• 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.
    • What is the future of imaging in forensic practice?

      Beck, Jamie J.W. (2011)
      The last two decades has seen increased use of imaging in forensic practice. Although radiography has been used historically, the evidence base for the use of computed tomography and magnetic resonance imaging in forensic practice appears to be growing. This article reviews the evidence base for the use of radiography, CT and MRI in an attempt to ascertain the future use of these imaging techniques in forensic medicine.
    • What makes a mobile app successful in supporting health behaviour change?

      Fitzgerald, Martin; McClelland, Gabrielle T. (2016)
      Introduction: Health promotion apps designed to support and reinforce health behaviours or to reduce risk behaviours are the most commonly downloaded apps. Such technologies have the potential to reach and deliver health care to new populations. But the extent to which they are successful in enabling the adoption of new and desired behaviours can vary. Some apps are more effective than others, some are free to download while others require a nominal or substantial charge. Cost alone is not indicative of quality or effectiveness. This is important because the use of health apps by the public will likely increase, as is the expectation that health care professionals understand this technology and its heuristic role in personalised health. Practitioners therefore need to be better informed regarding what makes a health app appealing to service users and successful as an intervention to facilitate behaviour change. Objective: This paper describes and discusses how the structure and content of health care apps can facilitate or inhibit behavioural change. The aim is to support practitioners in the screening and identification of suitable apps for clinical use. Method: Theory and literature review. Conclusion: App content that involved clinician input at the design stage and included internal drivers such as motivation, self-efficacy and illness understanding and external drivers such as illness information, social networking and user compatibility tend to do better in facilitating behaviour change than those that do not. Of these factors, motivation is considered to be the most important.
    • 'What really annoys me is people take it like it's a disability'. Epilepsy, disability and identity among people of Pakistani origin living in the UK.

      Rhodes, P.J.; Small, Neil A.; Ismail, Hanif; Wright, J. (2008)
      This paper reports on a study of Pakistani people with epilepsy. It explores their attitudes towards their condition, others’ attitudes, its impact on their lives, and the extent to which they considered themselves as disabled. Epilepsy was variously interpreted within biomedical, folk and religious paradigms. In line with popular understandings, participants associated disability with stable, permanent and visible physical impairments and did not consider themselves as disabled. However, they also recognised a social dimension to their experience. Much of the distress and disadvantage they experienced was socially determined, both through direct prejudice and discrimination, and indirectly through a fear of others’ negative reactions. However, the invisible and unpredictable nature of epilepsy meant that they could conceal their condition and thereby mitigate its social effects. ‘Disability’ was not experienced as a static and permanent state but as a potential identity that was both contingent and contested. The literature portrays people moving from biomedical to social interpretations of disability. However, the tensions experienced by people in the study were more between competing religious interpretations of their condition and, to some extent, between religious and medical approaches. Conceptions of disability, which are presented in the literature as antagonistic and mutually exclusive, were experienced as different dimensions reflecting the complexity of experience. The paper concludes by suggesting that for many people, for whom disability is an ambiguous, contingent and contested identity, public self-identification as disabled is an unrealistic goal. Rather than conceiving of disability as primarily physical or primarily social, it would be better construed as a complex interweaving of multiple factors—physical, environmental, socio-cultural and psychological factors.
    • What sources of bereavement support are perceived helpful by bereaved people and why? Empirical evidence for the compassionate communities approach

      Aoun, S.M.; Breen, L.; White, I.; Rumbold, B.; Kellehear, Allan (2018-09)
      Aims: To determine who provides bereavement support in the community, what sources are perceived to be the most or least helpful and for what reason, and to identify the empirical elements for optimal support in developing any future compassionate communities approach in palliative care. Design: A population-based cross-sectional investigation of bereavement experiences. Sources of support (informal, community and professional) were categorised according to the Public Health Model of Bereavement Support; most helpful reasons were categorised using the Social Provisions Scale, and least helpful were analysed using inductive content analysis. Setting and participants: Bereaved people were recruited from databases of funeral providers in Australia via an anonymous postal survey (2013–2014). Results: In total, 678 bereaved people responded to the survey. The most frequently used sources of support were in the informal category such as family, friends and funeral providers. While the professional category sources were the least used, they had the highest proportions of perceived unhelpfulness whereas the lowest proportions of unhelpfulness were in the informal category. The functional types of helpful support were Attachment, Reliable Alliance, Social Integration and Guidance. The five themes for least helpful support were: Insensitivity, Absence of Anticipated Support, Poor Advice, Lack of Empathy and Systemic Hindrance. Conclusion: A public health approach, as exemplified by compassionate communities policies and practices, should be adopted to support the majority of bereaved people as much of this support is already provided in informal and other community settings by a range of people already involved in the everyday lives of those recently bereaved. This study has provided further support for the need to strengthen the compassionate communities approach, not only for end of life care for dying patients but also along the continuum of bereavement support.
    • What you see is what you step: the horizontal-vertical illusion increases toe clearance in older adults during stair ascent.

      Foster, Richard J.; Whitaker, David J.; Scally, Andy J.; Buckley, John G.; Elliott, David B. (2015-05)
      Purpose.: Falls on stairs are a significant cause of morbidity and mortality in elderly people. A simple safety strategy to avoid tripping on stairs is increasing foot clearance. We determined whether a horizontal–vertical illusion superimposed onto stairs to create an illusory perceived increase in stair-riser height would increase stair ascent foot clearance in older participants. Methods.: Preliminary experiments determined the optimum parameters for the horizontal–vertical illusion. Fourteen older adults (mean age ± 1 SD, 68.5 ± 7.4 years) ascended a three-step staircase with the optimized version of the horizontal–vertical illusion (spatial frequency: 12 cycles per stair riser) positioned either on the bottom or top stair only, or on the bottom and top stair simultaneously. These were compared to a control condition, which had a plain stair riser with edge highlighters positioned flush with each stair-tread edge. Foot clearance and measures of postural stability were compared across conditions. Results.: The optimized illusion on the bottom and top stair led to a significant increase in foot clearance over the respective stair edge, compared to the control condition. There were no significant decreases in postural stability. Conclusions.: An optimized horizontal–vertical visual illusion led to significant increases in foot clearance in older adults when ascending a staircase, but the effects did not destabilize their postural stability. Inclusion of the horizontal–vertical illusion on raised surfaces (e.g., curbs) or the bottom and top stairs of staircases could improve stair ascent safety in older adults.
    • When is visual information used to control locomotion when descending a kerb?

      Buckley, John G.; Timmis, Matthew A.; Scally, Andy J.; Elliott, David B. (2011)
      Background: Descending kerbs during locomotion involves the regulation of appropriate foot placement before the kerb-edge and foot clearance over it. It also involves the modulation of gait output to ensure the body-mass is safely and smoothly lowered to the new level. Previous research has shown that vision is used in such adaptive gait tasks for feedforward planning, with vision from the lower visual field (lvf) used for online updating. The present study determined when lvf information is used to control/update locomotion when stepping from a kerb. Methodology/Principal Findings: 12 young adults stepped down a kerb during ongoing gait. Force sensitive resistors (attached to participants' feet) interfaced with an high-speed PDLC 'smart glass' sheet, allowed the lvf to be unpredictably occluded at either heel-contact of the penultimate or final step before the kerb-edge up to contact with the lower level. Analysis focussed on determining changes in foot placement distance before the kerb-edge, clearance over it, and in kinematic measures of the step down. Lvf occlusion from the instant of final step contact had no significant effect on any dependant variable (p>0.09). Occlusion of the lvf from the instant of penultimate step contact had a significant effect on foot clearance and on several kinematic measures, with findings consistent with participants becoming uncertain regarding relative horizontal location of the kerb-edge. Conclusion/Significance: These findings suggest concurrent feedback of the lower limb, kerb-edge, and/or floor area immediately in front/below the kerb is not used when stepping from a kerb during ongoing gait. Instead heel-clearance and pre-landing-kinematic parameters are determined/planned using lvf information acquired in the penultimate step during the approach to the kerb-edge, with information related to foot placement before the kerb-edge being the most salient.