• The journey effect: how travel affects the experiences of mental health in-patient service-users and their families

      Heyman, B.; Lavendar, E.; Islam, Shahid; Adey, A.; Ramsey, T.; Taffs, N.; Xplore Service-user and Carer Research Group (2015-07)
      The qualitative study presented in this paper explored the perspectives of serviceusers, family members and staff about the impact of travel issues on the lives of mental health in-patients and carers. This topic was chosen because it was prioritised by members of Xplore, a service-user and carer research group, and has received little research attention. Travel problems were a significant issue for many service-users and carers, bound-up with mental health issues and the recovery experience. Travel facilitation through the funding of taxis and the provision of guides was greatly appreciated. A few service-users and carers positively valued distancing from their previous home environment. The meaning of travel issues could only be understood in the context of individuals’ wider lives and relationships. The significance of the findings is discussed in relation to the social model of disability.
    • Journeying through Dementia, a community-based self-management intervention for people aged 65 years and over: a feasibility study to inform a future trial

      Sprange, K.; Mountain, Gail; Shortland, K.; Craig, C.; Blackburn, D.; Bowie, P.; Harkness, K.; Spencer, M. (2015-11-30)
      Background: A study to determine the feasibility of conducting a future population-based trial into a selfmanagement intervention for community-living adults with early stage dementia included evaluation of intervention content and modes of delivery, staffing requirements, recruitment methods and the utility and usability of patient reported outcomes. Methods: Participants identified through memory clinics in one city took part in an intervention called ‘Journeying through Dementia’. The 12-week programme incorporating four individual sessions with one of the facilitators encourages participants to engage in discussion and activities related to health and well-being positioning them as the expert enabling long-term behavioural change. Participants (n = 10) and their nominated carers (n = 7) were all asked to complete selected outcomes at baseline, 8 weeks (participants only) and post intervention and invited to comment on their usability. All participants and carers were qualitatively interviewed before intervention delivery about their expectations and participants; nominated carers and facilitators were all interviewed after cessation about their experiences. Results: The manualised intervention and modes of delivery proved acceptable to participants and carers. Reported benefits included increased confidence and self-efficacy, engagement in new or lapsed activities and reengagement in fun and friendships. People with dementia and carers were able to self-complete all outcome measures, but time required to complete the measures is a key factor. Strategies for recruitment need to include direct contact within 24–48 h post invitation to the study. Analysis of data on the primary outcome did not reveal any trends. Facilitators found the training and support to be appropriate and helpful. Conclusions: The tailored intervention reportedly met the needs of all participants. The study confirmed the need for careful identification and application of patient-reported outcome measures. Outcomes to measure some dimensions of reported benefit are not available.
    • Just an observation or tool for labour?

      Whitney, Elizabeth J. (2015-06)
    • Justice, Care and the Welfare State by Daniel Engster [Book review]

      Powell, Catherine (2016)
      Justice, Care and the Welfare State’ presents a justice theory to guide welfare policies across Western societies. As the author highlights “the main value of this book is to provide some insight into how Western welfare states can be reformed to better promote justice under contemporary social and economic conditions” (p.3).
    • Knowledge, attitudes and practices towards blood donation in Barbados

      Atherley, A.E.; Taylor, C.G.; Whittington, A.; Jonker, Cornelis (2016-12)
      Background: The World Health Organization (WHO) recommends 100% blood should be from voluntary non-remunerated donors (VNRD) yet the majority of blood donations (75%) in Barbados are family/replacement donations. Increasing VNRD is paramount to achieving a safe, reliable blood supply and understanding the population is a strategy suggested by the WHO to inform donor recruitment and education. Objective: To obtain information to devise strategies for a voluntary donor mobilization campaign in Barbados. Methods: Participants in Barbados (n=429) completed a self-administered questionnaire in 2014. The questionnaire comprised 31 questions including demographics (age, sex, highest educational attainment) and blood donation-related knowledge, attitudes and practices. Analysis of variance, t-test and linear regression were used to analyse data. Results: Fifty-three per cent (n=219) of participants had previously donated blood; only 23.9% of these had donated within the past two years and almost half were family/replacement donors only. Knowledge deficits included blood donation requirements, deferral factors and maximum yearly donations. Most participants (79%) were willing to donate with more information. Participants with higher educational attainment and previous donors had higher total knowledge and attitude scores (p<0.01). Single, female, and younger participants were less likely to donate blood (p<0.05). Conclusion: Barbados can likely increase voluntary blood donation rates by addressing knowledge deficits through education campaigns and increasing awareness of the need for donation.
    • Lack of attentional retraining effects in cigarette smokers attempting cessation: a proof of concept double-blind randomised controlled trial

      Begh, R.; Mulville, Jacqui.; Shiffman, S.; Ferguson, S.G.; Nichols, L.; Mohammed, Mohammed A.; Holder, R.L.; Sutton, S.; Aveyard, P. (2015-04-01)
      Observational studies have shown that attentional bias for smoking-related cues is associated with increased craving and relapse. Laboratory experiments have shown that manipulating attentional bias may change craving. Interventions to reduce attentional bias could reduce relapse in smokers seeking to quit. We report a clinical trial of attentional retraining in treatment-seeking smokers. This was a double-blind randomised controlled trial that took place in UK smoking cessation clinics. Smokers interested in quitting were randomised to five weekly sessions of attentional retraining (N=60) or placebo training (N = 58) using a modified visual probe task from one week prior to quit day. Both groups received 21 mg nicotine patches (from quit day onwards) and behavioural support. Primary outcomes included change in attentional bias reaction times four weeks after quit day on the visual probe task and craving measured weekly using the Mood and Physical Symptoms Scale. Secondary outcomes were changes in withdrawal symptoms, time to first lapse and prolonged abstinence. No attentional bias towards smoking cues was found in the sample at baseline (mean difference = 3 ms, 95% CI = -2, 9). Post-training bias was not significantly lower in the retraining group compared with the placebo group (mean difference = -9 ms, 95% CI = -20, 2). There was no difference between groups in change in craving (p = 0.89) and prolonged abstinence at four weeks (risk ratio = 1.00, 95% CI = 0.70, 1.43). Taken with one other trial, there appears to be no effect from clinic-based attentional retraining using the visual probe task. Attentional retraining conducted out of clinic may prove more effective. CLINICAL TRIAL REGISTRATION: UK Clinical Trials ISRCTN 54375405.
    • Larval debridement therapy: vascular wound management

      Tweedle, B.; Vig, S.; Vowden, Kath; Tyrer, J. (2014)
      Lower limb ulcers (LLU) are a common manifestation of long-standing vascular disease and may be exacerbated by trauma or dependency. Ulcers can be grouped according to the underlying aetiology with approximately 76% due to venous disease, 22% due to arterial and 5% occurring as a complication of diabetes. In up to 20% of patients there is some crossover where a mixed picture is present.
    • Leading in Health Care: challenging boundaries and future potential

      Hardy, Maryann L.; Snaith, Beverly; Henwood, S. (2014)
    • Lean management in the NHS: fad or panacea

      McIntosh, Bryan; Cookson, G. (2012)
      Lean principles emerged in the Japanese manufacturing industry after the Second World War. Lean management focuses on improving product quality while eliminating waste—primarily through process redesign and the integration of employees, management, suppliers and customers into the quality management process. The NHS is under significant pressure to improve productivity while maintaining or improving service quality, at the same time as service demand increases. The Quality, Innovation, Productivity and Prevention (QIPP) programme’s primary concern is to ensure that financial resources are used to bring maximum benefit and quality of care to patients (Department of Health, 2010). Lean management could therefore offer a panacea for the NHS, although its applicability to the health service sector is contested. This article investigates whether lean management is merely a fad or whether it could alleviate the pressure the NHS faces. While specific clinical processes may easily adopt lean processes and practices, healthcare organisations will need a paradigm shift in their management philosophy to adopt lean more widely. The promise of lean management remains elusive but could be harnessed by willing organisations.
    • Learning from mistakes: What leagues won’t do

      McIntosh, Bryan; Pascoe, P. (2016-04)
      In March, the Department of Health (DH) released the Learning from Mistakes League, in which NHS organisations are ranked by levels of openness and transparency (DH, 2016). While a welcome first step toward the centralised and open promotion of learning since the publication of the Francis and Berwick reports three years earlier, unfortunately, the league can be considered misleading for a number of reasons.
    • Letter re: Comparison of acetabular and femoral morphologies on hip, pelvic, and lumbar radiographs (Yun et al.)

      Snaith, Beverly; Flintham, K. (2018)
      We read with interest the recent article by Yun et al. [1] comparing acetabular and hip measurements across pelvis, hip and lumbar spine radiographs. The authors assert that lumbar radiographs can be utilised in place of routine pelvis radiographs for these measurements. The example lumbar spine radiograph (figure 2) appears to be an abdominal image, with a contrast urogram. Indeed, standard texts [2,3] confirm that the anteroposterior lumbar spine radiograph should not include any coverage of the hips as appropriate collimation should limit the anatomy to T12 superiorly, lower sacrum inferiorly and the sacroiliac joints laterally, which would exclude the hip joints. Thus assessing any hip measurements on an appropriately collimated lumbar spine radiograph should not be possible. This is further compounded by the description of the centring point within their study (iliac crest), which varies from the internationally recognised standard of lower costal margin/L3 [2,3].
    • A Limited Role for Suppression in the Central Field of Individuals with Strabismic Amblyopia.

      Barrett, Brendan T.; Panesar, Gurvinder K.; Scally, Andy J.; Pacey, Ian E. (2012)
      Background: Although their eyes are pointing in different directions, people with long-standing strabismic amblyopia typically do not experience double-vision or indeed any visual symptoms arising from their condition. It is generally believed that the phenomenon of suppression plays a major role in dealing with the consequences of amblyopia and strabismus, by preventing images from the weaker/deviating eye from reaching conscious awareness. Suppression is thus a highly sophisticated coping mechanism. Although suppression has been studied for over 100 years the literature is equivocal in relation to the extent of the retina that is suppressed, though the method used to investigate suppression is crucial to the outcome. There is growing evidence that some measurement methods lead to artefactual claims that suppression exists when it does not. Methodology/Results: Here we present the results of an experiment conducted with a new method to examine the prevalence, depth and extent of suppression in ten individuals with strabismic amblyopia. Seven subjects (70%) showed no evidence whatsoever for suppression and in the three individuals who did (30%), the depth and extent of suppression was small. Conclusions: Suppression may play a much smaller role in dealing with the negative consequences of strabismic amblyopia than previously thought. Whereas recent claims of this nature have been made only in those with micro-strabismus our results show extremely limited evidence for suppression across the central visual field in strabismic amblyopes more generally. Instead of suppressing the image from the weaker/deviating eye, we suggest the visual system of individuals with strabismic amblyopia may act to maximise the possibilities for binocular co-operation. This is consistent with recent evidence from strabismic and amblyopic individuals that their binocular mechanisms are intact, and that, just as in visual normals, performance with two eyes is better than with the better eye alone in these individuals.
    • Literature Evaluation and Critique

      Scally, Andy J.; Brealey, S. (2010)
    • Living well with dementia: a systematic review and correlational meta-analysis of factors associated with quality of life, well-being and life satisfaction in people with dementia

      Martyr, A.; Nelis, S.M.; Quinn, Catherine; Wu, Y.-T.; Lamont, R.A.; Henderson, C.; Clarke, R.; Hindle, J.V.; Thom, J.M.; Jones, I.R.; Morris, R.G.; Rusted, J.M.; Victor, C.R.; Clare, L. (2018-10)
      Current policy emphasises the importance of 'living well' with dementia, but there has been no comprehensive synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We examined the available evidence in a systematic review and meta-analysis. We searched electronic databases until 7 January 2016 for observational studies investigating factors associated with QoL, well-being and life satisfaction in people with dementia. Articles had to provide quantitative data and include ⩾75% people with dementia of any type or severity. We included 198 QoL studies taken from 272 articles in the meta-analysis. The analysis focused on 43 factors with sufficient data, relating to 37639 people with dementia. Generally, these factors were significantly associated with QoL, but effect sizes were often small (0.1-0.29) or negligible (<0.09). Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health (including depression and other neuropsychiatric symptoms) and poorer carer well-being were associated with poorer QoL. Longitudinal evidence about predictors of QoL was limited. There was a considerable between-study heterogeneity. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.
    • Living with a diagnosis of behavioural-variant frontotemporal dementia: The person’s experience.

      Griffin, J.; Oyebode, Jan R.; Allen, J. (2015)
      Research investigating behavioural-variant frontotemporal dementia has concentrated on identifying and quantifying people’s difficulties; yet few studies have considered how people with behavioural-variant frontotemporal dementia make sense of their difficulties. Five participants were interviewed and interpretive phenomenological analysis used to analyse the data. Two superordinate themes emerged: ‘Bewilderment’ and ‘Relationships with others’. ‘Bewilderment’ reflected the feelings of the participants from the start of their dementia, and was divided into two main themes (1) ‘Awareness of change: What’s the problem? and (2) Threats to self: This is not me. The superordinate theme, ‘Relationships with others’, reflected difficulties with social relationships and comprised two main themes (1) ‘Family and friends: Things haven’t changed… but do I say anything wrong?’ and (2) Coping with threats to self: Blame others or just avoid them. The themes were discussed in relation to literature evaluating the difficulties associated with behavioural-variant frontotemporal dementia together with implications for clinical practice.