• Vaginal birth after caesarean section (VBAC): exploring women's perceptions

      Meddings, Fiona S.; MacVane Phipps, Fiona E.; Haith-Cooper, Melanie; Haigh, Jacquelyn (2007)
      Aims and objectives.  This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. Background.  The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites’ choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology.  Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. Results.  This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions.  Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice.  This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.
    • Validation of the Primary Care Patient Measure of Safety (PC PMOS) questionnaire

      Giles, S.J.; Parveen, Sahdia; Hernan, A.L. (2018)
      Background The Primary Care Patient Measure of Safety (PC PMOS) is designed to capture patient feedback about the contributing factors to patient safety incidents in primary care. It required further reliability and validity testing to produce a robust tool intended to improve safety in practice. Method 490 adult patients in nine primary care practices in Greater Manchester, UK, completed the PC PMOS. Practice staff (n = 81) completed a survey on patient safety culture to assess convergent validity. Confirmatory factor analysis (CFA) assessed the construct validity and internal reliability of the PC PMOS domains and items. A multivariate analysis of variance was conducted to assess discriminant validity, and Spearman correlation was conducted to establish test–retest reliability. Results Initial CFA results showed data did not fit the model well (a chi-square to df ratio (CMIN/DF) = 5.68; goodness-of-fit index (GFI) = 0.61, CFI = 0.57, SRMR = 0.13  and root mean square error of approximation (RMSEA) = 0.10). On the basis of large modification indices (>10), standardised residuals >± 2.58 and assessment of item content; 22 items were removed. This revised nine-factor model (28 items) was found to fit the data satisfactorily (CMIN/DF = 2.51; GFI = 0.87, CFI = 0.91, SRMR = 0.04  and RMSEA = 0.05). New factors demonstrated good internal reliability with average inter-item correlations ranging from 0.20 to 0.70. The PC PMOS demonstrated good discriminant validity between primary care practices (F = 2.64, df = 72, p < 0.001) and showed some association with practice staff safety score (convergent validity) but failed to reach statistical significance (r = −0.64, k = 9, p = 0.06). Conclusion This study led to a reliable and valid 28-item PC PMOS. It could enhance or complement current data collection methods used in primary care to identify and prevent error.
    • Validity of dementia care mapping on a neuro-rehabilitation ward: Q-methodology with staff and patients

      Westbrook, J.L.; McIntosh, C.J.; Sheldrick, R.; Surr, Claire A.; Hare, D.J. (2013)
      BACKGROUND: Measuring the quality of care for people using neuro-rehabilitation services is a complex area requiring reliable methods that account for variable communication abilities/cognitive functioning. Dementia Care Mapping (DCM) is an observational method widely used in dementia care to improve person-centred care, which may be usefully applied to neuro-rehabilitation settings. Evaluation is vital to determine the tool's acceptability in this setting. PURPOSE: To explore the views of staff/patients regarding whether the use of DCM is acceptable in a neuro-rehabilitation setting. METHOD: DCM was conducted on an acute neuro-rehabilitation ward. Q-methodology, a technique for extracting subjective opinions, was used with 23 staff and 10 patients on the ward to evaluate the acceptability of DCM. RESULTS: Factor analysis was performed separately for staff and patient Q-sorts. Each found a "consensus" factor where all participants indicated positive acceptability for the use of DCM. Further exploratory factors indicated that some staff/patients had additional views/concerns that were not captured by the first consensus factor. CONCLUSIONS: The results from this preliminary study are promising and indicate that DCM is potentially an acceptable tool to use in acute neuro-rehabilitation. Further research is needed to explore the acceptability of this tool more widely across neuro-rehabilitation settings. IMPLICATIONS FOR REHABILITATION: Person-centred care is widely acknowledged as being important in all care settings, including neurorehabilitation. Dementia Care Mapping was deemed to be an acceptable approach for improving the quality of person-centred care on the basis of the views of staff and patients in a neurorehabilitation ward. Dementia Care Mapping, with adaptations for neurorehabilitation settings, successfully provides an acceptable framework for measuring and improving the quality of person-centred care in this setting.
    • Visual guidance of landing behaviour when stepping down to a new level

      Buckley, John G.; MacLellan, M.J.; Tucker, M.W.; Scally, Andy J.; Bennett, S.J. (2008)
      When stepping down from one level to another, the leading limb has to arrest downward momentum of the body and subsequently receive and safely support bodyweight before level walking can begin. Such step downs are performed over a wide range of heights and predicting when and where contact between the landing limb and the lower level will be made is likely a critical factor. To determine if visual feedback obtained after movement initiation is habitually used in guiding landing behaviour, the present study determined whether pre-landing kinematics and the mechanics of landing would be modulated according to the type of visual feedback available during the stepping down phase. Ten healthy participants (32.3 ± 7.9 years) stepped, from a standing position, down from three different heights onto a forceplatform, either coming immediately to rest or proceeding directly to walking across the laboratory. Repeated trials were undertaken under habitual vision conditions or with vision blurred or occluded 2¿3 s prior to movement initiation. Pre-landing kinematics were assessed by determining, for the instant of landing, lead-limb knee and ankle angle, stepping distance, forwards positioning of the body CM within the base of support and the forwards and downwards body CM velocity. Landing mechanics for the initial contact period were characterized using lead limb vertical loading and stiffness, and trail limb un-weighting. When vision was occluded movement time, ankle plantarflexion and knee flexion were significantly increased compared to that determined for habitual vision, whereas forwards body CM positioning and velocity, vertical loading and stiffness, and trail limb un-weighting, were significantly reduced (p < 0.05). Similar adaptations were observed under blurred conditions, although to a lesser extent. Most variables were significantly affected by stepping task and step height. Subjects likely reduced forwards CM position and velocity at instant of landing, in order to keep the CM well away from the anterior border of the base of support, presumably to ensure boundary margins of safety were high should landing occur sooner or later than expected. The accompanying increase in ankle plantarflexion at instant of landing, and increase in single limb support time, suggests that subjects tended to probe for the ground with their lead limb under modified vision conditions. They also had more bodyweight on the trail limb at the end of the initial contact period and as a consequence had a prolonged weight transfer time. These findings indicate that under blurred or occluded vision conditions subjects adopted a cautious strategy where by they ¿sat back¿ on their trail limb and used their lead limb to probe for the ground. Hence, they did not fully commit to weight transfer until somatosensory feedback from the lead limb confirmed they had safely made contact. The effect of blurring vision was not identical to occluding vision, and led to several important differences between these conditions consistent with the use of impoverished visual information on depth. These findings indicate that online vision is customarily used to regulate landing behaviour when stepping down.
    • Vitiligo linked to stigmatization in British South Asian women: a qualitative study of the experiences of living with vitiligo.

      Thompson, A.R.; Clarke, S.A.; Newell, Robert J.; Gawkrodger, D.J.; Appearance Research Collaboration (2010)
      Background Vitiligo is a visible condition that is more noticeable in darker-skinned people. Beliefs about illness have been linked to psychosocial adjustment. There is some evidence that such beliefs may be influenced by cultural factors. Surprisingly little is known about beliefs in relation to vitiligo. Objectives The study sought to explore in depth the ways in which British Asian women manage and adjust psychosocially to vitiligo, and the potential role of ethnicity and culture in this process. Methods In-depth semistructured interviews were conducted with seven British women of South Asian decent and analysed using the qualitative method of template analysis. Results Participants described feeling visibly different and all had experienced stigmatization to some extent. Avoidance and concealment were commonplace. Experiences of stigmatization were often perceived to be associated with cultural values related to appearance, status, and myths linked to the cause of the condition. Conclusions The findings of this study present a unique in-depth analysis of British South Asians living with vitiligo and suggest there is a need for further research to explore cultural associations of disfigurement and of adjustment to chronic skin conditions. Furthermore, they suggest that in addition to individual therapeutic interventions there may be a need for community interventions aimed at dispelling myths and raising awareness of sources of support and treatment.
    • Vulnerable migrant women and postnatal depression: A case of invisibility in maternity services?

      Firth, Amanda; Haith-Cooper, Melanie (2018)
      Vulnerable migrant women are at an increased risk of developing postnatal depression, compared with the general population. Although some symptoms are the same as in other pregnant women, there are specific reasons why vulnerable migrant women may present differently, or may not recognise symptoms themselves. Factors associated with migration may affect a woman’s mental health, particularly considering forced migration, where a woman may have faced violence or trauma, both in her home country and on the journey to the UK. Vulnerable migrant women engage less with maternity care than the average woman for reasons including a lack of knowledge of the UK healthcare system, fear of being charged for care, or fear that contact with clinicians will negatively affect their immigration status. This article explores the issues surrounding vulnerable migrant women that increase their risk of developing postnatal depression and presents reasons why this may go unrecognised by health professionals such as midwives.
    • Walking to improve cardiovascular health: a meta-analysis of randomised control trials

      Murtagh, E.M.; Nichols, L.; Mohammed, Mohammed A.; Holder, R.L.; Nevill, A.M.; Murphy, M.H.; Mary Immaculate College Research Directorate Seed Funding Scheme (2014)
      Physical inactivity causes approximately 17% of premature mortality in the UK. Walking offers a promising method for lowering risk of cardiovascular disease at population level, though a recent synthesis of evidence is lacking. This study aimed to conduct a meta-analysis of randomised controlled trials that have assessed the effect of walking on risk factors for cardiovascular disease in previously inactive adults. We searched PubMed, Web of Science, ScienceDirect, and the Cochrane Central Register of Controlled Trials for studies published in English between Jan 1, 1970, and May 31, 2012, using the following search terms: "walking", "exercise", "health", and "cardiovascular risk". Two authors identified randomised controlled trials of interventions (>4 weeks' duration) that included at least one group with walking as the only treatment and a comparator no-exercise group. Participants were inactive but otherwise healthy at baseline. Pooled results were reported as weighted mean treatment effects and 95% CIs in a random effects model. 32 articles reported the effects of walking interventions on risk factors for cardiovascular disease in participants aged 30–83 years. Mean length of interventions was 18·7 weeks (range 8–52). Duration of walking was 20–60 min on 2–7 days per week. Walking interventions reduced systolic and diastolic blood pressure (−3·6 mm Hg, 95% CI −5·19 to −1·97; −1·5 mm Hg, −2·83 to −0·26). Interventions also improved waist circumference (−1·5 cm, −2·34 to −0·68), weight (−1·4 kg, −1·75 to −1·00), body fat (−1·2%, −1·70 to −0·73), and body-mass index (BMI) (−0·5 kg/m2, −0·72 to −0·35). Walking improved aerobic fitness (3·2 mL/kg per min, 95% CI 2·57 to 3·80) but did not alter blood lipids. Significant heterogeneity (I2 statistic) was noted for aerobic fitness, BMI, weight, and percentage body fat. Many studies did not provide sufficient information to make firm judgments about risk of bias. These findings support the important role of walking in physical activity for health promotion. Health professionals involved in the primary prevention of cardiovascular disease should prescribe walking confident of the benefits it can provide in fitness, blood pressure, and adiposity.
    • A way forward: Process mapping and the delivery of mental health services

      McIntosh, Bryan; Breen, Liz; West, Sue (2016-12)
      Introduction: This paper demonstrates the practical application of process mapping principles as a model for evaluating NHS improvement. The NHS improvement in question was the merger of three crisis resolution teams within an NHS trust in 2012. The aims were to improve overall operational efficiency and enhance multidisciplinary working to meet operational targets. This paper examined changes following the merger to capture the effects of service improvement and the reality of the patient journey. Methods: A pooled cross-sectional approach, using six years of aggregated hospital data, was taken. To achieve operational efficiency, a process map of referrals, readmissions, length of stay and waiting times for crisis resolution team assessments was examined. Prevalence of clinical referral rates and disease classification before and after the merger were compared. Conclusion: Between 1 April 2009 and 30 March 2015, length of stay and readmissions for patients to crisis resolution team rates reduced. Operational sustainability and capacity was enhanced through the redistribution of clinical human resources. Multidisciplinary skill mix (e.g. through improved team composition) also improved.
    • Well-being and mental health in later life: The development and validation of the well-being evaluation scale.

      Kel A; Papadopoulos A; Oyebode, Jan R.; Backmark-Goodwill H; Halloran, L (2012)
    • What are meaningful psychosocial interventions for people with dementia and how can they be captured in research? Report of a pan-European consultation

      Øksnebjerg, L.; Diaz-Ponce, A.; Gove, A.; Moniz-Cook, E.; Mountain, Gail; Chattat, R.; Woods, B. (2018)
    • What are the barriers to care integration for those at the advanced stages of dementia living in care homes in the UK? Health care professional perspective

      Kupeli, N.; Leavey, G.; Harrington, J.; Lord, Kathryn; King, M.; Nazareth, I.; Moore, K.; Sampson, E.L.; Jones, L. (2016)
      People with advanced dementia are frequently bed-bound, doubly incontinent and able to speak only a few words. Many reside in care homes and may often have complex needs requiring efficient and timely response by knowledgeable and compassionate staff. The aim of this study is to improve our understanding of health care professionals’ attitudes and knowledge of the barriers to integrated care for people with advanced dementia. In-depth, interactive interviews conducted with 14 health care professionals including commissioners, care home managers, nurses and health care assistants in the UK. Barriers to care for people with advanced dementia are influenced by governmental and societal factors which contribute to challenging environments in care homes, poor morale amongst care staff and a fragmentation of health and social care at the end of life. Quality of care for people with dementia as they approach death may be improved by developing collaborative networks to foster improved relationships between health and social care services.
    • What can we bring to the therapeutic relationship? A qualitative study of the beliefs and experiences of physiotherapists working with people with chronic pain

      Carus, Catherine; Hunter, S.J. (2017)
      Objectives: To explore experienced physiotherapists’ attitudes, beliefs and experiences regarding their personal role in contributing to effective therapeutic relationships when working with people with chronic musculoskeletal pain. Design: Descriptive qualitative design using semi-structured interviews. Setting: Within physiotherapy departments in two National Health Service acute secondary care trusts in the North West of England. Participants: Six experienced physiotherapists working with people with chronic musculoskeletal pain. Data Analysis: Thematic coding analysis of transcribed interview recordings Main outcomes: Four overarching themes emerged from the data: Listening to the person; a caring understanding of the person’s situation; engaging the person and coming together; and moving forwards. Results: Participants emphasized the importance of building effective therapeutic relationships when working with people with chronic pain, seeking to create these by engaging with the person, to promote a strong collaborative partnership. Participants highlighted the themes of listening to the person’s story and showing a caring understanding of their situation through empathy and belief with validation. The final theme of moving forward emphasized how positive therapeutic relationships aid the rehabilitation process in enabling people to make positive changes in their lives. Conclusions: A clearer understanding of how physiotherapists engender positive therapeutic relationships has the potential to improve training and service development priorities for physiotherapists working in the area of chronic musculoskeletal pain. Future studies should seek to further define the core dimensions impacting therapeutic relationships, from the perspectives of both physiotherapists and people with chronic musculoskeletal pain.
    • What do adolescents perceive to be key features of an effective dementia education and awareness initiative?

      Parveen, Sahdia; Farina, N.; Shafiq, Saba; Hughes, L.J.; Griffiths, Alys W. (2018)
      The development of dementia friendly communities is a current global and national priority for the UK. As a response to policy, there have been a number of dementia awareness initiatives disseminated with the aim of reducing the stigma associated with a diagnosis of dementia. The inclusion of adolescents in such initiatives is imperative in order to sustain dementia friendly communities. With this in mind, the aim of this study was to establish the dementia education needs of adolescents and effective dissemination strategies to convey key messages. A total of 42 adolescents aged 12 to 18 years participated in eight focus group discussions. Key themes to emerge from discussions included: the importance of dementia awareness, topics of interest within dementia, preferred methods of learning, the inclusion of the person living with dementia and the use of social media. The findings of the study will enable the development of appropriate dementia awareness initiatives for adolescents and thus facilitate the sustainability of dementia friendly communities.
    • What do we know about brief interventions for physical activity that could be delivered in primary care consultations? A systematic review of reviews

      Lamming, Laura; Pears, S.; Mason, Dan; Morton, K.; Bijker, M.; Sutton, S.; Hardeman, W. (2017-06)
      This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30 min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5 min or less) that could be delivered in a primary care consultation.
    • What Drives Adaptive Gait Changes to Acutely Presented Monocular Blur?

      Chapman, Graham J.; Scally, Andy J.; Elliott, David B. (2011)
      Purpose. To determine whether gait alterations due to monocular spherical lens blur were a safety strategy or driven by lens magnification. Methods. Adaptive gait and visual function were measured in 10 older adults (mean age, 74.9 4.8 years) with the participants¿ optimal refractive correction and when monocularly blurred with 1.00 DS and 2.00 DS lens over the dominant eye. Adaptive gait measurements for the lead and trail foot included foot position before the raised surface, toe clearance of the raised surface edge, and foot position on the raised surface. Vision measurements included binocular visual acuity, contrast sensitivity, and stereoacuity. Results. Equal levels of monocular positive and negative spherical lens blur led to very different stepping strategies when negotiating a raised surface. Positive blur lenses led to an increased vertical toe clearance and reduced distance of the lead foot position on the raised surface. Negative lenses led to the opposite of these changes. Conclusions. Findings suggest that step negotiation strategies were driven by the magnification effect provided by the spherical lenses. Steps appeared closer and larger with magnification from positive lenses and further away and smaller with minification from negative lenses and gait was adjusted accordingly. These results suggest that previously reported adaptive gait changes to monocular spherical lens blur were not safety strategies as previously suggested but driven by lens magnification. The significance of these findings in terms of prescribing large refractive changes in frail older patients is discussed.
    • What factors affect the emotional well-being of newly qualified midwives in their first year of practice?

      Bacchus, A.; Firth, Amanda (2017-12)
      The Royal College of Midwives (RCM) reports that between 5–10% of newly qualified midwives (NQM) leave the profession in the UK within a year of registration, with similar losses reported internationally (RCM 2010). NQMs are in a position of vulnerability and are highly susceptible to workplace adversity that subsequently may affect their emotional well-being. This literature review explores the experiences of NQMs surrounding their emotional well-being within the first 12 months of transition. Following a thorough search and appraisal of the literature, four papers were reviewed. Two key themes were identified consisting of factors that challenge NQMs’ resilience causing negative emotional well-being, and factors that enhance resilience, promoting positive emotional well-being. The findings of this review demonstrate that there is a need for the consistent implementation of protective mechanisms such as structured preceptorship and supportive mentorship. Such interventions may improve physical and emotional well-being, increase retention and better prepare NQMs for the journey ahead; ultimately also improving quality of care for women and patient safety.
    • What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services.

      Burton, C.R.; Horne, Maria; Woodward-Nutt, K.; Bowen, A.; Tyrrell, P.J. (2015)
      Introduction: Multi-disciplinary team members predict each patient’s rehabilitation potential to maximise best use of resources. A lack of underpinning theory about rehabilitation potential makes it difficult to apply this concept in clinical practice. This study theorises about rehabilitation potential drawing on everyday decision-making by Health Care Professionals (HCPs) working in stroke rehabilitation services. Methods: A clinical scenario, checked for face validity, was used in two focus groups to explore meaning and practice around rehabilitation potential. Participants were 12 HCPs working across the stroke pathway. Groups were co-facilitated, audio-recorded and fully transcribed. Analysis paid attention to data grounded in first-hand experience, convergence within and across groups and constructed a conceptual overview of HCPs’ judgements about rehabilitation potential. Results: Rehabilitation potential is predicted by observations of “carry-over” and functional gain and managed differently across recovery trajectories. HCPs’ responses to rehabilitation potential judgements include prioritising workload, working around the system and balancing optimism and realism. Impacts for patients are streaming of rehabilitation intensity, rationing access to rehabilitation and a shifting emphasis between management and active rehabilitation. For staff, the emotional burden of judging rehabilitation potential is significant. Current service organisation restricts opportunities for feedback on the accuracy of previous judgements. Conclusion: Patients should have the opportunity to demonstrate rehabilitation potential by participation in therapy. As therapy resources are limited and responses to therapy may be context-dependent, early decisions about a lack of potential should not limit longer-term opportunities for rehabilitation. Services should develop strategies to enhance the quality of judgements through feedback to HCPs of longer-term patient outcomes.Implications for Rehabilitation Rehabilitation potential is judged at the level of individual patients (rather than population-based predictive models of rehabilitation outcome), draws on different sources of often experiential knowledge, and may be less than reliable. Decisions about rehabilitation potential may have far reaching consequences for individual patients, including the withdrawal of active rehabilitation in hospital or in the community and eventual care placement. A better understanding of what people mean by rehabilitation potential by all team members, and by patients and carers, may improve the quality of joint decision making and communication.