• Radiology responsibilities post NPSA guidelines for nasogastric tube insertion: A single centre review

      Snaith, Beverly; Flintham, K. (2015-02)
      There are well-recognised complications associated with malposition of nasogastric (NG) tubes. In 2011 the UK National Patient Safety Agency (NPSA) published an alert regarding their insertion and position confirmation. This alert also identified the expected radiology standards for both image acquisition and reporting. This was a retrospective review of referrals over a six-month period within a multi-site NHS Trust. A consecutive sampling approach was used and radiology reports where the text included the terms “NG tube”, “nasogastric” or “feeding” were included. Data were collected from the radiology information system and NG tube visibility and image quality were confirmed by two independent reviewers. 1137 examinations demonstrated an NG tube, of which 68.3% were performed to check tube position. There was statistically significant correlation between lower radiation exposure and non-visualisation (Fishers exact test, p < 0.001). The number of examinations with higher exposure index (EI) in the NG check cohort suggests that the radiographer increased the exposure to improve visualization (x2 = 2.846; 95% CI; p = 0.046), although the utility of this is unproven. Malplaced tubes were demonstrated either in the respiratory tract (1.8%) or proximal gastrointestinal tract (8.6%) as a result of insufficient length introduced. The prompt acquisition and reporting of radiographs is essential to reduce the risk of NG tube complications. Respiratory tract misplacement rates were in line with the published literature, but this study does raise concern regarding the number of tubes located in the proximal GI tract. Radiology's responsibility in accurate and effective reporting of medical interventions is significant.
    • A randomized controlled trial of a specialist liaison worker model for young people with intellectual disabilities with challenging behaviour and mental health needs.

      Raghavan, R.; Newell, Robert J.; Waseem, F.; Small, Neil A. (01/05/2009)
      Background Twenty six young people with intellectual disabilities and mental health needs from Pakistani and Bangladeshi communities were recruited as part of a bigger study to examine the effectiveness of a liaison worker in helping young people and their families access appropriate intellectual disabilities and mental health services. Method Twelve young people were randomly allocated to the treatment group, which had the help of the liaison worker, and 14 young people were allocated to the control group without the help of a liaison worker. Baseline measures were undertaken with all the young people and their carers. This was followed by a 9-month trial, consisting of the liaison worker helping the treatment group to get in touch with and take up appropriate services, mainly in the areas of psychiatric appointments, benefits advice, house adaptations, leisure facilities and support and care for the young person. The control group participants did not have the access to the liaison worker and were accessing services using the normal routine. Assessments were carried out posttreatment to assess whether the use of a liaison worker had had any effect on outcomes for the two groups. Results Twelve young people completed the study in the treatment group and 14 in the control group. Participants allocated to the specialist liaison worker had statistically significantly more frequent contact with services and with more outcomes, than the control group, and significantly lower scores on the Strengths and Difficulties Questionnaire (SDQ). Conclusion The use of specialist liaison services in ensuring adequate access to services for young people with learning disabilities and mental health needs from the South Asian community proved to be significant and effective compared with young people and their families accessing services on their own.
    • Re-Walking the City: People with Dementia Remember.

      Capstick, Andrea; Chatwin, John (2012)
      In recent years walking interviews have emerged as a valuable alternative to the standard research interview, particularly in studies related to place, community, and the urban environment (Clark and Emmel 2010). Although there is little literature on the use of walking interviews with people who have dementia, the method is particularly appropriate for this participant group, due to the strong memories for place and past events that are usually retained by people with dementia, even when short term memory deteriorates (Chaudhury 2008). Narrative biography work with people who have dementia shows a repeated tendency to use geographical markers as ¿signposts¿ to particular memories (Bryce et al 2010). In 2010 the authors piloted the use of walking interviews with three people with dementia within a care home environment. The film record of the process suggests that the combination of physical movement and reminiscence which was involved both facilitated and enhanced communication for people with dementia. These findings led to the present work which is based on walking interviews with people who have dementia in places which have particular meaning for them, such as the street where they grew up; the school they attended; a former workplace; public park; sports ground or other familiar space. The oral presentation will include film clips, contrasting ¿static¿ communication with each participant, with his or her verbal production, or non-verbal communication, in response to environmental prompts and recovered sights and sounds. In addition, we will draw on the film data to explore a series of thought-provoking questions related to changing inner and outer landscapes, the vagaries of memory, and the psychogeography of dementia. Can the frequently pathologised ¿wandering¿ of people with dementia in time and space be rehabilitated using situationist concepts such as the dérive and the flaneur?
    • Re-Walking the City: People with Dementia Remember.

      Capstick, Andrea (2015)
      Within the dominant biomedical discourse, late-life dementia is regarded as a pathological condition characterised by short-term memory loss, word finding difficulties and ‘problem behaviours’ such as ‘wandering and ‘repetitive questioning’. As its title suggests, one of the main purposes of this chapter is to shift the focus from what people with late-life dementia forget to what they remember, particularly as this relates to places they have known much earlier in life. A central part of my argument is that dementia, often somewhat crudely represented as wholesale memory loss, might better be regarded as a form of spatio-temporal disruption; a disruption which intersects with the theoretical territory of psychogeography.
    • A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

      Randell, Rebecca; Honey, S.; Hindmarsh, J.; Alvarado, Natasha; Greenhalgh, J.; Pearman, A.; Long, A.; Cope, A.; Gill, A.; Gardner, Peter H.; et al. (2017-06)
      Background: The implementation of robot-assisted surgery (RAS) can be challenging, with reports of surgical robots being underused. This raises questions about differences compared with open and laparoscopic surgery and how best to integrate RAS into practice. Objectives: To (1) contribute to reporting of the ROLARR (RObotic versus LAparoscopic Resection for Rectal cancer) trial, by investigating how variations in the implementation of RAS and the context impact outcomes; (2) produce guidance on factors likely to facilitate successful implementation; (3) produce guidance on how to ensure effective teamwork; and (4) provide data to inform the development of tools for RAS. Design: Realist process evaluation alongside ROLARR. Phase 1 – a literature review identified theories concerning how RAS becomes embedded into practice and impacts on teamwork and decision-making. These were refined through interviews across nine NHS trusts with theatre teams. Phase 2 – a multisite case study was conducted across four trusts to test the theories. Data were collected using observation, video recording, interviews and questionnaires. Phase 3 – interviews were conducted in other surgical disciplines to assess the generalisability of the findings. Findings: The introduction of RAS is surgeon led but dependent on support at multiple levels. There is significant variation in the training provided to theatre teams. Contextual factors supporting the integration of RAS include the provision of whole-team training, the presence of handpicked dedicated teams and the availability of suitably sized operating theatres. RAS introduces challenges for teamwork that can impact operation duration, but, over time, teams develop strategies to overcome these challenges. Working with an experienced assistant supports teamwork, but experience of the procedure is insufficient for competence in RAS and experienced scrub practitioners are important in supporting inexperienced assistants. RAS can result in reduced distraction and increased concentration for the surgeon when he or she is supported by an experienced assistant or scrub practitioner. Conclusions: Our research suggests a need to pay greater attention to the training and skill mix of the team. To support effective teamwork, our research suggests that it is beneficial for surgeons to (1) encourage the team to communicate actions and concerns; (2) alert the attention of the assistant before issuing a request; and (3) acknowledge the scrub practitioner’s role in supporting inexperienced assistants. It is beneficial for the team to provide oral responses to the surgeon’s requests. Limitations: This study started after the trial, limiting impact on analysis of the trial. The small number of operations observed may mean that less frequent impacts of RAS were missed. Future work: Future research should include (1) exploring the transferability of guidance for effective teamwork to other surgical domains in which technology leads to the physical or perceptual separation of surgeon and team; (2) exploring the benefits and challenges of including realist methods in feasibility and pilot studies; (3) assessing the feasibility of using routine data to understand the impact of RAS on rare end points associated with patient safety; (4) developing and evaluating methods for whole-team training; and (5) evaluating the impact of different physical configurations of the robotic console and team members on teamwork.
    • A reassuring presence: An evaluation of Bradford District Hospice at Home service

      Lucas, Beverley J.; Small, Neil A.; Greasley, Peter; Daley, A. (2008)
      Within the United Kingdom, a developing role for primary care services in cancer and palliative care has resulted in an increase in palliative home care teams. The provision of professional care in the home setting seeks to provide necessary services and enhanced choice for patients whose preference is to die at home. A mismatch between patient preference for home death and the actual number of people who died at home was identified within Bradford, the locality of this study. In response to this mismatch, and reflecting the policy environment of wishing to enhance community service provision, the four Primary Care Trusts (PCTs) in the city sought to offer support to patients who wished to remain in their own homes through the final stages of a terminal illness. To offer this support they set up a dedicated hospice at home team. This would provide services and support for patients in achieving a dignified, symptom free and peaceful death, allowing families to maximise time spent together. The aim of the study was to evaluate the Bradford hospice at home service from the perspective of carers, nurses and General Practitioners. Postal questionnaires were sent to carers (n = 289), district nurses (n = 508) and GP's (n = 444) using Bradford's hospice at home service. Resulting quantitative data was analysed using the Statical Package for Social Sciences (SPSS) and qualitative data was analysed using grounded theory techniques. The data from carers, district nurses and GPs provide general support for the Bradford hospice at home service. Carers valued highly the opportunity to 'fulfil a promise' to the individual who wished to be cared for at home. District nurses and GPs cited the positive impact of access to specialist expertise. This was a 'reassuring presence' for primary healthcare teams and offered 'relief of carer anxiety' by providing prompt, accessible and sensitive care. Carers and health professionals welcomed the increased possibility of patients being cared for at home. The study identified the need to focus on improving skill levels of staff and on ensuring continuity of care.
    • Reciprocity and Burnout in Direct care Staff

      Rose, J.; Madurai, T.; Thomas, K.; Duffy, B.; Oyebode, Jan R. (2010)
    • Recommended Standards for the Routine Performance Testing of Diagnostic X-Ray Systems

      Institute of Physics and Engineering in Medicine; Scally, Andy J. (2005)
      This Report replaces IPEM Report 77 and provides essential guidance for anyone responsible for diagnostic X-Ray equipment. This document gives clear advice on which routine performance tests are essential and which are desirable, where to get information on how to do them, who should be doing them and how often they should be done. For many tests it also gives guidance as to when the results indicate further action should be taken. This second edition takes into account the introduction of new technologies in medical imaging including CR, DDR and image display devices.
    • Recovering from Psychosis: Empirical Evidence and Lived Experience

      Williams, Stephen (2016-10)
      The use of first-hand service user accounts of mental illness is still limited in the professional literature available. This is, however, beginning to change, with a new ‘recovery’ focus in mental health services meaning that the voices of service users are finally being heard. Recovering from Psychosis: Empirical Evidence and Lived Experience synthesises a narrative approach alongside an evidence-based review of current treatment by including Stephen Williams’ own personal experience as it relates to psychosis, recovery and treatment. A mental health professional himself, the author’s account of his own recovery from severe mental health difficulties, without sustained intervention, challenges the orthodoxy of representation of service users in mental health. Recovering from Psychosis critically explores and reviews the current state of the art of research and knowledge about the nature and treatment of psychosis. Working simultaneously from empirical, lived experience and philosophical perspectives,Stephen Williams: Evaluates political and power related issues in professional understanding, knowledge-creation and treatment of people with psychosis; Introduces the current ‘recovery movement’, unpacking its origins and implications for the future development of ‘recovery oriented services’; Reviews, summarizes and critiques the current state of ‘recovery’ research, looking at the advantages and disadvantages of such an approach, examining how this is influencing the transformation of UK mental health services; Analyses the difficulties in organisational implementation of recovery approaches, summarises the most empirically robust approaches to practice, personal and service delivery measurement; Reviews current ‘models’ of psychosis and how various professional scientific groups explain the experience and nature of psychosis; Uses lived-experience accounts taken from the scientific literature, portraying the nature of such experiences and analysing them in the face of contemporary psychological models. Recovering from Psychosis is an essential comprehensive guide for mental health professionals, psychologists, social workers and carers, who are working with people with severe and enduring mental health difficulties diagnosed as psychosis. It addresses the practical implications of working with such difficult conditions and serves as a hopeful story of recovery for service users.
    • Recruitment of older adults to three preventative lifestyle improvement studies

      Chatters, R.; Newbould, L.; Sprange, K.; Hind, D.; Mountain, Gail; Shortland, K.; Powell, L.; Gossage-Worrall, R.; Chater, T.; Keetharuth, A.; et al. (2018-02)
      Background: Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). Methods: During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. Results: Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. Conclusions: Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research.
    • Reducing emergency hospital admissions: A population health complex intervention of an enhanced model of primary care and compassionate communities

      Abel, J.; Kingston, H.; Scally, Andy J.; Hartnoll, J.; Hannam, G.; Thomson-Moore, A.; Kellehear, Allan (2018-11)
      Background: Reducing emergency admissions to hospital has been a cornerstone of health care policy. There is little evidence of systematic interventions which achieved this aim across a population. We report the impact on unplanned admissions to hospital through a complex intervention over a 44 month period in Frome, Somerset. Aim: A population health complex intervention of an enhanced model of primary care and compassionate communities to improve population health and reduce emergency admissions to hospital Design: A cohort retrospective study of a complex intervention on all emergency admissions in Frome compared to Somerset from April 2013 to December 2017. Setting: Frome Medical Practice, Somerset Methods: Patients were identified using broad criteria including anyone with cause for concern. Patient centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome. Results: There was a progressive reduction, by 7.9 cases per quarter (95% CI: 2.8, 13.1; p=0.006) in unplanned hospital admissions across the whole population of Frome, over the study period from April 2014 to December 2017. At the same time, there was sharp increase in the number of admissions per quarter, within the Somerset, with an increase in the number of unplanned admissions of 236 per quarter (95% CI: 152, 320; p<0.001). Conclusion: The complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital with reduction of healthcare costs across the whole population of Frome
    • Reducing image interpretation errors – Do communication strategies undermine this?

      Snaith, Beverly; Hardy, Maryann L.; Lewis, Emily F. (2014-08)
      Errors in the interpretation of diagnostic images in the emergency department are a persistent problem internationally. To address this issue, a number of risk reduction strategies have been suggested but only radiographer abnormality detection schemes (RADS) have been widely implemented in the UK. This study considers the variation in RADS operation and communication in light of technological advances and changes in service operation. A postal survey of all NHS hospitals operating either an Emergency Department or Minor Injury Unit and a diagnostic imaging (radiology) department (n = 510) was undertaken between July and August 2011. The questionnaire was designed to elicit information on emergency service provision and details of RADS. 325 questionnaires were returned (n = 325/510; 63.7%). The majority of sites (n = 288/325; 88.6%) operated a RADS with the majority (n = 227/288; 78.8%) employing a visual ‘flagging’ system as the only method of communication although symbols used were inconsistent and contradictory across sites. 61 sites communicated radiographer findings through a written proforma (paper or electronic) but this was run in conjunction with a flagging system at 50 sites. The majority of sites did not have guidance on the scope or operation of the ‘flagging’ or written communication system in use. RADS is an established clinical intervention to reduce errors in diagnostic image interpretation within the emergency setting. The lack of standardisation in communication processes and practices alongside the rapid adoption of technology has increased the potential for error and miscommunication.
    • Reducing senility to 'bare life': are we heading for a new Holocaust at mid-C21?

      Capstick, Andrea (04/12/2013)
      The tradition of the oppressed teaches us that the 'state of emergency' in which we live is not the exception but the rule. We must attain to a conception of history that is in keeping with this insight¿.The current amazement that the things we are experiencing are 'still' possible in the twentieth century is not philosophical. This amazement is not the beginning of knowledge, unless it is the knowledge that the view of history which gives rise to it is untenable. (Benjamin, 1940: 248-249) The German-Jewish critical theorist Walter Benjamin (1892-1940) wrote these lines shortly before his death in exile whilst fleeing from the agents of fascism. They seem particularly relevant to a healthcare policy conference with the title ¿Condition Critical¿ taking place almost 70 years later. In this paper one of the things I hope to do is outline how Benjamin¿s concept of the permanent state of emergency relates to health and social care provision for older people with dementia today. Benjamin believed that the Holocaust came about because of the 'amnestic' view of history as an unbroken, linear process of scientific achievement, including the belief in human perfectibility. He suggested that in order to see history stripped of this ideological myth of progress, we need to wake from a collective 'dream history', from our usual somnolent acceptance of surface appearances (Cohen 1993: 5). Similarly it can be argued today that the 20th century 'dream history' of linear progress away from a never-to-be-repeated Holocaust is a myth. My strong claim in this paper is that present day demographic panic related to the economic 'burden of care' for an ageing population is leading to proposed solutions analogous to the ideological killing of psychiatric patients, the physically disabled, Jews and other victims of Nazism in the mid-20th century. Such 'solutions' are fuelled by media propaganda, the profit motives of what has been described as the 'medical-industrial complex' (Bond et al 2004) and a reductive, medicalised, biological determinist model of the cognitive changes of ageing.
    • Reducing spinal injuries in rugby: Is rugby league the solution?

      Beck, Jamie J.W. (2016-02-22)
      Sport as a whole has recently been under greater scrutiny over the safety of its participants. The tragic death of Australian Test Cricketer Philip Hughes brought into stark focus the risk of head injury but there has also been greater awareness of hypertrophic cardiomyopathy, concussion and use of performance enhancing drugs. Much of the research around concussion arises from what could be described as “collision” sports such as American football and ice hockey. The catalyst for discussions around concussion has tended to originate from these American sport. The significance of this increased awareness of safety has not been lost on the sport of rugby which has caused changes in practice in terms of concussion management but what appears not to have been fully appreciated is the additional risk of cervical spine injury associated with the sport.
    • A reference database for the Stratec XCT-2000 peripheral quantitative computed tomography (pQCT) scanner in healthy children and young adults aged 6–19 years

      Ashby, R.L.; Ward, K.A.; Roberts, S.A.; Edwards, Lisa; Mughal, M.Z.; Adams, Jenny E. (2009-08)
      Summary We have produced paediatric reference data for forearm sites using the Stratec XCT-2000 peripheral quantitative computed tomography scanner. These data are intended for clinical and research use and will assist in the interpretation of bone mineral density and bone geometric parameters at the distal and mid-shaft radius in children and young adults aged between 6–19 years. Introduction Peripheral quantitative computed tomography (pQCT) provides measurements of bone mineral content (BMC), density (BMD) and bone geometry. There is a lack of reference data available for the interpretation of pQCT measurements in children and young adults. The aim of this study was to provide reference data at the distal and midshaft radius. Methods pQCT was used to measure the 4% and 50% sites of the non-dominant radius in a cohort of healthy white Caucasian children and young adults aged between 5 and 25 years. The lambda, mu, sigma (LMS) technique was used to produce gender-specific reference centile curves and LMS tables for calculating individual standard deviations scores. Results The study population consisted of 629 participants (380 males). Reference centile curves were produced; total and trabecular BMD for age (distal radius) and for age and height, bone area (distal and mid-shaft radius), cortical area, cortical thickness, BMC, axial moment of inertia, stress– strain index and muscle area (mid-shaft radius). Conclusions We present gender-specific databases for the assessment of the distal and mid-shaft radius by pQCT. These data can be used as control data for research studies and allow the clinical interpretation of pQCT measurements in children and young adults by age and height.
    • Reflecting team processes in family therapy: A search for research

      Willott, S.; Hatton, T.; Oyebode, Jan R. (2012-05)
      Tom Andersen's Reflecting Team approach is widely (and creatively) employed in family therapy. Despite continuing enthusiasm for the practice, however, there are few journal articles reporting empirical research and only one (now dated) review of the literature. After defining reflecting team processes through practices that are embedded in particular approaches to knowledge construction and theoretical interpretation, we offer an overview of the empirical research found in our search of the literature. In the second half of this article we ask why there is so little existing research in this area. Various possible explanations are explored and future directions proposed. We conclude that a dialogue around the complex interweaving of practice, theory and research (that is, praxis) would be a helpful overall stance to adopt in relation to future work in this area.