• 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.
    • The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database

      Ward, S.T.; Hancox, A.; Mohammed, Mohammed A.; Ismail, T.; Griffiths, E.A.; Valori, R.; Dunckley, P. (2017-06)
      Objective: The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. Design: OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy ( JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable. Results: Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. Conclusions: There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate
    • 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.; et al. (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.
    • Living with advanced chronic obstructive pulmonary disease: patients concerns regarding death and dying

      Gardiner, C.; Gott, M.; Small, Neil A.; Payne, S.; Seamark, D.; Barnes, S.; Halpin, D.; Ruse, C. (2009)
      Prognosis in COPD is poor and many patients perceive shortcomings in the education they receive about aspects of their condition. This study explores the experiences of patients with COPD, particularly fears surrounding death and dying. Semi-structured interviews were conducted with 21 patients with moderate or severe COPD. Findings revealed that patient understanding of COPD was poor, most patients were unaware of the progressive nature of the condition, and few were aware they could die of COPD. Despite this, patients often expressed concerns that their condition might deteriorate. Patients had particular concerns regarding the manner of their death; the overriding fear was dying of breathlessness or suffocation. None of the patients' had discussed these fears with a health care professional. Improved patient education is needed in order to improve patients understanding of their condition and prognosis. Open communication regarding death, as advocated in a palliative care approach, is also appropriate to alleviate patients fears and to allow them to make decisions regarding the management of their care at the end of life.
    • Logical goal-setting frameworks for leprosy projects

      Ogbeiwi, Osahon (2020-05)
      Introduction: Goal setting is a fundamental practice in the effective management of healthcare services worldwide. This study investigated the extent to which leprosy goal formulation in Nigeria is logical and SMART. Method: Document review of baseline problems, goal statements and goal attainments for 2016 in six leprosy projects using a customised logical framework matrix. Results: A total of 15 main problems, 6 aims, 19 objectives and 42 indicators were found. The goals were problem-based and logically linked, with a pattern of a single aim per project, multiple objectives per aim, and multiple indicators per objective. Goal statements specified only impact in 5/6 aims, and only outcome and terminal timeframe in 17/19 (89.5%) objectives. Only one objective stated all four SMART components of outcome, indicator, target and timeframe. While three (7.1%) indicators and two (10.5%) objectives were measurable, no target was attainable. Discussion: Goal-setting frameworks for leprosy projects should be problem based and logical according to best practice. That most leprosy objectives were not completely SMART is similar to the reported structure of objectives published by other health organisations globally.
    • Long-Run Macroeconomic Determinants of Cancer Incidence

      Ferretti, F.; Jones, S.; McIntosh, Bryan (2013)
      Abstract: Background: Understanding how cancer incidence evolves during economic growth is useful for forecasting the economic impact of cancerous diseases, and for governing the process of resources allocation in planning health services. We analyse the relationship between economic growth and cancer incidence in order to describe and measure the influence of an increasing real per capita income on the overall rate of cancer incidence. Method:We test the relationship between real per capita income and the overall rate of cancer incidence with a cross-sectional analysis, using data from the World Bank and the World Health Organization databases, for 165 countries in 2008. We measure the elasticity of cancer incidence with respect to per capita income, and we decompose the elasticities coefficients into two components: age-effect and lifestyle-effect. Results: An Engel’s model, in a double-log quadratic specification, explains about half of the variations in the age-standardised rates and nearly two thirds of the variations in the incidence crude rates. All the elasticities of the crude rates are positive, but less than one. The income elasticity of the age-standardised rates are negative in lower income countries, and positive (around 0.25 and 0.32) in upper middle and high income countries, respectively. Conclusions:These results are used to develop a basic framework in order to explain how demand-side economic structural changes may affect the long run evolution of cancer incidence. At theoretical level, a J-Curve is a possible general model to represents, other things being equal, how economic growth influence cancer incidence.
    • The long-term (24-month) effect on health and well-being of the Lifestyle Matters community-based intervention in people aged 65 years and over: a qualitative study

      Chatters, R.; Roberts, J.; Mountain, Gail; Cook, S.; Windle, G.; Craig, C.; Sprange, K. (2017-09)
      Objectives To assess the long-term effect on health and well-being of the Lifestyle Matters programme. Design Qualitative study of a subset of intervention arm participants who participated in the Lifestyle Matters randomised controlled trial (RCT). Setting The intervention took place at community venues within two sites in the UK. Participants A purposeful sample of 13 participants aged between 66 and 88 years from the intervention arm of the RCT were interviewed at 24 months post randomisation. Interviews aimed to understand how participants had used their time in the preceding 2 years and whether the intervention had any impact on their lifestyle choices, participation in meaningful activities and well-being. Intervention Lifestyle Matters is a 4-month occupational therapy intervention, consisting of group and individual sessions, designed to enable community living older people to make positive lifestyle choices and participate in new or neglected activities through increasing self-efficacy. Results Interviews revealed that the majority of interviewed participants were reportedly active at 24 months, with daily routines and lifestyles not changing significantly over time. All participants raised some form of benefit from attending Lifestyle Matters, including an improved perspective on life, trying new hobbies and meeting new friends. A number of intervention participants spoke of adapting to their changing circumstances, but there were significant and lasting benefits for 2 of 13 intervention participants interviewed. Conclusion The majority of those who experienced the Lifestyle Matters intervention reported minor benefits and increases in self-efficacy, but they did not perceive that it significantly improved their health and well-being. The two participants who had experienced major benefits also reported having had life-changing events, suggesting that this intervention is most effective at the time when lifestyle has to be reconsidered if mental well-being is to be sustained.