• Barriers to achieving care at home at the end of life: transferring patients between care settings using patient transport services

      Ingleton, C.; Payne, S.; Sargeant, Anita R.; Seymour, J. (2009)
      Enabling patients to be cared for in their preferred location often involves journeys between care settings. The challenge of ensuring journeys are timely and safe emerged as an important issue in an evaluation of palliative care services, which informed a service redesign programme in three areas of the United Kingdom by the Marie Curie Cancer Care 'Delivering Choice Programme'. This article explores perceptions of service users and key stakeholders of palliative care services about problems encountered in journeys between care settings during end-of-life care. This article draws on data from interviews with stakeholders (n = 44), patients (n = 16), carers (n = 19) and bereaved carers (n = 20); and focus groups (n = 9) with specialist nurses. Data were gathered in three areas of the United Kingdom. Data were analysed using a framework approach. Transport problems between care settings emerged as a key theme. Four particular problems were identified: (1) urgent need for transport due to patients' rapidly changing condition; (2) limited time to organise transfers; (3) the management of specialist equipment and (4) the need to clarify the resuscitation status of patients. Partnership working between Ambulance Services and secondary care is required to develop joint protocols of care to ensure timely and safe transportation between care settings of patients, who are near their end of life. Commissioning of services should be responsive to the complexities of patients' needs and those of their families.
    • Born in Bradford, a cohort study of babies born in Bradford, and their parents: protocol for the recruitment phase

      Raynor, Pauline; Born in Bradford Collaborative Group (2008)
      BACKGROUND: Bradford, one of the most deprived cities in the United Kingdom, has a wide range of public health problems associated with socioeconomic deprivation, including an infant mortality rate almost double that for England and Wales. Infant mortality is highest for babies of Pakistani origin, who comprise almost half the babies born in Bradford. The Born in Bradford cohort study aims to examine environmental, psychological and genetic factors that impact on health and development perinatally, during childhood and subsequent adult life, and those that influence their parents' health and wellbeing. This protocol outlines methods for the recruitment phase of the study. METHODS: Most Bradford women attend for antenatal care and give birth at the Bradford Royal Infirmary, which has approximately 5,800 births per year. Women are eligible for recruitment if they plan to give birth here. Babies born from March 2007 are eligible to participate, recruitment is planned to continue until 2010. Fathers of babies recruited are invited to participate. Women are usually recruited when they attend for a routine oral glucose tolerance test at 26-28 weeks gestation. Recruitment of babies is at birth. Fathers are recruited whenever possible during the antenatal period, or soon after the birth. The aim is to recruit 10,000 women, their babies, and the babies' fathers. At recruitment women have blood samples taken, are interviewed to complete a semi-structured questionnaire, weighed, and have height, arm circumference and triceps skinfold measured. Umbilical cord blood is collected at birth. Within two weeks of birth babies have their head, arm and abdominal circumference measured, along with subscapular and triceps skinfold thickness. Fathers self-complete a questionnaire at recruitment, have height and weight measured, and provide a saliva sample. Participants are allocated a unique study number. NHS numbers will be used to facilitate record linkage and access to routine data. A wide range of hospital and community sources is being accessed to provide data for the women and children. Data are checked for accuracy and consistency. CONCLUSION: Born in Bradford will increase understanding of the factors that contribute to health and wellbeing, and identify factors that influence differences in them between people of Pakistani and European origin.
    • Clinical outcomes and cost-effectiveness of three alternative compression systems used in the management of venous leg ulcers

      Guest, J.F.; Gerrish, A.; Ayoub, N.; Vowden, Kath; Vowden, Peter (2015)
      OBJECTIVE: To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.
    • Coping with challenges to memory in people with mild to moderate Alzheimer's disease: observation of behaviour in response to analogues of everyday situations

      Oyebode, Jan R.; Motala, J.R.; Hardy, R.M.; Oliver, C. (2009)
      OBJECTIVES: To describe ways of coping in people with mild to moderate AD when faced with situations that are challenging to their memory. METHOD: Twenty-four participants (12 with mild and 12 with moderate AD) were presented with a set of seven tasks that were analogues of everyday situations that tax memory. The participants' responses were videotaped and analysed. RESULTS: Participants' coping responses were grouped into seven categories to best reflect the main strategies. Individuals used a significantly greater frequency of effortful problem solving (self-reliance and reliance on carers) (p < 0.01) than other ways of coping. Positive acknowledgement of memory difficulties was used significantly more than negative acknowledgement and defensive coping (concealment and avoidance) (p < 0.01). CONCLUSION: This study used novel methodology of observation of behavioural responses in analogues of everyday situations. The predominance of effortful problem-solving emphasizes the role of the person with AD as an active agent in the management of memory loss. An emphasis in previous literature on defensive coping and denial is counter-balanced by the finding that participants commonly coped by acknowledging their memory impairment.
    • Cross-cultural comparison of the perceptions and experiences of dementia care mapping "mappers" in the United States and the United Kingdom

      Douglass, C.; Keddie, A.; Brooker, Dawn J.R.; Surr, Claire A. (2010)
      OBJECTIVE: Survey results from 161 respondents trained in dementia care mapping (DCM) in the United States and United Kingdom (82 and 79 respondents, respectively) addressed the following: (a) To what extent are mappers using DCM? (b) How satisfied are mappers with DCM? (c) What affect does DCM have on mappers' attitudes toward their dementia practice? and (d) What challenges are encountered by mappers in the use of DCM? METHOD: Analyses using odds ratios were used to make international and training-level (basic vs. advanced) comparisons. RESULTS: Differences across countries were found in use of DCM and lack of satisfaction using DCM codes. Similarities were found with positive affects of DCM on attitudes and lack of time for DCM. DISCUSSION: Differences in mappers' experiences and perceptions exist across the two countries, warranting increased attention to the cultural contexts within which mappers are situated and how these affect the implementation of DCM within a country.
    • Emergency ultrasound in the prehospital setting: the impact of environment on examination outcomes

      Snaith, Beverly; Hardy, Maryann L.; Walker, A. (2011)
      This study aimed to compare ultrasound examinations performed within a land ambulance (stationary and moving) with those completed in a simulated emergency department (ED) to determine the feasibility of undertaking ultrasound examinations within the UK prehospital care environment. The findings suggest that abdominal aortic aneurysm and extended focused assessment with sonography in trauma emergency ultrasound examinations can be performed in the stationary or moving land ambulance environment to a standard consistent with those performed in the hospital ED.
    • Improving the safety of chemotherapy administration: an oncology nurse-led failure mode and effects analysis

      Ashley, L.J.; Dexter, R.; Marshall, F.; McKenzie, B.; Ryan, M.; Armitage, Gerry R. (2011)
      PURPOSE/OBJECTIVES: To assess and improve the safety of hospital-based adult chemotherapy administration. DESIGN: Prospective, systems-focused clinical risk assessment. SETTING: An adult inpatient and outpatient oncology unit in a large urban hospital in the United Kingdom. SAMPLE: 8-person nurse-led multidisciplinary team, which included managerial staff and patient safety researchers. METHODS: Failure mode and effects analysis (FMEA), a prospective, systems-focused risk assessment methodology, was undertaken in biweekly team meetings and included mapping the chemotherapy administration process, identifying and numerically prioritizing potential errors (failure modes) for each process step, and generating remedial strategies to counteract them. MAIN RESEARCH VARIABLES: The analysis aimed to identify chemotherapy administration failure modes and to generate remedial strategies to address them. User feedback on the FMEA process also was collected. FINDINGS: Several specific chemotherapy failure modes were identified, the majority of which had not previously been recognized, and several novel strategies to counteract them were generated. Many of the strategies were specific, environment-focused actions, which are simple, quick, and inexpensive to implement; however, more substantive, longer-term initiatives also were generated. User feedback generally was very positive, and the process of undertaking the analysis improved multidisciplinary teamwork and communication. CONCLUSIONS: Although time and resource intensive, FMEA is a useful safety improvement tool. IMPLICATIONS FOR NURSING: Nurses should be aware of and informed about FMEA as a tool they can use in partnership with management and other disciplines to proactively and collectively improve the safety of high-risk oncology procedures such as chemotherapy administration.
    • 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.
    • Service user involvement in cancer care: the impact on service users

      Cotterell, P.; Harlow, G.; Morris, C.; Beresford, P.; Hanley, B.; Sargeant, Anita R.; Sitzia, J.; Staley, K. (2011)
      BACKGROUND: Service user involvement is embedded in the United Kingdom's National Health Service, but knowledge about the impact of involvement on service users, such as the benefits and challenges of involvement, is scant. Our research addresses this gap. OBJECTIVE: To explore the personal impact of involvement on the lives of service users affected by cancer. DESIGN: We conducted eight focus groups with user groups supplemented by nine face-to-face interviews with involved individuals active at a local, regional and national level. Thematic analysis was conducted both independently and collectively. SETTING AND PARTICIPANTS: Sixty-four participants, engaged in involvement activities in cancer services, palliative care and research, were recruited across Great Britain. RESULTS: We identified three main themes: (i) 'Expectations and motivations for involvement'- the desire to improve services and the need for user groups to have a clear purpose, (ii) 'Positive aspects of involvement'- support provided by user groups and assistance to live well with cancer and (iii) 'Challenging aspects of involvement'- insensitivities and undervaluing of involvement by staff. CONCLUSIONS: This study identified that involvement has the capacity to produce varied and significant personal impacts for involved people. Involvement can be planned and implemented in ways that increase these impacts and that mediates challenges for those involved. Key aspects to increase positive impact for service users include the value service providers attach to involvement activities, the centrality with which involvement is embedded in providers' activities, and the capacity of involvement to influence policy, planning, service delivery, research and/or practice.
    • Test-retest variability of Randot stereoacuity measures gathered in an unselected sample of UK primary school children

      Adler, P.; Scally, Andy J.; Barrett, Brendan T. (2012)
      AIM: To determine the test-retest reliability of the Randot stereoacuity test when used as part of vision screening in schools. METHODS: Randot stereoacuity (graded-circles) and logMAR visual acuity measures were gathered in an unselected sample of 139 children (aged 4-12, mean 8.1+/-2.1 years) in two schools. Randot testing was repeated on two occasions (average interval between successive tests 8 days, range: 1-21 days). Three Randot scores were obtained in 97.8% of children. RESULTS: Randot stereoacuity improved by an average of one plate (ie, one test level) on repeat testing but was little changed when tested on the third occasion. Within-subject variability was up to three test levels on repeat testing. When stereoacuity was categorised as 'fine', 'intermediate' or 'coarse', the greatest variability was found among younger children who exhibited 'intermediate' or 'coarse'/nil stereopsis on initial testing. Whereas 90.8% of children with 'fine' stereopsis (</=50 arc-seconds) on the first test exhibited 'fine' stereopsis on both subsequent tests, only approximately 16% of children with 'intermediate' (>50 but </=140 arc-seconds) or 'coarse'/nil (>/=200 arc-seconds) stereoacuity on initial testing exhibited stable test results on repeat testing. CONCLUSIONS: Children exhibiting abnormal stereoacuity on initial testing are very likely to exhibit a normal result when retested. The value of a single, abnormal Randot graded-circles stereoacuity measure from school screening is therefore questionable.
    • The Rivermead Mobility Index allows valid comparisons between subgroups of patients undergoing rehabilitation after stroke who differ with respect to age, sex, or side of lesion

      Roorda, L.D.; Green, J.R.; Houwink, A.; Bagley, Pamela J.; Smith, J.; Molenaar, I.W.; Geurts, A.C. (2012)
      OBJECTIVE: To investigate differential item functioning or item bias of the Rivermead Mobility Index (RMI) and its impact on the drawing of valid comparisons with the RMI between subgroups of patients after stroke who differ with respect to age, sex, or side of lesion. DESIGN: Cross-sectional study. SETTING: A rehabilitation center in the Netherlands and 2 stroke rehabilitation units and the wider community in the United Kingdom. PARTICIPANTS: The RMI was completed for patients undergoing rehabilitation after stroke (N=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 269 [43%] right hemisphere lesion, and 304 [49%] left hemisphere lesion). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate differential item functioning of the RMI between subgroups of patients who differed with respect to age (young vs older), sex (men vs women), and side of stroke lesion (right vs left hemisphere). RESULTS: No differential item functioning was found for any of the comparison subgroups. CONCLUSIONS: The RMI allows valid comparisons to be made between subgroups of patients undergoing rehabilitation after stroke who differ with respect to age, sex, or side of lesion.
    • Using social media to create discussion

      Russell, S.; Middleton-Green, Laura; Johnston, B. (2015)