• Science or art: risk and project management in healthcare

      Sheppy, B.; Zuliani, J.D.; McIntosh, Bryan (2012)
      Despite its rapid growth in recent literature, risks in project management have received limited critical attention when compared to Lean principles and total quality management. The aim of this article is to examine the ongoing dialogue within health services funders and providers concerning the relationship between project management and its relationship to hard and soft environmental risk factors. The failure of high profile projects and cost to the taxpayer is on the increase. This article argues that the lack of understanding in relation to a holistic assessment of project success factors contributes to increased risk of failure. It argues that greater emphasis is needed on placing risk relative to both operational and cultural factors, as opposed to the frequent use of prescriptive mechanistic methodologies. These changes have the potential not merely to improve the success rates of healthcare management projects, but health outcomes too.
    • A scoping review to identify the techniques frequently used when analysing qualitative visual data

      Smith, S.K.; Mountain, Gail; Hawkins, R.J. (2016)
      Challenges were encountered when attempting to analyse video based data during a project exploring touch screen computer technology with people living with dementia. In order to inform the analytic process, a scoping review of published evidence was undertaken. Results of the scope illustrated the use of various techniques when analysing visual data, the most common of which was the transcription of video into text and analysed using conversation analysis. Three additional issues emerged in the course of the review. First, there is an absence of detail when describing the ethical implications involved when utilising visual methods in research. Second, limited priority is given to providing a clear rationale for utilising visual methods when audio or field notes may have been a viable alternative. Third, only 40% of reviewed articles clearly stated a chosen methodology. The conclusions of the review illustrate a lack of consistency across studies in the overall reporting of research methods and recommend that authors be explicit in their reporting of methodological issues across the research process.
    • Screening prior to gadolinium based contrast agent administration: A UK survey of guideline implementation and adherence

      Snaith, Beverly; Harris, Martine A.; Clarke, R. (2016-12)
      Contrast agents are used to enhance imaging examinations, however in magnetic resonance imaging (MRI) there is an association with nephrogenic systemic fibrosis (NSF). The risk is small, but elevated in patients with impaired renal function and screening of patients is advised prior to administration. This study examines adherence of UK hospitals to guidance on the use of gadolinium based contrast agents (GBCA) in MRI. This was a prospective study utilising an electronic survey. The sample comprised NHS Trusts in the UK (n = 174). An invitation was sent to all MRI lead radiographers including a link to the survey. 17.6% indicated they had no written protocol for the GBCA administration within radiology. 41.2% check blood test results for all patients undergoing a contrast MRI, whereas 45.6% only check those patients with known renal dysfunction or are high-risk. Comorbidities which categorised patients as high-risk included diabetes, cardiac or vascular disease and age, however the cut off varied from 65 to 75 years old. Six sites indicated point-of-care (POC) creatinine testing would be carried out where bloods were unavailable, a further 12 had considered POC testing and dismissed it as an adjunct to the patient pathway, the most commonly cited reason being the cost. Within the UK there is no consistent approach to renal function assessment prior to GBCA administration despite international guidance. POC testing may have a role to play, but a lack of evaluation in radiology has led to concerns that it may constrain capacity and increase costs.
    • See me, not just the dementia - Understanding people's experiences of living in a care home.

      Commission for Social Care Inspection (CSCI); Brooker, Dawn J.R.; Surr, Claire A.; Scally, Andy J. (2008)
      This report looks at the experiences of people with dementia living in care homes in England, with a particular focus on whether their care offers dignity and respect. Most similar studies have relied on the views of carers, care staff and people in the early stages of dementia. This study examines directly the experiences of people including those with advanced dementia.
    • Selecting stimuli parameters for video quality studies based on perceptual similarity distances

      Kumcu, A.; Platisa, L.; Chen, H.; Gislason-Lee, Amber J.; Davies, A.G.; Schelkens, P.; Taeymans, Y.; Philips, W. (2015-03)
      This work presents a methodology to optimize the selection of multiple parameter levels of an image acquisition, degradation, or post-processing process applied to stimuli intended to be used in a subjective image or video quality assessment (QA) study. It is known that processing parameters (e.g. compression bit-rate) or techni- cal quality measures (e.g. peak signal-to-noise ratio, PSNR) are often non-linearly related to human quality judgment, and the model of either relationship may not be known in advance. Using these approaches to select parameter levels may lead to an inaccurate estimate of the relationship between the parameter and subjective quality judgments – the system’s quality model. To overcome this, we propose a method for modeling the rela- tionship between parameter levels and perceived quality distances using a paired comparison parameter selection procedure in which subjects judge the perceived similarity in quality. Our goal is to enable the selection of evenly sampled parameter levels within the considered quality range for use in a subjective QA study. This approach is tested on two applications: (1) selection of compression levels for laparoscopic surgery video QA study, and (2) selection of dose levels for an interventional X-ray QA study. Subjective scores, obtained from the follow-up single stimulus QA experiments conducted with expert subjects who evaluated the selected bit-rates and dose levels, were roughly equidistant in the perceptual quality space - as intended. These results suggest that a similarity judgment task can help select parameter values corresponding to desired subjective quality levels.
    • Self-esteem, self-efficacy and optimism as psychological resources among family caregivers of people with dementia: findings from the IDEAL study

      Lamont, R.A.; Quinn, Catherine; Nelis, S.M.; Martyr, A.; Rusted, J.M.; Hindle, J.V.; Longdon, B.; Clare, L. (2019-09)
      Being a family caregiver, and in particular giving care to someone with dementia, impacts upon mental and physical health, and potentially reduces the ability of caregivers to ‘live well’. This paper examines whether three key psychological resources, self-efficacy, optimism and self-esteem, are associated with better outcomes for caregivers of people with dementia. Design and Participants Caregivers of 1283 people with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) project responded to measures of selfefficacy, optimism and self-esteem, and ‘living well’ (quality of life, life satisfaction and well-being). Multivariate linear regression was used to examine the association between psychological resources and ‘living well’. Results Self-efficacy, optimism and self-esteem were all independently associated with better capability to ‘live well’ for caregivers. This association persisted when accounting for a number of potential confounding variables (age group, sex, and hours of caregiving per day). Conclusions Low self-efficacy, optimism and self-esteem might present a risk of poor outcomes for caregivers of people with dementia. These findings encourage us to consider how new or established interventions might increase the psychological resilience of caregivers.
    • Self-expandable metal stent placement for the palliation of malignant gastroduodenal obstruction: experience in a large, single, UK centre.

      Lowe, A.S.; Beckett, C.G.; Jowett, S.; May, J.; Stephenson, S.; Scally, Andy J.; Tam, E.; Kay, C.L. (2007)
      To assess the technical success rate, and evaluate the clinical outcome, length of hospital stay, and cost of palliative gastro-duodenal stenting in a single-centre. Materials and methods Eight-seven patients referred for insertion of a gastroduodenal stent between April 1999 and April 2004 were recruited to a non-randomized, before and after intervention study performed in a single centre. Demographic data, diagnosis and symptoms along with clinical and technical outcomes were recorded. Results The technical success rate was 84/87 (96.6%), with inability to traverse the stricture in three patients. No immediate complications were demonstrated. There was marked improvement after stent placement with resolution of symptoms and commencement of dietary intake in 76 patients (87%). Stenting resulted in improved quality of life as reflected by an increase in Karnofsky score from 44/100, to 63/100 post-procedure. Late complications included perforation (n=1), migration (n=1) and stent occlusions due to tumour ingrowth/overgrowth (n=7; mean 165 days). Mean survival was 107 days (range 0¿411 days). Median hospital stay post-stent placement was 5.5 days, (range 1¿55 days) with a majority of patients (75%) discharged home. The mean cost of each treatment episode was £4146 ($7132 $US, ¿6,028 EUROS). Conclusion The present series confirms that combined endoscopic and radiological gastroduodenal stenting is a highly favourable treatment for patients with inoperable malignant gastric outlet obstruction. The results suggest that this minimally invasive procedure has a very high technical success rate, whilst at the same time providing excellent palliation of symptoms with improved quality of life in the majority of patients.
    • Sensitivity and specificity of the empirical lymphocyte genome sensitivity (LGS) assay: implications for improving cancer diagnostics

      Anderson, Diana; Najafzadeh, Mojgan; Gopalan, Rajendran C.; Ghaderi, Nader; Scally, Andy J.; Britland, Stephen T.; Jacobs, B.J.; Reynolds, P.D.; Davies, J.; Wright, A.L.; et al. (2014-10-28)
      Lymphocyte responses from 208 individuals: 20 with melanoma, 34 with colon cancer, and 4 with lung cancer (58), 18 with suspected melanoma, 28 with polyposis, and 10 with COPD (56), and 94 healthy volunteers were examined. The natural logarithm of the Olive tail moment (OTM) was plotted for exposure to UVA through 5 different agar depths (100 cell measurements/depth) and analyzed using a repeated measures regression model. Responses of patients with cancer plateaued after treatment with different UVA intensities, but returned toward control values for healthy volunteers. For precancerous conditions and suspected cancers, intermediate responses occurred. ROC analysis of mean log OTMs, for cancers plus precancerous/suspect conditions vs. controls, cancer vs. precancerous/suspect conditions plus controls, and cancer vs. controls, gave areas under the curve of 0.87, 0.89, and 0.93, respectively (P<0.001). Optimization allowed test sensitivity or specificity to approach 100% with acceptable complementary measures. This modified comet assay could represent a stand-alone test or an adjunct to other investigative procedures for detecting cancer.
    • Serious games, gamification and serious mental illness: A scoping review

      Fitzgerald, Martin; Ratcliffe, G. (American Psychiatric Association, 2020-02-01)
      The use of serious games and gamification to promote learning has a long history. More recently, serious games and gamification have been used in clinical settings to promote treatment and recovery. Yet there is little evidence to support their use with populations that experience serious mental illness. A scoping review was used to answer the following research question, What is the current state of knowledge about how games and gamification are used to promote treatment of serious mental illness? Scoping reviews clarify, define, and develop conceptual boundaries within a topic area. Twenty studies were identified and reviewed by using thematic content analysis. A range of game types, formats, and technology were assessed. Six themes emerged from analysis. Serious games and the use of gamification to promote treatment have potential to engage persons with serious mental illness in game content and promote treatment outcomes. Game design that supported clear instruction, a coherent narrative, a smooth interface between mechanics and play, and service user involvement early in the process of game design were important for the successful promotion of engagement and learning. Games reviewed offered the opportunity for problem solving, collaboration, and goal-oriented activity that supported the delivery of therapeutic outcomes. The use of serious games and gamification to promote treatment of serious mental illness had high levels of feasibility and acceptability among both users and providers. The potential treatment value of games, however, is dependent on key features related to the games’ design, operation, and rationale.
    • Service user involvement in cancer care: the impact on service users

      Cotterell, P.; Harlow, G.; Morris, C.; Beresford, P.; Hanley, B.; Sargeant, Anita R.; Sitzia, J.; Staley, K. (2011)
      BACKGROUND: Service user involvement is embedded in the United Kingdom's National Health Service, but knowledge about the impact of involvement on service users, such as the benefits and challenges of involvement, is scant. Our research addresses this gap. OBJECTIVE: To explore the personal impact of involvement on the lives of service users affected by cancer. DESIGN: We conducted eight focus groups with user groups supplemented by nine face-to-face interviews with involved individuals active at a local, regional and national level. Thematic analysis was conducted both independently and collectively. SETTING AND PARTICIPANTS: Sixty-four participants, engaged in involvement activities in cancer services, palliative care and research, were recruited across Great Britain. RESULTS: We identified three main themes: (i) 'Expectations and motivations for involvement'- the desire to improve services and the need for user groups to have a clear purpose, (ii) 'Positive aspects of involvement'- support provided by user groups and assistance to live well with cancer and (iii) 'Challenging aspects of involvement'- insensitivities and undervaluing of involvement by staff. CONCLUSIONS: This study identified that involvement has the capacity to produce varied and significant personal impacts for involved people. Involvement can be planned and implemented in ways that increase these impacts and that mediates challenges for those involved. Key aspects to increase positive impact for service users include the value service providers attach to involvement activities, the centrality with which involvement is embedded in providers' activities, and the capacity of involvement to influence policy, planning, service delivery, research and/or practice.
    • Service users and carers: preparing to be involved in work-based practice assessment

      Dearnley, Christine A.; Coulby, C.; Rhodes, C.; Taylor, J.D.; Coates, C.A. (2011)
      This paper will provide an overview of the specific issues related to involving service users and carers in work-based practice assessment of health and social care students. The outcomes of a shared workshop that involved service users and carers, practice assessors and students in the development of an interprofessional assessment tool, will be discussed. Key areas of concern, across all participants, were related to ethical, reliability and validity issues. These will be explored against the background of current literature, and recommendations will be made for involving service users and carers in assessment of practice. The original work for this paper was part of the Assessment and Learning in Practice Settings (ALPS) Centre for Excellence in Teaching and Learning (CETL), which is working towards a framework of interprofessional assessment of common competences in the health and social care professions.
    • Severe neonatal hypernatraemia: a population based study

      Oddie, S.J.; Craven, V.; Deakin, K.; Westman, J.; Scally, Andy J. (2013)
      AIMS: To describe incidence, presentation, treatment and short term outcomes of severe neonatal hypernatraemia (SNH, sodium >/=160 mmol/l). METHODS: Prospective, population based surveillance study over 13 months using the British Paediatric Surveillance Unit. Cases were >33 weeks gestation at birth, fed breast or formula milk and <28 days of age at presentation. RESULTS: Of 62 cases of SNH reported (7, 95% CI 5.4 to 9.0 per 1 00 000 live births), 61 mothers had intended to achieve exclusive breast feeding. Infants presented at median day 6 (range 2-17) with median weight loss of 19.5% (range 8.9-30.9). 12 had jaundice and 57 weight loss as a presenting feature. 58 presented with weight loss >/=15%. 25 babies had not stooled in the 24 h prior to admission. Serum sodium fell by median 12.9 mmol/l per 24 h (range 0-30). No baby died, had seizures or coma or was treated with dialysis or a central line. At discharge, babies had regained 11% of initial birth weight after a median admission of 5 (range 2-14) days. 10 were exclusively breast fed on discharge from hospital. CONCLUSIONS: Neonatal hypernatraemia at this level, in this population, is strongly associated with weight loss. It occurs almost exclusively after attempts to initiate breast feeding, occurs uncommonly and does not appear to be associated with serious short term morbidities, beyond admission to hospital.
    • Sexuality, Intimacy and Older Care Home Residents.

      Simpson, P.; Horne, Maria; Wilson, C.B.; Brown, L.; Dickinson, T.; Smith, S.; Torkington, K.; Tinkler, P. (2015)
      Over half a million people aged 65+ live in care homes (ONS 2011). Yet, sex, sexuality and intimacy and old people remain overlooked in social policy and professional practice (Hafford-Letchfield 2008). We explore narratives from a feasibility study based in Northwest England that consulted on the significance of researching sexuality and intimacy. We draw on narratives generated with two focus groups of professional carers (n = 16) and interviews with three residents, (two male and one female) and four female spouses (n = 7). All three types of stakeholders expressed concern about privacy and environmental impediments to intimacy (e.g. shortage of double rooms). However, distinct concerns were expressed by each group. Residents’ expressed scepticism that the topic was ‘too personal’, that old people were post-sexual or that sex/intimacy were part of range of needs and could be eclipsed by those relating to grand-parenting, avoiding isolation and personalization of care. Spouses emphasized the importance of intimacy over sex/sexuality as an indicator of the depth and longevity of a relationship but were concerned about unmet needs and loss of influence over their partners’ care. Obliged to meet a complex of legal, professional, ethical and interpersonal obligations, care staff articulated a need for guidance to help them support residents and their significant others. We conclude with practical recommendations that address barriers to enabling intimacy.
    • A SHARED study the benefits and costs of setting up a health research study involving lay coresearchers and how we overcame the challenges

      Mockford, C.; Murray, M.; Seers, K.; Oyebode, Jan R.; Grant, R.; Boex, S.; Staniszewska, S.; Diment, Y.; Leach, J.; Sharma, U.; et al. (2016-03-03)
      Background: Involving patients and the public in all stages of research has been the focus of the SHARED study. Patient and public involvement (PPI) is an important strategic priority for the Department of Health and funders such as the National Institute for Health Research. The aim of this paper is to describe the benefits, challenges and costs involved in setting up the research study with lay members as part of the research team. The study focused on developing service user-led recommendations for people with memory loss and their carers, on discharge from acute hospital to the community. Methods: This began with a discussion of an initial research idea with a lay group of carers and people living with dementia. Once funded, approval was sought from the Research Ethics Committee and NHS Trusts to conduct the research including the active involvement of lay co-researchers. Finally, to recruit, train and pay lay co-researchers in their role. Results: The benefits of PPI have included developing ideas which are important to people living with memory loss; support for PPI received from the funders and research ethics committee, high levels of interest from volunteer groups, and lasting enthusiasm from many of the co-researchers. Organisational challenges were met in the requirement for research passports and with payment methods for the co-researchers. Training was beneficial but incurred extra costs for repeated training days. Discussion: Overall the benefits outweighed the challenges which were overcome to varying degrees. The lay co-researchers gained membership of a study group and a beneficial partnership developed with the third sector. The biggest challenge was in overcoming the differences in approach to lay co-researchers between NHS Trusts. Organisational culture has been slow to incorporate PPI and this has not yet been fully addressed. It has the potential to delay the start of projects, affect recruitment time, incur extra research costs and disadvantage PPI.
    • 'She's usually quicker than the calculator': financial management and decision-making in couples living with dementia

      Boyle, Geraldine (2013)
      This article explores how married couples managed their finances and made financial decisions when one spouse had dementia, drawing comparisons with the approaches used prior to the illness. More specifically, the article examines the role of social factors in influencing the involvement of people with dementia in financial management and decision-making, particularly whether a gender dynamic adopted earlier in a marriage similarly influenced a gendered approach following dementia. The research formed part of a larger study of everyday decision-making by couples living with dementia which explored the role of non-cognitive factors in influencing whether people with dementia were involved in decision-making processes. Twenty-one married couples living at home took part; the recently-diagnosed were excluded. Qualitative methods -including participant observation and interviews - were used to examine the couples' fiscal management and decision-making-processes, the perceptions of people with dementia and their spouses about their current financial abilities and whether any support provided by spouse-carers influenced their partners' financial capacity. The fieldwork was undertaken in the North of England between June 2010 and May 2011. Thematic analysis of the data showed that social factors influenced the perceived capacity of people with dementia and the financial practices adopted by the couples. In particular, gender influenced whether people with dementia were involved in financial decisions. The research demonstrated that non-cognitive factors need to be taken into account when assessing and facilitating the capacity of people with dementia. In addition, as people with dementia were somewhat marginalised in decisions about designating financial authority (Lasting Power of Attorney), spouse-carers may need guidance on how to undertake advance care planning and how to support their relatives with dementia in major decision-making, particularly when there are communication difficulties.
    • Shifting sands: The erosion of higher education provision

      Breen, Liz; McIntosh, Bryan (2016-07)
      This commentary considers changes to education in UK mental health nursing.
    • Should all women with pregnancy-related pelvic girdle pain be treated with exercise?

      Bromley, R.; Bagley, Pamela J. (2014-08)
      This paper presents the main findings of a systematic literature review that was undertaken to investigate whether physiotherapist-guided exercise is effective in reducing the severity of pregnancy-related pelvic girdle pain (PPGP). Seven electronic databases were systematically searched. Studies that met the inclusion criteria were assessed for methodological quality and internal validity. Five primary randomized controlled trials (RCTs) and one post-partum follow-up study were included in the review. The authors of all six studies incorporated advice and physiotherapist-guided exercise, either in a group setting or as part of an individualized exercise programme, into at least one of their intervention groups, with or without the addition of a pelvic support belt, acupuncture or other physiotherapy treatment modality. Two of the primary RCTs found that exercise and advice effectively reduced pre-partum PPGP. One study concluded that exercise had no additional value beyond simply supplying a pelvic support belt and advice. The results of another trial supported the use of physiotherapist-guided stabilization exercises for the treatment of post-partum PPGP. Yet another study did not find any differences between the intervention groups involved. The works included in this review all reported that PPGP reduced over time, regardless of the intervention used to treat it, suggesting that the greatest factor influencing the resolution of PPGP is time rather than exercise. The findings do not support the routine use of physiotherapist-guided exercise in the treatment of all women with PPGP. Advice, information and a non-elastic pelvic support belt should be offered to women with pre-partum PPGP, whereas patients with persistent symptoms of post-partum PPGP should receive individualized physiotherapist-guided exercise aimed at stabilizing the pelvic area as part of a wider package of physiotherapy treatment.