• 3M COBAN 2 Compression made easy.

      Vowden, Kath; Vowden, Peter; Partsch, H; Treadwell, T (2011)
    • A call to action: an IWG charter for a public health approach to dying, death, and loss

      Becker, C.; Clark, E.; DeSpelder, L.A.; Dawes, J.; Ellershaw, J.; Howarth, G.; Kellehear, Allan; Kumar, S.; Monroe, B.; O'Connor, P.; Oliviere, D.; Relf, M.; Rosenberg, J.; Rowling, L.; Silverman, P.; Wilkie, D.J. (2014)
      The current systems of care for dying persons, the people caring for them, and the bereaved operate in ways that frequently lack sufficient sensitivity to their needs. We describe a new model for dying, death, and loss that adopts a public health approach. Specifically, we describe a deliberative process that resulted in a charter for a public health approach to dying, death, and loss. Modeled after the World Health Organization's 1986 Ottawa Charter, our charter includes a call to action. It has the potential to bring about significant change on local, societal, and global levels as exemplified by four projects from three countries. Public health and end-of-life services and organizations need to form partnerships with the community to develop a public health approach to dying, death, and loss. Learning from each other, they will affirm and enhance community beliefs and practices that make death part of life.
    • A call to arms: The efficient use of the maternity workforce

      Cookson, G.; McIntosh, Bryan; Sandall, J. (2012)
      NHS maternity services in England must increase productivity if the NHS is to make efficiency savings by 2014. At the same time, it is expected to maintain or improve patient outcomes such as safety and quality. Given staff costs are 60% of the budget; it is likely that either the number or composition of the workforce will need to be changed to meet these targets. In this article, the authors argue that very little is known about the impact of altering the skill mix on either productivity or patient outcomes. Furthermore, it is unclear whether output and outcomes are themselves trade-offs between increased workload, increased number of deliveries and the increased complexity of demand.
    • A comparative analysis of affirmative action in the United Kingdom and United States

      Archibong, Uduak E.; Sharps, P.W. (2011-07)
      Based on research conducted during a large-scale European Commission project on international perspectives on positive/affirmative action measures, the authors provide a comparative analysis of the legal context and perceptions of the impact of positive action in the United Kingdom and the United States. The study adopted participatory methods including consensus workshops, interviews, and legal analysis to obtain data from those individuals responsible for designing and implementing positive action measures. Findings are discussed, conclusions drawn, and wide-ranging recommendations are made at governmental and organizational levels. The authors conclude by suggesting possible implications for policy and argue for widespread awareness-raising campaigns of both the need for positive action measures for disadvantaged groups and the benefits of such measures for wider society. They also recommend the adoption of a more coherent and collaborative approach to the utilization and evaluation of the effectiveness of positive or affirmative action.
    • A Comparative Analysis of Affirmative Action in the United Kingdom and United States

      Archibong, Uduak E.; Sharps, P.W. (2013)
      Based on research conducted during a large-scale European Commission project on international perspectives on positive/affirmative action measures, the authors provide a comparative analysis of the legal context and perceptions of the impact of positive action in the United Kingdom and the United States. The study adopted participatory methods including consensus workshops, interviews, and legal analysis to obtain data from those individuals responsible for designing and implementing positive action measures. Findings are discussed, conclusions drawn, and wide-ranging recommendations are made at governmental and organizational levels. The authors conclude by suggesting possible implications for policy and argue for widespread awareness-raising campaigns of both the need for positive action measures for disadvantaged groups and the benefits of such measures for wider society. They also recommend the adoption of a more coherent and collaborative approach to the utilization and evaluation of the effectiveness of positive or affirmative action.
    • A multi-country perspective on nurses' tasks below their skill level: Reports from domestically trained nurses and foreign trained nurses from developing countries

      Bruyneel, L.; Li, B.; Aiken, L.H.; Lesaffre, E.; Van den Heede, K.; Sermeus, W.; McIntosh, Bryan (2013)
      Background Several studies have concluded that the use of nurses’ time and energy is often not optimized. Given widespread migration of nurses from developing to developed countries, it is important for human resource planning to know whether nursing education in developing countries is associated with more exaggerated patterns of inefficiency. Objectives First, to describe nurses’ reports on tasks below their skill level. Second, to examine the association between nurses’ migratory status (domestically trained nurse or foreign trained nurse from a developing country) and reports on these tasks. Design The Registered Nurse Forecasting Study used a cross-sectional quantitative research design to gather data from 33,731 nurses (62% response rate) in 486 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden and Switzerland. Methods For this analysis, nurse-reported information on migratory status and tasks below their skill level performed during their last shift was used. Random effects models estimated the effect of nurses’ migratory status on reports of these tasks. Results 832 nurses were trained in a developing country (2.5% of total sample). Across countries, a high proportion of both domestically trained and foreign trained nurses from developing countries reported having performed tasks below their skill level during their last shift. After adjusting for nurses’ type of last shift worked, years of experience, and level of education, there remained a pronounced overall effect of being a foreign trained nurse from a developing country and an increase in reports of tasks below skill level performed during the last shift. Conclusion The findings suggest that there remains much room for improvement to optimize the use of nurses’ time and energy. Special attention should be given to raising the professional level of practice of foreign trained nurses from developing countries. Further research is needed to understand the influence of professional practice standards, skill levels of foreign trained nurses from developing countries and values attached to these tasks resulting from previous work experiences in their home countries. This will allow us to better understand the conditions under which foreign trained nurses from developing countries can optimally contribute to professional nursing practice in developed country contexts.
    • A new methodology for costing wound care

      Harding, K.; Posnett, J.; Vowden, Kath (2013)
      Increasing pressure on health care budgets highlights the need for clinicians to understand the true costs of wound care, in order to be able to defend services against indiscriminate cost cutting. Our aim was to develop and test a straightforward method of measuring treatment costs, which is feasible in routine practice. The method was tested in a prospective study of leg ulcer patients attending three specialist clinics in the UK. A set of ulcer-related health state descriptors were defined on the basis that they represented distinct and clinically relevant descriptions of wound condition ['healed', 'progressing'; 'static''deteriorating; 'severe' (ulcer with serious complications)]. A standardised data-collection instrument was used to record information for all patients attending the clinic during the study period regarding (i) the health state of the ulcer; (ii) treatment received during the clinic visit and (iii) treatment planned between clinic visits. Information on resource use was used to estimate weekly treatment costs by ulcer state. Information was collected at 827 independent weekly observations from the three study centres. Treatment costs increased markedly with ulcer severity: an ulcer which was 'deteriorating' or 'severe' cost between twice and six times as much per week as an ulcer which was progressing normally towards healing. Higher costs were driven primarily by more frequent clinic visits and by the costs of hospitalisation for ulcers with severe complications. This exercise has demonstrated that the proposed methodology is easy to apply, and produces information which is of value in monitoring healing and in potentially reducing treatment costs.
    • A pilot study on the potential of remote support to enhance wound care for nursing-home patients

      Vowden, Kath; Vowden, Peter (2013)
      OBJECTIVE: To evaluate the effectiveness of a telehealth system, using digital pen-and-paper technology and a modified smartphone, to remotely monitor and support the effectiveness of wound management in nursing home residents. METHOD: A randomised controlled pilot study was conducted in selected nursing homes in Bradford, which were randomised to either the control or evaluation group. All patients with a wound of any aetiology or severity, resident in the selected nursing homes were considered eligible to participate in the study. Residents in the control homes who had, or developed, a wound during the study period, continued to receive unsupported care directed by the nursing home staff (defined as 'standard care'), while those in the evaluation homes received standard care supported by input from the remote experts. RESULTS: Thirty-nine patients with a wound were identified in the 16 participating Bradford nursing homes. Analysis of individual patient management pathways suggested that the system provided improved patient outcomes and that it may offer cost savings by improving dressing product selection, decreasing inappropriate onward referral and speeding healing. Despite initial anxiety related to the technology most nursing-home staff found the system of value and many were keen to see the trial continue to form part of routine patient management. CONCLUSION: The current study supports the potential value of telemedicine in wound care and indicates the value that such a system may have to nursing-home staff and patients. DECLARATION OF INTEREST: This study was funded by a Regional Innovation Fund grant from the Yorkshire and Humberside Strategic Health Authority. The authors have no conflict of interest to declare with respect to the article or its contents.
    • A systematic review of the relationships between social capital and socioeconomic inequalities in health: a contribution to understanding the psychosocial pathway of health inequalities

      Uphoff, E.P.; Pickett, K.E.; Cabieses, B.; Small, Neil A.; Wright, J. (2013)
      Recent research on health inequalities moves beyond illustrating the importance of psychosocial factors for health to a more in-depth study of the specific psychosocial pathways involved. Social capital is a concept that captures both a buffer function of the social environment on health, as well as potential negative effects arising from social inequality and exclusion. This systematic review assesses the current evidence, and identifies gaps in knowledge, on the associations and interactions between social capital and socioeconomic inequalities in health. Through this systematic review we identified studies on the interactions between social capital and socioeconomic inequalities in health published before July 2012. The literature search resulted in 618 studies after removal of duplicates, of which 60 studies were eligible for analysis. Self-reported measures of health were most frequently used, together with different bonding, bridging and linking components of social capital. A large majority, 56 studies, confirmed a correlation between social capital and socioeconomic inequalities in health. Twelve studies reported that social capital might buffer negative health effects of low socioeconomic status and five studies concluded that social capital has a stronger positive effect on health for people with a lower socioeconomic status. There is evidence for both a buffer effect and a dependency effect of social capital on socioeconomic inequalities in health, although the studies that assess these interactions are limited in number. More evidence is needed, as identified hypotheses have implications for community action and for action on the structural causes of social inequalities.
    • Academic reflective writing: a study to examine its usefulness

      Bowman, M.; Addyman, Berni (2014)
      Reflection is widely regarded as important for learning from practice in Nursing. Academic reflective writing (ARW) is increasingly being used to assess reflective practice. However, there is currently scant literature on ARW, which is extremely complex, requiring students to link their own experiences to published literature. There are also concerns in the literature about the validity of ARW as a medium of assessment. In this paper, an exploratory discussion on ARW is illustrated with reference to the views of 8 self-selected students on a course for post-registered nurses. These students found ARW extremely challenging, and highlighted a range of difficulties associated with it. In conclusion, it is argued that the student experience of ARW warrants further investigation. In addition, it is suggested that either scaffolding should be put in place to facilitate the production of successful ARW, or alternatives should be explored.
    • Accessible Mobile Learning: Exploring the Concept of Mobile Learning for All.

      Dearnley, Christine A.; Walker, Stuart A.; Fairhall, John R. (2010)
    • Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis.

      Brealey, S.; Scally, Andy J.; Hahn, S.; Thomas, N.; Godfrey, C.; Coomarasamy, A. (2005)
      To determine the accuracy of radiographer plain radiograph reporting in clinical practice. MATERIALS AND METHODS Studies were identified from electronic sources and by hand searching journals, personal communication and checking reference lists. Eligible studies assessed radiographers' plain radiograph reporting in clinical practice compared with a reference standard, and provided accuracy data to construct 2×2 contingency tables. Data were extracted on study eligibility and characteristics, quality and accuracy. Summary estimates of sensitivity and specificity and receiver operating characteristic curves were used to pool the accuracy data. RESULTS Radiographers compared with a reference standard, report plain radiographs in clinical practice at 92.6% (95% CI: 92.0¿93.2) and 97.7% (95% CI: 97.5¿97.9) sensitivity and specificity, respectively. Studies that compared selectively trained radiographers and radiologists of varying seniority against a reference standard showed no evidence of a difference between radiographer and radiologist reporting accuracy of accident and emergency plain radiographs. Selectively trained radiographers were also found to report such radiographs as accurately as those not solely from accident and emergency, although some variation in reporting accuracy was found for different body areas. Training radiographers improved their accuracy when reporting normal radiographs. CONCLUSION This study systematically synthesizes the literature to provide an evidence-base showing that radiographers can accurately report plain radiographs in clinical practice.
    • Accuracy of Radiographers red dot or triage of accident and emergency radiographs in clinical practice: a systematic review.

      Brealey, S.; Scally, Andy J.; Hahn, S.; Thomas, N.; Godfrey, C.; Crane, S. (2006)
      AIM: To determine the accuracy of radiographers red dot or triage of accident and emergency (A&E) radiographs in clinical practice. MATERIALS AND METHODS Eligible studies assessed radiographers red dot or triage of A&E radiographs in clinical practice compared with a reference standard and provided accuracy data to construct 2×2 tables. Data were extracted on study eligibility and characteristics, quality, and accuracy. Pooled sensitivities and specificities and chi-square tests of heterogeneity were calculated. RESULT Three red dot and five triage studies were eligible for inclusion. Radiographers' red dot of A&E radiographs in clinical practice compared with a reference standard is 0.87 [95% confidence interval (CI) 0.85¿0.89] and 0.92 (0.91¿0.93) sensitivity and specificity, respectively. Radiographers' triage of A&E radiographs of the skeleton is 0.90 (0.89¿0.92) and 0.94 (0.93¿0.94) sensitivity and specificity, respectively; and for chest and abdomen is 0.78 (0.74¿0.82) and 0.91 (0.88¿0.93). Radiographers' red dot of skeletal A&E radiographs without training is 0.71 (0.62¿0.79) and 0.96 (0.93¿0.97) sensitivity and specificity, respectively; and with training is 0.81 (0.72¿0.87) and 0.95 (0.93¿0.97). Pooled sensitivity and specificity for radiographers without training for the triage of skeletal A&E radiographs is 0.89 (0.88¿0.91) and 0.93 (0.92¿0.94); and with training is 0.91 (0.88¿0.94) and 0.95 (0.93¿0.96). CONCLUSION Radiographers red dot or triage of A&E radiographs in clinical practice is affected by body area, but not by training.
    • Achieving ecological validity of occupation-based interventions for healthy aging

      Orellano-Colon, E.M.; Varas-Diaz, N.; Bernal, G.; Mountain, Gail (2014-12)
      Aim: To develop a culturally sensitive occupation-based health promotion intervention for older Hispanic adults who live alone. Methods: We used a mixed method design for the content validation of the intervention and the Ecological Validity Model (EVM) to culturally center the intervention. In the quantitative phase, aging experts as well as community members from two activity centers for the elderly in Puerto Rico completed a content validity ratio exercise. In the qualitative phase, we conducted three focus groups with these participants. Data analysis included content validity ratio and a directed content analysis. Results: This resulted in a working version of the intervention protocol addressing the eight dimensions of the EVM. Conclusions: The EVM can be used to culturally center preventive interventions to other ethnic minority groups to augment the external validity and cultural competence of interventions. Future research must test the feasibility of this new intervention.