• Are we fully implementing guidelines and working within a multidisciplinary team when managing venous leg ulceration?

      Vowden, Peter; Vowden, Kath (2013)
      High compression therapy, whether with bandage systems or hosiery, is the accepted treatment of lower limb venous ulceration. Compression has not only been shown to improve healing, it has been demonstrated to reduce oedema and improve tissue oxygen levels (Stacey et al, 1990), reversing some of the changes associated with chronic venous insufficiency (Vandongen and Stacey, 2000). The introduction of multilayer high compression bandage systems in the late 1980s, and subsequent improvements in bandage textiles and design, have undoubtedly improved outcomes for many patients. However, compression alone does not address the underlying pathology of venous ulceration, chronic venous insufficiency (CVI), and without treatment CVI continues to cause skin damage and increases the risk of recurrent ulceration. In 1999, Nelzen emphasised that compression treatment has been used since the days of Hippocrates and yet has not solved the problem of leg ulceration (Nelzen, 1999).
    • Artificial intelligence in diagnostic imaging: impact on the radiography profession

      Hardy, Maryann L.; Harvey, H. (2020-03)
      The arrival of artificially intelligent systems into the domain of medical imaging has focused attention and sparked much debate on the role and responsibilities of the radiologist. However, discussion about the impact of such technology on the radiographer role is lacking. This paper discusses the potential impact of artificial intelligence (AI) on the radiography profession by assessing current workflow and cross-mapping potential areas of AI automation such as procedure planning, image acquisition and processing. We also highlight the opportunities that AI brings including enhancing patient-facing care, increased cross-modality education and working, increased technological expertise and expansion of radiographer responsibility into AI-supported image reporting and auditing roles.
    • Assessing community readiness for early intervention programmes to promote social and emotional health in children

      Islam, Shahid; Small, Neil A.; Bryant, M.; Bridges, S.; Hancock, N.; Dickerson, J. (2019-06)
      Evidence for early intervention and prevention-based approaches for im-proving social and emotional health in young children is robust. However, rates of participation in programmes are low. We explored the dynamics which affect levels of community readiness to address the issues of social and emotional health for preg-nant women, young children (0-4 years) and their mothers.Setting:A deprived inner‐city housing estate in the north of England. The estate falls within the catchment area of a project that has been awarded long-term funding to address social and emotional health during pregnancy and early childhood.Methods:We interviewed key respondents using the Community Readiness Model. This approach applies a mixed methodology, incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling the placement of the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework approach to generate con-textual information to augment the numerical scores.Results:An overall score consistent with vague awareness was achieved, indicating a low level of community readiness for social and emotional health interventions. This score suggests that there will be a low likelihood of participation in programmes that address these issues.Conclusion:Gauging community readiness offers a way of predicting how willing and prepared a community is to address an issue. Modifying implementation plans so that they first address community readiness may improve participation rates.
    • Assessing Sagittal Rotation on Posteroanterior Chest Radiographs: The Effect of Body Morphology on Radiographic Appearances.

      Hardy, Maryann L.; Scotland, Blake; Herron, Lisa (2015-12)
      Chest radiography is one of the most commonly performed radiographic examinations worldwide. Routinely acquired in the erect posteroanterior (PA) position, a chest radiograph displays substantial amounts of medical information when accurate patient positioning is achieved. However, a rotated PA chest radiograph has reduced diagnostic quality and appearances may mask or mimic chest pathology. Radiographic assessment of patient rotation around the sagittal plane has traditionally been undertaken by assessing the distance between the medial end of the clavicles and a line drawn through the spinous processes at the level of the clavicles. This approach continues to be advocated in radiographic technique textbooks internationally although no identified author has provided criteria to determine when a rotated PA chest radiograph should be repeated; determined the relationship between perceived clavicle to spinous process distance and actual degree of patient rotation; or considered the impact of body morphology, in particular the anteroposterior thoracic diameter, on radiographic appearances of rotation. Objectives To determine the impact of anteroposterior chest diameter on radiographic appearances of sagittal rotation on PA chest radiographs. Design Experimental study. Methods and Settings Sixty computed tomography thorax examinations, stratified for gender, were reviewed and data aggregated to determine average anteroposterior (AP) thoracic dimensions. A bespoke experimental unit was constructed specifically to enable testing of the impact of sagittal rotation on radiographic appearances. The experimental unit was situated within a calibrated circular frame enabling 360° rotation at 1° intervals around a central rotational point. The experimental unit components were varied in 1 cm intervals from 9 cm to 15 cm around the central rotation point to reflect varying AP chest diameters. At each interval, images were acquired at 0, 2, 5, 7, 10, and 15° sagittal rotation using a horizontal central ray, consistent centring point, and a source-image distance of 180 cm. Results A clear linear relationship between AP thoracic diameter and the radiographic appearances of sagittal rotation was noted. Considering significant rotation to be when the medial end of clavicle overlaps the spinous process on the radiographic image, this appearance occurred at a much smaller degree of rotation on wide AP thoracic diameters (15 cm, 5°) than narrower AP thoracic diameters (9 cm, 10°). Conclusions The routine application of the distance between the medial end of the clavicles and a line drawn through the spinous processes at the level of the clavicles as a method of assessing degree of sagittal rotation, diagnostic image quality, and need for repeat is flawed. Persistence in the application of this approach without cognisance of the impact of body morphology on radiographic appearances will result in persons with large AP thoracic diameters being more likely to have a PA chest radiograph repeated for a specified degree of rotation than persons with smaller AP thoracic diameters.
    • Assessing the pulse rate in adult patients

      Lowry, M.; Ashelford, Sarah L. (2015)
      Assessing the pulse is a common procedure and an important aspect of many nursing interventions; it should always be done with care and reassessed as needed. Assessment should always be taken seriously, with any deviations from the norm reported to a senior clinician, and pulse rate, rhythm and strength must always be documented. Pulses indicate numerous patient characteristics including the degree of relaxation, regularity of cardiac contractions and sufficiency of cardiac output. This article considers the relevant anatomy, physiology and practice of pulse assessment and recording.
    • Assessment of cognitive function across pregnancy using CANTAB: A longitudinal study

      Farrar, D.; Tuffnell, D.J.; Neill, D.; Scally, Andy J.; Marshall, Kay M. (2014-02)
      Significant changes in endogenous plasma hormone levels are required to sustain pregnancy which provides a unique opportunity to study their effect on cognitive function. Four carefully selected tests from the Cambridge Neuropsychological Automated Test Battery (CANTAB) were administered to assess the cognitive function of a group of 23 women during each trimester of pregnancy and at three months following birth. Test scores were compared with a control group of 24 non-pregnant women. The Edinburgh Postnatal Depression Scale was administered to assess anxiety and risk of depression. The National Adult Reading Test (NART) was used as a measure of verbal intelligence. Plasma hormone levels were measured at each time-point. The pregnant group scored significantly lower than the control group on the Spatial Recognition Memory (SRM) test at the second trimester and postpartum assessments (p ⩽ 0.004). A significant pregnant group-time interaction (p = 0.005) for SRM performance was demonstrated. Compared to their first trimester assessment, the pregnant group scored on average 11.7% less on each subsequent SRM test. The pregnant group reported more symptoms of anxiety and depression compared to the control group (EPDS-4 point increase in mean score at each assessment, p = 0.002). There were no plasma hormone levels and test score associations identified.
    • Assessment of Knee Flexor and Extensor Muscle Balance

      Graham-Smith, P.; Jones, P.A.; Comfort, P.; Munro, Allan G. (2013)
    • Assistant radiographer practitioners: Creating capacity or challenging professional boundaries?

      Palmer, D.; Snaith, Beverly; Harris, Martine A. (2018-08)
      Introduction Over the last 2 decades the assistant radiographer practitioner (ARP) role has been introduced into NHS diagnostic imaging departments as a strategy to expand the workforce and create capacity. This skill mix initiative has not been implemented in a standardised way and there is limited knowledge of the current role scope within general radiography (X-Ray). Method An electronic survey of ARPs working within UK diagnostic imaging departments was conducted. Both open and closed questions sought information regarding basic demographic data (age category; gender; geographic region), scope of practice (patient groups; anatomical regions; imaging outside of the diagnostic imaging department), limitations placed on practice, supervision and additional roles. Results A total of 108 responses, including 13 trainees, were received. Most sites employ three or less ARPs in general radiography (n = 43/66; 65.2%), although 11 sites have five (range 1–15). The majority undertake imaging of both adults and children (n = 85/108; 78.7%), although limitations on age were described. Their scope of practice covers a broad anatomical range and included some non-ambulant patients. The level of supervision varied with some sites empowering ARPs to check the referral prior to examination (n = 25) or images post acquisition (n = 32) (both n = 20/66; χ2 = 16.003; 1df; p = 0.000). Conclusion ARPs are helping to maintain capacity in imaging departments but we suggest there is further scope for expansion. The practice described by the post holders suggests that many are working beyond the scope envisaged by the radiography professional body.
    • Assistive technology: creating and engaging collaborative communities

      Bangar, S.; Mountain, Gail; Cudd, P. (2015)
      This paper outlines the remit of the UK Engineering and Physical Sciences Research Council KT-EQUAL (Knowledge Transfer for Extending Quality of Life for older and disabled people) programme. Case examples drawing on the range of activities undertaken by KT-EQUAL highlight where assistive technology developments have been facilitated, the value of network activities and an underpinning model of engagement and collaboration. Given an increasing emphasis on the impact of research the model and innovative approaches deployed by KT-EQUAL are even more crucial in future developments which aim to ensure that research can be used to benefit society.
    • The association between smoking cessation and glycaemic control in patients with type 2 diabetes: a THIN database cohort study

      Lycett, D.; Ryan, R.; Farley, A.; Roalfe, A.; Mohammed, Mohammed A.; Szatkowski, L.; Coleman, T.; Morris, R.; Farmer, A.; Aveyard, P.; et al. (2015-06)
      Background Smoking increases the risk of developing type 2 diabetes. However, several population studies also show a higher risk in people 3–5 years after smoking cessation than in continuing smokers. After 10–12 years the risk equates to that of never-smokers. Small cohort studies suggest diabetes control deteriorates temporarily during the first year after quitting. We examined whether or not quitting smoking was associated with altered diabetes control in a population study, for how long this association persisted, and whether or not this association was mediated by weight change. Methods We did a retrospective cohort study (Jan 1, 2005, to Dec 31, 2010) of adult smokers with type 2 diabetes using The Health Improvement Network (THIN), a large UK primary care database. We developed adjusted multilevel regression models to investigate the association between a quit event, smoking abstinence duration, change in HbA1c, and the mediating effect of weight change. Findings 10 692 adult smokers with type 2 diabetes were included. 3131 (29%) quit smoking and remained abstinent for at least 1 year. After adjustment for potential confounders, HbA1c increased by 0·21% (95% CI 0·17–0·25; p<0·001; [2·34 mmol/mol (95% CI 1·91–2·77)]) within the first year after quitting. HbA1c decreased as abstinence continued and became comparable to that of continual smokers after 3 years. This increase in HbA1c was not mediated by weight change. Interpretation In type 2 diabetes, smoking cessation is associated with deterioration in glycaemic control that lasts for 3 years and is unrelated to weight gain. At a population level, this temporary rise could increase microvascular complications.
    • The association between the nationality of nurses and safety culture in maternity care units of Oman

      Al Nadabi, Waleed; Faisal, Muhammad; Muhammed, Muhammed A. (2020)
      Background: Patient safety culture/climate in maternity units has been linked to better safety outcomes. Nurses have a crucial role in patient safety and represent the majority of staff in maternity units. In many countries, nurses are recruited from abroad, bringing their own perceptions of patient safety culture. Nonetheless, little is known about the relationship between perceptions of patient safety culture and nurses’ nationality. Understanding this relationship will assist stakeholders in designing a responsive programme to improve patient safety culture. Aims: To investigate the association between nurses’ nationality and their perceptions about patient safety culture in maternity units in Ministry of Health hospitals in Oman. Methods: In 2017, the Safety Attitude Questionnaire (SAQ) was distributed to all staff (892 distributed, 735 returned) in 10 maternity units. Results: About three-quarters (74%, 541/735) of the returned SAQs were completed by nurses, of whom 34% were non-Omani, 21.8% were Omani and 44.7% did not report their nationality (missing). Overall, the mean safety score for non-Omani nurses was significantly higher than for the Omani nurses: 3.9 (SD 1.3) vs 3.6 (SD 1.2) (P < 0.001). The mean safety score for stress recognition was significantly lower for non-Omani nurses: 2.8 (SD 1.5) vs 3.2 (SD 1.3) (P < 0.001). Conclusion: Non-Omani nurses have a more positive perception of patient safety culture than Omani nurses except in respect of stress recognition. Decision-makers, directors, and clinicians should consider these differences when designing interventions to improve patient safety culture.
    • Associations of autozygosity with a broad range of human phenotypes

      Clark, D.W.; Okada, Y.; Moore, K.H.S.; Mason, D.; Pirastu, N.; Gandin, I.; Mattsson, H.; Barnes, C.L.K.; Lin, K.; Zhao, J.H.; et al. (2019-10)
      In many species, the offspring of related parents suffer reduced reproductive success, a phenomenon known as inbreeding depression. In humans, the importance of this effect has remained unclear, partly because reproduction between close relatives is both rare and frequently associated with confounding social factors. Here, using genomic inbreeding coefficients (FROH) for >1.4 million individuals, we show that FROH is significantly associated (p < 0.0005) with apparently deleterious changes in 32 out of 100 traits analysed. These changes are associated with runs of homozygosity (ROH), but not with common variant homozygosity, suggesting that genetic variants associated with inbreeding depression are predominantly rare. The effect on fertility is striking: FROH equivalent to the offspring of first cousins is associated with a 55% decrease [95% CI 44–66%] in the odds of having children. Finally, the effects of FROH are confirmed within full-sibling pairs, where the variation in FROH is independent of all environmental confounding.
    • Associations of Circulating Calcium and 25-Hydroxyvitamin D With Glucose Metabolism in Pregnancy: A Cross-Sectional Study in European and South Asian Women

      Whitelaw, D.C.; Scally, Andy J.; Tuffnell, D.J.; Davies, T.J.; Fraser, W.D.; Bhopal, R.S.; Wright, J.; Lawlor, D.A. (2014-03)
      Background: Vitamin D deficiency is thought to impair insulin action and glucose metabolism; however, previous studies have not examined ethnic differences or the influence of calcium and parathyroid hormone. We investigated this in a cohort of predominantly white European and south Asian women during pregnancy. Methods: In this cross-sectional study from an urban population in northern England (53.8°N), 1467 women were recruited when undergoing glucose tolerance testing (75 g oral glucose tolerance test) at 26 weeks' gestation. Results: Gestational diabetes mellitus (GDM) was diagnosed in 137 women (9.3%). Median 25-hydroxyvitamin D concentration for the study population was 9.3 ng/mL (interquartile range 5.2, 16.9) and was higher in European [15.2 ng/mL (10.7, 23.5)] than in south Asian women [5.9 ng/mL (3.9, 9.4), P < .001]. After appropriate adjustment for confounders, 25-hydroxyvitamin D showed a weak inverse association with fasting plasma glucose (FPG; mean difference 1.0% per 1 SD; the ratio of geometric means (RGM) 0.99, 95% confidence interval (CI) 0.98, 1.00), and PTH was weakly associated with FPG (RGM 1.01, 95% CI 1.00, 1.02), but neither was associated with fasting insulin, postchallenge glucose, or GDM. Serum calcium (albumin adjusted) was strongly associated with fasting insulin (RGM 1.06; 95% CI 1.03, 1.08), postchallenge glucose (RGM 1.03, 95% CI 1.01, 1.04), and GDM (odds ratio 1.33, 95% CI 1.06, 1.66) but not with FPG. Associations were similar in European and south Asian women. Conclusions: These findings do not indicate any important association between vitamin D status and glucose tolerance in pregnancy. Relationships between circulating calcium and glucose metabolism warrant further investigation.
    • Asylum seekers and refugees: A cross European perspective

      Balaam, M-C.; Haith-Cooper, Melanie; Korfker, D.; Savona-Ventura, C. (2017-06-13)
      In this chapter we explore issues of psychosocial resilience and risk related to asylum seeking and refugee women during the perinatal period, drawing on experiences from three diverse European countries; the United Kingdom (UK), Malta and the Netherlands. First we define the terms asylum seekers and refugees to allow us to focus on the issues that pertain specifically to women experiencing this form of migration. We also note the prevalence of migration in contemporary society. We explore recent research on asylum seeking and refugee women in the perinatal period to identify; the barriers women face in accessing care in their reception countries and their experiences of perinatal care. Through this work, the challenges faced by healthcare professionals to provide culturally appropriate and high quality care to these women who face a range of psychosocial challenges are also highlighted. We suggest possible ways to address some of these challenges including how health professionals can actively build on the resilience of asylum seeking and refugee women to improve their perinatal experiences. We conclude by focusing on the implications of these findings; drawing on examples of good practice from the UK, Netherland and Malta to provide recommendations for practice and service development.
    • Attentional bias retraining in cigarette smokers attempting smoking cessation (ARTS): study protocol for a double bline randomised controlled trial

      Begh, R.; Munafò, M.R.; Shiffman, S.; Ferguson, S.G.; Nichols, L.; Mohammed, Mohammed A.; Holder, R.L.; Sutton, S.; Aveyard, P. (2013)
      Smokers attend preferentially to cigarettes and other smoking-related cues in the environment, in what is known as an attentional bias. There is evidence that attentional bias may contribute to craving and failure to stop smoking. Attentional retraining procedures have been used in laboratory studies to train smokers to reduce attentional bias, although these procedures have not been applied in smoking cessation programmes. This trial will examine the efficacy of multiple sessions of attentional retraining on attentional bias, craving, and abstinence in smokers attempting cessation. This is a double-blind randomised controlled trial. Adult smokers attending a 7-session weekly stop smoking clinic will be randomised to either a modified visual probe task with attentional retraining or placebo training. Training will start 1 week prior to quit day and be given weekly for 5 sessions. Both groups will receive 21 mg transdermal nicotine patches for 8–12 weeks and withdrawal-orientated behavioural support for 7 sessions. Primary outcome measures are the change in attentional bias reaction time and urge to smoke on the Mood and Physical Symptoms Scale at 4 weeks post-quit. Secondary outcome measures include differences in withdrawal, time to first lapse and prolonged abstinence at 4 weeks post-quit, which will be biochemically validated at each clinic visit. Follow-up will take place at 8 weeks, 3 months and 6 months post-quit. This is the first randomised controlled trial of attentional retraining in smokers attempting cessation. This trial could provide proof of principle for a treatment aimed at a fundamental cause of addiction.
    • Autobiographical memory in Parkinson's disease: A retrieval deficit

      Smith, Sarah J.; Souchay, C. (2013)
      This study examined the effects of providing cues to facilitate autobiographical memory retrieval in Parkinson's disease. Previous findings have shown that individuals with Parkinson's disease retrieve fewer specific autobiographical memories than older adult controls. These findings are clinically significant since the quality of autobiographical memory is linked to identity and sense of self. In the current study, 16 older adults with Parkinson's disease without dementia and 16 matched older adult controls were given 3 min in which to recall autobiographical memories associated with five different time periods and to give each memory a short title. Participants were later asked to retrieve the memories in three phases: firstly in a free recall phase; secondly in response to general cues (time periods) and finally in response to specific cues (the short titles previously given). The number of memories and the quality of the memory (general or specific) was recorded in each condition. Compared with matched older adult controls, the Parkinson's disease group was impaired in retrieving the memories that they had previously given in the free recall phase and in response to general cues. The performance of the group with Parkinson's disease was only equivalent to the older adults when they retrieved memories in response to self-generated cues. The findings are discussed in relation to theories of autobiographical memory and the neuropsychology of Parkinson's disease.
    • The autumn statement and healthcare delivery.

      McIntosh, Bryan (2016-01)
      The potential impact of the autumn statement on the future healthcare workforce.