• General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia.

      Downs, Murna G.; Iliffe, S.; Turner, S.; Wilcock, J.; Bryans, M.; Keady, J.; O'Carroll, R.; Levin, E. (2004)
      Objective: to measure general practitioners' knowledge of, confidence with and attitudes to the diagnosis and management of dementia in primary care. Setting: 20 general practices of varying size and prior research experience in Central Scotland, and 16 similarly varied practices in north London. Participants: 127 general practitioners who had volunteered to join a randomised controlled trial of educational interventions about dementia diagnosis and management. Methods: self-completion questionnaires covering knowledge, confidence and attitudes were retrieved from practitioners prior to the educational interventions. Results: general practitioners' knowledge of dementia diagnosis and management is good, but poor awareness of its epidemiology leads to an over-estimate of caseload. Knowledge of local diagnostic and support services is less good, and one third of general practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in management of behaviour and other problems in dementia. The main difficulties identified by general practitioners were talking with patients about the diagnosis, responding to behaviour problems and coordinating support services. General practitioners perceived lack of time and lack of social services support as the major obstacles to good quality care more often than they identified their own unfamiliarity with current management or with local resources. Attitudes to the disclosure of the diagnosis, and to the potential for improving the quality of life of patients and carers varied, but a third of general practitioners believed that dementia care is within a specialist's domain, not that of general practice. More experienced and male general practitioners were more pessimistic about dementia care, as were general practitioners with lower knowledge about dementia. Those reporting greater difficulty with dementia diagnosis and management and those with lower knowledge scores were also less likely to express attitudes endorsing open communication with patient and carer. Conclusion: educational support for general practitioners should concentrate on epidemiological knowledge, disclosure of the diagnosis and management of behaviour problems in dementia. The availability and profile of support services, particularly social care, need to be enhanced, if earlier diagnosis is to be pursued as a policy objective in primary care.
    • General Practitioners’ perceptions of the stigma of dementia and the role of reciprocity

      Gove, Dianne M.; Small, Neil A.; Downs, Murna G.; Vernooij-Dassen, M. (2017)
      A qualitative exploration of the stigma of dementia reported that GPs described lack of reciprocity as one way in which people with dementia are perceived within society. This was closely linked to their perception of dementia as a stigma. In this paper, we explore whether GPs perceive people with dementia as lacking reciprocity and, so, if this is linked with societal opinions about dementia as a stigma. The implications of both perceptions of people with dementia failing to reciprocate and of stigma for timely diagnosis are explored. GPs’ perceptions of societal views of people with dementia included a perception of a lack of reciprocity. Specifically, an absence of reciprocity was linked with; failing to respond to human contact, the absence of an appropriate return on social investment and failing to contribute to, or being a burden to, society. GPs reported a link between societal perceptions of lack of reciprocity and stereotypes about advanced dementia, difficulties communicating with people with dementia and lack of opportunities for people with dementia to reciprocate. GPs occupy a key position, they can challenge stereotypes and, with support and targeted training about communicating with people living with dementia, can emphasise the ways in which people with dementia can communicate, thereby enhancing their potential to reciprocate. Such changes have implications for improved care and quality of life through the continued maintenance of social inclusion and perceptions of personhood.
    • General Radiography

      Clough, Gillian R.; Beck, Jamie J.W. (2008)
    • Genetics in the National Curriculum: is there room for development?

      Ashelford, Sarah L. (2008-09)
      This article describes how the teaching of variation and genetics can give rise to the mistaken idea that genes are the sole determinants of our characteristics, that genes work in isolation to produce genetic disorders, such as cystic fibrosis. It goes on to discuss examples of gene environment interactions that give a more relevant and realistic account of how genes and environment interact in human genetic disease and stem cell technology. Finally, a conceptual model is introduced that might be useful for teaching, in which genes and environment are given equal status in explaining development.
    • Goal-oriented cognitive rehabilitation in early-stage dementia: study protocol for a multi-centre single-blind randomised controlled trial (GREAT).

      Clare, L.; Bayer, A.; Burns, A.; Corbett, A.; Jones, R.; Knapp, M.; Kopelman, M.D.; Kudlicka, A.; Leroi, I.; Oyebode, Jan R.; et al. (2013-05-27)
      Background: Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer's disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design: In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion: If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration: Current Controlled Trials ISRCTN21027481
    • GP tutor opinions on quality criteria generated for undergraduate education in primary care: a practice-based educational evaluation

      Kaur, I.; Lucas, Beverley J. (2013)
      This study explores GP tutor views of a nationally derived list of quality criteria for undergraduate and postgraduate practice-based teaching. Whilst these published criteria provided a means of benchmarking locally, an evaluation of utility in practice required further exploration. This educational evaluation was conducted within a West Yorkshire locality as a means of supporting their practice-based primary care education. A survey approach using an online Likert scaled questionnaire was distributed to all GP tutors with an additional opportunity for free text qualitative comments. Data were analysed using an online reporting package for survey results (MarketSight) and thematic analysis of qualitative data. Key findings were that in general all the criteria were rated having a high level of importance with 83% of GPs claiming they would find such a list important in directing their learning and teaching approach. The opinions on out-of-hours experiences for medical students were also interesting as they differed greatly. These findings will be of interest to those involved in the organisation and delivery of medical education within primary care as the list of criteria could act as a structural guide for directing medical student teaching, learning and its quality assurance. Implications for further research include the utility of core criteria and the exploration of out-of-hours experience for medical student education.
    • Grief and bereavement.

      Oyebode, Jan R. (2014)
    • Grief counseling

      Oyebode, Jan R. (2016)
    • Grieving

      Oyebode, Jan R. (2013)
    • Grieving

      Oyebode, Jan R. (2016)
    • The growing burden of leg ulcers in the UK

      Vowden, Kath; Vowden, Peter (2016)
      Improved treatment, diagnostics and greater patient participation could help to reduce both the financial and the social cost of leg ulcers in the UK
    • Growing up in Bradford: Protocol for the age 7-11 follow up of the Born in Bradford birth cohort

      Bird, P.K.; McEachan, Rosemary; Mon-Williams, M.; Small, Neil A.; West, Jane; Whincup, P.; Wright, J.; Andrews, E.; Barber, S.E.; Hill, L.J.B.; et al. (2019-07-12)
      Born in Bradford (BiB) is a prospective multi-ethnic pregnancy and birth cohort study that was established to examine determinants of health and development during childhood and, subsequently, adult life in a deprived multi-ethnic population in the north of England. Between 2007 and 2010, the BiB cohort recruited 12,453 women who experienced 13,776 pregnancies and 13,858 births, along with 3353 of their partners. Forty five percent of the cohort are of Pakistani origin. Now that children are at primary school, the first full follow-up of the cohort is taking place. The aims of the follow-up are to investigate the determinants of children's pre-pubertal health and development, including through understanding parents' health and wellbeing, and to obtain data on exposures in childhood that might influence future health. Methods: We are employing a multi-method approach across three data collection arms (community-based family visits, school based physical assessment, and whole classroom cognitive, motor function and wellbeing measures) to follow-up over 9000 BiB children aged 7-11 years and their families between 2017 and 2021. We are collecting detailed parent and child questionnaires, cognitive and sensorimotor assessments, blood pressure, anthropometry and blood samples from parents and children. Dual x-ray absorptiometry body scans, accelerometry and urine samples are collected on subsamples. Informed consent is collected for continued routine data linkage to health, social care and education records. A range of engagement activities are being used to raise the profile of BiB and to disseminate findings. Discussion: Our multi-method approach to recruitment and assessment provides an efficient method of collecting rich data on all family members. Data collected will enhance BiB as a resource for the international research community to study the interplay between ethnicity, socioeconomic circumstances and biology in relation to cardiometabolic health, mental health, education, cognitive and sensorimotor development and wellbeing.
    • Guided reflection as an organisational learning and data collection tool in a gender equality change management programme

      Archibong, Uduak E.; O'Mullane, M.; Kallayova, D.; Karodia, Nazira; Ni Laoire, C.; Picardi, I. (2016-03)
      This paper presents a guided reflection (GR) framework compiled and used specifically in a gender equality change management programme. The programme involves seven partners (one being an evaluation partner) from across Europe, each partner implementing a change management programme in their university setting. A guided reflection framework, including verbal reflective discussions and written reflections, was devised and deployed to enable and facilitate the collection of narratives and stories on the experience of gender transformation within the university institutions. The resulting outcome so far has been a successful application of the GR framework, with emerging findings suggesting that participants found the opportunity to share and reflect useful. Both written and verbal reflection tools were effective within this programme, with lessons emerging around increasing and improving the journaling aspect of written reflections. The process findings illustrate how people in our organisations are very constrained for time for reflection within their busy work schedules, and therefore the applicability and usefulness of the GR framework has been in enabling a space for such reflection and thought, which in turn contributes to organizational learning and potential for change.
    • Hand, Fingers and Thumb

      Culpan, Gary (2011)
    • The HAPPY (Healthy and Active Parenting Programme for Early Years) feasability randomised control trial: acceptability and feasability of an intervention to reduce infant Obesity

      McEachan, Rosemary; Santorelli, G.; Bryant, M.; Sahota, P.; Farrar, D.; Small, Neil A.; Akhtar, Shaheen; Sargent, J.; Barber, Sally E.; Taylor, N.; et al. (2016-03-01)
      prevent obesity at this age. This study tested the acceptability and feasibility of evaluating a theory-based intervention aimed at reducing risk of obesity in infants of overweight/obese women during and after pregnancy: the Healthy and Active Parenting Programme for Early Years (HAPPY). Methods: A feasibility randomised controlled trial was conducted in Bradford, England. One hundred twenty overweight/obese pregnant women (Body Mass Index [BMI] ≥25 kg/m2) were recruited between 10–26 weeks gestation. Consenting women were randomly allocated to HAPPY (6 antenatal, 6 postnatal sessions: N = 59) or usual care (N = 61). Appropriate outcome measures for a full trial were explored, including: infant’s length and weight, woman’s BMI, physical activity and dietary intake of the women and infants. Health economic data were collected. Measurement occurred before randomisation and when the infant was aged 6 months and 12 months. Feasibility outcomes were: recruitment/attrition rates, and acceptability of: randomisation, measurement, and intervention. Intra-class correlations for infant weight were calculated. Fidelity was assessed through observations and facilitator feedback. Focus groups and semi-structured interviews explored acceptability of methods, implementation, and intervention content. Results: Recruitment targets were met (~20 women/month) with a recruitment rate of 30 % of eligible women (120/396). There was 30 % attrition at 12 months; 66 % of recruited women failed to attend intervention sessions, but those who attended the first session were likely to continue to attend (mean 9.4/12 sessions, range 1–12). Reaction to intervention content was positive, and fidelity was high. Group clustering was minimal; an adjusted effect size of −0.25 standard deviation scores for infant weight at 12 months (95 % CI: −0.16–0.65) favouring the intervention was observed using intention to treat analyses. No adverse events were reported. Conclusions: The HAPPY intervention appeared feasible and acceptable to participants who attended and those delivering it, however attendance was low; adaptations to increase initial attendance are recommended. Whilst the study was not powered to detect a definitive effect, our results suggest a potential to reduce risk of infant obesity. The evidence reported provides valuable lessons to inform progression to a definitive trial.
    • HARP (Health for Asylum Seekers and Refugees) project final evaluation

      Haith-Cooper, Melanie; Balaam, M.C.; Mathew, D. (University of Bradford, 2021-09)
    • HARP (Health for Asylum Seekers and Refugees) project interim evaluation

      Haith-Cooper, Melanie; Balaam, M.C.; Mathew, D.; Big Lottery (Refugee Council, 2020-09)
    • Has NICE guidance changed the management of the suspected scaphoid fracture: A survey of UK practice

      Snaith, Beverly; Walker, A.; Robertshaw, S.; Spencer, N.J.B.; Smith, A.; Harris, M.A. (2021-05)
      Introduction: Despite scaphoid fractures being relatively uncommon pro-active treatment of suspected fractures has been seen as a risk management strategy. The poor positive predictive value of X-rays has led to published guidelines advocating MRI as a first-line or early imaging tool. It is unclear whether UK hospitals have been able to introduce early scanning and this national survey sought to establish the current management strategies for patients with a suspected scaphoid fracture. Method: An electronic survey of UK emergency departments (ED) was conducted to establish the initial and follow up strategies for patients with negative imaging. Comparison of first and second-line imaging modalities was undertaken together with review of the clinical speciality responsible for ongoing management. Results: 166 UK NHS Trusts were identified with emergency department facilities of which 66 (39.8%) responded. All sites perform an X-ray as the initial examination. For those with a negative examination ED follow up was the most common approach (54.6%), although many sites refer patients to other specialities including orthopaedics (39.4%) for follow up. The data demonstrated inconsistencies in the number of follow-up episodes and the different imaging investigations utilised. Frustration with the challenges presented by this patient cohort was evident. Conclusion: The suspected scaphoid fracture represents an ongoing challenge to the NHS with many resource intensive pathways reliant on access to complex imaging investigations. Implications for practice: Our study identified that UK Emergency Departments have limited early access to complex imaging for scanning of the scaphoid. A range of strategies are used for follow up of suspected scaphoid fractures and these are resource intensive. Overtreatment of patients with suspected scaphoid fracture is used as a risk management approach.