• A pilot randomised controlled trial of a Telehealth intervention in patients with chronic obstructive pulmonary disease: challenges of clinician-led data collection

      Bentley, C.L.; Mountain, Gail; Thompson, J.; Fitzsimmons, D.A.; Lowrie, K.; Parker, S.G.; Hawley, M.S. (2014-08-06)
      Background: The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a pilot randomised controlled trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. Methods: A two-arm pragmatic pilot RCT was conducted comparing the standard service with a Telehealth-supported service and assessed the potential for progressing into a full RCT. The co-primary outcome measures were the proportion of COPD patients readmitted to hospital and changes in patients’ self-reported quality of life. The objectives were to assess the suitability of the methodology, produce a sample size calculation for a full RCT, and to give an indication of cost-effectiveness for both pathways. Results: Sixty three participants were recruited (n = 31 Standard; n = 32 Telehealth); 15 participants were excluded from analysis due to inadequate data completion or withdrawal from the Telehealth arm. Recruitment was slow with significant gaps in data collection, due predominantly to an unanticipated 60% reduction of staff capacity within the clinical team. The sample size calculation was guided by estimates of clinically important effects and COPD readmission rates derived from the literature. Descriptive analyses showed that the standard service group had a lower proportion of patients with hospital readmissions and a greater increase in self-reported quality of life compared to the Telehealth-supported group. Telehealth was cost-effective only if hospital admissions data were excluded. Conclusions: Slow recruitment rates and service reconfigurations prevented progression to a full RCT. Although there are advantages to conducting an RCT with data collection conducted by a frontline clinical team, in this case, challenges arose when resources within the team were reduced by external events. Gaps in data collection were resolved by recruiting a research nurse. This study reinforces previous findings regarding the difficulty of undertaking evaluation of complex interventions, and provides recommendations for the introduction and evaluation of complex interventions within clinical settings, such as prioritisation of research within the clinical remit.
    • Place memory and dementia: Findings from participatory film-making in long-term social care

      Capstick, Andrea; Ludwin, Katherine (2015)
      A participatory film-making study carried out in long-term social care with 10 people with Alzheimer-type dementia found that places the participants had known early in life were spontaneously foregrounded. Participants’ memories of such places were well-preserved, particularly when photo-elicitation techniques, using visual images as prompts, were employed. Consistent with previous work on the ‘reminiscence bump’ in dementia, the foregrounded memories belonged in all cases to the period of life between approximately 5 and 30 years. Frequently the remembered places were connected with major life events which continued to have a strong emotional component. The continuing significance of place in the context of long-term dementia care is considered from a psychogeographical perspective.
    • Places in the heart: nostalgia, psychogeography and late-life dementia.

      Capstick, Andrea (2010)
      It's all long gone now...they've closed the shop on the corner of Athlone Street...it was a rough one with a pub on the corner...my dad ran it a long time ago...that time... Within the dominant biomedical discourse, late-life dementia is regarded as a pathological condition characterised by disorientation in time and space, word finding difficulties and 'problem behaviours' such as 'wandering' and 'repetitive questioning'. Once taken out of its biomedical straightjacket, however, dementia emerges as a condition which has much in common with the conscious projects of surrealist and situationist arts movements. This includes the subversion of the idea of time (and history) as linear, unidirectional progress. People diagnosed with dementia frequently state a desire to return (or indeed a fear of returning) to places from the past which no longer exist in physical space, but which remain real as remembered worlds and sources of nostalgia (literally 'the pain of returning'). These are also issues central to the field of psychogeography - an interdisciplinary approach to exploring the emotional and sensory impact of specific, particularly urban, locations. Informed by the work of poets such as Blake, Baudelaire, and Rimbaud, as theorised by, for example, Walter Benjamin and Guy Debord, psychogeography privileges undirected 'wandering' through its emphasis on concepts such as the flaneur, and the dérive (or 'drift'). In this paper, such concepts will be used as a way of exploring the spatio-temporal experiences of people with dementia, using extracts from film and narrative life stories.
    • The Placing Test: Preliminary investigations of a quick and simple memory test designed to be sensitive to pre-dementia Alzheimer's disease but not normal ageing

      Anderson, Elizabeth J. (formerly Milwain); De Jager, C.; Iversen, S. (2006)
      The medial temporal lobe (MTL) memory system is damaged early in Alzheimer's disease. Cognitive tests designed to help diagnose the disease must detect dysfunction in this system, but must also be insensitive to the cognitive slowing that characterizes normal ageing. On the assumption that the MTL system forms new memories by binding together the many informational aspects of events into units, The Placing Test was designed to index this function by measuring the ability to remember associations between faces and their locations. The influence of normal ageing was minimized by using procedures that compensate for the difficulties in learning and retrieval caused by the cognitive slowing of normal ageing. In two experiments The Placing Test was administered as part of a battery of neuropsychological tests to a group of healthy older people. In both studies, performance in The Placing Test correlated significantly with other measures of memory, but had weaker associations than standard memory measures with other types of cognitive function. The Placing Test appeared not to be biased by age, education or gender, although a larger sample is needed to verify this. A final study examined the performance of 16 patients with suspected Alzheimer's disease. These patients showed clear impairment in The Placing Test, with 81% scoring below the 5th percentile, despite the majority having normal MMSE scores. It is concluded that The Placing Test provides a quick, simple and sensitive measure of memory that has potential to be useful in routine diagnostic investigations for Alzheimer's disease.
    • Point of care creatinine testing in diagnostic imaging: a feasibility study within the outpatient computed tomography setting

      Snaith, Beverly; Harris, M.A.; Shinkins, B.; Messenger, M.; Lewington, A.; Jordaan, M.; Spencer, N. (2019-03)
      Introduction: Although the risks associated with iodinated contrast administration are acknowledged to be very low, screening of kidney function prior to administration is still standard practice in many hospitals. This study has evaluated the feasibility of implementing a screening form in conjunction with point of care (PoC) creatinine testing as a method to manage the risks of post contrast acute kidney injury (PC-AKI) within the CT imaging pathway. Method: Over an eight-week period 300 adult outpatients attending a UK CT department for contrast-enhanced scans were approached. Participants completed a screening questionnaire for co-morbidities linked to kidney dysfunction and consented to have a PoC and laboratory creatinine tests. Comparison was made against with previous baseline blood tests obtained within the preceding 3 months, as required by the study site. Participants were also invited to attend for follow up PoC and laboratory bloods tests at 48–72 h. Results: 14 patients (4.7%) had a scan-day eGFR below 45mL/min/1.73m2, all identified through screening. The majority of patients (n=281/300; 93.7%) fell in the same risk category based on previous and scan-day blood results. Six PoC test failures were recorded on the scan day. The constant error between the Abbott i-STAT PoC scan-day measurements and the laboratory scan-day measurements was -3.71 (95% CI: -6.41 to -0.50). Five patients had an elevated creatinine (≥25% from baseline) post contrast administration, but no instances of PC-AKI (≥50% from baseline) were identified. Conclusion: PoC creatinine testing is a practical method of ensuring renal function and is feasible in the radiology environment.
    • Point-of-care creatinine testing for kidney function measurement prior to contrast-enhanced diagnostic imaging: evaluation of the performance of three systems for clinical utility

      Snaith, Beverly; Harris, Martine A.; Shinkins, B.; Jordaan, M.; Messenger, M.; Lewington, A. (2018)
      Acute kidney injury (AKI) can occur rarely in patients exposed to iodinated contrast and result in contrast-induced AKI (CI-AKI). A key risk factor is the presence of pre-existing chronic kidney disease (CKD), therefore it is important to assess patient risk and obtain kidney function measurement prior to administration. Point of care (PoC) testing provides an alternative strategy but there remains uncertainty, with respect to diagnostic accuracy and clinical utility. A device study compared three PoC analysers (Nova StatSensor, Abbott i-STAT, Radiometer ABL800 FLEX) with a reference laboratory standard (Roche Cobas 8000 series, enzymatic creatinine). Three hundred adult patients attending a UK hospital phlebotomy department were recruited to have additional blood samples for analysis on the PoC devices. The ABL800 FLEX had the strongest concordance with laboratory measured serum creatinine (mean bias=-0.86, 95% limits of agreement = -9.6 to 7.9) followed by the i-STAT (average bias=3.88, 95% limits of agreement = -8.8 to 16.6) and StatSensor (average bias=3.56, 95% limits of agreement = -27.7 to 34.8). In risk classification, the ABL800 FLEX and i-STAT identified all patients with an eGFR≤30, whereas the StatSensor resulted in a small number of missed high-risk cases (n=4/13) and also operated outside of the established performance goals. The screening of patients at risk of CI-AKI may be feasible with PoC technology. However in this study it was identified that the analyser concordance with the laboratory reference varies. It is proposed that further research exploring PoC implementation in imaging department pathways is needed.
    • Point-of-care lactate measurement for suspected sepsis in the prehospital environment: are we missing the point at the sharp end?

      Lightowler, Bryan (Mark Allen Group, 2020-04-02)
      Expecting ambulance clinicians to dependably differentiate the life-threatening organ dysfunction caused by sepsis from an inflammatory response to a non-infectious aetiology, relying upon vital signs and a physical examination of the patient alone, must be considered unrealistic. Although lactate measurement has been integrated into numerous prehospital sepsis screening tools, it is not yet measured routinely within UK ambulance services. Research has generally focused on whether handheld point-of-care lactate measurement devices are as accurate as laboratory analysis of venous or arterial samples. The weight of literature has concluded negatively in relation to this. However, there is potential for handheld devices to be used independently to monitor trends in lactate elimination or accumulation to inform decisions on the efficacy of prehospital interventions, or simply to report categorical data in terms of whether lactate levels are elevated or not. This offers UK paramedics the opportunity to improve sepsis care through the enhanced assessment of risk and acuity, the identification of patients with cryptic shock, more aggressive fluid resuscitation and advanced notification to receiving units.
    • Policy and practice change at local, regional and international levels: impacts from Born in Bradford

      Small, Neil A. (2015-10)
      Born in Bradford is a prospective pregnancy and birth cohort in the UKs 6th largest city. Between 2007 and 2011 12,453 women (13,776 pregnancies), 3,448 of their partners and 13,818 babies were recruited. Half of families are in the poorest fifth of deprivation for England and Wales, and 45% are of Pakistani origin. Recruitment was in one Metropolitan District. This allows consideration of the impact of local circumstances, including service provision and policy choices, and engagement with the local community to implement evidence based responses to study findings. The introduction of a large study into a local health economy contributed to organizational changes including the development of a paperless maternity data system and better links between primary, secondary, and child health services. Embedding research in practice can lead to improved quality of routine data collected, for example on infant growth, and make routine data available for research, enhancing its cost effectiveness. Early adoption of research findings locally includes the introduction of routine vitamin D supplementation and an oral glucose tolerance test for all pregnant women. Findings that consanguinity was associated with a doubling of risk for congenital anomaly and that 30% of all anomalies in children of Pakistani origin could be attributed to consanguinity reinforced local commitment to community education about genetics and targeted genetic counselling. These findings also led to the establishment of a regional congenital anomalies register. In partnership with the European ESCAPE consortium (14 cohorts in 12 countries) a significant association was found between fetal growth and air pollution. The European Environmental Agency Director stated that this evidence is sufficient to trigger changes in EU regulations. Some findings can be quickly embedded in local provision, some have a resonance that prompts regional changes, some are generated with collaborators and can lead to policy change at international level.
    • Positive Action in the United Kingdom.

      Archibong, Uduak E.; Ashraf, Fahmida (2010)
    • Positive Action Measures Across Different Equality Grounds, Organisations and Sectors in European and Non-european Countries

      Archibong, Uduak E.; Scally, Andy J.; Eferakorho, Jite; Darr, Aliya; Atkin, K.; Baxter, C.; Bell, M.; Waddington, L.; Wladasch, K.; Bedard, T.; et al. (2010)
      Abstract: This article is based on a large-scale European Commission project on international perspectives on positive action measures. The paper presents an analysis of the perceptions of positive action held by respondents from all the countries participating in an international survey, focussing specifically upon differences across equality grounds, sector and organisation type. This paper will also provide examples of positive action being applied in European and non-European countries that participated in the study. The study adopted extensive literate and online survey to obtain data from designers of positive action. Findings are discussed, conclusions drawn and wide-ranging recommendations are made at the European Commission, individual countries and organisational levels.
    • Positive birth experiences: a systematic review of the lived experience from a birthing person’s perspective

      Hill, E.; Firth, Amanda (2018-03)
      Background: Positive birth (PB) experiences assist with successful transition into parenthood and psychological growth. Identifying contributing factors, which assist in the achievement of such experiences, could inform birth workers and maternity service providers and improve experiences for future parents. Objective: To undertake a systematic review of factors which the birthing person perceived as contributing to their PB experience. Search strategy: Six databases were searched with English language restriction. Grey literature sources and relevant journal content were searched. Main results: Sixty-eight participants were included from studies conducted in Norway, Sweden, the United States (US) and the United Kingdom (UK). The major themes of the thematic synthesis were: strength through preparation; a positive mental attitude; feeling safe and connected through autonomy; the presence of others; and fond memories that were formulated. Findings informed birth workers that their authentic presence is valued by birthing people, and that a person’s or provider’s birthing culture impacts on a person’s perception of their birth experiences. In order to experience PB, maternity services should support individualised care. Conclusions: A PB experience matters to families, and enables self-esteem and confidence to be felt as a new parent. The unique individualised care and authentic presence of the birth workers provided strength, reassurance and encouragement during the birth process.
    • Postacute Care for Older People in Community Hospitals: A Multicentre Randomised, Controlled Trial

      Young, J.; Green, J.R.; Forster, A.; Small, Neil A.; Lowson, K.; Bogle, S.; George, J.; Heseltine, D.; Jayasuriya, T.; Rowe, J. (2007)
      OBJECTIVES: To compare the effects of community hospital care on independence for older people needing rehabilitation with that of general hospital care. DESIGN: Randomized, controlled trial. SETTING: Seven community hospitals and five general hospitals in the midlands and north of England. PARTICIPANTS: Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness. INTERVENTION: Multidisciplinary team care for older people in community hospitals. MEASUREMENTS: The primary outcome was the Nottingham extended activities of daily living scale (NEADL); secondary outcomes were the Barthel Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale, mortality, discharge destination, 6-month residence status, and satisfaction with services. RESULTS: Loss of independence at 6 months was significantly less likely in the community hospital group (mean adjusted NEADL change score group difference 3.27; 95% confidence interval 0.26–6.28; P=.03). The results for the secondary outcome measures were similar for the two groups. CONCLUSION: Postacute community hospital rehabilitation care for older people is associated with greater independence.
    • Posterolateral corner injuries of the knee: a serious injury commonly missed

      Pacheco, R.J.; Ayre, Colin A.; Bollen, S.R. (2011)
      We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury. Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.
    • Postural stability changes in the elderly during sensory perturbations and dual tasking: the influence of refractive blur

      Anand, Vijay; Buckley, John G.; Scally, Andy J.; Elliott, David B. (2003)
      PURPOSE. To determine the influence of refractive blur on postural stability during somatosensory and vestibular system perturbation and dual tasking. METHODS. Fifteen healthy, elderly subjects (mean age, 71 ± 5 years), who had no history of falls and had normal vision, were recruited. Postural stability during standing was assessed using a force platform, and was determined as the root mean square (RMS) of the center of pressure (COP) signal in the anterior-posterior (A-P) and medial-lateral directions collected over a 30-second period. Data were collected under normal standing conditions and with somatosensory and vestibular system perturbations. Measurements were repeated with an additional physical and/or cognitive task. Postural stability was measured under conditions of binocular refractive blur of 0, 1, 2, 4, and 8 D and with eyes closed. The data were analyzed with a population-averaged linear model. RESULTS. The greatest increases in postural instability were due to disruptions of the somatosensory and vestibular systems. Increasing refractive blur caused increasing postural instability, and its effect was greater when the input from the other sensory systems was disrupted. Performing an additional cognitive and physical task increased A-P RMS COP further. All these detrimental effects on postural stability were cumulative. CONCLUSIONS. The findings highlight the multifactorial nature of postural stability and indicate why the elderly, many of whom have poor vision and musculoskeletal and central nervous system degeneration, are at greater risk of falling. The findings also highlight that standing instability in both normal and perturbed conditions was significantly increased with refractive blur. Correcting visual impairment caused by uncorrected refractive error could be a useful intervention strategy to help prevent falls and fall-related injuries in the elderly.
    • Postural Stability Changes in the Elderly with Cataract Simulation and Refractive Blur

      Anand, Vijay; Buckley, John G.; Scally, Andy J.; Elliott, David B. (2003)
      PURPOSE. To determine the influence of cataractous and refractive blur on postural stability and limb-load asymmetry (LLA) and to establish how postural stability changes with the spatial frequency and contrast of the visual stimulus. METHODS. Thirteen elderly subjects (mean age, 70.76 ± 4.14 [SD] years) with no history of falls and normal vision were recruited. Postural stability was determined as the root mean square [RMS] of the center of pressure (COP) signal in the anterior¿posterior (A-P) and medial¿lateral directions and LLA was determined as the ratio of the average body weight placed on the more-loaded limb to the less-loaded limb, recorded during a 30-second period. Data were collected under normal standing conditions and with somatosensory system input disrupted. Measurements were repeated with four visual targets with high (8 cyc/deg) or low (2 cyc/deg) spatial frequency and high (Weber contrast, ¿95%) or low (Weber contrast, ¿25%) contrast. Postural stability was measured under conditions of binocular refractive blur of 0, 1, 2, 4, and 8 D and with cataract simulation. The data were analyzed in a population-averaged linear model. RESULTS. The cataract simulation caused significant increases in postural instability equivalent to that caused by 8-D blur conditions, and its effect was greater when the input from the somatosensory system was disrupted. High spatial frequency targets increased postural instability. Refractive blur, cataract simulation, or eye closure had no effect on LLA. CONCLUSIONS. Findings indicate that cataractous and refractive blur increase postural instability, and show why the elderly, many of whom have poor vision along with musculoskeletal and central nervous system degeneration, are at greater risk of falling. Findings also highlight that changes in contrast sensitivity rather than resolution changes are responsible for increasing postural instability. Providing low spatial frequency information in certain environments may be useful in maintaining postural stability. Correcting visual impairment caused by uncorrected refractive error and cataracts could be a useful intervention strategy to help prevent falls and fall-related injuries in the elderly.
    • The potential role of the occupational therapist in acute psychiatric services: A comparative evaluation

      Fitzgerald, Martin (2016)
      Aims and background: This analysis paper describes a comparative evaluation of service deliverables within the Service Level Agreements (SLA) of two acute psychiatric services; one inclusive and the other exclusive of occupational therapy. Methods: Six SLA agreements provided the standards by which the two services were evaluated. The SLAs were evaluated because they are used by the service managers and commissioners to measure performance and clinical effectiveness. The role of the occupational therapists and their contribution to the planning and delivery of the performance indicators is also considered. An evaluation framework was applied to explore the potential role occupational therapy may have had in any performance difference between the two sites. In doing so it is hoped to provide some evidence to support and inform occupational therapists and service managers on the role and of occupational therapy in acute mental health services. This comparative evaluation followed the first three of the five audit stages: 1. Preparing for audit; 2. Selecting criteria; and 3. Measuring performance level. Findings: The service with occupational therapy performed better on home leave day use, ward occupancy and less than 3-day admissions. Conclusions: By delivering their key roles of individual assessment, therapeutic groups, individual treatment and discharge planning occupational therapist were able to contribute to the overall efficiency of service delivery. These findings support the role of the occupational therapist in an acute psychiatric setting and provide guidance for managers on how to utilise occupational therapy in the delivery of service outcomes.
    • Potential social, economic and general health benefits of consanguineous marriage: results from the Born in Bradford cohort study

      Bhopal, R.S.; Petherick, E.S.; Wright, J.; Small, Neil A. (2014)
      BACKGROUND: More than 1 billion people live in societies where consanguineous marriages are common. When children are born to consanguineous unions, there is an increased probability of the expression of single-gene disorders with a recessive mode of inheritance. There are presumptive social benefits of consanguineous marriages reported in the literature. METHODS: The UK's Born in Bradford birth cohort study recruited 12 453 women at 26-28 weeks' gestation between 2007 and 2010. In all, 11 396 completed a questionnaire, including questions about their relationship to their baby's father. We compared Pakistani and Other ethnic groups in consanguineous relationships and Pakistani, Other and White British groups not in consanguineous relationships, calculating percentages and age-adjusted prevalence ratios (95% confidence intervals). RESULTS: In the Pakistani group, 59.3% of women (n = 3038) were blood relatives of their baby's father. Consanguinity was uncommon in the Other ethnic group (7.3%, n = 127) and rare (n = 5) in the White British group. Compared with non-consanguineous counterparts, mothers in consanguineous relationships were socially and economically disadvantaged (e.g. never employed, less likely to have higher education). The Pakistani consanguineous group's social, economic and health lifestyle circumstances were equivalent to, in some cases better than, women in non-consanguineous relationships (e.g. up-to-date in paying bills, or in disagreeing that they wished for more warmth in their marital relationship). The consanguineous relationship group had less separation/divorce. Rates of cigarette smoking during pregnancy were lower in mothers in consanguineous relationships. CONCLUSION: Debate about consanguinity should balance the potential protective effect of consanguineous relationships with established genetic risk of congenital anomaly in children.
    • The Power of Belief? Review of the Evidence on Religion or Belief and Equalities in Great Britain.

      Macey, Marie; Carling, Alan; Furness, Sheila M. (University of Bradford, 2009)
      A new legal framework has been developed in Great Britain over the last ten years which protects individuals against unfair treatment on the grounds of their religion or belief. This framework regards all the major faith groups, secular belief systems (such as Humanism or Atheism), and non-belief on formally equal terms. There has also been a rapid growth of research interest in religion/belief in contemporary scholarship on equalities. This report provides a critical overview of this extensive research base relating mainly to England, Scotland and Wales up until 2008.