• Team-based learning: Teaching the heart and mind of palliative care.

      Middleton-Green, Laura (2014-03-01)
      As a domain of knowledge for healthcare professionals, palliative care is complex and demanding; not least for educators. Effective teaching in palliative care relies on educators both being able to develop and encourage interpersonal skills, and also to capture an authentic sense of the real world in teaching clinical aspects of care. The recommendations of the Francis Report present a challenge to educators: how do we "educate" (literally, "to develop the faculties and powers of") the palliative care providers of the future? How do we ensure they are competent, compassionate communicators? Team-based learning is currently being piloted in at the University of Bradford as a means of achieving these goals. This technique, developed by Larry Michaelson and colleagues in the United States, uses sound pedagogical principles to encourage debate and dissent between small teams related to complex and ambiguous areas of knowledge. The role of the educator is to guide and facilitate discussion, and challenge preconceptions and assumptions. There is minimal use of lectures other than to consolidate conclusions. It was decided to pilot the technique within the palliative care content of the curriculum, because of the opportunities to develop students skills of critical thinking, awareness and compassion. Initial analysis of questionnaire and focus group data within Bradford is overwhelmingly in support; students are demonstrating evidence of increased critical thinking, more effective teamwork, evolving listening skills, and satisfaction at learning in a way which they perceive to be much more akin to clinical practice than didactic lectures and seminars. This presentation will look at the structure of team-based learning, review the evidence, and examine how it was applied specifically to palliative care using scenarios based on Patient Journeys in the last year of life. The opportunities for its use in clinical, interprofessional and post-registration palliative care education will be explored.
    • Technical Note: Impact on detective quantum efficiency of edge angle determination method by International Electrotechnical Commission methodology for cardiac x-ray image detectors

      Gislason-Lee, Amber J.; Tunstall, C.M.; Kengyelics, S.K.; Cowen, A.R.; Davies, A.G. (2015-08)
      Purpose: Cardiac x-ray detectors are used to acquire moving images in real-time for angiography and interventional procedures. Detective quantum efficiency (DQE) is not generally measured on these dynamic detectors; the required “for processing” image data and control of x-ray settings have not been accessible. By 2016, USA hospital physicists will have the ability to measure DQE and will likely utilize the International Electrotechnical Commission (IEC) standard for measuring DQE of dynamic x-ray imaging devices. The current IEC standard requires an image of a tilted tungsten edge test object to obtain modulation transfer function (MTF) for DQE calculation. It specifies the range of edge angles to use; however, it does not specify a preferred method to determine this angle for image analysis. The study aimed to answer the question “will my choice in method impact my results?” Four different established edge angle determination methods were compared to investigate the impact on DQE. Methods: Following the IEC standard, edge and flat field images were acquired on a cardiac flat-panel detector to calculate MTF and noise power spectrum, respectively, to determine DQE. Accuracy of the methods in determining the correct angle was ascertained using a simulated edge image with known angulations. Precision of the methods was ascertained using variability of MTF and DQE, calculated via bootstrapping. Results: Three methods provided near equal angles and the same MTF while the fourth, with an angular difference of 6%, had a MTF lower by 3% at 1.5 mm−1 spatial frequency and 8% at 2.5 mm−1; corresponding DQE differences were 6% at 1.5 mm−1 and 17% at 2.5 mm−1; differences were greater than standard deviations in the measurements. Conclusions: DQE measurements may vary by a significant amount, depending on the method used to determine the edge angle when following the IEC standard methodology for a cardiac x-ray detector. The most accurate and precise methods are recommended for absolute assessments and reproducible measurements, respectively.
    • Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics

      Meiland, F.; Innes, A.; Mountain, Gail; Robinson, L.; Van der Roest, H.; García-Casal, A.; Gove, Dianne M.; Thyrian, J.R.; Evans, S.; Dröes, R.; Kelly, F.; Kurz, A.; Casey, D.; Szcześniak, D.; Dening, T.; Craven, M.P.; Span, M.; Felzmann, H.; Tsolaki, M.; Franco-Martin, M. (2017-01-17)
      Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.
    • Teenage pregnancy: do nurses know how to respond?

      Nichols, Joanna (2018-02-13)
      Teenage pregnancy is often a very emotive subject. The media image of pregnant teenagers and young parents can be very negative, promoting the idea that young people become pregnant for financial reasons or for want of a responsible attitude. In reality, this is seldom true and the picture is far more complex. For many young parents the decision to become pregnant is not taken lightly. Their parenting, though perhaps more challenging than for older parents, is no less caring and effective. Sadly, this is not the experience for all young parents and their children. A number of negative outcomes for teenage parent families have been identified (see Box 1).1 As well as the difficulties faced by teenage parents, many young people become pregnant without intending to be and do not continue their pregnancies. Figures from the Office for National Statistics show that in 2015 almost 50% of under 18 pregnancies ended in termination. Risk factors for teenage pregnancy include poor school experience, low educational attainment, bullying and domestic violence, use of alcohol and spending time in local authority care.
    • Test-retest reproducibility of accommodation measurements gathered in an unselected sample of UK primary school children.

      Adler, P.; Scally, Andy J.; Barrett, Brendan T. (2012)
      Purpose To determine the test-retest reproducibility of accommodation measurements gathered in an unselected sample of primary school children. Methods Monocular and binocular amplitudes of accommodation (AA) were collected by five different Testers using the push-up method in an unselected sample of school children (n=137, age: 8.1±2.1-years). Testing was conducted on three occasions (average testing interval: 8-days) in 91.2% of the children. Results The median AA was 19.1D, the variation due to the identity of the Tester was 3.1D (p<0.001) and the within-subject variation (which takes the variation due to Tester identity into account) was 5.2D. Around 75-79% of children exhibited monocular AAs-12D when tested on the first occasion, but more than 90% exhibited an AA-12D when subsequently tested. Around 74-80% of those with an AA<12D on the first occasion had values-12D on subsequent testing even though no treatment had been undertaken. Poorer initial AA measurements were less likely to improve on repeat testing. Conclusions Our results reveal substantial intra-individual variation in AA measurements, raising questions about the usefulness of this test in children aged 4-12-years. We suggest that AA assessment may prove most useful in children in this age range as a pass/fail check for substantially reduced AA, for example, where the AA is <12D. Our sample would suggest that the prevalence of persistently reduced AA may be around 3.2% when tested under binocular conditions and 4-6.4% when tested monocularly.
    • Test-retest variability of Randot stereoacuity measures gathered in an unselected sample of UK primary school children

      Adler, P.; Scally, Andy J.; Barrett, Brendan T. (2012)
      AIM: To determine the test-retest reliability of the Randot stereoacuity test when used as part of vision screening in schools. METHODS: Randot stereoacuity (graded-circles) and logMAR visual acuity measures were gathered in an unselected sample of 139 children (aged 4-12, mean 8.1+/-2.1 years) in two schools. Randot testing was repeated on two occasions (average interval between successive tests 8 days, range: 1-21 days). Three Randot scores were obtained in 97.8% of children. RESULTS: Randot stereoacuity improved by an average of one plate (ie, one test level) on repeat testing but was little changed when tested on the third occasion. Within-subject variability was up to three test levels on repeat testing. When stereoacuity was categorised as 'fine', 'intermediate' or 'coarse', the greatest variability was found among younger children who exhibited 'intermediate' or 'coarse'/nil stereopsis on initial testing. Whereas 90.8% of children with 'fine' stereopsis (</=50 arc-seconds) on the first test exhibited 'fine' stereopsis on both subsequent tests, only approximately 16% of children with 'intermediate' (>50 but </=140 arc-seconds) or 'coarse'/nil (>/=200 arc-seconds) stereoacuity on initial testing exhibited stable test results on repeat testing. CONCLUSIONS: Children exhibiting abnormal stereoacuity on initial testing are very likely to exhibit a normal result when retested. The value of a single, abnormal Randot graded-circles stereoacuity measure from school screening is therefore questionable.
    • The Birmingham Relationship Continuity Measure: the development and evaluation of a measure of the perceived continuity of spousal relationships in dementia

      Riley, G.A.; Fisher, G.; Hagger, B.F.; Elliott, A.; Le Serve, H.; Oyebode, Jan R. (2013)
      BACKGROUND: Qualitative research has suggested that spousal carers of someone with dementia differ in terms of whether they perceive their relationship with that person as continuous with the premorbid relationship or as radically different, and that a perception of continuity may be associated with more person-centered care and the experience of fewer of the negative emotions associated with caring. The aim of the study was to develop and evaluate a quantitative measure of the extent to which spousal carers perceive the relationship to be continuous. METHODS: An initial pool of 42 questionnaire items was generated on the basis of the qualitative research about relationship continuity. These were completed by 51 spousal carers and item analysis was used to reduce the pool to 23 items. The retained items, comprising five subscales, were then administered to a second sample of 84 spousal carers, and the questionnaire's reliability, discriminative power, and validity were evaluated. RESULTS: The questionnaire showed good reliability: Cronbach's alpha for the full scale was 0.947, and test-retest reliability was 0.932. Ferguson's delta was 0.987, indicating good discriminative power. Evidence of construct validity was provided by predicted patterns of subscale correlations with the Closeness and Conflict Scale and the Marwit-Meuser Caregiver Grief Inventory. CONCLUSION: Initial psychometric evaluation of the measure was encouraging. The measure provides a quantitative means of investigating ideas from qualitative research about the role of relationship continuity in influencing how spousal carers provide care and how they react emotionally to their caring role.
    • The combined influence of distance and neighbourhood deprivation on Emergency Department attendance in a large English population: a retrospective database study

      Rudge, G.M.; Mohammed, Mohammed A.; Fillingham, S.C.; Girling, A.J.; Sidhu, K.; Stevens, A.J. (2013)
      The frequency of visits to Emergency Departments (ED) varies greatly between populations. This may reflect variation in patient behaviour, need, accessibility, and service configuration as well as the complex interactions between these factors. This study investigates the relationship between distance, socio-economic deprivation, and proximity to an alternative care setting (a Minor Injuries Unit (MIU)), with particular attention to the interaction between distance and deprivation. It is set in a population of approximately 5.4 million living in central England, which is highly heterogeneous in terms of ethnicity, socio-economics, and distance to hospital. The study data set captured 1,413,363 ED visits made by residents of the region to National Health Service (NHS) hospitals during the financial year 2007/8. Our units of analysis were small units of census geography having an average population of 1,545. Separate regression models were made for children and adults. For each additional kilometre of distance from a hospital, predicted child attendances fell by 2.2% (1.7%-2.6% p<0.001) and predicted adult attendances fell by 1.5% (1.2% -1.8%, p<0.001). Compared to the least deprived quintile, attendances in the most deprived quintile more than doubled for children (incident rate ratio (IRR) = 2.19, (1.90-2.54, p<0.001)) and adults (IRR 2.26, (2.01-2.55, p<0.001)). Proximity of an MIU was significant and both adult and child attendances were greater in populations who lived further away from them, suggesting that MIUs may reduce ED demand. The interaction between distance and deprivation was significant. Attendance in deprived neighbourhoods reduces with distance to a greater degree than in less deprived ones for both adults and children. In conclusion, ED use is related to both deprivation and distance, but the effect of distance is modified by deprivation.
    • The concept of advanced radiographic practice: An international perspective

      Hardy, Maryann L.; Legg, J.; Smith, T.; Ween, B.; Williams, I.; Motto, J. (2008)
      Advanced radiographic practice has been the focus of much discussion and debate over the last decade, not only in the United Kingdom where advanced practitioner roles are now recognised within the national career framework, but also internationally. Yet, despite almost simultaneous professional movement towards advanced radiographic practice philosophy and ideals in many countries, international collaboration on this development has been minimal. This paper marks a growing international dialogue in this field. It discusses the theoretical concepts of advanced radiographic practice and the development of advanced practitioner roles, incorporating evidence and ideas from differing international perspectives and debates progress towards a potential unified global advanced practice identity.
    • The Dilemma of Performance Appraisal

      Prowse, Peter J.; Prowse, Julie M. (2009)
    • The Dilemma of Performance Appraisal

      Prowse, Peter J.; Prowse, Julie M. (2010)
    • The effects of monocular refractive blur on gait parameters when negotiating a raised surface

      Vale, Anna; Scally, Andy J.; Buckley, John G.; Elliott, David B. (2008)
      Falls in the elderly are a major cause of mortality and morbidity. Elderly people with visual impairment have been found to be at increased risk of falling, with poor visual acuity in one eye causing greater risk than poor binocular visual acuity. The present study investigated whether monocular refractive blur, at a level typically used for monovision correction, would significantly reduce stereoacuity and consequently affect gait parameters when negotiating a raised surface. Fourteen healthy subjects (25.8 +/- 5.6 years) walked up to and on to a raised surface, under four visual conditions; binocular, +2DS blur over their non-dominant eye, +2DS blur over their dominant eye and with their dominant eye occluded. Analysis focussed on foot positioning and toe clearance parameters. Monocular blur had no effect on binocular acuity, but caused a small decline in binocular contrast sensitivity and a large decline in stereoacuity (p < 0.01). Vertical toe clearance increased under monocular blur or occlusion (p < 0.01) with a significantly greater increase under blur of the dominant eye compared with blur of the non-dominant eye (p < 0.01). Increase in toe clearance was facilitated by increasing maximum toe elevation (p < 0.01). Findings indicate that monocular blur at a level typically used for monovision correction significantly reduced stereoacuity and consequently the ability to accurately perceive the height and position of a raised surface placed within the travel path. These findings may help explain why elderly individuals with poor visual acuity in one eye have been found to have an increased risk of falling.