• Machine vision image quality measurement in cardiac x-ray imaging

      Kengyelics, S.M.; Gislason-Lee, Amber J.; Keeble, C.; Magee, D.; Davies, A.G. (2015-03)
      The purpose of this work is to report on a machine vision approach for the automated measurement of x-ray image contrast of coronary arteries lled with iodine contrast media during interventional cardiac procedures. A machine vision algorithm was developed that creates a binary mask of the principal vessels of the coronary artery tree by thresholding a standard deviation map of the direction image of the cardiac scene derived using a Frangi lter. Using the mask, average contrast is calculated by tting a Gaussian model to the greyscale pro le orthogonal to the vessel centre line at a number of points along the vessel. The algorithm was applied to sections of single image frames from 30 left and 30 right coronary artery image sequences from di erent patients. Manual measurements of average contrast were also performed on the same images. A Bland-Altman analysis indicates good agreement between the two methods with 95% con dence intervals -0.046 to +0.048 with a mean bias of 0.001. The machine vision algorithm has the potential of providing real-time context sensitive information so that radiographic imaging control parameters could be adjusted on the basis of clinically relevant image content.
    • Maintaining Professional Identity and Role in the Modern Workplace

      Fitzgerald, Martin (2014)
      In the last decade, occupational therapists have faced new performance and commissioning demands from the state. These demands, such as Payment by Results (PbR) or funding tied to performance, have, on the face of it, improved service delivery and patient experience. However, they have also introduced new ways of working and new demands from management that have contributed to a crisis of identity, as therapists struggle to reconcile conflict- ing professional, managerial, and service demands with their day-to-day practice (Lloyd et al 2010). Professionals possess a unique and complex body of knowledge that cannot easily be appreciated and under- stood by those outside the profession. This body of knowledge, along with autonomy and self-regulation, are regarded as important aspects of professionalism and professional identity. However, it is now customary for occupational therapists to work as lone professionals within multi-disciplinary teams, often with professionals of other disciplines as their line or service managers, thereby experiencing differing local management and variant local practice.
    • Making patients better: a qualitative descriptive study of Registered Nurses reasons for working in surgical areas

      Mackintosh, Carolyn (2007)
      Little is known about the career decisions qualified nurses make, although it is clear that some areas of practice are more popular than others. This qualitative descriptive study considers one common area, surgery, and explores the motivation for decisions made by Registered Nurses (RNs) to work in this area. A sample of 16 RNs working within surgical areas participated in semi-structured interviews, using a thematic interview schedule. Findings were analysed using the framework suggested by Morse and Field. Analysis of findings indicates that all participants actively chose to work within surgery and that this was because of the pace and turnover of surgical work, personal satisfaction at the recovery of patients; the close links between this type of work; and participants' original aims when first entering nursing and participants' preference of surgery to other areas of nursing work. Participants actively rejected working in areas where patients were likely to suffer from chronic long-term conditions where recovery was unlikely and felt that these areas were likely to be depressing and unrewarding. These findings suggest that participants actively chose to work with 'healthy' patients in preference to those who may be considered 'ill', and this is closely linked to the identified need of participants to be able to 'make patients better'. Participants were reluctant to work in areas where they would be unlikely to achieve this aim.
    • A managed decline: Higher education provision

      Breen, Liz; McIntosh, Bryan (2016)
    • The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: A longitudinal cohort study

      White, N.; Leurent, B.; Lord, Kathryn; Scott, S.; Jones, L.; Sampson, E.L. (2017)
      Background: The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals. Method(s): A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave-AD scale), as well as documentation of pharmacological prescriptions and non-pharmacological management. Results: The overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p= 0.008). Nonpharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients’ admissions. Conclusions: Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.
    • Managers’ perspectives on promotion and professional development for black African nurses in the UK

      Likupe, G.; Baxter, C.; Jogi, M.; Archibong, Uduak E. (2014)
      An exploratory qualitative study design was adopted for this study and underpinned by Rex’s migrant workers framework (Rex, 1999). Semi-structured interviews were conducted with ten ward managers from four NHS trusts in the north-east of England to gain an insight into their experiences of working with black African nurses with regard to equal opportunities in accessing professional development and promotion. Managers reported that black African nurses experienced racism from patients, racism from colleagues, discrimination and lack of equal opportunities. A unique finding of the study was that managers stereotyped black African nurses as lacking motivation for professional development and promotion. The authors recommend that NHS ward managers receive training in implementing antidiscrimination policies and valuing equality and diversity.
    • Managing high viscosity exudate

      Vowden, Peter; Bond, E.; Meulenetre, F. (2015)
      Wound pain, odour and exudate have a major impact on patient quality of life. Understanding the management of these core components of wound healing is essential if patient outcomes are to be optimised. This paper discusses the role and types of exudate, the impact of high viscosity exudate on management and what to consider when selecting an appropriate dressing with the aim of restoring a satisfactory moist wound environment for healing.
    • Mapping the Offender Health Pathway - Challenges and Opportunities for Support Through Community Nursing

      Eshareturi, Cyril; Serrant-Green, L. (2016-06)
      The health needs of released offenders are significantly greater than those of the general population with a lack of equity existing between need and supply. Offender health indicates that they re-enter their communities with limited pre-release preparation for the continuity of access to healthcare once outside prison. This report relates the findings of a three year study commissioned by Burdett Trust to map the released offender health pathway towards identifying ‘touch points’ in the community for the delivery of a nurse led intervention.
    • Maximising the Potential of Longitudinal Cohorts for Research in Neurodegenerative Diseases: A Community Perspective

      Moody, Catherine L.; Mitchell, D.; Kiser, G.; Aarsland, D.; Berg, D.; Brayne, C.; Costa, A.; Ikram, M.A.; Mountain, Gail; Rohrer, J.D.; Teunissen, C.E.; van den Berg, L.H.; Wardlaw, J.M. (2017)
      Despite a wealth of activity across the globe in the area of longitudinal population cohorts, surprisingly little information is available on the natural biomedical history of a number of age-related neurodegenerative diseases (ND), and the scope for intervention studies based on these cohorts is only just beginning to be explored. The Joint Programming Initiative on Neurodegenerative Disease Research (JPND) recently developed a novel funding mechanism to rapidly mobilise scientists to address these issues from a broad, international community perspective. Ten expert Working Groups, bringing together a diverse range of community members and covering a wide ND landscape (Alzheimer’s, Parkinson’s, frontotemporal degeneration, amyotrophic lateral sclerosis, Lewy-body and vascular dementia) were formed to discuss and propose potential approaches to better exploiting and coordinating cohort studies. The purpose of this work is to highlight the novel funding process along with a broad overview of the guidelines and recommendations generated by the ten groups, which include investigations into multiple methodologies such as cognition/functional assessment, biomarkers and biobanking, imaging, health and social outcomes, and pre-symptomatic ND. All of these were published in reports that are now publicly available online.
    • Meaningful social interactions between older people in institutional care settings.

      Hubbard, G.; Tester, S.; Downs, Murna G. (2009-10-21)
      This paper is a contribution to the developing understanding of social relationships in institutional care settings. It focuses on two areas that have been neglected in research: the reasons for and types of social interaction in institutional settings, and the ways in which the context of people's lives shapes social interaction. The paper draws on ethnographic observations conducted in four care settings in Scotland using a symbolic interactionist perspective. It finds that residents communicate and interact, and that the personal, cultural and structural contexts frame social interaction and influence the ways that residents use humour, express sexuality, and show hostility. The paper concludes that residents create social interactions in which action is embedded, but do so within specific structural and cultural contexts. These contexts `control¿ resident action by establishing frameworks for the interpretation of meaning. At the same time, each facet of context is `controlled¿ by the ways in which residents actively take on the `role¿ of others, and project `self¿ and a `label¿.
    • Measuring parenting practices and family functioning with brief and simple instruments: Validation of the Spanish version of the PAFAS.

      Mejia, A.; Filus, A.; Calam, R.; Morawska, A.; Sanders, M.R. (2015-06)
      A set of instruments with different response formats is usually used to assess parenting practices in clinical settings and in research studies. These complex protocols can be problematic for parents with low-literacy levels. The Parenting and Family Adjustment Scales (PAFAS) is a brief, easy to read instrument that has been developed to address these concerns. The English version of this instrument suggested that it has good internal consistency (range from .70 to .96), as well as satisfactory construct and predictive validity. The aim of the present study was to explore the validity and reliability of the Spanish version of the PAFAS. A sample of 174 Spanish-speaking parents (85 % mothers; M = 37 years old; SD = 9.1) from Panama in Central America completed the instrument alongside the Parenting Scale and the Depression Anxiety Stress Scale (DASS-21). Psychometric evaluations revealed that the measure had satisfactory construct and concurrent validity as well as good internal consistency (values >.60 for all subscales) and test–retest reliability (ICC >.60 for all subscales). The PAFAS shows promise as a brief outcome measure to assess parenting practices and family functioning with Spanish-speaking parents. Potential uses of the measure and implications for further validation with diverse samples are discussed.
    • Measuring the well-being of people with dementia living in formal care settings: the use of Dementia Care Mapping.

      Innes, C.; Surr, Claire A. (2001)
      Over the years there have been advances in the quality of care provision for people with dementia. How to measure the impact of care on the person with dementia has challenged researchers as, until recently, no evaluation tool offered a comprehensive overview of the behaviour patterns and well-being of persons with dementia. Dementia Care Mapping (DCM) is a tool used by care practitioners and researchers to capture both the process (behaviours) and outcome (well-being) of care and is therefore of use as a tool to evaluate quality of care. This study aims to assess, through DCM, the experience of dementia care provision in residential and nursing homes in two voluntary organizations in England. The data illustrates similarities in the well-being and behaviour patterns of 76 persons with dementia living in six care settings throughout England. Examples of instances when people with dementia were "put down" and when well-being was enhanced, are outlined. The homes in the study were meeting the physical care but not the broader psychosocial care needs of the observed residents. The action taken by the organizations as a result of the DCM evaluations is summarized.
    • The mechanics of landing when stepping down in unilateral lower-limb amputees

      Twigg, Peter C.; Jones, S.F.; Scally, Andy J.; Buckley, John G. (2006)
    • Medical Error: perspectives from Hospice Management.

      Sirriyeh, R. (See also Harrison, R.); Armitage, Gerry R.; Gardner, P.; Lawton, R. (2010)
    • Medicine information sources used by nurses at the point of care.

      Ndosi, M.; Newell, Robert J. (01/09/2010)
      Aims: To identify sources of medicine information that nurses use while administering medicines.
    • Medicines Optimisation - extracting the last vestiges of value from your medicines

      Breen, Liz (2016-09)
      The concept of waste and how it can be reduced, recycled, refurbished or reused in its current form has been widely discussed in industry. The importance of waste reduction from an environmental and economic perspective has also heightened in both industry and within the research arena. Thus said, stringent steps have been taken to facilitate the collection of and capture residual value in waste items. This article explores this premise in relation to medicines waste as part of the wider medicines optimisation agenda.
    • Medicines Reconciliation Using a Shared Electronic Health Care Record.

      Moore, P.; Armitage, Gerry R.; Wright, J.; Dobrzanski, S.; Ansari, N.; Hammond, I.; Scally, Andy J. (2011)
      Objective: This study aimed to evaluate the use of a shared electronic primary health care record (EHR) to assist with medicines reconciliation in the hospital from admission to discharge. Methods: This is a prospective cross-sectional, comparison evaluation for 2 phases, in a short-term elderly admissions ward in the United Kingdom. In phase 1, full reconciliation of the medication history was attempted, using conventional methods, before accessing the EHR, and then the EHR was used to verify the reconciliation. In phase 2, the EHR was the initial method of retrieving the medication history-validated by conventional methods. Results: Where reconciliation was led by conventional methods, and before any access to the EHR was attempted, 28 (28%) of hospital prescriptions were found to contain errors. Of 99 prescriptions subsequently checked using the EHR, only 50 (50%) matched the EHR. Of the remainder, 25% of prescriptions contained errors when verified by the EHR. However, 26% of patients had an incorrect list of current medications on the EHR. Using the EHR as the primary method of reconciliation, 33 (32%) of 102 prescriptions matched the EHR. Of those that did not match, 39 (38%) of prescriptions were found to contain errors. Furthermore, 37 (36%) of patients had an incorrect list of current medications on the EHR. The most common error type on the discharge prescription was drug omission; and on the EHR, wrong drug. Common potentially serious errors were related to unidentified allergies and adverse drug reactions. Conclusions: The EHR can reduce medication errors. However, the EHR should be seen as one of a range of information sources for reconciliation; the primary source being the patient or their carer. Both primary care and hospital clinicians should have read-and-write access to the EHR to reduce errors at care transitions. We recommend further evaluation studies.