Recent Submissions

  • The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database

    Ward, S.T.; Hancox, A.; Mohammed, Mohammed A.; Ismail, T.; Griffiths, E.A.; Valori, R.; Dunckley, P. (2017-06)
    Objective: The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. Design: OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy ( JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable. Results: Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. Conclusions: There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate
  • Patients treated for hyperthyroidism are at increased risk of becoming obese: findings from a large prospective secondary care cohort

    Torlinska, B.; Nichols, L.; Mohammed, Mohammed A.; McCabe, C.; Boelaert, K. (Mary Ann Leibert Inc., 2019-10-15)
    Background: The most commonly reported symptom of hyperthyroidism is weight loss; successful treatment increases weight. Weight gain faced by patients with hyperthyroidism is widely considered a simple reaccumulation of premorbid weight, whereas many patients feel there is a significant weight “overshoot” attributable to the treatment. We aimed to establish if weight gain seen following treatment for hyperthyroidism represents replenishment of premorbid weight or “overshoot” beyond expected regain and, if there is excessive weight gain, whether this is associated with the applied treatment modality. Methods: We calculated the risk of becoming obese (body mass index [BMI] >30 kg/m2) following treatment for hyperthyroidism by comparing BMI of 1373 patients with overt hyperthyroidism seen in a secondary care setting with the age- and sex-matched background population (Health Survey for England, 2007–2009). Next, we investigated the effect of treatment with an antithyroid drug (ATD) alone in regard to ATD with radioactive iodine (131I) therapy. We modeled the longitudinal weight data in relation to the treatment pathway to thyroid function and the need for long-term thyroxine replacement. Results: During treatment of hyperthyroidism, men gained 8.0 kg (standard deviation ±7.5) and women 5.5 kg (±6.8). At discharge, there was a significantly increased risk of obesity in male (odds ratio = 1.7 [95% confidence interval 1.3–2.2], p < 0.001) and female (1.3, 1.2–1.5, p < 0.001) patients with hyperthyroidism compared with the background population. Treatment with 131I was associated with additional weight gain (0.6 kg, 0.4–0.8, p < 0.001), compared with ATD treatment alone. More weight gain was seen if serum thyrotropin (TSH) was markedly increased (TSH >10 mIU/L; 0.5 kg, 0.3–0.7, p < 0.001) or free thyroxine (fT4) was reduced (fT4 ≤ 10 pmol/L (0.8 ng/dL); 0.3 kg, 0.1–0.4, p < 0.001) during follow-up. Initiation of levothyroxine was associated with further weight gain (0.4 kg, 0.2–0.6, p < 0.001) and the predicted excess weight gain in 131I-induced hypothyroidism was 1.8 kg. Conclusions: Treatment for hyperthyroidism is associated with significant risks of becoming obese. 131I treatment and subsequent development of hypothyroidism were associated with small but significant amounts of excess weight gain compared with ATD alone. We advocate that the discussion over the weight “overshoot” risk forms part of the individualized treatment decision-making process.
  • Affirmative action measures and gender equality: review of evidence, policies, and practices

    Archibong, Uduak E.; Utam, Kingsley U. (Encyclopedia of the UN Sustainable Development Goals. Springer, Cham, 2020)
    The central aim of this chapter is to describe the policy and practice of affirmative action measures. It synthesizes findings from published studies and highlights the rationale, drivers, benefits, beneficiaries, effectiveness, and impacts of affirmative action policies and practices in different countries. The chapter will discuss the possible lessons from these studies and highlight the link between affirmative action policies and practices and contributions to achieving target 5 of the Sustainable Development Goals (SDG).
  • Sustaining the commitment to patient safety huddles: insights from eight acute hospital ward teams

    Montague, Jane; Crosswaite, Kate; Lamming, Laura; Cracknell, A.; Lovatt, A.; Mohammed, Mohammed A. (2019-11-14)
    Background: A recent initiative in hospital settings is the patient safety huddle (PSH): a brief multidisciplinary meeting held to highlight patient safety issues and actions to mitigate identified risks. Aim: The authors studied eight ward teams that had sustained PSHs for over 2 years in order to identify key contributory factors. Methods: Unannounced observations of the PSH on eight acute wards in one UK hospital were undertaken. Interviews and focus groups were also conducted. These were recorded and transcribed for framework analysis. Findings: A range of factors contributes to the sustainability of the PSH including a high degree of belief and consensus in purpose, adaptability, determination, multidisciplinary team involvement, a non-judgemental space, committed leadership and consistent reward and celebration. Conclusion: The huddles studied have developed and been shaped over time through a process of trial and error, and persistence. Overall this study offers insights into the factors that contribute to this sustainability.
  • Impact of Vertical Integration of General Practices with an Acute Hospital on Hospital Admissions: a Retrospective Synthetic Matched Controlled Database Study

    Yu, V.; Wyatt, S.; Woodall, M.; Sultan, M.; Klaire, V.; Bailey, K.; Mohammed, Mohammed A. (2020)
    Background: Healthcare systems are exploring new care models to enhance care coordination, efficiency and outcomes. From June 2016 an NHS provider hospital integrated with ten general practices, assuming responsibility for delivering primary medical services for 67,402 registered patients. Aim: We examined the impact of this complex intervention, known as vertical integration (VI), on unplanned hospital care. Design and Setting: The intervention was enacted in Royal Wolverhampton NHS Trust. A retrospective database study using synthetic controls was used to estimate the causal effect of VI. Method: For each VI GP practice, a synthetic counterpart was constructed. We compare the difference in rate of emergency department (ED) attendances, unplanned admissions, and unplanned readmissions, pooled across VI practice versus synthetic control practices pre versus post VI. Results: Across the 10 practices pooled rates of ED attendances did not change significantly after VI. However, there were significant reductions in the rates of unplanned admissions (- 0.11, 95% CI -0.18 to -0.045, p = 0.0012) and unplanned readmissions (-0.021, 95% CI -0.037 to -0.0049, p = 0.012), per 100 patients per month. These effect sizes represent 888 avoided unplanned hospital admissions and 168 readmissions for a population of 67,402 patients per annum. Conclusion: VI is associated with a reduction in the rate of unplanned hospital admissions and readmissions. Further work is required to understand the mechanisms involved in this complex intervention, assess the generalisability of these findings and to determine the impact on patient satisfaction, health outcomes and GP workload.
  • Time to make healthcare professions more accessible to women with children

    Archibong, Uduak E.; McIntosh, Bryan; Donaghy, L. (2020-03)
    In response to a recent report published by the Royal College of Nursing, Bryan McIntosh, Uduak Archibong and Louise Donaghy discuss the impact of motherhood, part-time hours and career breaks on the cultural perceptions and experiences of female healthcare professionals.
  • Exploring Diversity Management in Transnational Corporations Through the Lens of Migration and Expatriation

    Utam, Kingsley U.; Archibong, Uduak E.; Walton, S.; Eshareturi, Cyril (2020)
    In this study, we aim to develop an understanding of the similarity between migration and expatriation, identify both as elements in diversity, and draw attention to the additional layer of ethnic diversity created by the high number of top management expatriates in some Nigerian subsidiaries of transnational corporations. Using the qualitative research design, we thematically analysed data from semistructured interviews with six indigenous managers in four transnational corporations. We found a significant number of expatriate managers in two subsidiaries and a lack of diversity management framework to address the new layer of diversity as reflected in the unequal treatment of indigenous managers. We conclude that migration and expatriation are similar and could be better managed through effective diversity management framework.
  • Disproportionality in NHS Disciplinary Proceedings

    Archibong, Uduak E.; Kline, R.; Eshareturi, Cyril; McIntosh, Bryan (2019-04-01)
    This article investigates the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings. The study involved an in-depth knowledge review and analysis of literature on the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings from 2008 to 2017, as well as semi-structured interviews with 15 key stakeholders. Participants were stakeholders from both primary and secondary care and included equality and diversity leads, human resource professionals, NHS service managers, representatives of trade unions and health professional regulatory council representatives. The knowledge review indicates that to date, black, Asian and minority ethnic staff are disproportionately represented in NHS disciplinary proceedings. Evidence gathered demonstrates the continuation of inappropriate individual disciplinary action and failure to address organisational shortcomings against black, Asian and minority ethnic members of staff. Overall, six factors were identified as underpinning the disproportionate representation of black minority ethnic staff in disciplinaries: closed culture and climate; subjective attitudes and behaviour; inconclusive disciplinary data; unfair decision making; poor disciplinary support; and disciplinary policy misapplication.
  • The Nigerian health workforce in a globalized context

    Archibong, Uduak E.; Eshareturi, Cyril (2019-10)
    Nigerian health professionals are impacted by several global forces bearing down on them, one of which is the positive economic prospects associated with emigrating to work abroad. This emigration is an aspect of increased global mobility which has had an adverse effect on the Nigerian health economy. This is important globally because countries with the smallest healthcare workforce capacities such as Nigeria have the poorest health outcomes. The emigration of health professionals from Nigeria will continue until domestic structures such as improved healthcare infrastructures, job security, and financial rewards change for the better. Thus, it is important that measures aimed at supporting the Nigerian health workforce be implemented with a focus on building and managing for sustainability within the context of international interdependency. Accordingly, this chapter is aimed at creating a theoretical framework for building capacities and managing the challenges of the Nigerian health workforce vis-à-vis the opportunities offered by globalization.
  • Disrupting disproportionality proceedings: The recommendations

    Archibong, Uduak E.; Kline, R.; Eshareturi, Cyril; McIntosh, Bryan (2019-06-02)
    An in-depth knowledge review and analysis of literature on the involvement of Black and Minority Ethnic (BAME) staff in NHS disciplinary proceedings from 2008 to 2017 as did 15 semi-structured interviews with key stakeholders. The research findings indicate that BME staff are disproportionately represented in NHS disciplinary proceedings, there is a continuation of inappropriate individual disciplinary action and a failure to address organisational shortcomings. Six factors emerged: closed culture and climate; subjective attitudes and behaviour; inconclusive disciplinary data; unfair decision making; poor disciplinary support and disciplinary policy mis-application were all identified as underpinning the disproportionate representation of BME staff in disciplinary procedures. Disciplinary policy needs streamlining and greater clarity needs to be achieved regarding the difference between disciplinary, capability and performance issues and to this respect we make several recommendations.
  • Towards a practice theory of goal setting: assessing the theoretical goal-setting of a leprosy organisation in Nigeria

    Ogbeiwi, Osahon (2020)
    Goal-setting is indispensable for effective healthcare management. Yet, literature evidence suggests many organisations worldwide do not know how to formulate ‘SMART’ goals. Evidence of how existing theories work in practice is scarce, and the practices in low-income countries are unknown. Therefore, this research explored how leprosy project goals were formulated to describe the theoretical practice framework of A leprosy-focused organisation in Nigeria. Using a case-study design, ten managers were interviewed individually concerning their goal-setting knowledge, experience and perspective; and documented goals of six projects were reviewed. A five-step constructionist thematic data analysis generated eleven theoretical frameworks from the concepts of the emergent core themes of ‘stakeholders’, ‘strategies’ and ‘statements.’ Further theorisation reduced them to one general framework. This revealed organisational goal-setting practice as a four-stage centre-led, top-down, beneficiary-focused and problem-based process. The stages were national preparation, baseline needs-survey, centralised goal formulation and nationalised planning. The outcome was the formulation of assigned, ‘non-SMART’ objective statements, which are then used for planning projects. Other theoretical models constructed included a Goal Effects Cycle, ‘SMARTA’ goal attributes and hierarchical criteria for differentiating goal-types. A theory developed from the goal-setting practice postulates that: ‘Assigned non-SMART goal formulation directly results from centralised goal-setting practice and is the predictor of unrealistic project planning.’ Therefore, I propose that goal statements will be ‘SMARTA’ and plans, more realistic and relevant if goal-setting is done collaboratively by all stakeholders at all stages of the process. Also, ‘Change-Beneficiary-Indicator-Target-Timeframe’ and ‘Change-Beneficiary-Location-Timeframe’ frameworks are recommended as templates for writing SMART objectives and aims respectively.
  • Why part-time nurses should be valued

    McIntosh, Bryan; Archibong, Uduak E. (2020-02)
    The article discusses how nurses are increasingly being valued as autonomous decision makers and co-ordinators of patient care. Topics include relating to the age of the dependent children, a woman's working hours and any successive career breaks, woman's career progression directly related to the school age of the dependent children, and children being inhibit and is driven in part by a determination to maintain traditional employment practices.
  • Logical goal-setting frameworks for leprosy projects

    Ogbeiwi, Osahon (2020-05)
    Introduction: Goal setting is a fundamental practice in the effective management of healthcare services worldwide. This study investigated the extent to which leprosy goal formulation in Nigeria is logical and SMART. Method: Document review of baseline problems, goal statements and goal attainments for 2016 in six leprosy projects using a customised logical framework matrix. Results: A total of 15 main problems, 6 aims, 19 objectives and 42 indicators were found. The goals were problem-based and logically linked, with a pattern of a single aim per project, multiple objectives per aim, and multiple indicators per objective. Goal statements specified only impact in 5/6 aims, and only outcome and terminal timeframe in 17/19 (89.5%) objectives. Only one objective stated all four SMART components of outcome, indicator, target and timeframe. While three (7.1%) indicators and two (10.5%) objectives were measurable, no target was attainable. Discussion: Goal-setting frameworks for leprosy projects should be problem based and logical according to best practice. That most leprosy objectives were not completely SMART is similar to the reported structure of objectives published by other health organisations globally.
  • The prevalence and predictors of loneliness in caregivers of people with dementia: findings from the IDEAL programme

    Victor, C.R.; Rippon, I.; Quinn, Catherine; Nelis, S.M.; Martyr, A.; Hart, N.; Lamont, R.; Clare, L. (2020)
    Objectives: To establish the prevalence of loneliness among family caregivers of people with dementia and to identify potential risk factors for loneliness. Methods: Using data from the baseline wave of the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study, we examined loneliness in 1283 family caregivers of people with mild-to-moderate dementia living in Great Britain. Multinomial regression was used to examine the relative influence of a series of risk factors for caregiver loneliness. Results: Almost half, 43.7%, of caregivers reported moderate loneliness and 17.7% reported severe loneliness. Greater social isolation and increased caregiving stress were linked with both moderate and severe loneliness. Better quality of relationship with the person with dementia along with increased levels of well-being and life satisfaction were associated with a lower relative risk of reporting both moderate and severe loneliness. Discussion: This study examines the prevalence and predictors of loneliness in a large sample of family caregivers of people with dementia. Notably over two-thirds of caregivers in our sample reported feeling lonely. Interventions aimed at reducing caregiving stress and supporting meaningful relationships may go some way towards helping to reduce loneliness.
  • The co-development and feasibility-testing of an innovative digital animation intervention (DAISI) to reduce the risk of maternal sepsis in the postnatal period

    Haith-Cooper, Melanie; Stacey, T.; Bailey, F.; Broadhead-Croft, S. (2020-04)
    Introduction: Sepsis is one of the most common causes of mortality in postnatal women globally and many other women who develop sepsis are left with severe morbidity. Women’s knowledge of postnatal sepsis and how it can be prevented by simple changes to behaviour is lacking. Methods: This paper describes the co-development and feasibility testing of a digital animation intervention called DAISI (digital animation in service improvement). This DAISI is designed to enhance postnatal women’s awareness of sepsis and how to reduce their risk of developing the condition. We co-designed the digital animation over a six-month period underpinned by theory, best evidence and key stakeholders, translated it into Urdu then assessed its use, firstly in a focus group with women from different Black, Asian and Minority Ethnic (BAME) groups and secondly with 15 clinical midwives and 15 women (including BAME women). Following exposure to the intervention, midwives completed a questionnaire developed from the COM-B behaviour change model and women participated in individual and focus group interviews using similar questions. Results: The animation was considered acceptable, culturally sensitive and simple to implement and follow. Discussion: DAISI appears to be an innovative solution for use in maternity care to address difficulties with the postnatal hospital discharge process. We could find no evidence of digital animation being used in this context and recommend a study to test it in practice prior to adopting its use more widely. If effective, the DAISI principle could be used in other maternity contexts and other areas of the NHS to communicate health promotion information.
  • Interpreting trauma radiographs

    Hardy, Maryann L.; Barrett, Christine (2003-10)
    Background: Many accident and emergency clinicians regard the radiographic image as an extension of the clinical examination, as a provisional diagnosis, based on clinical signs and symptoms, can be confirmed or refuted by inspection of X-rays. However, the value of radiography in this context is not determined by the actual presence of trauma or pathology on the radiograph, but is dependent on the ability of a clinician to identify any trauma or pathology present. Traditionally, the responsibility for interpreting radiographic images within the accident and emergency environment in the United Kingdom (UK) has been with medical clinicians. However, expansion of the nursing role has begun to change the boundaries of professional practice and now many nurses are both requesting and interpreting trauma radiographs. Aim: To ascertain the ability of accident and emergency doctors and nurses to interpret trauma radiographs, and identify whether there is a consistent standard of interpretive accuracy that could be used as a measure of competence. Methods: A literature review was conducted using the Cochrane Library, Medline and CINAHL databases and the keywords radiographic interpretation, radiographic reporting, accident and emergency and emergency/nurse practitioner. Findings: The ability of accident and nursing doctors and nurses to interpret trauma radiographs accurately varies markedly, and no identified published study has established an appropriate level of accuracy that should be achieved in order to demonstrate satisfactory competence in the interpretation of radiographic images. Conclusions: Determining a measure of interpretive accuracy that can be used to assess ability to interpret radiographic trauma images is fraught with difficulties. Consequently, nurses may attempt to prove their skills by directly comparing their abilities to those of their medical colleagues. However, as a result of marked variation in the ability of senior house officers to interpret trauma radiographs, a similar ability does not automatically imply that a satisfactory level of ability has been achieved.
  • The immobilisation and restraint of paediatric patients during plain film radiographic examinations

    Graham, P.; Hardy, Maryann L. (2004-02)
    Purpose: The immobilisation and restraint of children to facilitate radiographic examination is a controversial issue that has been relatively ignored by radiography research. The aim of this study was to begin to fill this gap by providing a description of restraint used in a limited number of clinical sites in order to highlight any perceived need for training, policies or guidelines in the use of child immobilisation and restraint. Methods: A cross-sectional survey design using a postal questionnaire was adopted. One hundred and sixty-seven questionnaires were distributed to radiographers employed within six hospital Trusts. Results: A response rate of 83.2% (n=139/167) was achieved. Ninety-three percent (93.5%, n=130/139) of respondents indicated that restraining techniques were used although only 19.2% (n=25/130) had received specific training in safe restraining techniques and 7.9% (n=11/139) in distraction techniques as an alternative to restraint. A need for further guidance and support for clinical staff was evident with 73.3% (n=74/101) of respondents identifying a need for specific guidelines and 84.6% (n=110/130) indicating that further training opportunities were required. Conclusions: The use of restraint in paediatric plain film radiography is an apparently widespread practice and support for clinical radiographers through the development of training opportunities and practice guidelines are seen as essential in order to promote high quality paediatric radiography practices.
  • Requesting and interpreting trauma radiographs: a role extension for accident & emergency nurses

    Hardy, Maryann L.; Barrett, Christine (2003-10)
    Government supported expansion of the nursing role within Accident & Emergency (A&E) departments in the United Kingdom (UK) has begun to break down the traditional barriers to professional practice. Today, many nurses working within A&E departments are both requesting and interpreting radiographic examinations as part of their normal working practice. However, role expansion does not occur without increased responsibility. Unsatisfactory requests for radiography and inaccurate radiographic interpretation may result in inappropriate patient treatment, misuse of resources, patient recall and litigation. Nurses undertaking these role extensions need to ensure that their levels of knowledge and skill to perform the role are appropriate and adequately supported. This article summarises the results of a national questionnaire survey of A&E nurse managers that aimed to identify current working practices, including education, training and limitations to practice, with respect to the requesting and interpretation of trauma radiographs by A&E nurses.
  • Role extension and role advancement - Is there a difference? A discussion paper

    Hardy, Maryann L.; Snaith, Beverly (2006-11)
    The terms ‘extended’ and ‘advanced’ practice are commonly used to describe clinical practitioner roles. However, these terms have not been clearly defined within the context of modern radiography practice despite their fundamental importance to establishing the 4 tier structure, implementing Agenda for Change and promoting a coherent clinical radiography career structure. This paper discusses the terms ‘extension’ and ‘advancement’ in relation to radiography practice and, using evidence from the debates of other health professions, attempts to offer some clarity to the terminology, presenting one interpretation of its possible application to the radiographer role in the United Kingdom.
  • Accident and emergency radiography: A comparison of radiographer commenting and 'red dotting'

    Hardy, Maryann L.; Culpan, Gary (2007-02)
    Purpose: The College of Radiographers has called for ‘Red Dot’ schemes to evolve and has recommended the development of radiographer commenting. The implementation of a radiographer comment scheme assumes that radiographers previously participating in ‘red dot’ schemes have been accurately recognising radiographic abnormalities and are, therefore, able to comment upon, and describe, such radiographic appearances. Research evidence to support such an assumption is sparse. This study compares the ability of radiographers attending a short course on musculoskeletal trauma to ‘red dot’ and comment on A&E radiographic appearances. Methods: This study adopted a pre-test, post-test approach. One hundred and twenty one radiographers attending a short course on musculoskeletal trauma (Bradford Red Dot Course) were invited to undertake an assessment of their ability to recognise (‘red dot’) and describe (comment upon) radiographic abnormalities at the start and end of the short course. Results: One hundred and fifteen radiographers (n = 115/121; 95.0%) completed both the pre- and post-training assessments. Post-training mean scores per case improved on average by 9.8% [p = 0.012; 95% CI: 2.4, 17.1] for ‘red dots’ and 12.7% [p = 0.007; 95% CI: 3.8, 21.5] for commenting. However, the difference between mean ‘red dot’ and commenting scores remained similar with mean radiographer comment scores being 13.7% less than mean ‘red dot’ scores pre-training and 10.8% less post-training. Conclusions: The results of this study indicate that the accuracy of radiographer comments was significantly reduced when compared to the accuracy of ‘red dots’ for the same radiographic images. The clinical significance of these findings for departments wanting to move from a ‘red dot’ system to a radiographer commenting scheme is that without appropriate training and audit, the quality of service and assistance to the A&E department could be significantly reduced.

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