• NAD(P)H:Quinone oxidoreductase-1 C609T polymorphism analysis in human superficial bladder cancers: relationship of genotype status to NQO1 phenotype and clinical response to Mitomycin C.

      Basu, Saurajyoti; Brown, John E.; Flannigan, G. Michael; Gill, Jason H.; Loadman, Paul M.; Martin, Sandie W.; Naylor, Brian; Puri, Rajiv; Scally, Andy J.; Seargent, Jill M.; et al. (2004)
      NAD(P)H:Quinone oxidoreductase-1 (NQO1) has been implicated in the bioreductive activation of the clinically active anticancer drug Mitomycin C (MMC) and a polymorphic variant of NQO1 which lacks functional enzyme activity (NQO1*2) has been linked with poor survival in patients treated with MMC. The relationship between NQO1 activity and cellular response to MMC is however controversial and the aim of this study was to determine whether the response of bladder cancer patients to MMC can be forecast on the basis of NQO1*2 genotype status. Genomic DNA was extracted from formalin-fixed, paraffin-embedded tissue from 148 patients with low to intermediate grade (G1/G2) superficial (Ta/T1) bladder cancers and NQO1*2 genotype status determined by PCR-RFLP. NQO1*2 genotype status was retrospectively compared with clinical response to intravesical administered MMC with the primary end-point being time to first recurrence. NQO1 phenotype was determined by immunohistochemistry. Of the 148 patients genotyped, 85 (57.4%) were NQO1*1 (wild-type), 59 (39.8%) were NQO1*1/*2 (heterozygotes) and 4 (2.7%) were NQO1*2/*2. No NQO1 protein expression was detected in NQO1*2/*2 tumours. A broad spectrum of NQO1 protein expression existed in tumours genotyped as NQO1*1 and NQO1*1/*2 although tumours with NQO1*1 typically expressed higher NQO1 protein. A poor correlation existed between NQO1*2 genotype status and clinical response to MMC. The results of this retrospective study suggest that tailoring MMC therapy to individual patients with superficial bladder cancer on the basis of NQO1 genotype status is unlikely to be of clinical benefit.
    • The National Early Warning Score and its subcomponents recorded within ±24 hours of emergency medical admission are poor predictors of hospital-acquired acute kidney injury

      Faisal, Muhammad; Scally, Andy J.; Elgaali, M.A.; Richardson, D.; Beatson, K.; Mohammed, Mohammed A. (2018-02-01)
      Background: Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. Aim: To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. We report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity.
    • The Nature of Contemporary Dying: Obsessions, Distortions, Challenges

      Kellehear, Allan (2016)
      This article makes critical observations about the popular examination of dying and its care, identifies the key challenges to modern dying, and argues for a public health approach to end-of life care. Only by adopting a global and non-clinical perspective on the human experience of dying can we address people’s concerns where these arise—in their own homes and workplaces—and to offer alternatives to the more radical choices offered by modern medicine.
    • Near-peer teaching and exam results: the acceptability, impact, and assessment outcomes of a novel biological sciences revision programme taught by senior medical students

      Mann, J.; Protty, M.B.; Duffy, J.; Mohammed, Mohammed A.; Wiskin, C. (2014)
      Near-peer teaching is becoming increasingly popular as a learning methodology. We report the development of a novel near-peer biological sciences revision course and its acceptability and impact on student confidence and exam performance. A cross-sectional analysis of tutee-completed evaluation forms before and after each session was performed, providing demographic details, quality scores, and self-rating of confidence in the topic taught on a 0 to 100 mm visual analogue scale (VAS). The confidence data was examined using analysis of means. Exam performance was examined by analysis of variance and canonical correlation analysis. Thirty-eight sessions were delivered to an average of 69.9 (±27.1) years 1 and 2 medical students per session generating 2656 adequately completed forms. There was a mean VAS gain of 19.1 (5.3 to 27.3) in self-reported confidence. Looking at relationship between attendance and exam scores, only two topics showed significant association between number of sessions attended and exam performance, fewer than hypothesised. The present study demonstrates that near-peer teaching for biological sciences is feasible and is associated with improved self-reported confidence in the sessions taught. The outcome data, showing significant effect for only a small number of items, demonstrates the difficulty of outcome related research.
    • A necessary change: the transfer of care from hospital to community.

      McIntosh, Bryan (2012)
      The National Health Service (NHS) in England must improve productivity by 6% per annum if projected savings of £21 billion are to be attained by 2014, while simultaneously improving or at least maintaining the quality of care (Department of Health (DH), 2009; 2010a). Given that staff costs represent 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforce will need to be changed to meet these targets. In the Department of Health's draft Structural Reform Plan (2010b), the emphasis is on shifting resources to promote better healthcare outcomes, to which end a review of working practices and role relationship must take place, with increased delivery of services by community nurses.
    • The need for excellence centres in clinical imaging

      McIntosh, Bryan; Bishop, C. (2016-03)
    • The need to “carer proof” healthcare decisions

      Al-Janabi, H.; Nicholls, J.; Oyebode, Jan R. (2016-03-24)
      Population ageing and fiscal austerity are set to increase the reliance on family carers, who already provide much of the support for people with long term health conditions. Although most carers are willing, providing care can be hugely stressful, affecting mental and physical health1 and resulting in social isolation and financial hardship.2 When under strain, carers are less likely to be effective, increasing the risk that the care recipient is admitted to hospital or a care home.3 Health systems could reduce strain on family carers by routinely considering carers’ needs alongside patients’ needs in everyday healthcare decisions—a concept we term “carer proofing”.
    • A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia

      De Poli, C.; Oyebode, Jan R.; Airoldi, M.; Glover, R. (2020-07)
      BACKGROUND: Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction. METHODS: Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories. RESULTS: The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users' resistance to offers, users' appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need. CONCLUSION: The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements.
    • A needs-led framework for understanding the impact of caring for a family member with dementia

      Pini, S.; Ingleson, E.; Megson, M.; Clare, L.; Wrigth, P.; Oyebode, Jan R. (2018-03-19)
      Approximately half the care for people with dementia is provided by families. It is therefore imperative that research informs ways of maintaining such care. In this study we propose that a needs-led approach can provide a useful, novel means of conceptualising the impact of caring on the lives of family carers. Our aim was to develop and present a needs-led framework for understanding how providing care impacts on carers’ fulfilment of needs. In this qualitative study we conducted 42 semi-structured interviews with a purposively diverse sample of family carers to generate nuanced contextualised accounts of how caring impacted on carers’ lives. Our inductive thematic analysis focused upon asking: ‘What need is being impacted here?’ in order to generate a needs-led framework for understanding. In this qualitative study we conducted 42 semi-structured interviews with a purposively diverse sample of family carers to generate nuanced contextualised accounts of how caring impacted on carers’ lives. Our inductive thematic analysis focused upon asking: ‘What need is being impacted here?’ in order to generate a needs-led framework for understanding. Nine themes were widely endorsed. Each completed the sentence: “Being a carer impacts on fulfilling my need to/for….”: Freedom; feel close to my relative; feel in control of my life; be my own person; protect my relative; share/express my thoughts and feelings; take care of myself; feel connected to the people around me; get things done. These needs echo those from other research areas, with relational needs emerging as particularly central. The needs-led approach offers a perspective that is able to capture both stresses and positives aspects of caregiving. We recommend that clinical interviewing using Socratic questioning to discover human needs that are being impacted by caring would provide a valuable starting point for care planning.
    • Negotiating identity and alterity: Cultural competence, colonization and cultural voyeurism in students’ work-based learning

      Hart, Andrew; Montague, Jane (2015-10-23)
      There is increasing demand for work-based learning experiences to form part of undergraduate degrees concerned with working with people. Social justice and anti-oppressive practice underpin the philosophies of many such degrees which attract students with the promise of working within diverse communities and with the marginalized and vulnerable. Benefits to students include the development of a professional identity, an anti-oppressive approach and culturally competent practices. Despite this, critical approaches to work-based learning highlight ways in which the student can be colonized by dominant values via ‘cultural voyeurism’. This can lead to power inequalities being replicated and perpetuated by the student rather than challenged. The roles of identity and alterity in these learning processes are examined and the concept of professional identity is questioned. The article concludes that the tasks of negotiating identity and alterity are characterized by uncertainty and unfinalizability, and that the notion of cultural competence is itself problematic.
    • A new hope: Public social partnerships

      McIntosh, Bryan; West, Sue (2016-11)
    • New techniques for wound debridement

      Madhok, B.M.; Vowden, Kath; Vowden, Peter (2013)
      Debridement is a crucial component of wound management. Traditionally, several types of wound debridement techniques have been used in clinical practice such as autolytic, enzymatic, biodebridement, mechanical, conservative sharp and surgical. Various factors determine the method of choice for debridement for a particular wound such as suitability to the patient, the type of wound, its anatomical location and the extent of debridement required. Recently developed products are beginning to challenge traditional techniques that are currently used in wound bed preparation. The purpose of this review was to critically evaluate the current evidence behind the use of these newer techniques in clinical practice. There is some evidence to suggest that low frequency ultrasound therapy may improve healing rates in patients with venous ulcers and diabetic foot ulcers. Hydrosurgery debridement is quick and precise, but the current evidence is limited and further studies are underway. Debridement using a monofilament polyester fibre pad and plasma-mediated bipolar radiofrequency ablation are both very new techniques. The initial evidence is limited, and further studies are warranted to confirm their role in management of chronic wounds.
    • A new tomorrow: cancer and pain management

      Fascia, M.; McIntosh, Bryan (2014)
    • The Nigerian health workforce in a globalized context

      Archibong, Uduak E.; Eshareturi, Cyril (2019-10)
      Nigerian health professionals are impacted by several global forces bearing down on them, one of which is the positive economic prospects associated with emigrating to work abroad. This emigration is an aspect of increased global mobility which has had an adverse effect on the Nigerian health economy. This is important globally because countries with the smallest healthcare workforce capacities such as Nigeria have the poorest health outcomes. The emigration of health professionals from Nigeria will continue until domestic structures such as improved healthcare infrastructures, job security, and financial rewards change for the better. Thus, it is important that measures aimed at supporting the Nigerian health workforce be implemented with a focus on building and managing for sustainability within the context of international interdependency. Accordingly, this chapter is aimed at creating a theoretical framework for building capacities and managing the challenges of the Nigerian health workforce vis-à-vis the opportunities offered by globalization.
    • Noise estimation in cardiac x-ray imaging: a machine vision approach

      Kengyelics, S.M.; Gislason-Lee, Amber J.; Keeble, C.; Magee, D.R.; Davies, A.G. (2016-12-16)
      We propose a method to automatically parameterize noise in cardiac x-ray image sequences. The aim was to provide context-sensitive imaging information for use in regulating dose control feedback systems that relates to the experience of human observers. The algorithm locates and measures noise contained in areas of approximately equal signal level. A single noise metric is derived from the dominant noise components based on their magnitude and spatial location in relation to clinically relevant structures. The output of the algorithm was compared to noise and clinical acceptability ratings from 28 observers viewing 40 different cardiac x-ray imaging sequences. Results show good agreement and that the algorithm has the potential to augment existing control strategies to deliver x-ray dose to the patient on an individual basis.
    • Non medical prescribing.

      Armitage, Gerry R.; Marshall, Kay M.; Shah, K. (2011)
    • Non-medical prescribing and advanced practice in children's hospices

      Tatterton, Michael J. (Together for Short Lives, 2021)
      In recent years, as the prevalence of prescribers has increased, there has been discord and confusion around exactly how to refer to prescribers who are not doctors (Nuttall and Rutt-Howard, 2020). Professional regulators continue to define prescribers by specific profession, using terms such as ‘nurse prescriber’ (Nursing and Midwifery Council, 2018a), ‘pharmacist prescriber’ (General Pharmaceutical Society, 2018) and ‘allied health professional prescriber’ (Health and Care Professions Council, 2016). However, there is a broader range of literature using the collective term of ‘non-medical prescribers’ (All Wales Medicines Strategy Group, 2017; Department of Health Northern Ireland, 2020; NHS England, 2020; Scottish Government, 2020), highlighting the multidisciplinary nature of contemporary prescribing practices across the UK, and the shared responsibility of prescribers for assuring safe and effective practice. Within this chapter, we refer to prescribers collectively, as non-medical prescribers. Although this chapter has been written with the four countries of the UK in mind, it is important that you consider any country-specific, and profession-specific guidelines.
    • Not a level playing field: a qualitative study exploring structural, community and individual determinants of greenspace use amongst low-income multi-ethnic families

      Cronin de Chavez, A.; Islam, Shahid; McEachan, Rosemary (2019-03)
      Greenspace is important for physical and mental health. Low-income, multi-ethnic populations in deprived urban areas experience several barriers to using greenspace. This may exacerbate health inequalities. The current study explored structural and individual determinants of greenspace use amongst parents of young children in an urban, deprived, multi-cultural area situated in the North of England, UK. Semi-structured in-depth interviews and focus group discussions were conducted with 30 parents of children aged 0–3 between December 2016 and May 2017 from a range of ethnic groups. Thematic analyses were informed by the Human Health Habitat Map and the Theoretical Domains Framework. The results show that whilst all families recognised the benefits of greenspaces, use was bounded by a variety of structural, community, and individual determinants. Individual determinants preventing use included lack of knowledge about where to go, or how to get there and confidence in managing young children whilst outdoors. Fear of crime, antisocial behaviour and accidents were the overriding barriers to use, even in high quality spaces. Social and community influences both positively encouraged use (for example, positive social interactions, and practical support by others) and prevented use (antisocial or inappropriate behaviours experienced in greenspace). The built environment was a key barrier to use. Problems related to unsuitable or unsafe playgrounds, no gardens or safe areas for children's play, poor accessibility, and lack of toilets were identified. However, the value that parents and children placed on natural blue and green features was an enabler to use. Contextual influences included external time pressures, difficulties of transporting and caring for young children and poor weather. Multi-sectoral efforts are needed to tackle the uneven playing field experienced by multi-ethnic, urban, deprived communities. Initiatives to increase use should tackle structural quality issues, addressing fears about safety, whilst simultaneously encouraging communities to reclaim their local greenspaces.