• Facial Difference, Consumer Culture and Being “Normal”

      Peacock, Rose; Sargeant, Anita R.; Small, Neil A. (2016)
      The face is not the property of an individual; it is a key part of our communicating body. It is performed, in social interaction (Goffman, 1982) and seen and responded to within historicised and gendered ideals of the normal and of beauty. The normal and the beautiful have a particular resonance in a visually mediated consumer society, “looks matter”. But more than half-a million people in the UK have a significant disfigurement to their face (Changing Faces, 2007). This chapter explores the way facial difference illuminates debates on bodily representation. It explores how people living with visible facial difference invoke discursive formations of disfigurement (Garland-Thomson, 2009). It asks how we encounter and respond to facial difference and examines how close personal relationships can offer a source of support. The chapter contextualises the relevance of the face for communication and then examines implications for social selves in personal communities. Seventeen people living with visible facial difference were interviewed as part of a PhD study and interview extracts illuminate different aspects of the aesthetics of inclusion.
    • Factor structure of the Hospital Anxiety and Depression Scale in individuals with facial disfigurement.

      Martin, C.R.; Newell, Robert J. (2004)
      The factor structure of the Hospital Anxiety and Depression Scale (HADS) were investigated in 376 individuals with facial disfigurement. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument. Competing one-factor, two-factor and three-factor models were evaluated to identify best model fit. The best model fit to the data was found to be consistently provided by three-factor models. However, further research into the factor structure of the HADS is suggested, particularly in terms of developing and scoring the instrument as a three-dimensional affective state screening tool.
    • Factors affecting women’s adherence with pelvic floor muscle exercises in a first pregnancy: a qualitative interview study

      Cooper, H.E.; Carus, Catherine (2015-08)
      Evidence-based national guidelines recommend that women practise pelvic floor muscle exercises (PFMEs) during their first pregnancy in order to reduce the likelihood of becoming incontinent of urine. Adherence to these exercises during pregnancy is low, although little is known about the factors that influence some women to exercise during pregnancy while others do not. The aim of this study was to increase understanding of the motivating factors for, and barriers to, performing PFMEs during a first pregnancy using data gathered from four qualitative interviews. Analysis of the interview transcripts revealed four relevant themes: knowledge and understanding; experience of incontinence; attitude to incontinence; and cues to exercise. Having adequate knowledge of the PFMEs and the benefits of these exercises, knowing an incontinent woman of the same age and believing that the PFMEs would prevent incontinence, and having a regular cue to exercise prompted exercise adherence. Recommendations are made for practice and further research.
    • Factors associated with accelerometer measured movement behaviours among White British and South Asian children aged 6-8 years during school terms and school holidays.

      Nagy, Liana C.; Faisal, Muhammad; Horne, M.; Collins, P.; Barber, S.; Mohammed, Mohammed A. (2019-08)
      To investigate factors associated with movement behaviours among White British (WB) and South Asian (SA) children aged 6-8 years during school terms and holidays. Cross-sectional. Three primary schools from the Bradford area, UK. One hundred and sixty WB and SA children aged 6-8 years. Sedentary behaviour (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) measured by accelerometry during summer, winter and spring and during school terms and school holidays. Data were analysed using multivariate mixed-effects multilevel modelling with robust SEs. Factors of interest were ethnicity, holiday/term, sex, socioeconomic status (SES), weight status, weekend/weekday and season. One hundred and eight children (67.5%) provided 1157 valid days of data. Fifty-nine per cent of children were WB (n=64) and 41% (n=44) were SA. Boys spent more time in MVPA (11 min/day, p=0.013) compared with girls and SA children spent more time in SB (39 min, p=0.017) compared with WB children in adjusted models. Children living in higher SES areas were more sedentary (43 min, p=0.006) than children living in low SES areas. Children were more active during summer (15 min MVPA, p<0.001; 27 LPA, p<0.001) and spring (15 min MVPA, p=0.005; 38 min LPA, p<0.001) and less sedentary (−42 min and −53 min, p<0.001) compared with winter. Less time (8 min, p=0.012) was spent in LPA during school terms compared with school holidays. Children spent more time in MVPA (5 min, p=0.036) during weekend compared with weekdays. Overweight and obese children spent more time in LPA (21 min, p=0.021) than normal-weight children. The results of our study suggest that significant child level factors associated with movement behaviours are ethnicity, sex, weight-status and area SES. Significant temporal factors are weekends, school holidays and seasonality. Interventions to support health enhancing movement behaviours may need to be tailored around these factors.
    • Factors associated with self- and informant ratings of quality of life, well-being and life satisfaction in people with mild-to-moderate dementia: results from the Improving the experience of Dementia and Enhancing Active Life programme

      Wu, Y-T.; Nelis, S.M.; Quinn, Catherine; Martyr, A.; Jones, I.R.; Victor, C.R.; Knapp, M.; Henderson, C.; Hindle, J.V.; Jones, R.W.; et al. (2020-05)
      Background: a large number of studies have explored factors related to self- and informant ratings of quality of life in people with dementia, but many studies have had relatively small sample sizes and mainly focused on health conditions and dementia symptoms. The aim of this study is to compare self- and informant-rated quality of life, life satisfaction and well-being, and investigate the relationships of the two different rating methods with various social, psychological and health factors, using a large cohort study of community-dwelling people with dementia and carers in Great Britain. Methods: this study included 1,283 dyads of people with mild-to-moderate dementia and their primary carers in the Improving the experience of Dementia and Enhancing Active Life study. Multivariate modelling was used to investigate associations of self- and informant-rated quality of life, life satisfaction and well-being with factors in five domains: psychological characteristics and health; social location; capitals, assets and resources; physical fitness and health; and managing everyday life with dementia. Results: people with dementia rated their quality of life, life satisfaction and well-being more highly than did the informants. Despite these differences, the two approaches had similar relationships with social, psychological and physical health factors in the five domains. Conclusion: although self- and informant ratings differ, they display similar results when focusing on factors associated with quality of life, life satisfaction and well-being. Either self- or informant ratings may offer a reasonable source of information about people with dementia in terms of understanding associated factors.
    • Factors influencing accuracy of referral and the likelihood of false positive referral by optometrists in Bradford, United Kingdom

      Davey, Christopher J.; Scally, Andy J.; Green, Clare; Mitchell, E.S.; Elliott, David B. (2016-07)
      Aims: Levels of false positive referral to ophthalmology departments can be high. This study aimed to evaluate commonality between false positive referrals in order to find the factors which may influence referral accuracy. Methods: In 2007/08, a sample of 431 new Ophthalmology referrals from the catchment area of Bradford Royal Infirmary were retrospectively analysed. Results: The proportion of false positive referrals generated by optometrists decreases with experience at a rate of 6.2% per year since registration (p < 0.0001). Community services which involved further investigation done by the optometrist before directly referring to the hospital were 2.7 times less likely to refer false positively than other referral formats (p = 0.007). Male optometrists were about half as likely to generate a false positive referral than females (OR = 0.51, p = 0.008) and as multiple/corporate practices in the Bradford area employ less experienced and more female staff, independent practices generate about half the number of false positive referrals (OR = 0.52, p = 0.005). Conclusions: Clinician experience has the greatest effect on referral accuracy although there is also a significant effect of gender with women tending to refer more false positives. This may be due to a different approach to patient care and possibly a greater sensitivity to litigation. The improved accuracy of community services (which often refer directly after further investigation) supports further growth of these schemes.
    • Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview study

      Randell, Rebecca; Honey, S.; Alvarado, Natasha; Greenhalgh, J.; Hindmarsh, J.; Pearman, A.; Jayne, D.; Gardner, Peter H.; Gill, A.; Kotze, A.; et al. (2019-06-14)
      To capture stakeholders’ theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice. A literature review provided tentative theories that were revised through a realist interview study. Literature-based theories were presented to the interviewees, who were asked to describe to what extent and in what ways those theories reflected their experience. Analysis focused on identifying mechanisms through which robot-assisted surgery becomes integrated into practice and contexts in which those mechanisms are triggered. Nine hospitals in England where robot-assisted surgery is used for colorectal operations. Forty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists. Interviewees emphasised the importance of support from hospital management, team leaders and surgical colleagues. Training together as a team was seen as beneficial, increasing trust in each other’s knowledge and supporting team bonding, in turn leading to improved teamwork. When first introducing robot-assisted surgery, it is beneficial to have a handpicked dedicated robotic team who are able to quickly gain experience and confidence. A suitably sized operating theatre can reduce operation duration and the risk of de-sterilisation. Motivation among team members to persist with robot-assisted surgery can be achieved without involvement in the initial decision to purchase a robot, but training that enables team members to feel confident as they take on the new tasks is essential. We captured accounts of how robot-assisted surgery has been introduced into a range of hospitals. Using a realist approach, we were also able to capture perceptions of the factors that support and constrain the integration of robot-assisted surgery into routine practice. We have translated these into recommendations that can inform future implementations of robot-assisted surgery.
    • Factors that contribute to undergraduate student success.

      Dearnley, Christine A.; Matthew, B. (2009-05-29)
    • Fad or panacea - Lean management

      McIntosh, Bryan; Schmall, S.B. (2011)
      The NHS will need to make real term cost savings whilst maintaining and, where possible, enhancing the quality of essential services. The require-ment for efficiency savings to enable reinvestment in quality is estimated to be up to £21.1 billion by 2014 (Department of Health, 2010; Appleby, 2009.). This requires the NHS to increase productivity by 6 percent per annum (Appleby, 2010) while the Office of National Statistics estimates that productivity1 actually fell by approximately 0.3 percent per annum over the period 1995-2008 (ONS, 2010). Productivity is highly variable within the NHS and even within trusts (NHS Institute for Innovation and Improvement, 2004). Given these pressures, the productivity of healthcare organiza-tions is an incredibly salient topic; lean management is a particular pertinent and topical issue.
    • Failure Mode and Effects Analysis: an empirical analysis of failure mode scoring procedures

      Ashley, L.J.; Armitage, Gerry R.; Neary M.; Hollingsworth, G. (2010)
      Objectives: To empirically compare 2 different commonly used failure mode and effects analysis (FMEA) scoring procedures with respect to their resultant failure mode scores and prioritization: a mathematical procedure, where scores are assigned independently by FMEA team members and averaged, and a consensus procedure, where scores are agreed on by the FMEA team via discussion. Methods: A multidisciplinary team undertook a Healthcare FMEA of chemotherapy administration. This included mapping the chemotherapy process, identifying and scoring failure modes (potential errors) for each process step, and generating remedial strategies to counteract them. Failure modes were scored using both an independent mathematical procedure and a team consensus procedure. Results: Almost three-fifths of the 30 failure modes generated were scored differently by the 2 procedures, and for just more than one-third of cases, the score discrepancy was substantial. Using the Healthcare FMEA prioritization cutoff score, almost twice as many failure modes were prioritized by the consensus procedure than by the mathematical procedure. Conclusions: This is the first study to empirically demonstrate that different FMEA scoring procedures can score and prioritize failure modes differently. It found considerable variability in individual team members' opinions on scores, which highlights the subjective and qualitative nature of failure mode scoring. A consensus scoring procedure may be most appropriate for FMEA as it allows variability in individuals' scores and rationales to become apparent and to be discussed and resolved by the team. It may also yield team learning and communication benefits unlikely to result from a mathematical procedure.
    • Falls prevention and the value of exercise: salient beliefs among South Asian and White British older adults.

      Horne, Maria; Skelton, D.A.; Speed, S.; Todd, C. (2014-02)
      The importance of increasing exercise to prevent falls among older adults remains a key worldwide public health priority. However, older adults do not necessarily take up exercise as a preventative measure for falls. This qualitative study aimed to explore the beliefs of community-dwelling South Asian and White British older adults aged 60 to 70 about falls and exercise for fall prevention through 15 focus groups (n = 87) and 40 in-depth interviews. Data were transcribed verbatim and analyzed using a framework approach. Data analysis identified six salient beliefs that influenced older adults’ intention to exercise for fall prevention. In general, older adults aged 60 to 70 did not acknowledge their risk of falling and were not motivated to exercise simply to help prevent falls. Positive beliefs were found to be an unlikely barrier to taking up exercise for fall prevention for those who had experienced a fall. The implications for health promotion and health professionals with this group of older adults are discussed.
    • Family carers' perspectives on post-school transition of young people with intellectual disabilities with special reference to ethnicity

      Raghavan, R.; Pawson, Nicole; Small, Neil A. (2013)
      School leavers with intellectual disabilities (ID) often face difficulties in making a smooth transition from school to college, employment or more broadly to adult life. The transition phase is traumatic for the young person with ID and their families as it often results in the loss of friendships, relationships and social networks. The aim of this study was to explore the family carers' views and experiences on transition from school to college or to adult life with special reference to ethnicity. Forty-three families (consisting of 16 White British, 24 Pakistani, 2 Bangladeshi and one Black African) were interviewed twice using a semi-structured interview schedule. The carers were interviewed twice, Time 1 (T1) and Time 2 (T2), T2 being a year later to observe any changes during transition. The findings indicate that although transition planning occurred it was relatively later in the young person's school life. Parents were often confused about the process and had limited information about future options for their son or daughter. All family carers regardless of ethnicity, reported lack of information about services and expressed a sense of being excluded. South Asian families experienced more problems related to language, information about services, culture and religion. The majority of families lacked knowledge and awareness of formal services and the transition process. Socio-economic status, high levels of unemployment and caring for a child with a disability accounted for similar family experiences, regardless of ethnic background. The three key areas relevant for ethnicity are interdependence, religion and assumptions by service providers.
    • Family involvement in timely detection of changes in health of nursing homes residents: a qualitative exploratory study

      Powell, Catherine; Blighe, Alan J.; Froggatt, K.A.; McCormack, B.; Woodward-Carlton, Barbara; Young, J.; Robinson, L.; Downs, Murna G. (2018-01)
      This article aims to explore family perspectives on their involvement in the timely detection of changes in their relatives' health in UK nursing homes. Increasingly, policy attention is being paid to the need to reduce hospitalisations for conditions that, if detected and treated in time, could be managed in the community. We know that family continue to be involved in the care of their family members once they have moved into a nursing home. Little is known, however, about family involvement in the timely detection of changes in health in nursing home residents. This was a qualitative exploratory study with thematic analysis. A purposive sampling strategy was applied. 14 semi-structured one-to-one telephone interviews with family members of people living in 13 different UK nursing homes. Data were collected from November 2015 to March 2016. Families were involved in the timely detection of changes in health in three key ways: noticing signs of changes in health, informing care staff about what they noticed, and educating care staff about their family members' changes in health. Families suggested they could be supported to detect timely changes in health by developing effective working practices with care staff. Families can provide a special contribution to the process of timely detection in nursing homes. Their involvement needs to be negotiated, better supported, as well as given more legitimacy and structure within the nursing home. Families could provide much needed support to nursing home nurses, care assistants, and managers in timely detection of changes in health. This may be achieved through communication about their preferred involvement on a case-by-case basis as well as providing appropriate support or services.
    • A family living with Alzheimer’s disease: The communicative challenges

      Jones, Danielle K. (2015-09-29)
      Alzheimer’s disease irrevocably challenges a person’s capacity to communicate with others. Earlier research on these challenges focused on the language disorders associated with the condition and situated language deficit solely in the limitations of a person’s cognitive and semantic impairments. This research falls short of gaining insight into the actual interactional experiences of a person with Alzheimer’s and their family. Drawing on a UK data set of 70 telephone calls recorded over a two-and-a-half year period (2006–2008) between one elderly woman affected by Alzheimer’s disease, and her daughter and son-in-law, this paper explores the role which communication (and its degeneration) plays in family relationships. Investigating these interactions, using a conversation analytic approach, reveals that there are clearly communicative difficulties, but closer inspection suggests that they arise due to the contingencies that are generated by the other’s contributions in the interaction. That being so, this paper marks a departure from the traditional focus on language level analysis and the assumption that deficits are intrinsic to the individual with Alzheimer’s, and instead focuses on the collaborative communicative challenges that arise in the interaction itself and which have a profound impact on people’s lives and relationships.
    • Family relationships and dementia: A synthesis of qualitative research including the person with dementia

      La Fontaine Papadopoulos, Jenny H.; Oyebode, Jan R. (2014-08)
      Family relationships are important for wellbeing across the life course and are known to be important for people living with dementia, bringing benefits to self-esteem and identity, as well as providing support for people living at home. Recent research has explored the impact of dementia upon relationships. Much of this research is qualitative in nature and rarely included in systematic reviews, however, it has the potential to provide significant contributions to understanding the interplay between family relationships and dementia and to inform interventions. A systematic synthesis of qualitative research concerning the impact of dementia upon family relationships was undertaken, using thematic synthesis. Eleven articles were reviewed, which address the perspectives of people living with dementia and their spouse and/or adult children. The aims of this review are to illuminate what is currently known about the reciprocal influences between family relationships and dementia from the perspectives of the family (including the person with dementia); and to consider the implications of these findings for research and practice. Four super-ordinate themes were identified: A shared history, negotiating the impact of dementia upon the relationship, openness and awareness, and shifting sands. This synthesis contributes to an emerging field but also highlights gaps in current understanding of the impact of dementia upon relationships and in providing appropriate interventions. Implications for research and practice are considered.
    • A feasibility randomised controlled trial of the DECIDE intervention: dementia carers making informed decisions

      Lord, Kathryn; Livingston, G.; Cooper, C. (2017-02)
      Family carers report high levels of decisional conflict when deciding whether their relative with dementia can continue to be cared for in their own home. We tested, in a feasibility randomised controlled trial, the first decision aid (the DECIDE manual) aiming to reduce such conflict. Twenty family carers received the DECIDE intervention, and 21 received usual treatment. The intervention group had reduced decisional conflict compared with controls (mean difference −11.96, 95% confidence interval −20.10 to −3.83, P=0.005). All carers receiving the intervention completed and valued it, despite some still reporting difficulties with family conflict and problems negotiating services. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
    • Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke

      Nijenhuis, S.M.; Prange, G.B.; Amirabdollahian, F.; Sale, P.; Infarinato, F.; Nasr, N.; Mountain, Gail; Hermens, H.J.; Stienen, A.H.A.; Buurke, J.H.; et al. (2015-10-09)
      Background: Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. Methods: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. Results: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. Conclusions: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings.
    • Feelings of remembering and knowing: Memory and aging from a first-person perspective.

      Moulin, C.J.A.; Souchay, C.; Williams, H.; Smith, Sarah J.; Rathbone, C.J. (2009)
    • Female Soccer: Part 1 – A Needs Analysis

      Turner, E.; Munro, Allan G.; Comfort, P. (2013)
      It is imperative for strength and conditioning coaches to conduct a detailed analysis of the demands of a sport, identifying normative data where possible to permit an evidence-based evaluation of an athlete’s current performance status and to inform the development of specific goals for the athletes’ development. Part one of this article reviews the demands of female soccer and provides normative data from published research identifying specific areas that require development in female soccer players. Part two recommends evidence-based approaches integrated to athlete development and injury prevention strategies, as a result of the needs analysis.
    • Female Soccer: Part 2 – Training Considerations and Recommendations

      Turner, E.; Munro, Allan G.; Comfort, P. (2013)
      Part 1 of this article identified the demands of female soccer and the specific areas of development required to optimize performance and reduce the risk of common injuries. Increases in aerobic capacity, strength, and lower limb control were required to improve performance and reduce the risks of common injuries. The aims of part 2 are to provide examples of evidence-based integrated strategies to address the issues identified in part 1 and to ensure not only enhanced performance but also a reduced incidence of common injuries in female soccer players.