• Using ethnography (or qualitative methods) to investigate medication errors: a critique of a published study.

      Armitage, Gerry R.; Hodgson, Ian J. (2009-11-18)
      The effects of drug errors and any consequent adverse events frequently impact on patients, their relatives and professional carers. Furthermore, the financial cost to the National Health Service is considerable (DoH, 2000; DoH, 2001; DoH, 2004). In a study of two London teaching hospitals, Vincent et al. (2001) found that 10% of patients are exposed to an adverse event, which adds a mean 8.5 days to their hospital stay. Drug errors are recurrently reported to account for between 10 and 20% of all adverse events (DoH, 2004). In response to Department of Health policy, NHS trusts are changing their approach to the management of error to encourage more reporting. The emphasis is on openness and support, and individual and organisational learning rather than blame. Research designed to increase a knowledge of the aetiology and context of drug errors should be carefully constructed and include qualitative methods which, if implemented according to established convention, can reflect the approaches described above. This paper will critique a recently published study that focused on nursing practice and was, in our view, inappropriately described as ethnographic. The study undoubtedly adds to the body of existing knowledge about drug errors and, crucially, if the study contributes to improved patient safety, it must, fundamentally, be valued. Nevertheless, some qualitative research conventions were broken and, as such, it is suggested, some opportunities for a broader understanding and for learning may have been lost. The critique will lead to a range of recommendations about future qualitative studies in this research domain which, it is argued, could produce a fuller picture of the context, culture and, perhaps, even the cause of error.
    • Using latent class analysis to develop a model of the relationship between socioeconomic position and ethnicity: cross-sectional analyses from a multi-ethnic birth cohort study.

      Fairley, L.; Cabieses, B.; Small, Neil A.; Petherick, E.S.; Lawlor, D.A.; Pickett, K.E.; Wright, J. (2014-08-12)
      Background Almost all studies in health research control or investigate socioeconomic position (SEP) as exposure or confounder. Different measures of SEP capture different aspects of the underlying construct, so efficient methodologies to combine them are needed. SEP and ethnicity are strongly associated, however not all measures of SEP may be appropriate for all ethnic groups. Methods We used latent class analysis (LCA) to define subgroups of women with similar SEP profiles using 19 measures of SEP. Data from 11,326 women were used, from eight different ethnic groups but with the majority from White British (40%) or Pakistani (45%) backgrounds, who were recruited during pregnancy to the Born in Bradford birth cohort study. Results Five distinct SEP subclasses were identified in the LCA: (i) "Least socioeconomically deprived and most educated" (20%); (ii) "Employed and not materially deprived" (19%); (iii) "Employed and no access to money" (16%); (iv) "Benefits and not materially deprived" (29%) and (v) "Most economically deprived" (16%). Based on the magnitude of the point estimates, the strongest associations were that compared to White British women, Pakistani and Bangladeshi women were more likely to belong to groups: (iv) "benefits and not materially deprived" (relative risk ratio (95% CI): 5.24 (4.44, 6.19) and 3.44 (2.37, 5.00), respectively) or (v) most deprived group (2.36 (1.96, 2.84) and 3.35 (2.21, 5.06) respectively) compared to the least deprived class. White Other women were more than twice as likely to be in the (iv) "benefits and not materially deprived group" compared to White British women and all ethnic groups, other than the Mixed group, were less likely to be in the (iii) "employed and not materially deprived" group than White British women. Conclusions LCA allows different aspects of an individual’s SEP to be considered in one multidimensional indicator, which can then be integrated in epidemiological analyses. Ethnicity is strongly associated with these identified subgroups. Findings from this study suggest a careful use of SEP measures in health research, especially when looking at different ethnic groups. Further replication of these findings is needed in other populations.
    • Using mobile technologies for assessment and learning in practice settings: a case study.

      Dearnley, Christine A.; Haigh, Jacquelyn; Fairhall, John R. (2008)
    • Using Mobile Technologies for Assessment and Learning in Practice Settings: Outcomes of Five Case Studies

      Dearnley, Christine A.; Taylor, J.D.; Hennessay, S.; Parks, M.; Coates, C.A.; Haigh, Jacquelyn; Fairhall, John R.; Riley, K.; Dransfield, M. (2009)
    • Using out-of-office blood pressure measurements in established cardiovascular risk scores: implications for practice

      Stevens, S.L.; Stevens, R.J.; de Leeuw, P.; Kroon, A.A.; Greenfield, S.; Mohammed, Mohammed A.; Gill, P.; Verberk, W.J.; McManus, R.J. (2018)
      Abstract Background: Blood pressure (BP) measurement is increasingly carried out through home or ambulatory monitoring, yet existing cardiovascular risk scores were developed for use with measurements obtained in clinic. Aim: To describe differences in cardiovascular risk estimates obtained using ambulatory or home BP measurements instead of clinic readings. Design and setting: Secondary analysis of data from adults aged 30-84 without prior history of cardiovascular disease (CVD) in two BP monitoring studies (BP-Eth and HOMERUS). Method: The primary comparison was Framingham risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements. The QRISK2 and SCORE risk equations were also studied. Statistical and clinical significance were determined using the Wilcoxon signed-rank test and scatter plots respectively. Results: In 442 BP-Eth patients (mean age = 58 years, 50% female) the median absolute difference in 10-year Framingham cardiovascular risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements was 1.84% (interquartile range 0.65 to 3.63, p=0.67). Only 31/ 442 (7.0%) of patients were reclassified across the 10% risk treatment threshold. In 165 HOMERUS patients (mean age = 56 years, 46% female) the median difference in 10-year risk was 2.76% (IQR 1.19 to 6.39, p<0.001) and only 8/165 (4.8%) of patient were reclassified. Conclusion: Estimates of cardiovascular risk are similar when calculated using BP measurements obtained as in the risk score derivation study or through ambulatory monitoring. Further research is required to determine if differences in estimated risk would meaningfully influence risk score accuracy.
    • Using Participatory Video to enhance involvement for people with dementia.

      Capstick, Andrea; Ludwin, Katherine; Chatwin, John (2014)
    • Using participatory video to understand diversity among people with dementia in long-term care.

      Ludwin, Katherine; Capstick, Andrea (2015-01)
      Within care organizations, “people with dementia” are often labeled as a homogenous group with little differentiating them from each other. This can mark them out as separate from and less capable than those without dementia. When individuals with dementia are described, understood, and related to in terms of their diagnosis, individuality may get lost. In this article, we seek to unsettle the socially constructed boundary between “people with dementia” and people without dementia. This is explored in the context of fieldwork we undertook as part of a Participatory Video project where we worked alongside people with a dementia diagnosis to co-create short films about their interests and concerns. In the process of this work, we found that alternative unities emerged between ourselves and people with dementia, as the dementia label faded into the background and the person, with all his or her diverse interests and life experiences, came to the fore. We found ourselves building rapport and making connections with our research participants, a diverse group of individuals whose life experiences, outlooks, and experiences were simultaneously unique to them but also shared in many ways between themselves, and with us. As we spent time with participants in the communal lounge, in the adjoining day center, walking the hallways, out in the garden, or in individual apartments when invited, we found that people shared a wealth of information with us: about how they were feeling, things they liked, things they had done, instances of trauma, as well as some of their happiest times.
    • Using routine blood test results to predict the risk of death for emergency medical admissions to hospital: an external model validation study

      Faisal, Muhammad; Howes, R.; Steyerberg, E.W.; Richardson, D.; Mohammed, Mohammed A. (2016-08-02)
      Background The Biochemistry and Haematology Outcome Model (BHOM) relies on the results from routine index blood tests to predict the patient risk of death. We aimed to externally validate the BHOM model. Method We considered all emergency adult medical patients who were discharged from Northern Lincolnshire and Goole (NLAG) hospital in 2014. We compared patient characteristics between NLAG (the validation sample) and the hospital where BHOM was developed. We evaluated the predictive performance, according to discriminative ability (with a concordance statistic, c), and calibration (agreement between observed and predicted risk). Result There were 29 834 emergency discharges of which 24 696 (83%) had complete data. In comparison with the development sample, the NLAG sample was similar in age, blood test results, but experienced a lower mortality (4.7% vs 8.7%). When applied to NLAG, the BHOM model had good discrimination (c-statistic 0.83 [95% CI 0.823 - 0.842]). Calibration was good overall, although the BHOM model overpredicted for lowest (<5%, observed = 229,predicted =286) and highest (≥50%, observed = 31, predicted = 49) risk groups, even after recalibrating for the differences in baseline risk of death. Conclusion Differences in patient case-mix profile and baseline risk of death need to be considered before the BHOM model can be used in another hospital. After re-calibrating for the baseline difference in risk the BHOM model had good discrimination but less adequate calibration.
    • Using social media to create discussion

      Russell, S.; Middleton-Green, Laura; Johnston, B. (2015)
    • Using Team-Based Learning in Teaching Undergraduate Pathophysiology for Nurses

      Middleton-Green, Laura; Ashelford, Sarah L. (2013)
      This paper describes the development, implementation and evaluation of Team-Based Learning (TBL) in a third year undergraduate nursing module.
    • Using text messages to support recovering substance misusers

      McClelland, Gabrielle T.; Duffy, P.; Davda, P. (2018-09)
      Background: The use of digital technology in health and social care is developing rapidly. It is promoted in UK policy and research which suggests varied results surrounding its implementation and outcomes. Introduction: This article aimed to test the implementation and outcomes of a short messaging service sent to a dedicated phone. The target cohort were drug treatment clients in two sites in Northern England. Materials and methods: Through staff focus groups and interviews with a small cohort of clients, the implementation and perceptions of the system were examined. Results: Nineteen participants were recruited to site 1 (15 male, 4 female, average age=37.7 years) and 12 participants were recruited to site 2 (9 male, 3 female, average age=40.3 years). One outcome that was of interest was well-being in treatment which, in this study, was described as an overall sense of feeling better rather than just focusing on the rehabilitation aspect of the programme. Other outcomes included: the successful completion of treatment and any relapse or associated reported drug use. Discussion: The system shows some evidence of its ‘social actor’ role; however, its implementation was hindered by staff citing that it called for increased resources. For future implementation the use of client’s own phones may be considered which may help to embed the system more fully in recovery planning and targeting clients at a different treatment stage. Conclusions: Despite some indications of positive results for clients and a perception that the system may have value as an addition to existing clinical interventions, more evaluation is required to determine whether this system can be implemented in a drug treatment setting.
    • 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. (2019-04)
      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.
    • The value of a Patient Access Portal in primary care: a cross-sectional survey of 62,486 registered users in the UK

      Mohammed, Mohammed A.; Montague, Jane; Faisal, Muhammad; Lamming, Laura (2020)
      In England, primary care patients have access to Patient Access Portals (PAPs), enabling them to book appointments, request repeat medication prescriptions, send/receive messages and review their medical records. Few studies have elicited user views and value of PAPs, especially in a publicly funded primary care setting. This study aimed to elicit the value users of PAPs place on online access to medical records and linked services. Secondary data analysis of the completed electronic survey (available 2 May 2015–27 June 2015) distributed via the EMIS PAP to all its registered users. EMIS designed the survey; responses were voluntary. There were 62,486 responders (95.7% self-completed). The PAP was mainly used for medication requests (86.3%) and online appointment bookings (78.4%), and, to a lesser extent, medical record viewing (18.3%) and messaging (9.5%). The majority (70%) reported a positive impact from using it. One in five rated it as their favourite online service second only to online banking. Almost three out of four responders stated that availability of online access would influence their move to another practice. Nonetheless, responders were reluctant to award a high monetary value to it. These findings correlated with the number of long-term conditions. The majority of users place a relatively high value, but not monetary value, on the PAP and report a positive impact from using it. The potential for PAPs to enhance patient experience, especially for those with long-term conditions, appears to be largely untapped. Research exploring the reasons for non-use is also required.
    • Variation and interactional non-standardization in neuropsychological tests: The case of the Addenbrooke’s Cognitive Examination

      Jones, Danielle K.; Wilkinson, R.; Jackson, C.; Drew, P. (2020-02)
      The Addenbrooke’s Cognitive Examination (ACE-111) is a neuropsychological test used in clinical practice to inform a dementia diagnosis. The ACE-111 relies on standardized administration so that patients’ scores can be interpreted by comparison with normative scores. The test is delivered and responded to in interaction between clinicians and patients, which places talk-in-interaction at the heart of its administration. In this article, conversation analysis (CA) is used to investigate how the ACE-111 is delivered in clinical practice. Based on analysis of 40 video/audio-recorded memory clinic consultations in which the ACE-111 was used, we have found that administrative standardization is rarely achieved in practice. There was evidence of both (a) interactional variation in the way the clinicians introduce the test and (b) interactional non-standardization during its implementation. We show that variation and interactional non-standardization have implications for patients’ understanding and how they might respond to particular questions.
    • Variation in pelvic radiography practice: Why can we not standardise image acquisition techniques?

      Snaith, Beverly; Field, L.; Lewis, E.F.; Flintham, K. (2019-11)
      Introduction: Pelvic radiographs remain an essential investigation in orthopaedic practice. Although it is recognised that acquisition techniques can affect image appearances and measurement accuracy, it remains unclear what variation in practice exists and what impact this could have on decision making. Method: This was a cross sectional survey of UK radiology departments utilising an electronic tool. An introductory letter and link was distributed. Responses were received from 69 unique hospital sites within the specified timeframe, a response rate of 37.9%. Results: There was no consistent technique for the positioning of patients for pelvic radiographs. The distance varied between 90 and 115 cm and 10 different centering points were described. In relation to leg position, the feet are usually internally rotated (65 of 69 [94.2%]). Only 1 teaching hospital (1 of 69 [1.4%]) uses a weight-bearing position as standard. Orthopaedic calibration devices were not in routine use, with only 21 using on pelvic x-rays (30.4%). Further, the type of device and application criteria were inconsistent. Conclusions: To our knowledge this is the first study to directly compare radiographic positioning across hospital sites. Our data demonstrated marked variation in technique for pelvis radiographs with associated implications for clinical decision making. Research is required to determine the standard technique and quality outcome measures to provide confidence in diagnostic interpretation particularly for serial radiographs.
    • Video rasterstereography of the spine and pelvis in eight erect positions: A reliability study

      Alzyoud, K.; Hogg, P.; Snaith, Beverly; Preece, S.; England, A. (2020-02)
      Introduction: To investigate the reliability and variability of Video Rasterstereography (VR) measurements of the spine and pelvis, for eight proposed standing postures, in order to help define an optimal standing position for erect pelvis radiography. Methods: Surface topography data were collected using the formetic 4D dynamic modelling (Diers) system. 61 healthy participants were recruited; each participant performed eight different standing positions. Four positions were performed with the feet shoulder width apart and parallel, and four positions were performed with the feet shoulder width apart and internally rotated. For the upper extremity, each of the (two sets of) four positions were performed with different arm positions (arms by the sides, arms crossed over the chest, arms 30° flexed and touching the medial end of the clavicle, arms 30° flexed with the hands holding a support). Three sets of surface topography were collected in the eight positions (n = 24). The variability was assessed by calculating standard error of the measurement (SEm) and the coefficient of variation (CV). Reliability was assessed using intra-class correlation coefficients (ICC ± 95% CI). Results: No significant differences in the SEm were found between the three paired measurements for all standing positions (P > 0.05). ICC values demonstrated excellent reliability for all measurements across the eight standing positions (range 0.879–1.00 [95% CI 0.813–1.00]). Conclusion: Evaluating eight standing positions radiographically would be unethical as it would involve repeat radiation exposures. Using the formetic 4D dynamic modelling (Diers) system, provides an alternative and has shown that there was only a minimal, non-statistically significant, differences between the eight different standing positions.