2009; 2010a). Given that staff costs represent 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforce will need to be changed to meet these targets. In the Department of Health's draft Structural Reform Plan (2010b), the emphasis is on shifting resources to promote better healthcare outcomes, to which end a review of working practices and role relationship must take place, with increased delivery of services by community nurses.
    • The need for excellence centres in clinical imaging

      McIntosh, Bryan; Bishop, C. (2016-03)
    • The need to “carer proof” healthcare decisions

      Al-Janabi, H.; Nicholls, J.; Oyebode, Jan R. (2016-03-24)
      Population ageing and fiscal austerity are set to increase the reliance on family carers, who already provide much of the support for people with long term health conditions. Although most carers are willing, providing care can be hugely stressful, affecting mental and physical health1 and resulting in social isolation and financial hardship.2 When under strain, carers are less likely to be effective, increasing the risk that the care recipient is admitted to hospital or a care home.3 Health systems could reduce strain on family carers by routinely considering carers’ needs alongside patients’ needs in everyday healthcare decisions—a concept we term “carer proofing”.
    • A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia

      De Poli, C.; Oyebode, Jan R.; Airoldi, M.; Glover, R. (2020-07)
      BACKGROUND: Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction. METHODS: Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories. RESULTS: The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users' resistance to offers, users' appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need. CONCLUSION: The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements.
    • A needs-led framework for understanding the impact of caring for a family member with dementia

      Pini, S.; Ingleson, E.; Megson, M.; Clare, L.; Wrigth, P.; Oyebode, Jan R. (2018-03-19)
      Approximately half the care for people with dementia is provided by families. It is therefore imperative that research informs ways of maintaining such care. In this study we propose that a needs-led approach can provide a useful, novel means of conceptualising the impact of caring on the lives of family carers. Our aim was to develop and present a needs-led framework for understanding how providing care impacts on carers’ fulfilment of needs. In this qualitative study we conducted 42 semi-structured interviews with a purposively diverse sample of family carers to generate nuanced contextualised accounts of how caring impacted on carers’ lives. Our inductive thematic analysis focused upon asking: ‘What need is being impacted here?’ in order to generate a needs-led framework for understanding. In this qualitative study we conducted 42 semi-structured interviews with a purposively diverse sample of family carers to generate nuanced contextualised accounts of how caring impacted on carers’ lives. Our inductive thematic analysis focused upon asking: ‘What need is being impacted here?’ in order to generate a needs-led framework for understanding. Nine themes were widely endorsed. Each completed the sentence: “Being a carer impacts on fulfilling my need to/for….”: Freedom; feel close to my relative; feel in control of my life; be my own person; protect my relative; share/express my thoughts and feelings; take care of myself; feel connected to the people around me; get things done. These needs echo those from other research areas, with relational needs emerging as particularly central. The needs-led approach offers a perspective that is able to capture both stresses and positives aspects of caregiving. We recommend that clinical interviewing using Socratic questioning to discover human needs that are being impacted by caring would provide a valuable starting point for care planning.
    • Negotiating identity and alterity: Cultural competence, colonization and cultural voyeurism in students’ work-based learning

      Hart, Andrew; Montague, Jane (2015-10-23)
      There is increasing demand for work-based learning experiences to form part of undergraduate degrees concerned with working with people. Social justice and anti-oppressive practice underpin the philosophies of many such degrees which attract students with the promise of working within diverse communities and with the marginalized and vulnerable. Benefits to students include the development of a professional identity, an anti-oppressive approach and culturally competent practices. Despite this, critical approaches to work-based learning highlight ways in which the student can be colonized by dominant values via ‘cultural voyeurism’. This can lead to power inequalities being replicated and perpetuated by the student rather than challenged. The roles of identity and alterity in these learning processes are examined and the concept of professional identity is questioned. The article concludes that the tasks of negotiating identity and alterity are characterized by uncertainty and unfinalizability, and that the notion of cultural competence is itself problematic.
    • A new hope: Public social partnerships

      McIntosh, Bryan; West, Sue (2016-11)
    • New techniques for wound debridement

      Madhok, B.M.; Vowden, Kath; Vowden, Peter (2013)
      Debridement is a crucial component of wound management. Traditionally, several types of wound debridement techniques have been used in clinical practice such as autolytic, enzymatic, biodebridement, mechanical, conservative sharp and surgical. Various factors determine the method of choice for debridement for a particular wound such as suitability to the patient, the type of wound, its anatomical location and the extent of debridement required. Recently developed products are beginning to challenge traditional techniques that are currently used in wound bed preparation. The purpose of this review was to critically evaluate the current evidence behind the use of these newer techniques in clinical practice. There is some evidence to suggest that low frequency ultrasound therapy may improve healing rates in patients with venous ulcers and diabetic foot ulcers. Hydrosurgery debridement is quick and precise, but the current evidence is limited and further studies are underway. Debridement using a monofilament polyester fibre pad and plasma-mediated bipolar radiofrequency ablation are both very new techniques. The initial evidence is limited, and further studies are warranted to confirm their role in management of chronic wounds.
    • A new tomorrow: cancer and pain management

      Fascia, M.; McIntosh, Bryan (2014)