• Health economic burden that wounds impose on the National Health Service in the UK

      Guest, J.F.; Ayoub, N.; McIlwraith, T.; Uchegbu, I.; Gerrish, A.; Weidlich, D.; Vowden, Kath; Vowden, Peter (2015-12-07)
      OBJECTIVE: To estimate the prevalence of wounds managed by the UK's National Health Service (NHS) in 2012/2013 and the annual levels of healthcare resource use attributable to their management and corresponding costs. METHODS: This was a retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database. Records of 1000 adult patients who had a wound in 2012/2013 (cases) were randomly selected and matched with 1000 patients with no history of a wound (controls). Patients' characteristics, wound-related health outcomes and all healthcare resource use were quantified and the total NHS cost of patient management was estimated at 2013/2014 prices. RESULTS: Patients' mean age was 69.0 years and 45% were male. 76% of patients presented with a new wound in the study year and 61% of wounds healed during the study year. Nutritional deficiency (OR 0.53; p<0.001) and diabetes (OR 0.65; p<0.001) were independent risk factors for non-healing. There were an estimated 2.2 million wounds managed by the NHS in 2012/2013. Annual levels of resource use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million GP visits and 3.4 million hospital outpatient visits. The annual NHS cost of managing these wounds and associated comorbidities was pound5.3 billion. This was reduced to between pound5.1 and pound4.5 billion after adjusting for comorbidities. CONCLUSIONS: Real world evidence highlights wound management is predominantly a nurse-led discipline. Approximately 30% of wounds lacked a differential diagnosis, indicative of practical difficulties experienced by non-specialist clinicians. Wounds impose a substantial health economic burden on the UK's NHS, comparable to that of managing obesity ( pound5.0 billion). Clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS.
    • Healthcare in crisis: what happened to mentoring?

      McIntosh, Bryan; Ferretti, F. (2013)
      The perceived decline in care and benchmark standards is arguably a product of competing benchmarks and the decline of traditional mentoring approaches positioned with the patient experience at its core.
    • Healthcare practice placements: back to the drawing board?

      Millington, Paul; Hellawell, Michael; Graham, Claire; Edwards, Lisa (2019-03)
      Background: Sourcing healthcare practice placements continues to present a challenge for higher education institutions. Equally, the provision of clinical placements by healthcare providers is not at the forefront of their agenda. In view of this, the historic and traditional models of clinical placements is becoming more difficult to provide. In light of this, new models of clinical placements are being explored. Aims: This literature review explores the differing models of clinical placements in use and examines the merits and limitation of each. Methods: A mixed-methods literature review with a pragmatic approach has been used. Findings: Several placement models were described, including the traditional 1:1 model as well as 2:1, 3:1. The hub and spoke, capacity development facilitator, collaborative learning in practice and role emerging placement models were also discussed. Conclusion: There is a considerable paucity of high-quality evidence evaluating differing placement modules. Further research is required to evaluate the differing placement models from a students, clinical educators and service user’s perspective.
    • Healthcare use for children with complex needs: using routine health data linked to a multiethnic, ongoing birth cohort

      Bishop, C.; Small, Neil A.; Parslow, Roger C.; Kelly, B. (2018-03)
      Objectives Congenital anomaly (CA) are a leading cause of disease, death and disability for children throughout the world. Many have complex and varying healthcare needs which are not well understood. Our aim was to analyse the healthcare needs of children with CA and examine how that healthcare is delivered. Design Secondary analysis of observational data from the Born in Bradford study, a large prospective birth cohort, linked to primary care data and hospital episode statistics. Negative binomial regression with 95% CIs was performed to predict healthcare use. The authors conducted a subanalysis on referrals to specialists using paper medical records for a sample of 400 children. Setting Primary, secondary and tertiary healthcare services in a large city in the north of England. Participants All children recruited to the birth cohort between March 2007 and December 2011. A total of 706 children with CA and 10 768 without CA were included in the analyses. Primary and secondary outcome measures Healthcare use for children with and without CA aged 0 to <5 years was the primary outcome measure after adjustment for confounders. Results Primary care consultations, use of hospital services and referrals to specialists were higher for children with CA than those without. Children in economically deprived neighbourhoods were more likely to be admitted to hospital than consult primary care. Children with CA had a higher use of hospital services (β 1.48, 95% CI 1.36 to 1.59) than primary care consultations (β 0.24, 95% CI 1.18 to 0.30). Children with higher educated mothers were less likely to consult primary care and hospital services. Conclusions Hospital services are most in demand for children with CA, but also for children who were economically deprived whether they had a CA or not. The complex nature of CA in children requires multidisciplinary management and strengthened coordination between primary and secondary care.
    • Healthy minds, healthy workplaces

      Kelsey, Catherine (2017-02-23)
      Mental ill health in the workplace is a high profile issue, but what are the starting points for successful policies and interventions?
    • Heart failure nurses experiences of palliative care.

      Sargeant, Anita R.; Payne, S.; Ingleton, C.; Seymour, J. (2008)
    • Helping occupational performance through engagement: A service evaluation of a programme for informal carers of people with dementia

      Hampson, C.; Smith, Sarah J. (2015-03-01)
      Statement of context: The Helping Occupational Performance through Engagement programme is a series of workshops which aim to equip informal caregivers with the skills and knowledge they require to engage a person with dementia in meaningful daily occupations. Reflection on practice: Following the initial implementation of the programme, a service evaluation was carried out to establish whether these aims were being met. The evaluation took a mixed methods approach, combining questionnaire and focus group data obtained from participants of the programme. Implications for practice: Results demonstrated that whilst in general the programme is fulfilling its aims, further evaluation is required to establish the long-term impact of the programme.
    • Heroes or villains: the PIP scandal and whistleblowing

      McIntosh, Bryan; Cohen, I.K.; Sheppy, B. (2012)
      The article traces the history of the Poly Implant Prosthesis (PIP) scandal from an ethical perspective and explores the underpinning moral dilemmas inherent in the act of ‘whistleblowing.’ It goes on to consider the consequential stakeholder and broader societal reaction to whistleblowing which is discussed through deontological and teleological perspectives of ethically driven motives to act. It draws on the duty of care responsibility of healthcare professionals and the dilemma of personal consequence by the act of whistleblowing, whereby the objective of that act is the maintenance or improvement of patient standards and care. It argues that a cultural shift in organisational behaviour is urgently required to abrogate the needs for whistleblowing by means of internal systems and processes. Whistleblowing would thus become a supererogatory act of moral courage rather than carrying negative consequences in the interests of short-term saving face.
    • Hidden hunger? Experiences of food insecurity amongst Pakistani and white British women

      Power, M.; Small, Neil A.; Doherty, B.; Pickett, K.E. (2018)
      Purpose: Foodbank use in the UK is rising but, despite high levels of poverty, Pakistani women are less likely to use foodbanks than white British women. This study aimed to understand the lived experience of food in the context of poverty amongst Pakistani and white British women in Bradford, including perspectives on food aid. Design: Sixteen Pakistani and white British women, recruited through community initiatives, participated in three focus groups (one interview was also held as a consequence of recruitment difficulties). Each group met for two hours aided by a moderator and professional interpreter. The transcripts were analysed thematically using a three-stage process. Findings: Women in low-income households employed dual strategies to reconcile caring responsibilities and financial obligations: the first sought to make ends meet within household income; the second looked to outside sources of support. There was a reported near absence of food insecurity amongst Pakistani women which could be attributed to support from social/familial networks; resource management within the household; and cultural and religious frameworks. A minority of participants and no Pakistani respondents accessed charitable food aid. There were three reasons for the non-use of food aid: it was not required because of resource management strategies within the household and assistance from familial/social networks; it was avoided out of shame; and knowledge about its existence was poor. Originality: This case study is the first examination of varying experiences of food insecurity amongst UK white British and Pakistani women. Whilst the sample size is small, it presents new evidence on perceptions of food insecurity amongst Pakistani households and on why households of varying ethnicities do not use food aid.
    • Hidden labour: The skilful work of clinical audit data collection and its implications for secondary use of data via integrated health IT

      McVey, Lynn; Alvarado, Natasha; Greenhalgh, J.; Elshehaly, Mai; Gale, C.P.; Lake, J.; Ruddle, R.A.; Dowding, D.; Mamas, M.; Feltbower, R.; et al. (Springer/Biomed Central, 2021-07-16)
      Background: Secondary use of data via integrated health information technology is fundamental to many healthcare policies and processes worldwide. However, repurposing data can be problematic and little research has been undertaken into the everyday practicalities of inter-system data sharing that helps explain why this is so, especially within (as opposed to between) organisations. In response, this article reports one of the most detailed empirical examinations undertaken to date of the work involved in repurposing healthcare data for National Clinical Audits. Methods: Fifty-four semi-structured, qualitative interviews were carried out with staff in five English National Health Service hospitals about their audit work, including 20 staff involved substantively with audit data collection. In addition, ethnographic observations took place on wards, in ‘back offices’ and meetings (102 hours). Findings were analysed thematically and synthesised in narratives. Results: Although data were available within hospital applications for secondary use in some audit fields, which could, in theory, have been auto-populated, in practice staff regularly negotiated multiple, unintegrated systems to generate audit records. This work was complex and skilful, and involved cross-checking and double data entry, often using paper forms, to assure data quality and inform quality improvements. Conclusions: If technology is to facilitate the secondary use of healthcare data, the skilled but largely hidden labour of those who collect and recontextualise those data must be recognised. Their detailed understandings of what it takes to produce high quality data in specific contexts should inform the further development of integrated systems within organisations.
    • The Highest Mountain – T- Cell Technology

      McIntosh, Bryan; Fascia, M. (2014)
      T-lymphocytes (T-cell) therapy offers a treatment for cancers. Developing this technology in the future provides the opportunity to revolutionise treatment and to make cancer a chronic condition. T-cells in themselves are a type of lymphocytes (itself a type of white blood cell) that play a central role in cell mediated immunity. They can be distinguished from other lymphocytes, such as B-cells and natural killer cells (NK cells), by the presence of a T-cell receptor (TCR) on the cell surface. T-cells have the capacity to destroy diseased cells, but tumours present a considerable challenge that reduces their impact. As cancer cells are frequently ‘invisible’ to the immune system, and they create an environment that suppresses T-cell activity., genetic engineering of T-cells can be used therapeutically to overcome these challenges. T-cells can be taken from the blood of cancer patients and then modified to recognise and destroy cancer-specific antigens.
    • HIV enteropathy: crypt stem and transit cell hyperproliferation induces villous atrophy in HIV/Microsporidia-infected jejunal mucosa.

      Batman, Philip A.; Kotler, D.P.; Kapembwa, M.S.; Booth, D.; Orenstein, J.M.; Scally, Andy J.; Griffin, G.; Potten, C.S. (2007)
      Objectives: The study aim was to analyse the kinetics of stem and transit cells in the crypts of jejunal mucosa infected with HIV and Microsporidia. Design: The size of villi, depth of crypts and proliferative activity of transit and stem cells in jejunal mucosa were measured using morphometric techniques. Methods: The surface area/volume ratio (S/V) of jejunal biopsies was estimated under light microscopy using a Weibel graticule. Crypt length was measured by counting enterocytes along the crypt side from the base to the villus junction, and the mean crypt length was calculated. The S/V and crypt lengths of the jejunal mucosa of 21 HIV and Microsporidia-infected test cases were compared with 14 control cases. The labelling index in relation to the crypt cell position of 10 of the test cases was analysed compared with 13 control cases. Results: Differences were found in the S/V and crypt length, and there was a negative correlation between S/V and crypt length in test and control cases combined. Cell labelling indices fell into low and high proliferation groups. There were significant differences in labelling indices between low proliferation test cases and controls, between high proliferation test cases and controls, and between high and low proliferation test cases. Conclusion: Villous atrophy induced by HIV and Microsporidia is attributed to crypt cell hyperplasia and the encroachment of crypt cells onto villi. These infections induce crypt hypertrophy by stimulating cell mitosis predominantly in transit cells but also in stem cells. Increased stem cell proliferation occurs only in high proliferation cases.
    • Hope and glory: an expanded social strategy diagnosis model to incorporate corporate social responsibility within business strategy

      Areal, A.; McIntosh, Bryan; Sheppy, B. (2016)
      Corporate social responsibility has been seen by corporations as a practice to adopt as an act of philanthropy. There have been attempts to expand the role of social responsibility to business problems however there has never been an attempt to consider the strategic alignment of social outcomes to strategy. This article analyses the role of strategy by providing a review of strategy using Whittington’s generic strategies model and expanding the same model to incorporate a social strategy model that supports the anecdotal idea that social responsibility can be potentially strategic. The paper centres its argument within the Indian context.
    • Hospice nurses’ views on single nurse administration of controlled drugs

      Taylor, Vanessa; Middleton-Green, Laura; Carding, S.; Perkins, P. (2015-07)
      Background: The involvement of two nurses to dispense and administer controlled drugs is routine practice in most clinical areas despite there being no legal or evidence-based rationale. Indeed, evidence suggests this practice enhances neither safety nor care. Registered nurses at two hospices agreed to change practice to single nurse dispensing and administration of controlled drugs (SNAD). Participants’ views on SNAD were evaluated before and after implementation. The aim of this study was to explore the views and experiences of nurses who had implemented SNAD and to identify the views and concerns of those who had not yet experienced SNAD. Method: Data was obtained through semi-structured interviews. Results: Qualitative thematic analysis of interview transcripts identified three key themes: practice to enhance patient benefit and care; practice to enhance nursing care and satisfaction; and practice to enhance organisational safety. Conclusion: The findings have implications for the understanding of influences on medicines safety in clinical practice and for hospice policy makers.
    • Hospital admissions after vertical integration of general practices with an acute hospital: a retrospective synthetic matched controlled database study

      Yu, V.; Wyatt, S.; Woodall, M.; Sultan, M.; Klaire, V.; Bailey, K.; Mohammed, Mohammed A. (2020)
      Background New healthcare models are being explored to enhance care coordination, efficiency, and outcomes. Evidence is scarce regarding the impact of vertical integration of primary and secondary care on emergency department (ED) attendances, unplanned hospital admissions, and readmissions. Aim To examine the impact of vertical integration of an NHS provider hospital and 10 general practices on unplanned hospital care Design and setting A retrospective database study using synthetic controls of an NHS hospital in Wolverhampton integrated with 10 general practices, providing primary medical services for 67 402 registered patients. Method For each vertical integration GP practice, a synthetic counterpart was constructed. The difference in rate of ED attendances, unplanned hospital admissions, and unplanned hospital readmissions was compared, and pooled across vertical integration practices versus synthetic control practices pre-intervention versus post-intervention. Results Across the 10 practices, pooled rates of ED attendances did not change significantly after vertical integration. However, there were statistically significant reductions in the rates of unplanned hospital admissions (−0.11, 95% CI = −0.18 to −0.045, P = 0.0012) and unplanned hospital readmissions (−0.021, 95% CI = −0.037 to −0.0049, P = 0.012), per 100 patients per month. These effect sizes represent 888 avoided unplanned hospital admissions and 168 readmissions for a population of 67 402 patients per annum. Utilising NHS reference costs, the estimated savings from the reductions in unplanned care are ∼£1.7 million. Conclusion Vertical integration was associated with a reduction in the rate of unplanned hospital admissions and readmissions in this study. Further work is required to understand the mechanisms involved in this complex intervention, to assess the generalisability of these findings, and to determine the impact on patient satisfaction, health outcomes, and GP workload.
    • Hospital pharmacy: A new relationship

      Rania, T.; McIntosh, Bryan; West, Sue (2014)
      There are 353 NHS hospitals in the United Kingdom, and within these hospitals there is wide variation in the electronic prescribing systems applied. Indeed, only one hospital uses a single system in all of its clinical areas. Medication error is the biggest issue in the health care profession in respect to patient safety—
    • Hospital postnatal discharge and sepsis advice: Perspectives of women and midwifery students

      Haith-Cooper, Melanie; Stacey, T.; Bailey, F. (2018-04)
      Background Women are discharged home from hospital increasingly early, but there is little evidence examining the postnatal hospital discharge process and how this may impact on the health of women and babies. In particular, there is little on sepsis prevention advice, despite it being the biggest direct cause of maternal mortality. Aim To explore the perceptions of women and senior student midwives related to the postnatal hospital discharge process and maternal sepsis prevention advice. Methods Three focus group interviews were undertaken, involving 9 senior student midwives and 14 women attending paid or specialist classes for vulnerable migrant women. Findings All participants believed that the postnatal hospital discharge process was inadequate, rushed and inconsistent. Sepsis advice was patchy and the condition underplayed. Conclusions Cost effective, time-efficient and innovative ways to impart vital information are required to support the postnatal hospital discharge process.
    • How do consultant radiographers contribute to imaging service delivery and leadership?

      Snaith, Beverly; Clarke, R.; Coates, A.; Field, L.; McGuinness, A.; Yunis, S. (2019-01-02)
      Background: Consultant radiographer numbers remain low despite the ongoing capacity challenges in diagnostic imaging. This is compounded by the limited evidence of how such roles can positively impact on service delivery, particularly in relation to their leadership expectations. Aims: To examine the activities undertaken by consultant radiographers; evidence the impact of the roles, and consider whether the roles encompass the four domains of consultant practice. Method: Six consultant radiographers employed in a single NHS Trust completed an activity diary over a period of 7 days. Interval sampling every 15 minutes enabled the collection of a large volume of complex data. Findings: All consultants worked beyond their contacted hours. The documented activities demonstrate the breadth of the roles and confirmed that the participants were undertaking all four core functions of consultant practice. Conclusion: The impact of the roles stretched beyond the local department and organisation to the health system and wider profession.
    • How do team experience and relationships shape new divisions of labour in robot-assisted surgery? A realist investigation

      Randell, Rebecca; Greenhalgh, J.; Hindmarsh, J.; Honey, S.; Pearman, A.; Alvarado, Natasha; Dowding, D. (2021-03-01)
      Safe and successful surgery depends on effective teamwork between professional groups, each playing their part in a complex division of labour. This article reports the first empirical examination of how introduction of robot-assisted surgery changes the division of labour within surgical teams and impacts teamwork and patient safety. Data collection and analysis was informed by realist principles. Interviews were conducted with surgical teams across nine UK hospitals and, in a multi-site case study across four hospitals, data were collected using a range of methods, including ethnographic observation, video recording and semi-structured interviews. Our findings reveal that as the robot enables the surgeon to do more, the surgical assistant's role becomes less clearly defined. Robot-assisted surgery also introduces new tasks for the surgical assistant and scrub practitioner, in terms of communicating information to the surgeon. However, the use of robot-assisted surgery does not redistribute work in a uniform way; contextual factors of individual experience and team relationships shape changes to the division of labour. For instance, in some situations, scrub practitioners take on the role of supporting inexperienced surgical assistants. These changes in the division of labour do not persist when team members return to operations that are not robot-assisted. This study contributes to wider literature on divisions of labour in healthcare and how this is impacted by the introduction of new technologies. In particular, we emphasise the need to pay attention to often neglected micro-level contextual factors. This can highlight behaviours that can be promoted to benefit patient care.