• Family relationships and dementia: A synthesis of qualitative research including the person with dementia

      La Fontaine Papadopoulos, Jenny H.; Oyebode, Jan R. (2014-08)
      Family relationships are important for wellbeing across the life course and are known to be important for people living with dementia, bringing benefits to self-esteem and identity, as well as providing support for people living at home. Recent research has explored the impact of dementia upon relationships. Much of this research is qualitative in nature and rarely included in systematic reviews, however, it has the potential to provide significant contributions to understanding the interplay between family relationships and dementia and to inform interventions. A systematic synthesis of qualitative research concerning the impact of dementia upon family relationships was undertaken, using thematic synthesis. Eleven articles were reviewed, which address the perspectives of people living with dementia and their spouse and/or adult children. The aims of this review are to illuminate what is currently known about the reciprocal influences between family relationships and dementia from the perspectives of the family (including the person with dementia); and to consider the implications of these findings for research and practice. Four super-ordinate themes were identified: A shared history, negotiating the impact of dementia upon the relationship, openness and awareness, and shifting sands. This synthesis contributes to an emerging field but also highlights gaps in current understanding of the impact of dementia upon relationships and in providing appropriate interventions. Implications for research and practice are considered.
    • A feasibility randomised controlled trial of the DECIDE intervention: dementia carers making informed decisions

      Lord, Kathryn; Livingston, G.; Cooper, C. (2017-02)
      Family carers report high levels of decisional conflict when deciding whether their relative with dementia can continue to be cared for in their own home. We tested, in a feasibility randomised controlled trial, the first decision aid (the DECIDE manual) aiming to reduce such conflict. Twenty family carers received the DECIDE intervention, and 21 received usual treatment. The intervention group had reduced decisional conflict compared with controls (mean difference −11.96, 95% confidence interval −20.10 to −3.83, P=0.005). All carers receiving the intervention completed and valued it, despite some still reporting difficulties with family conflict and problems negotiating services. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
    • Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke

      Nijenhuis, S.M.; Prange, G.B.; Amirabdollahian, F.; Sale, P.; Infarinato, F.; Nasr, N.; Mountain, Gail; Hermens, H.J.; Stienen, A.H.A.; Buurke, J.H.; et al. (2015-10-09)
      Background: Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. Methods: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. Results: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. Conclusions: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings.
    • Feelings of remembering and knowing: Memory and aging from a first-person perspective.

      Moulin, C.J.A.; Souchay, C.; Williams, H.; Smith, Sarah J.; Rathbone, C.J. (2009)
    • Female Soccer: Part 1 – A Needs Analysis

      Turner, E.; Munro, Allan G.; Comfort, P. (2013)
      It is imperative for strength and conditioning coaches to conduct a detailed analysis of the demands of a sport, identifying normative data where possible to permit an evidence-based evaluation of an athlete’s current performance status and to inform the development of specific goals for the athletes’ development. Part one of this article reviews the demands of female soccer and provides normative data from published research identifying specific areas that require development in female soccer players. Part two recommends evidence-based approaches integrated to athlete development and injury prevention strategies, as a result of the needs analysis.
    • Female Soccer: Part 2 – Training Considerations and Recommendations

      Turner, E.; Munro, Allan G.; Comfort, P. (2013)
      Part 1 of this article identified the demands of female soccer and the specific areas of development required to optimize performance and reduce the risk of common injuries. Increases in aerobic capacity, strength, and lower limb control were required to improve performance and reduce the risks of common injuries. The aims of part 2 are to provide examples of evidence-based integrated strategies to address the issues identified in part 1 and to ensure not only enhanced performance but also a reduced incidence of common injuries in female soccer players.
    • Festival in a Box: Development and qualitative evaluation of an outreach programme to engage socially isolated people with dementia

      Eades, M.; Lord, Kathryn; Cooper, C. (2016)
      We co-designed and piloted ‘Festival in a Box’, an outreach programme to enable socially isolated people with dementia to engage with and enjoy cultural activities in their homes. It comprised 3–4 weekly home visits, each led by a professional artist to create art works using materials brought in ‘the box’. Activities included music, poetry, pottery, crafts and photography. We qualitatively interviewed 13 participants (6 people with dementia, 4 artists, 3 befrienders). Six participants with dementia completed, enjoyed and engaged with the planned visits. Main themes were: engagement, reflection on value of previous cultural activities, precariousness and isolation in current neighbourhood and the importance of a voice and being heard. Befrienders reported their preconceptions of what participants could do were challenged. Artists reported shifts in their preconceptions about dementia and the influence of the project on their professional practice. We propose that the ‘Festival in a Box’ pilot study suggests a means through which community arts festivals could work with socially isolated people with dementia to contribute to the creation of ‘Dementia Friendly Communities’. A larger-scale pilot study is now needed to develop this hypothesis.
    • Fidelity and the impact of patient safety huddles on teamwork and safety culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project.

      Lamming, Laura; Montague, Jane; Crosswaite, Kate; Faisal, Muhammad; McDonach, E.; Mohammed, A. Mohammed; Cracknell, A.; Lovatt, A.; Slater, B. (2021-10-01)
      The Patient Safety Huddle (PSH) is a brief multidisciplinary daily meeting held to discuss threats to patient safety and actions to mitigate risk. Despite growing interest and application of huddles as a mechanism for improving safety, evidence of their impact remains limited. There is also variation in how huddles are conceived and implemented with insufficient focus on their fidelity (the extent to which delivered as planned) and potential ways in which they might influence outcomes. The Huddle Up for Safer Healthcare (HUSH) project attempted to scale up the implementation of patient safety huddles (PSHs) in five hospitals - 92 wards - across three UK NHS Trusts. This paper aims to assess their fidelity, time to embed, and impact on teamwork and safety culture. A multi-method Developmental Evaluation was conducted. The Stages of Implementation Checklist (SIC) was used to determine time taken to embed PSHs. Observations were used to check embedded status and fidelity of PSH. A Teamwork and Safety Climate survey (TSC) was administered at two time-points: pre- and post-embedding. Changes in TSC scores were calculated for Trusts, job role and clinical speciality. Observations confirmed PSHs were embedded in 64 wards. Mean fidelity score was 4.9/9. PSHs frequently demonstrated a 'fear free' space while Statistical Process Control charts and historical harms were routinely omitted. Analysis showed a positive change for the majority (26/27) of TSC questions and the overall safety grade of the ward. PSHs are feasible and effective for improving teamwork and safety culture, especially for nurses. PSH fidelity criteria may need adjusting to include factors deemed most useful by frontline staff. Future work should examine inter-disciplinary and role-based differences in TSC outcomes.
    • Fiscal and economic stability in the eurozone.

      Cohen, I.K.; McIntosh, Bryan; Richardson, M-A. (2012)
      Every day the news is filled with increasingly depressing news about the economy. The recent Autumn Statement (29 November 2011) to the House of Commons by UK Chancellor of the Exchequer, George Osborne, confirmed that the cause of a potential ?double dip? recession in the British economy lay largely at the doors of the European Union and, in particular, the eurozone. It is easy to understand why some commentators feel that perhaps the European single currency is in its death-throes, and that the European Union itself needs major structural revisions. But for the sake of perspective it is important to remember the underlying rationale behind the ?European project? which remains as relevant today as it did in the 1950s.
    • Flexible working and work-life balance: Midwives’ experiences and views

      Prowse, Julie M.; Prowse, Peter J. (2016)
      Both flexible working and worklife balance (WLB) are important issues for the midwifery profession and can have both positive and negative consequences for midwives working in the National Health Service (NHS). This study examined midwives’ views and experiences of flexible working, work-life balance and the implications for the midwifery profession.
    • Flexible working and work–life balance: midwives’ experiences and views

      Prowse, Julie M.; Prowse, Peter J. (2015-09-10)
      This article presents midwives’ views and experiences of flexible working and work-life balance. Both flexible working and work-life balance are important contemporary agendas within midwifery and can have both positive and negative consequences for midwives. Full-time midwives and those without caring commitments feel disadvantaged by flexible working and work-life balance policies as they have to fit when they work around part-time midwives and are increasingly expected to cover extra work. They feel their work-life balance is marginalised and this is fuelling discontent and resentment among midwives and leading to divisions between full and part-time staff that reinforce flexibility stigma. Although flexible working and work-life balance are important for recruiting and retaining midwives they are part of the ongoing tensions and challenges for midwives and the midwifery profession. Keywords flexibility stigma, flexible working, full-time work, marginalisation, midwives, National Health Service,
    • Food choice motives, attitude towards and intention to adopt personalised nutrition

      Rankin, A.; Bunting, B.P.; Poinhos, R.; van der Lans, I.A.; Fischer, A.R.H.; Kuznesof, S.; Almeida, M.D.V.; Markovina, Jerko; Frewer, L.J.; Stewart-Knox, Barbara (2018-10)
      The present study explored associations between food choice motives, attitudes towards and intention to adopt personalised nutrition, to inform communication strategies based on consumer priorities and concerns. Design/Setting: A survey was administered online which included the Food Choice Questionnaire (FCQ) and items assessing attitudes towards and intention to adopt personalised nutrition. Subjects: Nationally representative samples were recruited in nine EU countries (n 9381). Results: Structural equation modelling indicated that the food choice motives ‘weight control’, ‘mood’, ‘health’ and ‘ethical concern’ had a positive association and ‘price’ had a negative association with attitude towards, and intention to adopt, personalised nutrition. ‘Health’ was positively associated and ‘familiarity’ negatively associated with attitude towards personalised nutrition. The effects of ‘weight control’, ‘ethical concern’, ‘mood’ and ‘price’ on intention to adopt personalised nutrition were partially mediated by attitude. The effects of ‘health’ and ‘familiarity’ were fully mediated by attitude. ‘Sensory appeal’ was negatively and directly associated with intention to adopt personalised nutrition. Conclusions: Personalised nutrition providers may benefit from taking into consideration the importance of underlying determinants of food choice in potential users, particularly weight control, mood and price, when promoting services and in tailoring communications that are motivationally relevant.
    • Food insecurity and socio-demographic characteristics in two UK ethnic groups: an analysis of women in the Born in Bradford cohort

      Power, M.; Uphoff, E.P.; Stewart-Knox, Barbara; Small, Neil A.; Doherty, B.; Pickett, K.E. (2017-03-28)
      The use of foodbanks has risen sharply in the UK; however, the epidemiology of UK food insecurity is undeveloped. This study contributes to the field by analysing socio-demographic risk factors for food insecurity in a female, ethnically diverse population. Methods Data from the Born in Bradford (BiB) cohort were matched with data on food insecurity from the nested BiB1000 study (N = 1280). Logistic regression was used to model food insecurity in relation to ethnicity and socio-demographic factors. Results Food insecurity, reported by 13.98% of the sample, was more likely among White British than Pakistani women (crude Odds Ratio (OR) 1.94, 95% CI: 1.37; 2.74, adjusted OR 2.37, 95% CI: 1.57; 3.59). In fully adjusted analyses, food insecurity was associated with a range of socio-economic measures, particularly the receipt of mean-tested benefits (adjusted OR 2.11, 95% CI: 1.41; 3.15) and perception of financial insecurity (adjusted OR 8.91, 95% CI: 4.14; 19.16 for finding it difficult/very difficult compared to living comfortably). Conclusions The finding that food insecurity prevalence may be higher than previously thought and that food insecurity is highly associated with socio-economic status, notably benefit receipt, is a cause for concern necessitating an urgent policy response.
    • Fools’ Gold - Lean management in the health sector

      McIntosh, Bryan; Sheppy, B.; Cohen, I.K. (2014)
      Purpose of paper: This paper provides a critical evaluation of the impact of lean practices in informing healthcare policy. Methodology: Review of primary and secondary literature Finding: There has been considerable interest in the implementation of practices imported from manufacturing into healthcare as a solution to address rising healthcare spending and disappointing patient safety indicators. This encompasses a number of practices in Operations Management and Human Resource Management, including Just-in-Time (JIT), Total Quality Management (TQM), Total Productive Maintenance (TPM), employee empowerment, and extensive training. Used together there is great potential to improve overall firm competitiveness. However, despite widespread enthusiasm about the potential of lean management processes, evidence about its contribution to higher organisational performance remains inconsistent. Contribution to knowledge: Our paper contributes to the organisational management literature in healthcare by showing that even though lean management in healthcare appears to have the potential to improve organisational performance; there remain problems with its application.
    • The forgotten people in British public health: a national neglect of the dying, bereaved and caregivers

      Karapliagou, Aliki; Kellehear, Allan (2016)
      The clinical and social epidemiology of living with a life-threatening or life-limiting illness, frail ageing, long-term caregiving, and grief and bereavement is well documented in the palliative care, psycho-oncology and psychiatric literature but this investigation asks what interest exists from the mainstream public health sector in these health and illness experiences. This paper reports a content analysis of 7 key British public health journals, 14 major public health textbooks and 3 public health websites employing key word and synonym searches to assess the size and quality of interest in populations related to ageing, dying, caregiving, and grief and bereavement. Compared with other public health issues, such as obesity and tobacco use, for examples, interest in the social experience and epidemiology of end-of-life experiences is extremely low. Reasons for this lack of interest are explored.
    • Frameworks and Models, Scaffolding or Straight Jackets? Problematising Reflective Practice

      Kelsey, Catherine; Hayes, S. (2015-11)
      This paper aims to open a debate about the impact of reflective practice questioning whether reflective frameworks and models argued to facilitate the education of highly skilled reflective practitioners can be oppressive rather than emancipatory in outcome. Contemporary education focuses on evidence based and effective practice with reflection at its core leading to empowerment and ultimately emancipation of the profession as independent and equal to medics and other health care professionals. Models and frameworks have therefore been developed to facilitate the education of highly skilled reflective practitioners; able to recognise the need to draw on evidence based practice in order to challenge out-dated methods and engage in new ways of working. This paper however questions the current focus on reflective practice suggesting that reflection in itself can be oppressive and support the commodification of nursing as a ‘workforce’, the profession at the beck and call of current governmental policy and control.
    • “A Friend in the Corner”: Supporting people at home in the last year of life via telephone and video consultation – an evaluation

      Middleton-Green, Laura; Gadoud, A.; Norris, Beverley; Sargeant, Anita R.; Nair, S.; Wilson, L.; Livingstone, H.; Small, Neil A. (2016)
      Objective: To evaluate a 24/7, nurse led telephone and video-consultation support service for patients thought to be in the last year of life in Bradford, Airedale, Wharfedale and Craven. Method: Activity and other data recorded at the time of calls were analysed. Interviews with 13 participants captured patients and carers perspectives. Results: Between April 1st 2014 and March 31st 2015, 4648 patients were registered on the Gold Line. 42% had a non-cancer diagnosis and 46% were not known to specialist palliative care services. The median time on the caseload was 49 days (range 1-504 days). 4533 telephone calls and 573 video consultations were received from 1813 individuals. 39% of the 5106 calls were resolved by Gold Line team without referral to other services. 69% of calls were made outside normal working hours. Interviews with patients and carers reported experiences of support and reassurance and the importance of practical advice. Conclusion: A nurse led, 24/7 telephone and video consultation service can provide valuable support for patients identified to be in the last year of life and their cares. The line enabled them to feel supported and remain in their place of residence, reducing avoidable hospital admissions and use of other services. Providing this service may encourage health care professionals to identify patients approaching the last year of life, widening support offered to this group of patients beyond those known to specialist palliative care services.
    • From embracing to managing risks

      Keen, J.; Nicklin, E.; Wickramasekera, N.; Long., A.; Randell, Rebecca; Ginn, C.; McGinnis, E.; Willis, S.; Whittle, J. (2018-11)
      Objective: To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services. Setting: Four acute National Health Service hospitals in England. Participants: 111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff. Results: There were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff. Conclusions: The findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices.