• A qualitative formative evaluation of a patient centered patient safety intervention delivered in collaboration with hospital volunteers

      Louch, G.; O'Hara, J.K.; Mohammed, Mohammed A. (2017-10)
      Background: Evidence suggests that patients can meaningfully feed back to healthcare providers about the safety of their care. The PRASE (Patient Reporting and Action for a Safe Environment) intervention provides a way to systematically collect feedback from patients to support service improvement. The intervention is being implemented in acute care settings with patient feedback collected by hospital volunteers for the first time. Objective: To undertake a formative evaluation which explores the feasibility and acceptability of the PRASE intervention delivered in collaboration with hospital volunteers from the perspectives of key stakeholders. Design: A qualitative evaluation design was adopted across two acute NHS Trusts in the UK between July 2014 and November 2015. We conducted five focus groups with hospital volunteers (n = 15), voluntary services and patient experience staff (n = 3) and semistructured interviews with ward staff (n = 5). Data were interpreted using framework analysis. Results: All stakeholders were positive about the PRASE intervention as a way to support service improvement, and the benefits of involving volunteers. Volunteers felt adequate training and support would be essential for retention. Staff concentrated on the infrastructure needed for implementation and raised concerns around sustainability. Findings were fed back to the implementation team to support revisions to the intervention moving into the subsequent summative evaluation phase. Conclusion: Although there are concerns regarding sustainability in practice, the PRASE intervention delivered in collaboration with hospital volunteers is a promising approach to collect patient feedback for service improvement.
    • Qualitatively exploring the suitability of tablet computers to encourage participation with activities by people with moderate stage dementia

      Smith, S.K.; Mountain, Gail; Hawkins, R.J. (2018)
      Introduction: Opportunities to participate with enjoyable activities is one of the most frequently reported unmet needs by the person living with dementia. Enabling and intuitive technologies may offer accessible ways to engage with such activities. Objectives: To explore how tablet computers might encourage participation in enjoyable activities by people with moderate levels of dementia and to consider how such technologies might be incorporated into the repertoire of activities currently provided through day care settings. Methods: A focused visual ethnographic approach was developed specifically to meet the research objectives. Twelve participants attending a community day care centre and nine supporters (both volunteers and paid staff) consented to take part in the research. Technology facilitated group activity sessions took place twice a week for a period of four weeks and all were video recorded. Findings: Video analysis demonstrated that the majority of people with dementia found the technology an effective means of participating in enjoyable activities. Analysis also revealed the extent to which participation relies on the existence of effective support. It showed how maintaining focus on retained strengths and abilities enabled the group overall to meet and often exceed their own and others perceived capacity to participate. Finally, analysis confirmed the importance of enjoyment of activities ‘in the moment’ and the need for those supporting people in the moderate stages of dementia to acknowledge and work with this. Conclusion: The use of tablet computers to enhance participation in sociable and enjoyable activities in day care settings is realistic and achievable if supported appropriately.
    • Quality of care in diabetic patients attending routine primary care clinics compared with those attending GP specialist clinics.

      Ismail, Hanif; Wright, J.; Rhodes, P.J.; Scally, Andy J. (2006)
      Aim To determine the impact on clinical outcomes of specialist diabetes clinics compared with routine primary care clinics. Methods Observational study measuring clinical performance (process/outcome measures) in the primary care sector. A cohort of patients attending specialist diabetes clinics was compared with a control cohort of patients attending routine primary care clinics. Results Patients seen in specialist diabetes clinics had a significantly higher HbA1c than patients in routine primary care clinics (mean difference 0.58%; P < 0.001) but there was no significant difference in rate of improvement with visits compared with primary care clinics. In contrast, patients seen in the routine primary care clinics had significantly higher cholesterol levels (mean difference 0.24 mmol/l; P < 0.001) compared with patients in specialist diabetes clinics and their improvement was significantly greater over time (mean difference 0.14 mmol/l per visit compared with 0.10 mmol/l; P < 0.006). Patients in routine primary care clinics also had significantly higher diastolic blood pressure (mean difference 1.6 mmHg; P < 0.007) but there was no difference in improvement with time compared with specialist diabetes clinics. Uptake of podiatry and retinal screening was significantly lower in patients attending routine primary care clinics, but this difference disappeared with time, with significant increases in uptake in the primary care clinic group. Weight increased in both groups significantly with time, but more so in the specialist clinic patients (mean increase 0.18 kg per visit more compared with routine clinic primary care patients; P < 0.001). Conclusions This study provides evidence that the provision of primary care services for patients with diabetes, whether traditional general practitioner clinics or diabetes clinics run by general practitioners with special interests, is effective in reducing HbA1c, cholesterol and blood pressure. However, the same provision of care was unable to prevent increasing weight or creatinine over time. No evidence was found that patients in specialist clinics do better than patients in routine primary care clinics.
    • Quantitative proteomic profiling of matched normal and tumor breast tissues.

      Sutton, Chris W.; Rustogi, Nitin; Gurkan, C.; Scally, Andy J.; Loizidou, M.A.; Hadjisavvas, A.; Kyriacou, K. (2010)
      Proteomic analysis of breast cancer tissue has proven difficult due to its inherent histological complexity. This pilot study presents preliminary evidence for the ability to differentiate adenoma and invasive carcinoma by measuring changes in proteomic profile of matched normal and disease tissues. A dual lysis buffer method was used to maximize protein extraction from each biopsy, proteins digested with trypsin, and the resulting peptides iTRAQ labeled. After combining, the peptide mixtures they were separated using preparative IEF followed by RP nanoHPLC. Following MALDI MS/MS and database searching, identified proteins were combined into a nonredundant list of 481 proteins with associated normal/tumor iTRAQ ratios for each patient. Proteins were categorized by location as blood, extracellular, and cellular, and the iTRAQ ratios were normalized to enable comparison between patients. Of those proteins significantly changed (upper or lower quartile) between matched normal and disease tissues, those from two invasive carcinoma patients had >50% in common with each other but <22% in common with an adenoma patient. In invasive carcinoma patients, several cellular and extracellular proteins that were significantly increased (Periostin, Small breast epithelial mucin) or decreased (Kinectin) have previously been associated with breast cancer, thereby supporting this approach for a larger disease-stage characterization effort.
    • Radiographer reporting in the UK: A longitudinal analysis

      Snaith, Beverly; Hardy, Maryann L.; Lewis, Emily F. (2015-05)
      Radiographer reporting of plain film radiographs is an established role in the UK. Despite this previous research has demonstrated widespread inconsistencies in implementation, scope and utilisation. A cross-sectional postal survey was undertaken to provide a longitudinal insight into changes in radiographer reporting practice. The sample comprised all individual hospital sites in the UK, Channel Islands and Isle of Man with both a radiology and trauma service A response rate of 63.7% (n = 325/510) was achieved. Reporting radiographers were in place at 179 sites (55.1%) but less likely to be employed at sites with a minor injury unit rather than a full emergency department (χ2 = 71.983; p < 0.001; d.f. = 1). Radiographer utilisation has increased since 2007, although local barriers to implementation and activity were identified. Geographical variation was evident in relation to reporter employment and anatomical scope. A significant association was noted between broader anatomical scope and a wider range of referral sources (χ2 = 34.441; p < 0.001; d.f. = 1). Delayed reporting of radiographs remains the standard service delivery model across the UK. This study confirms the significant contribution that radiographers are making to reporting capacity in the UK, although there continue to be geographical variations, particularly around anatomical scope and referral groups.
    • Radiographer reporting in the UK: Is the current scope of practice limiting plain film reporting capacity?

      Milner, R.C.; Culpan, Gary; Snaith, Beverly (2016)
      Objective: To update knowledge on individual radiographer contribution to plain-film reporting workloads; to assess whether there is scope to further increase radiographer reporting capacity within this area. Methods: Reporting radiographers were invited to complete an online survey. Invitations were posted to every acute National Health Service trust in the UK whilst snowball sampling was employed via a network of colleagues, ex-colleagues and acquaintances. Information was sought regarding the demographics, geographical location and anatomical and referral scope of practice. Results: A total of 259 responses were received. 15.1% and 7.7% of respondents are qualified to report chest and abdomen radiographs, respectively. The mean time spent reporting per week is 14.5 h (range 1–37.5). 23.6% of radiographers report only referrals from emergency departments whilst 50.6% of radiographers have limitations on their practice. Conclusion: The scope of practice of reporting radiographers has increased since previous studies; however, radiographer reporting of chest and abdomen radiographs has failed to progress in line with demand. There remain opportunities to increase radiographer capacity to assist the management of reporting backlogs. Advances in knowledge: This study is the first to examine demographic factors of reporting radiographers across the UK and is one of the largest in-depth studies of UK reporting radiographers, at individual level, to date.
    • Radiographer reporting: A literature review to support cancer workforce planning in England

      Culpan, Gary; Culpan, A.-M.; Docherty, P.; Denton, E. (2019)
      Objective: Clinical Imaging contributes to screening, diagnosis, planning and monitoring of treatment and surveillance in cancer care. This literature review summarises evidence about radiographer reporting to help imaging service providers respond to Health Education England's 2017 Cancer Workforce Plan project to expand radiographer reporting in clinical service provision. Key findings: Papers published between 1992 and 2018 were reviewed (n ¼ 148). Evidence related to dynamic examinations (fluoroscopy, ultrasound) and mammography was excluded. Content was analysed and summarised using the following headings: clinical scope of practice, responsibilities, training, assessment, impact in practice and barriers to expansion. Radiographer reporting is well established in the United Kingdom. Scope of practice varies individually and geographically. Deployment of appropriately trained reporting radiographers is helping the NHS maintain high quality clinical imaging service provision and deliver a cost-effective increase in diagnostic capacity. Conclusion: Working within multiprofessional clinical imaging teams, within a defined scope of practice and with access to medical input when required, reporting radiographers augment capacity in diagnostic pathways and release radiologist time for other complex clinical imaging responsibilities.
    • Radiographers as doctors: A profile of UK doctoral achievement

      Snaith, Beverly; Harris, Martine A.; Harris, R. (2016-11)
      Radiography aspires to be a research active profession, but there is limited information regarding the number of individuals with, or studying for, a doctoral award. This study aims to profile UK doctoral radiographers; including their chosen award, approach and employment status. This was a prospective cohort study utilising an electronic survey. No formal database of doctoral radiographers existed therefore a snowball sampling method was adopted. The study sample was radiographers (diagnostic and therapeutic) based in the UK who were registered with the Health and Care Professions Council (HCPC) and who held, or were studying for, a doctoral award. A total of 90 unique responses were received within the timescale. The respondents comprised 58 females (64.4%) and the majority were diagnostic radiographers (n = 71/90; 78.9%). The traditional PhD was the most common award, although increasing numbers were pursuing Education or Professional Doctorates. An overall increase in doctoral studies is observed over time, but was greatest amongst those working in academic institutions, with 63.3% of respondents (n = 57/90) working solely within a university, and a further 10% employed in a clinical–academic role (n = 9/90). This study has demonstrated that radiography is emerging as a research active profession, with increasing numbers of radiographers engaged in study at a doctoral level. This should provide a platform for the future development of academic and clinical research.
    • 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 (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.
    • 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?