• Balancing Risk and Benefit in Medical Radiology.

      Scally, Andy J. (2008)
      This book provides an introductory overview of a wide range of commonly encountered medical imaging tests including radiation- based techniques such as plain film radiography, computed tomography and nuclear medicine, and non-ionising imaging techniques such as medical ultrasound and magnetic resonance imaging... Chapter 7 Balancing risk and benefit in diagnostic imaging.
    • Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: a qualitative interview study

      Peat, George W.; Fylan, Beth; Marques, Iuri; Rayner, D.K.; Breen, Liz; Olaniyan, Janice; Alldred, David P. (2022-03)
      Objective To explore the barriers/facilitators to deprescribing in primary care in England from the perspectives of clinicians, patients living with frailty who reside at home, and their informal carers, drawing on the Theoretical Domains Framework to identify behavioural components associated with barriers/facilitators of the process. Design Exploratory qualitative study. Setting General practice (primary care) in England. Participants 9 patients aged 65+ living with frailty who attended a consultation to reduce or stop a medicine/s. 3 informal carers of patients living with frailty. 14 primary care clinicians including general practitioners, practice pharmacists and advanced nurse practitioners. Methods Qualitative semistructured interviews took place with patients living with frailty, their informal carers and clinicians. Patients (n=9) and informal carers (n=3) were interviewed two times: immediately after deprescribing and 5/6 weeks later. Clinicians (n=14) were interviewed once. In total, 38 interviews were undertaken. Framework analysis was applied to manage and analyse the data. Results 6 themes associated with facilitators and barriers to deprescribing were generated, respectively, with each supported by between two and three subthemes. Identified facilitators of deprescribing with patients living with frailty included shared decision-making, gradual introduction of the topic, clear communication of the topic to the patient and multidisciplinary working. Identified barriers of deprescribing included consultation constraints, patients' fear of negative consequences and inaccessible terminology and information. Conclusions This paper offers timely insight into the barriers and facilitators to deprescribing for patients living with frailty within the context of primary care in England. As deprescribing continues to grow in national and international significance, it is important that future deprescribing interventions acknowledge the current barriers and facilitators and their associated behavioural components experienced by clinicians, patients living with frailty and their informal carers to improve the safety and effectiveness of the process.
    • 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.
    • Barriers to advance care planning in chronic obstructive pulmonary disease

      Gott, M.; Gardiner, C.; Small, Neil A.; Payne, S.; Seamark, D.; Barnes, S.; Halpin, D.; Ruse, C. (2009)
      The English End of Life Care Strategy promises that all patients with advanced, life limiting illness will have the opportunity to participate in Advance Care Planning (ACP). For patients with Chronic Obstructive Pulmonary Disease (COPD), the barriers to this being achieved in practice are under-explored. Five focus groups were held with a total of 39 health care professionals involved in the care of patients with COPD. Participants reported that discussions relating to ACP are very rarely initiated with patients with COPD and identified the following barriers: inadequate information provision about the likely course of COPD at diagnosis; lack of consensus regarding who should initiate ACP and in which setting; connotations of comparing COPD with cancer; ACP discussions conflicting with goals of chronic disease management; and a lack of understanding of the meaning of 'end of life' within the context of COPD. The findings from this study indicate that, for patients with COPD, significant service improvement is needed before the objective of the End of Life Care Strategy regarding patient participation in end of life decision-making is to be achieved. Whilst the findings support the Strategy's recommendations regarding an urgent for both professional education and increased public education about end of life issues, they also indicate that these alone will not be enough to effect the level of change required. Consideration also needs to be given to the integration of chronic disease management and end of life care and to developing definitions of end of life care that fit with concepts of 'continuous palliation'.
    • Bay Tree Voices: Inclusive practice in the involvement of people with dementia in practitioner education.

      Capstick, Andrea (2012)
      Dementia has been a latecomer to the field of service user involvement. Although there are now beginning to be welcome signs of improvement in the inclusion of the service-user voice, at present those with milder cognitive impairment, those who are still living at home, and those who come from white, professional backgrounds are over-represented. The BSc/MSc Dementia Studies programmes at the University of Bradford recruit part-time students who are already employed in the field of dementia care. The majority of students work in long-term or intermediate care, with smaller sub-groups working in the community, in acute care and on general hospital wards. The client groups with dementia they encounter in these settings are diverse, and tend to have different needs and perspectives from those articulated by mainstream service user groups. For this reason we have been seeking to develop an inclusive approach to service user involvement in the degree programmes we run, in order to ensure that the whole range of experiences of dementia is covered. Over the last five years this has involved developing an outreach programme in order to involve people with dementia in the environments where they spend their time, rather than restricting service user involvement to on-site activities at the University. This presentation showcases one such project which involved members of the course team working with clients attending a resource centre for older people with dementia to develop a series of short film clips (Bay Tree Voices) which were then embedded into the course learning materials in order to model alternative approaches to communication. The presentation includes formal and informal evaluations of these film-based teaching resources from service users, students and care staff.
    • Beacons of Excellence in Stress Prevention

      Giga, Sabir I.; Faragher, B.; Gurr, E.; Jordan, J. (2004)
      This report describes the work of Robertson Cooper Ltd and UMIST to identify good practice in stress prevention and then identify organisations within the UK that could be called beacons of excellence in comparison to this model. Part one of this report summarises and draws conclusions from all of the substantive academic studies on stress prevention over the last decade and uses this information, as well as advice gained from a panel of international experts, to develop a comprehensive stress prevention model. Part two of the report uses this model to describe examples of stress prevention practices that Robertson Cooper Ltd has identified within a wide range of UK organisations. Case studies are presented for each aspect of the good practice model. Examples of real documentation and organisational practice are presented.
    • Becoming the Queen's Nurse

      Kelsey, Catherine (2016-10)
    • Behaviour modification and gentle teaching workshops: management of children with learning disabilities exhibiting challenging behaviour and implications for learning disability nursing

      Gates, B.; Newell, Robert J.; Wray, J. (2001)
      Background. Challenging behaviours (behaviour difficulties) represent a problem of considerable clinical significance for learning disability nurses, and a source of much human distress. Gentle teaching is a relatively new approach to dealing with behavioural difficulties, and has been received with enthusiasm by clinicians, but has so far received little empirical support. The current study attempted to compare gentle teaching with a well-established alternative (behaviour modification) and a control group. Objectives. To examine the comparative effectiveness of gentle teaching, behaviour modification and control interventions for challenging behaviour amongst children with learning disabilities. Design. Nonrandomized controlled trial. Setting. Service users¿ homes in East Yorkshire. Participants. Seventy-seven children who presented with learning disabilities and challenging behaviour (behaviour difficulties) and their parents. Procedure. One-day workshops in were offered by recognized authorities in either behaviour modification or gentle teaching that were not otherwise involved with the research project. Forty-one participants were recruited to the gentle teaching condition; 36 to behaviour modification; 26 to the control group. Random allocation was not possible, because of the slow uptake by interested parents. Measures was preintervention, and at assessment points up until 12 months following intervention. Analysis. Quantitative analysis of pre¿post differences between the groups, using t-test. Results. In general, no significant differences were found between the treatment groups and controls. Significant improvements were found for both gentle teaching and behaviour modification children over controls on the AAMR ABS XVII (social engagement) subscale. Controls had more contact with medical practitioner (GP) services than behaviour modification children and less than gentle teaching children. Conclusion. Although very few differences were found between the three groups, those that did exist generally favoured behaviour modification. Implications for service provision and learning disability nursing practice are described.
    • Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital: Prospective Cohort study

      Sampson, E.L.; White, N.; Leurent, B.; Scott, S.; Lord, Kathryn; Round, J.; Jones, L. (2014-09)
      Background Dementia is common in older people admitted to acute hospitals. There are concerns about the quality of care they receive. Behavioural and psychiatric symptoms of dementia (BPSD) seem to be particularly challenging for hospital staff. Aims To define the prevalence of BPSD and explore their clinical associations. Method Longitudinal cohort study of 230 people with dementia, aged over 70, admitted to hospital for acute medical illness, and assessed for BPSD at admission and every 4 (± 1) days until discharge. Other measures included length of stay, care quality indicators, adverse events and mortality. Results Participants were very impaired; 46% at Functional Assessment Staging Scale (FAST) stage 6d or above (doubly incontinent), 75% had BPSD, and 43% had some BPSD that were moderately/severely troubling to staff. Most common were aggression (57%), activity disturbance (44%), sleep disturbance (42%) and anxiety (35%). Conclusions We found that BPSD are very common in older people admitted to an acute hospital. Patients and staff would benefit from more specialist psychiatric support.
    • Behaviours that prompt primary school teachers to adopt and implement physically active learning: a meta synthesis of qualitative evidence.

      Daly-Smith, Andrew; Morris, J.L.; Norris, E.; Williams, T.L.; Archbold, V.; Kallio, J.; Tammelin, T.H.; Singh, A.; Mota, J.; von Seelen, J.; et al. (2021-11-20)
      Physically active learning (PAL) - integration of movement within delivery of academic content - is a core component of many whole-of-school physical activity approaches. Yet, PAL intervention methods and strategies vary and frequently are not sustained beyond formal programmes. To improve PAL training, a more comprehensive understanding of the behavioural and psychological processes that influence teachers' adoption and implementation of PAL is required. To address this, we conducted a meta-synthesis to synthesise key stakeholders' knowledge of facilitators and barriers to teachers' implementing PAL in schools to improve teacher-focussed PAL interventions in primary (elementary) schools. We conducted a meta-synthesis using a five-stage thematic synthesis approach to; develop a research purpose and aim, identify relevant articles, appraise studies for quality, develop descriptive themes and interpret and synthesise the literature. In the final stage, 14 domains from the Theoretical Domain Framework (TDF) were then aligned to the final analytical themes and subthemes. We identified seven themes and 31 sub-themes from 25 eligible papers. Four themes summarised teacher-level factors: PAL benefits, teachers' beliefs about own capabilities, PAL teacher training, PAL delivery. One theme encompassed teacher and school-level factors: resources. Two themes reflected school and external factors that influence teachers' PAL behaviour: whole-school approach, external factors. Ten (of 14) TDF domains aligned with main themes and sub-themes: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, Beliefs about Consequences, Reinforcement, Goals, Environmental Context and Resources, Social influences and Emotion. Our synthesis illustrates the inherent complexity required to change and sustain teachers' PAL behaviours. Initially, teachers must receive the training, resources and support to develop the capability to implement and adapt PAL. The PAL training programme should progress as teachers' build their experience and capability; content should be 'refreshed' and become more challenging over time. Subsequently, it is imperative to engage all levels of the school community for PAL to be fully integrated into a broader school system. Adequate resources, strong leadership and governance, an engaged activated community and political will are necessary to achieve this, and may not currently exist in most schools.
    • Behind the stiff upper lip: war narratives of older men with dementia.

      Capstick, Andrea; Clegg, D. (2013)
      The concept of the stiff upper lip stands as a cultural metaphor for the repression and figurative ¿biting back¿ of traumatic experience, particularly in military contexts. For men born in the first half of the 20th century, maintaining a stiff upper lip involved the ability to exert high levels of cognitive control over the subjective, visceral and emotional domains of experience. In the most common forms of dementia, which affect at least one in five men now in their 80s and 90s, this cognitive control is increasingly lost. One result is that, with the onset of dementia, men who have in the intervening years maintained a relative silence about their wartime experiences begin to disclose detailed memories of such events, in some cases for the first time. This article draws on narrative biographical data from three men with late-onset dementia who make extensive reference to their experience of war. The narratives of Sid, Leonard and Nelson are used to explore aspects of collective memory of the two World Wars, and the socially constructed masculinities imposed on men who grew up and came of age during those decades. The findings show that in spite of their difficulties with short term memory, people with dementia can contribute rich data to cultural studies research. Some aspects of the narratives discussed here may also be considered to work along the line of the counter-hegemonic, offering insights into lived experiences of war that have been elided in popular culture in the post-War years.
    • Beliefs About Dementia: Development and Validation of the Representations and Adjustment to Dementia Index (RADIX)

      Quinn, Catherine; Morris, R.G.; Clare, L. (2018-06)
      The Self-Regulation Model (SRM) identifies that the beliefs people hold about an illness can influence their responses to that illness. Although there are generic measures of illness representations, there is a need for a brief tailored measure to use with people with dementia. The aim of this study was to develop and validate a brief measure called the Representations and Adjustment to Dementia Index (RADIX). The RADIX contains questions on the SRM elements: Identity, Cause, Timeline, Control, and Consequences. The RADIX validation was conducted with a sample of 385 community-dwelling people with mild to moderate dementia who were taking part in the IDEAL cohort study. Test-retest reliability was conducted over a 4-week period with a separate sample of 20 people with dementia. The validation process resulted in a reduction in the number of items in the Timeline, Control, and Consequences items. The resulting RADIX demonstrated good acceptability, internal reliability, and test-retest reliability. All the RADIX items had low missing data, indicating good acceptability. The factor analysis confirmed that the Consequences items formed two subscales (practical and emotional consequences) that had Cronbach's α of 8 and 0.91 respectively. Test-retest reliability indicated that the Identity, Timeline, and Control items had moderate reliability and the practical and emotional consequences scales had good reliability. The RADIX demonstrates acceptable psychometric properties, proves to be a useful measure for exploring people's beliefs about dementia, and could aid the provision of tailored information and support to people with dementia.
    • Bereavement and the role of religious and cultural factors.

      Oyebode, Jan R.; Owens, R.G. (21/08/2013)
      The aim of this article is to give an overview of some of the key dimensions of variation in cultural and religious rituals during the immediate period after a death and in the longer term, in order to inform service delivery in multi-cultural societies. For each area we give examples of different customs, and consider their functions and possible impact. Dimensions considered in the immediate period after bereavement are: The time and space given to formal rituals, expression of feelings, assertion of status and disposal of the body. In the longer term, we look at variations in remembering the deceased and in continuing bonds. Throughout we consider the interplay between individual responses and the person¿s cultural and religious context. Our objective is to provide an accessible introduction for practitioners new to working with bereavement and provide a succinct reference point for more experienced bereavement workers.
    • Bereavement counseling

      Oyebode, Jan R. (2013)
    • Between-session reliability of four hop tests and the agility T-test

      Munro, Allan G.; Herrington, L.C. (2011)
      The purposes of this study were firstly to investigate whether learning affects were present in the administration of 4 hop tests and the Agility T-test and secondly to assess the between-session reliability of these tests. Twenty-two recreational athletes (11 women: age 22.3 ± 3.7 years, height 167.7 ± 6.2 cm, weight 59.2 ± 6.9 kg and 11 men: age 22.8 ± 3.1 years, height 179.8 ± 4 cm, weight 79.6 ± 10 kg) took part in the study. The subjects performed 6 repetitions of each hop test and 4 repetitions of the Agility T-test once a week over a period of 3 weeks. Distances were normalized to leg length and presented as a percentage value for the single, triple and crossover hop. Results showed that there were significant differences in scores between genders and that learning affects were present in all tests. Intraclass correlation coefficients ranged from 0.76 to 0.92 for the hop tests and 0.82 to 0.96 for the Agility T-test. The results indicated that the hop and Agility T-tests are reliable tests for use with subjects in a clinical or team sport environment. The error measurement statistics presented could be of help to practitioners to determine whether changes in individuals' scores in the hop and Agility T-tests are because of a true change in performance or measurement error. Of most importance was the fact that all subjects achieved at least 90% limb symmetry index on all 4 hop tests. Therefore, we recommend that a minimum limb symmetry value of 90%, rather than previously recommended 85%, should be adopted during rehabilitation and conditioning.
    • Between-session reliability of the star excursion balance test

      Munro, Allan G.; Herrington, L.C. (2010)
      Objective To assess the learning effect, test–retest reliability and measurement error associated with the SEBT. Design Repeated-measures study. Setting Controlled university laboratory environment. Participants Twenty-two healthy recreational athletes (11 male age 22.3 ± 3.7 years, 11 female age 22.8 ± 3.1 years). Main Outcome Measures Repeated-measures ANOVA assessed learning affects. Intraclass correlations coefficients, standard error of measurement and smallest detectable difference values were calculated to assess reliability and measurement error. Results Results showed that excursion distances stabilised after four trials, therefore trials five to seven were analysed for reliability. Test–retest reliability for all reach directions was high, with intraclass correlation coefficients ranging from 0.84 to 0.92. 95% confidence intervals, standard error of measurement and smallest detectable difference ranged from 77.84 to 94.00, 2.21–2.94% and 6.13–8.15%, respectively. Conclusion These statistics will allow clinicians to evaluate whether changes in SEBT scores are due to change in an individual’s performance or random error. The findings of this study show that the SEBT is a reliable measure of lower limb function in healthy recreational athletes. Changes in normalised scores of at least 6–8% are needed to feel confident that a real change in SEBT performance has occurred.
    • Beyond image interpretation: Capturing the impact of radiographer advanced practice through activity diaries

      Snaith, Beverly; Milner, R.C.; Harris, Martine A. (2016-11)
      There is limited evidence of the impact of radiographers working in advanced roles beyond task substitution. This study reviews the contribution of advanced (and consultant) practitioner radiographers to service delivery whilst reporting radiographs and demonstrates the impact this has on patients and staff, both internal and external to the imaging department. The study was a prospective exploratory study using activity diaries to allow interval sampling when individuals were rostered to report. Data was coded using a compiled list of activities and recorded in 15-min intervals over the period of one week. Thirteen radiographers who independently report radiographs participated across 6 locations in a busy multisite English National Health Service (NHS) Trust. Radiographers reported the majority of the examinations during the study period (n = 4512/5671; 79.6%). The total number of coded activities recorded over the study period was 1527, equating to 380.5 relative hours. The majority of available time was spent reporting, including dictating and verifying the reports of colleagues or trainees, although 69.5% of reporting time was interrupted. Based upon the hours of reporting there was an average of 19.3 reports (patient episodes) produced per hour. Direct patient care tasks and support for staff in decision making were regularly documented. Supplementary tasks included administrative activity, amendments to rotas, preparing presentations and documenting incidents identified during reporting. This study has demonstrated the breadth and complexity of the activities performed by advanced practice radiographers. The findings confirm their role in supporting service delivery beyond image interpretation.
    • Bias in plain film reading performance studies.

      Brealey, S.; Scally, Andy J. (2001)
      Radiographers and other healthcare professionals are becoming increasingly involved in radiological reporting, for instance plain radiographs, mammography and ultrasound. Systematic reviews of research evidence can help to assimilate a knowledge base by ordering and evaluating the available evidence on the reporting accuracy of different professional groups. This article reviews the biases that can undermine the results of plain ¿lm reading performance studies. These biases are subdivided into three categories. The ¿rst category refers to the selection of subjects, including both ¿lms and professionals, and covers the validity of generalizing results beyond the study population. The other two categories are concerned with study design and the interpretation both of ¿lms and of reports and the effect on study validity. An understanding of these biases is essential when designing such studies and when interpreting the results of existing studies.
    • The big green lab project

      Lucas, Beverley J.; Comerford Boyes, Louise; Karodia, Nazira; Munshi, Tasnim; Martin, William H.C.; Hopkinson, Peter G. (2014-03)
      Beverley Lucas and her colleagues give us a big green welcome to the Ecoversity of Bradford In 2005, the Higher Education Funding Council for England (Hefce) stated that ‘the greatest contribution a university can make to sustainable development is through the education of their graduates’. The University of Bradford took up the gauntlet, embedding sustainable development in all areas of its campus whilst also transforming the curriculum across the university to educate for sustainable development. This led to them coining themselves an ecoversity.
    • Bilateral L1 and L2 dorsal root ganglion blocks for discogenic low-back pain.

      Richardson, J.; Collinghan, N.; Scally, Andy J.; Gupta, S. (2000)
      Background It is possible that interruption of nociceptive input from intervertebral discs can be modulated through bilateral L1 and L2 dorsal root ganglia (DRG) blockade. In order to test this hypothesis, we prospectively collected data from patients with low-lumbar pain, accurately diagnosed as discogenic using provocation discography. Methods Twelve patients were recruited with a mean (SD) symptom duration of 13.7 (8.2) years. Bilateral DRG blocks of L1 and L2 were performed using methylprednisolone 80 mg, clonidine 75 µg and 0.5% bupivacaine 4 ml in each patient. Results Analysis of Brief Pain Inventories showed no significant change in pain scores. Conclusion We conclude that blocks of this nociceptive pathway in humans using bilateral DRG blocks has no therapeutic value.