• What is important to people with dementia living at home? A set of core outcome items for use in the evaluation of non-pharmacological community-based health and social care interventions

      Reilly, Siobhan T.; Harding, A.J.E.; Morbey, H.; Ahmed, F.; Williamson, P.R.; Swarbrick, C.; Leroi, I.; Davies, L.; Reeves, D.; Holland, F.; et al. (2020-07)
      Objectives: Inconsistency in outcome measurement in dementia care trials impedes the comparisons of effectiveness between trials. The key aim of this study is to establish an agreed standardised core outcome set (COS) for use when evaluating non-pharmacological health and social care interventions for people with dementia living at home. Method: We used a mixed-methods research design, including substantive qualitative research with five key stakeholders groups. We consulted with people living with dementia for many aspects of this research. We applied a modified two-round 54 item Delphi approach to attain consensus on core outcomes. The COS was finalised in a face-to-face consensus meeting in 2018. Results: Of the 288 who completed round 1 (21 people living with dementia, 58 care partners, 137 relevant health and social care professionals, 60 researchers, 12 policy makers), 246 completed round 2 (85% response rate). Twenty participants attended the consensus meeting. We reached consensus for the inclusion of 13 outcome items. Conclusion: We identified 13 outcome items which are considered core; many relate to social health. Providing there are adequate measures, measuring these core outcome items will enhance comparisons for effectiveness making trial evidence more useful. The items will provide commissioners and service planners with information on what types of interventions are most likely to be valued highly by people living with dementia.
    • 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, Liz; 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.
    • When it comes round to marking assignments: how to impress and how to 'distress' lecturers ...

      Greasley, Peter; Cassidy, Andrea M. (2010)
      What do lecturers look for when marking essays? What impresses them and what frustrates them? In this paper, we present the results of a survey which asked lecturers to address these questions. Thirty-two lecturers responded to an email survey in which they listed the problems they found most frustrating when marking essays and the factors which most impressed them. This resulted in 206 comments related to sources of frustration and 139 comments listing factors which impress them. The comments were then coded into themes and ranked in order of importance by 16 lecturers from the original sample. The results highlight a range of issues that may be useful for lecturers when discussing assignments, and instructive for students when writing their assignments.
    • When Pain Memories Are Lost: A Pilot Study of Semantic Knowledge of Pain in Dementia

      Oosterman, J.M.; Hendriks, H.; Scott, S.; Lord, Kathryn; White, N.; Sampson, E.L. (2014)
      Objective It has been documented that pain in people with dementia is often under-reported and poorly detected. The reasons for this are not clearly defined. This project aimed to explore semantic concepts of pain in people with dementia and whether this is associated with clinical pain report. Design Cohort study with nested cross-sectional analysis. Setting Acute general hospital medical wards for older people. Subjects People with dementia (N = 26) and control participants (N = 13). Methods Two subtests of semantic memory for pain: 1) Identifying painful situations from a standardized range of pictures; 2) Describing the concept of pain. Participants also indicated whether they were in pain or not, were observed for pain (PAINAD scale) and completed the Wong–Baker FACES scale to indicate pain severity. Results Compared with the control group, people with dementia were less able to identify painful situations and used fewer categories to define their concept of pain. In turn, the performance on these two measures was related to the reported presence and, albeit less strongly, to the reported severity of pain, indicating that a reduction in semantic memory for pain is associated with a decline in reported pain. Conclusions This study is the first to show that semantic memory for pain is diminished in dementia patients. When using clinical pain tools, clinicians should consider these effects which may bias clinical pain ratings when they evaluate and manage pain in these patients. This might improve the recognition and management of pain in people with dementia.
    • When two worlds collide: corporate and clinical governance

      Gupte, A.; McIntosh, Bryan; Sheppy, B. (2012)
      Clinical and corporate governance have been an area of ongoing concerns in the NHS. Since the Bristol Royal Infirmary scandal of the 1990s and the events concerning Sir Jimmy Savile there has been a dilemma of its true nature and relationship. Clinical and corporate governance are closely related as the two of them share similar processes such as openness, performance review, striving for effective end results, and accountability in the use of resources and power within healthcare management.
    • A whole system approach to increasing children's physical activity in a multi-ethnic UK city: a process evaluation protocol

      Hall, Jennifer; Bingham, Daniel D.; Seims, Amanda; Dogra, Sufyan A.; Burkhardt, Jan; Nobles, J.; McKenna, J.; Bryant, M.; Barber, Sally E.; Daly-Smith, Andrew (2021-12-18)
      Engaging in regular physical activity requires continued complex decision-making in varied and dynamic individual, social and structural contexts. Widespread shortfalls of physical activity interventions suggests the complex underlying mechanisms of change are not yet fully understood. More insightful process evaluations are needed to design and implement more effective approaches. This paper describes the protocol for a process evaluation of the JU:MP programme, a whole systems approach to increasing physical activity in children and young people aged 5-14 years in North Bradford, UK. This process evaluation, underpinned by realist philosophy, aims to understand the development and implementation of the JU:MP programme and the mechanisms by which JU:MP influences physical activity in children and young people. It also aims to explore behaviour change across wider policy, strategy and neighbourhood systems. A mixed method data collection approach will include semi-structured interview, observation, documentary analysis, surveys, and participatory evaluation methods including reflections and ripple effect mapping. This protocol offers an innovative approach on the use of process evaluation feeding into an iterative programme intended to generate evidence-based practice and deliver practice-based evidence. This paper advances knowledge regarding the development of process evaluations for evaluating systems interventions, and emphasises the importance of process evaluation.
    • Why do fish produce so many eggs?

      Ashelford, Sarah L. (2009)
    • Why do patients with low back pain choose not to engage with physiotherapy following assessment?

      Hinchliffe, N.C.; Lavin, Nicole (2018-03)
      Background/Aims: This research explored the reasons why patients with low back pain chose not to return to physiotherapy following an assessment. Methods: Qualitative, semi-structured interviews were conducted using five participants with low back pain. Data were analysed to produce codes, categories and themes. Findings: Data analysis produced expectations, communication and satisfaction as key themes. Findings suggest that expectations may and may not be linked to previous physiotherapy experience, with no clear link between expectations and satisfaction. Communication including sufficient time, listening skills, empathy, and caring qualities were highly regarded. Satisfaction levels were rated highly, despite not returning to physiotherapy. Participants reported pain resolution and personal choice as reasons for not returning. Conclusions: Findings support previous research suggesting expectations are multifaceted and individualised and not always linked to previous experience. Findings suggest the physiotherapist's excellent communication skills ensured an overall positive patient experience, maintaining high satisfaction levels.
    • Why education is 'riding the tiger'

      Sheppy, B.; Evans, P.; McIntosh, Bryan (2013)
      The Chinese idiom ‘riding a tiger’ relates to being stuck in a difficult position with no way out. Bruce Sheppy, Paul Evans and Bryan McIntosh discuss why this might apply to political leadership in education.
    • Why part-time nurses should be valued

      McIntosh, Bryan; Archibong, Uduak E. (2020-02)
      The article discusses how nurses are increasingly being valued as autonomous decision makers and co-ordinators of patient care. Topics include relating to the age of the dependent children, a woman's working hours and any successive career breaks, woman's career progression directly related to the school age of the dependent children, and children being inhibit and is driven in part by a determination to maintain traditional employment practices.
    • Why undertake a pilot in a qualitative PhD study? Lessons learned to promote success

      Wray, J.; Archibong, Uduak E.; Walton, Sean (2017-01)
      Background Pilot studies can play an important role in qualitative studies. Methodological and practical issues can be shaped and refined by undertaking pilots. Personal development and researchers’ competence are enhanced and lessons learned can inform the development and quality of the main study. However, pilot studies are rarely published, despite their potential to improve knowledge and understanding of the research. Aim To present the main lessons learned from undertaking a pilot in a qualitative PhD study. Discussion This paper draws together lessons learned when undertaking a pilot as part of a qualitative research project. Important methodological and practical issues identified during the pilot study are discussed including access, recruitment, data collection and the personal development of the researcher. The resulting changes to the final study are also highlighted. Conclusion Sharing experiences of and lessons learned in a pilot study enhances personal development, improves researchers’ confidence and competence, and contributes to the understanding of research.
    • Why written objectives need to be really SMART.

      Ogbeiwi, Osahon (2017)
      All successful programmes share goal-setting as a standard practice, and many write their goal statements to satisfy the S.M.A.R.T. criteria. To be SMART, objective statements should be constructed to specify four components: Outcome, Indicator, Target-level and Timeframe (O.I.T.T.). This study reviewed the goal framework of published objective statements to determine the extent to which they are SMART. The statements of 17 published examples of SMART objectives found in literature of mainly four major health organisations: CDC, WHO, NHS and Save the Children, were structurally analysed to measure the completeness of their goal framework according to the OITT components. Only four examples are outcome objectives. 13 (76%) are process or task oriented. The structure of two thirds of the statements shows the similar objective-writing templates used within CDC. All objective statements have an incomplete set of OITT components. The commonest framework has 3 components of indicator, target and timeframe (75% completeness) in 12 statements. Almost all statements specify a timeframe; three-quarter of them mention a target and three-fifth an indicator, but less than 1 in 5 state an outcome. Thus, none of the objective statement is really SMART, and goal-setters are significantly less likely to specify an outcome, than indicator, target or timeframe in their objectives. A high prevalence of non-SMART objectives with low potential for goal attainment in healthcare projects is proposed.