• The gait initiation process in unilateral lower-limb amputees when stepping up and stepping down to a new level

      Twigg, Peter C.; Buckley, John G.; Jones, S.F.; Scally, Andy J. (2005)
      Unilateral lower-limb amputees lead with their intact limb when stepping up and with their prosthesis when stepping down; the gait initiation process for the different stepping directions has not previously been investigated. Ten unilateral amputees (5 transfemoral and 5 transtibial) and 8 able-bodied controls performed single steps up and single steps down to a new level (73 and 219 mm). Duration, a-p and m-l centre of mass and centre of pressure peak displacements and centre of mass peak velocity of the anticipatory postural adjustment and step execution phase were evaluated for each stepping direction by analysing data collected using a Vicon 3D motion analysis system. There were significant differences (in the phase duration, peak a-p and m-l centre of pressure displacement and peak a-p and m-l centre of mass velocity at heel-off and at foot-contact) between both amputee sub-groups and controls (P<0.05), but not between amputee sub-groups. These group differences were mainly a result of amputees adopting a different gait initiation strategy for each stepping direction. Findings indicate the gait initiation process utilised by lower-limb amputees was dependent on the direction of stepping and more particularly by which limb the amputee led with; this suggests that the balance and postural control of gait initiation is not governed by a fixed motor program, and thus that becoming an amputee will require time and training to develop alternative neuromuscular control and coordination strategies. These findings should be considered when developing training/rehabilitation programs.
    • Gait termination on a declined surface in trans-femoral amputees: Impact of using microprocessor-controlled limb system

      Abdulhasan, Zahraa M.; Scally, Andy J.; Buckley, John G. (2018-08)
      Background: Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. Methods: Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its ‘ramp-descent’ mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. Findings: Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). Interpretation: Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity.
    • Gendered migrations and precarity in the post-Brexit-vote UK: the case of Polish women as workers and carers

      Duda-Mikulin, Eva A. (2018)
      Polish migration to the UK post European Union enlargement has been studied extensively but limited attention has been paid to women and their gendered mobility. In this paper, I argue that it is key to turn attention to women migrants as those who are often responsible for reproductive labour and who raise future generations of workers and citizens. This is pivotal to consider in light of ageing European societies and the need for workers and Brexit. Arguably, precarity is characteristic of contemporary life. This applies to the post-Brexit-vote UK and the uncertainty linked to the future after 2019. Precarity is inevitably characteristic of many migrants’ lives often punctuated by a lack of job security which is linked to limited material and psychological well-being. For women migrants, this state of affairs is further compounded by their attachment to the private sphere which often constitutes a barrier to their engagement in the paid labour market on the same footing as men. This paper draws on qualitative primary data gathered from 32 Polish women migrants who were initially interviewed in 2012/2013 and subsequently some of them were re-interviewed in 2016/2017.
    • General concepts of goals and goal-setting in health: A narrative analysis

      Ogbeiwi, Osahon (2018)
      Goal-setting is fundamental to organisational management, yet not every manager knows how do it well. A narrative literature review was done to explore current knowledge of definitions and classifications of goals, and principles of goal-setting in the health sector. Online databases generated 65 relevant articles. Additional literature sources were snowballed from referenced articles, and textbooks. Most academic authors define ‘goal’ synonymously as ‘aim’ or ‘objective’, but with evidence of hermeneutical confusion in general literature. Goal classifications are diverse, differing according to their contextual, structural, functional and temporal characteristics. Many authors agree that goal-setting is problem-based, change-oriented and can effectively motivate attainment, if the goal statement is formulated with a specific and challenging or SMART framework. However, recent authors report varying defining attributes for SMART, and evidence of past studies that have empirically examined the nature and efficacy of frameworks currently used for formulating goal statements for health programmes is lacking.
    • General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia.

      Downs, Murna G.; Iliffe, S.; Turner, S.; Wilcock, J.; Bryans, M.; Keady, J.; O'Carroll, R.; Levin, E. (2004)
      Objective: to measure general practitioners' knowledge of, confidence with and attitudes to the diagnosis and management of dementia in primary care. Setting: 20 general practices of varying size and prior research experience in Central Scotland, and 16 similarly varied practices in north London. Participants: 127 general practitioners who had volunteered to join a randomised controlled trial of educational interventions about dementia diagnosis and management. Methods: self-completion questionnaires covering knowledge, confidence and attitudes were retrieved from practitioners prior to the educational interventions. Results: general practitioners' knowledge of dementia diagnosis and management is good, but poor awareness of its epidemiology leads to an over-estimate of caseload. Knowledge of local diagnostic and support services is less good, and one third of general practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in management of behaviour and other problems in dementia. The main difficulties identified by general practitioners were talking with patients about the diagnosis, responding to behaviour problems and coordinating support services. General practitioners perceived lack of time and lack of social services support as the major obstacles to good quality care more often than they identified their own unfamiliarity with current management or with local resources. Attitudes to the disclosure of the diagnosis, and to the potential for improving the quality of life of patients and carers varied, but a third of general practitioners believed that dementia care is within a specialist's domain, not that of general practice. More experienced and male general practitioners were more pessimistic about dementia care, as were general practitioners with lower knowledge about dementia. Those reporting greater difficulty with dementia diagnosis and management and those with lower knowledge scores were also less likely to express attitudes endorsing open communication with patient and carer. Conclusion: educational support for general practitioners should concentrate on epidemiological knowledge, disclosure of the diagnosis and management of behaviour problems in dementia. The availability and profile of support services, particularly social care, need to be enhanced, if earlier diagnosis is to be pursued as a policy objective in primary care.
    • General Practitioners’ perceptions of the stigma of dementia and the role of reciprocity

      Gove, Dianne M.; Small, Neil A.; Downs, Murna G.; Vernooij-Dassen, M. (2017)
      A qualitative exploration of the stigma of dementia reported that GPs described lack of reciprocity as one way in which people with dementia are perceived within society. This was closely linked to their perception of dementia as a stigma. In this paper, we explore whether GPs perceive people with dementia as lacking reciprocity and, so, if this is linked with societal opinions about dementia as a stigma. The implications of both perceptions of people with dementia failing to reciprocate and of stigma for timely diagnosis are explored. GPs’ perceptions of societal views of people with dementia included a perception of a lack of reciprocity. Specifically, an absence of reciprocity was linked with; failing to respond to human contact, the absence of an appropriate return on social investment and failing to contribute to, or being a burden to, society. GPs reported a link between societal perceptions of lack of reciprocity and stereotypes about advanced dementia, difficulties communicating with people with dementia and lack of opportunities for people with dementia to reciprocate. GPs occupy a key position, they can challenge stereotypes and, with support and targeted training about communicating with people living with dementia, can emphasise the ways in which people with dementia can communicate, thereby enhancing their potential to reciprocate. Such changes have implications for improved care and quality of life through the continued maintenance of social inclusion and perceptions of personhood.
    • General Radiography

      Clough, Gillian R.; Beck, Jamie J.W. (2008)
    • Goal-oriented cognitive rehabilitation in early-stage dementia: study protocol for a multi-centre single-blind randomised controlled trial (GREAT).

      Clare, L.; Bayer, A.; Burns, A.; Corbett, A.; Jones, R.; Knapp, M.; Kopelman, M.; Kudlicka, A.; Leroi, I.; Oyebode, Jan R.; Pool, J.; Woods, B.; Whitaker, R. (2013-05-27)
      Background: Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer's disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design: In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion: If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration: Current Controlled Trials ISRCTN21027481
    • GP tutor opinions on quality criteria generated for undergraduate education in primary care: a practice-based educational evaluation

      Kaur, I.; Lucas, Beverley J. (2013)
      This study explores GP tutor views of a nationally derived list of quality criteria for undergraduate and postgraduate practice-based teaching. Whilst these published criteria provided a means of benchmarking locally, an evaluation of utility in practice required further exploration. This educational evaluation was conducted within a West Yorkshire locality as a means of supporting their practice-based primary care education. A survey approach using an online Likert scaled questionnaire was distributed to all GP tutors with an additional opportunity for free text qualitative comments. Data were analysed using an online reporting package for survey results (MarketSight) and thematic analysis of qualitative data. Key findings were that in general all the criteria were rated having a high level of importance with 83% of GPs claiming they would find such a list important in directing their learning and teaching approach. The opinions on out-of-hours experiences for medical students were also interesting as they differed greatly. These findings will be of interest to those involved in the organisation and delivery of medical education within primary care as the list of criteria could act as a structural guide for directing medical student teaching, learning and its quality assurance. Implications for further research include the utility of core criteria and the exploration of out-of-hours experience for medical student education.
    • Grief and bereavement.

      Oyebode, Jan R. (2014)
    • Grief counseling

      Oyebode, Jan R. (2016)
    • Grieving

      Oyebode, Jan R. (2016)
    • Grieving

      Oyebode, Jan R. (2013)
    • The growing burden of leg ulcers in the UK

      Vowden, Kath; Vowden, Peter (2016)
      Improved treatment, diagnostics and greater patient participation could help to reduce both the financial and the social cost of leg ulcers in the UK
    • Guided reflection as an organisational learning and data collection tool in a gender equality change management programme

      Archibong, Uduak E.; O'Mullane, M.; Kallayova, D.; Karodia, Nazira; Ni Laoire, C.; Picardi, I. (2016-03)
      This paper presents a guided reflection (GR) framework compiled and used specifically in a gender equality change management programme. The programme involves seven partners (one being an evaluation partner) from across Europe, each partner implementing a change management programme in their university setting. A guided reflection framework, including verbal reflective discussions and written reflections, was devised and deployed to enable and facilitate the collection of narratives and stories on the experience of gender transformation within the university institutions. The resulting outcome so far has been a successful application of the GR framework, with emerging findings suggesting that participants found the opportunity to share and reflect useful. Both written and verbal reflection tools were effective within this programme, with lessons emerging around increasing and improving the journaling aspect of written reflections. The process findings illustrate how people in our organisations are very constrained for time for reflection within their busy work schedules, and therefore the applicability and usefulness of the GR framework has been in enabling a space for such reflection and thought, which in turn contributes to organizational learning and potential for change.
    • Hand, Fingers and Thumb

      Culpan, Gary (2011)
    • The HAPPY (Healthy and Active Parenting Programme for Early Years) feasability randomised control trial: acceptability and feasability of an intervention to reduce infant Obesity

      McEachan, R.R.C.; Santorelli, G.; Bryant, M.; Sahota, P.; Farrar, D.; Small, Neil A.; Akhtar, Shaheen; Sargent, J.; Barber, Sally E.; Taylor, N.; Richardson, G.; Farrin, A.J.; Bhopal, R.S.; Bingham, D.D.; Ahern, S.M.; Wright, J. (2016-03-01)
      prevent obesity at this age. This study tested the acceptability and feasibility of evaluating a theory-based intervention aimed at reducing risk of obesity in infants of overweight/obese women during and after pregnancy: the Healthy and Active Parenting Programme for Early Years (HAPPY). Methods: A feasibility randomised controlled trial was conducted in Bradford, England. One hundred twenty overweight/obese pregnant women (Body Mass Index [BMI] ≥25 kg/m2) were recruited between 10–26 weeks gestation. Consenting women were randomly allocated to HAPPY (6 antenatal, 6 postnatal sessions: N = 59) or usual care (N = 61). Appropriate outcome measures for a full trial were explored, including: infant’s length and weight, woman’s BMI, physical activity and dietary intake of the women and infants. Health economic data were collected. Measurement occurred before randomisation and when the infant was aged 6 months and 12 months. Feasibility outcomes were: recruitment/attrition rates, and acceptability of: randomisation, measurement, and intervention. Intra-class correlations for infant weight were calculated. Fidelity was assessed through observations and facilitator feedback. Focus groups and semi-structured interviews explored acceptability of methods, implementation, and intervention content. Results: Recruitment targets were met (~20 women/month) with a recruitment rate of 30 % of eligible women (120/396). There was 30 % attrition at 12 months; 66 % of recruited women failed to attend intervention sessions, but those who attended the first session were likely to continue to attend (mean 9.4/12 sessions, range 1–12). Reaction to intervention content was positive, and fidelity was high. Group clustering was minimal; an adjusted effect size of −0.25 standard deviation scores for infant weight at 12 months (95 % CI: −0.16–0.65) favouring the intervention was observed using intention to treat analyses. No adverse events were reported. Conclusions: The HAPPY intervention appeared feasible and acceptable to participants who attended and those delivering it, however attendance was low; adaptations to increase initial attendance are recommended. Whilst the study was not powered to detect a definitive effect, our results suggest a potential to reduce risk of infant obesity. The evidence reported provides valuable lessons to inform progression to a definitive trial.