• Optimising diagnostics through imaging informatics: Costs and opportunities

      Culpan, Gary; McIntosh, Bryan (2017)
      Increasing diagnostic capacity is a national priority to expedite the timeliness and appropriateness of patient treatment interventions. Imaging—encompassing a range of technologies including X-ray, CT, MRI, nuclear medicine and ultrasound—is a key diagnostic service and central to decision-making in most, if not all, disease pathways. However, imaging is an expensive discipline accounting for an estimated 3–5% of the annual NHS budget. As a result, it is imperative that we maximise service efficiency while optimising patient outcomes.
    • Optimising person-centred transitions in the dementia journey: A comparison of national dementia strategies.

      Fortinsky, R.H.; Downs, Murna G. (2014-04)
      The journey for people with Alzheimer’s disease or another dementia involves the need for increasing levels of support, with transitions across care settings. Although transitional care has received increasing attention in the health care arena, no widely accepted transitions typology exists for the dementia journey. At the same time, national dementia strategies are proliferating. We developed a typology containing six transitions that cover the dementia journey from symptom recognition to end-of-life care. We then critically evaluated whether and how the national dementia strategies of Australia, England, France, the Netherlands, Norway, Scotland, and the United States addressed each transition. Adopting a person-centered perspective, we found that most or all of the national strategies adequately address earlier transitions in the journey, but fewer strategies address the later transitions. We recommend that next-generation national dementia strategies focus on later transitions, specify how care coordination and workforce training should make transitions more person centered, and use person-centered outcomes in evaluating the success of the strategies’ implementation and dissemination.
    • Optimising productivity, quality and efficiency in community nursing.

      Holland, A.; McIntosh, Bryan (2012)
      By 2014 the NHS is expected to make �21 billion in efficiency savings and increase productivity by 6% per annum, while maintaining or improving the quality of care. Given that the cost of the 1.7 million strong workforce represents 60% of the NHS budget, changes are likely. This context of innovation and cost-effectiveness has resulted in an ever greater emphasis to fully engage and support community nursing.
    • Optimizing diagnostic imaging through skills mix: costs and opportunities

      McIntosh, Bryan; Hardy, Maryann (2017-06)
      Increasing diagnostic capacity is a national priority to expedite the timeliness and appropriateness of patient treatment interventions. Imaging, encompassing a range of technologies including X-ray, Computer Tomography, Magnetic Resonance Imaging and ultrasound, is a key diagnostic service and central to decision making in most, if not all, disease pathways. However, imaging is an expensive discipline accounting for an estimated 3-5% of the annual NHS budget. As a result, it is imperative that we maximize service efficiency while optimizing patient outcomes.
    • Optimum positioning for anteroposterior pelvis radiography: A literature review

      Alzyoud, K.; Hogg, P.; Snaith, Beverly; Flintham, K.; England, A. (2018-09)
      Aim: Pelvic radiography is used for the identification of hip joint changes, including pathologies such as osteoarthritis. Several studies have recommended that the position for this radiological procedure should be standing, not supine, to reflect the functional appearances of the hip joint. The aim of this review was to evaluate pelvis radiography positioning with respect to the image appearances and information provided for clinical decision-making. Aside from this, potential recommendations to the radiographic technique for an erect pelvis projection will be considered. Method: A literature search was performed using databases/abstract systems (ScienceDirect, Web of Science, PubMed, and MEDLINE). Only articles written in English were included. Results: Twenty-five articles were identified. Findings from the review describe the effect of repositioning from supine to erect on a series of specific hip measurements. These include pelvic tilt, joint space width, and the acetabular component. Conclusion: Evidence within the literature illustrates that in several studies, there were differences when repositioning from supine to standing for a number of pelvic metrics. Standing positioning is promoted by some authors since this may facilitate the early diagnosis of hip joint pathology and assist in the planning of surgical interventions. Literature is very limited on how to optimally perform erect pelvis radiography, and this should be an area for future research.
    • Organisation, practice and experiences of mouth hygiene in stroke unit care: a mixed methods study.

      Horne, Maria; McCracken, G.; Walls, A.; Tyrrell, P.J.; Smith, C.J. (2015-03)
      Aims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Background Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.
    • Overcoming challenges of conducting research in nursing homes

      Jenkins, C.; Smythe, A.; Galant-Miecznikowska, M.; Bentham, P.; Oyebode, Jan R. (2016-05)
      In the UK, one third of the 850,000 people with dementia live in care homes. This article explores the process of carrying out research in nursing homes, identifying barriers and enabling factors, and making recommendations for researchers. The authors’ experiences derive from an ongoing study investigating the effect of educational interventions to promote and embed person-centred care, designed for nurses caring for the people with dementia in nursing homes. Design issues arose from the need to use cluster randomisation which requires a large sample size, implementation fidelity, poor compliance and high numbers of participants lost to follow up. Further difficulties included gaining ethical approval, recruitment, raising concerns and the practicalities of participant retention. There are many benefits of conducting research in care homes, for the homes themselves, their staff and residents. These include training and education, networking and empowerment of staff and subsequent improved standards of care. For the research team, benefits include opportunities to contribute to an underserved setting, to advance care standards and improve nurses’ working lives.
    • Overgeneral autobiographical memory in Parkinson's disease

      Smith, Sarah J.; Souchay, C.; Conway, M.A. (2010)
      Autobiographical memory (AM) concerns the ability to remember past events from one's own life and consists of autobiographical knowledge (personal facts) and autobiographical incidents (personal events). The novelty of this research was to assess both personal factual and personal event AM in Parkinson's disease (PD) for specified lifetime periods. An autobiographical fluency task was used in which participants were asked to recall personal events and personal facts from five separate lifetime periods. Previous findings as well the brain regions affected in PD lead to the hypothesis that Parkinson's patients would recall less autobiographical memories especially for the most recent lifetime periods. Sixteen non-demented and non-depressed Parkinson's patients and sixteen age-education-matched controls participated. The results showed a temporal gradient for the recall of personal events in Parkinson's patients as they recalled fewer events for recent time periods. The PD group also had more difficulties in recalling autobiographical events rather than an autobiographical knowledge. The difficulty in recalling autobiographical events was characterized by overgenerality, with PD patients failing to generate specific episodic memories.
    • Pain and delirium in people with dementia in the acute general hospital setting

      Feast, A.R.; White, N.; Lord, Kathryn; Kupeli, N.; Vickerstaff, V.; Sampson, E.L. (2018-11-01)
      Background: Pain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting. Objective: To investigate the relationship between pain and delirium in people with dementia, on admission and throughout a hospital admission. Design: Exploratory secondary analysis of observational prospective longitudinal cohort data. Setting: Two acute hospitals in the UK. Methodology: Two-hundred and thirty participants aged ≥70 years were assessed for dementia severity, delirium ((Confusion Assessment Method (CAM), pain (Pain Assessment in Advanced Dementia (PAINAD)) scale and prescription of analgesics. Logistic and linear regressions explored the relationship between pain and delirium using cross-sectional data. Results: Pain at rest developed in 49%, and pain during activity for 26% of participants during their inpatient stay. Incident delirium developed in 15%, of participants, and 42% remained delirious for at least two assessments. Of the 35% of participants who were delirious and unable to self-report pain, 33% of these participants experienced pain at rest, and 56 experienced pain during activity. The odds of being delirious were 3.26 times higher in participants experiencing pain at rest (95% Confidence Interval 1.03–10.25, P = 0.044). Conclusion: An association between pain at rest and delirium was found, suggesting pain may be a risk factor for delirium. Since pain and delirium were found to persist and develop during an inpatient stay, regular pain and delirium assessments are required to manage pain and delirium effectively.
    • Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards

      Sampson, E.L.; White, N.; Lord, Kathryn; Leurent, B.; Vickerstaff, V.; Scott, S.; Jones, L. (2015-04)
      Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen–Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (b 5 0.20, 95% confidence interval [CI] 5 0.07- 0.32, P 5 0.002) and at rest (b 5 0.41, 95% CI 5 0.14-0.69, P 5 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.
    • Pakistani women: feeding decisions

      Meddings, Fiona S.; Porter, Jan (2007-07)
      Lecturers Fiona Meddings and Jan Porter of the division of midwifery and women’s health at the School of Health Studies at the University of Bradford detail the difficulties faced by UK Pakistani women in making informed choices on breastfeeding.
    • Palliative care - the new essentials

      Abel, J.; Kellehear, Allan; Karapliagou, Aliki (2018)
      Background: If global palliative care is to successfully address challenges of unequal access, continuity of care, and health services reductionism, new practice models to address these issues need to be identified, debated and tested. This paper offers one such practice model based on a public health approach to palliative care that has so far shown promising evidence of effectiveness. Methods: We describe how four essential elements within a public health model can work together to address quality and continuity of care as well as addressing the numerous barriers of access. These elements are: (I) specialist, and (II) generalist palliative care services working with (III) communities and neighbourhoods, working in their turn with their (IV) key civic institutions. Results: The positive and negative impact and advantages of each of these elements is described and discussed. Conclusions: A solely clinical model of palliative care is inadequate to addressing the multiple comorbidities and access issues characteristic of modern palliative care. A public health approach based on a close partnership between clinical services and communities/civic institutions is the optimal practice model.
    • Palliative care reimagined: a needed shift

      Abel, J.; Kellehear, Allan (2016-03)
      Palliative care, since its inception over 60 years ago, has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms that included social, spiritual and allied health workers—an outgrowth of the recognition that routine work with the dying, their carers, and the bereaved required more than solely clinical skills; and the unique partnership with communities that yielded the volunteer movement within palliative care. Professional, evidence-based symptom management and the importance of supportive care in its widest possible sense were and remain the cornerstones of the modern palliative care approach. However, the majority of people with terminal illnesses do not have access to palliative care teams, whose main focus of care remains patients with cancer. In the context outlined above this paper therefore poses two key questions: how can we provide an equitable level of care for all people irrespective of diagnosis and how can we increase the range and quality of non-medical/nursing supportive care in a context of diminishing resources? We argue that an important opportunity and solution can be found by adopting the principles of a public health approach to end-of-life care.
    • Palliative curriculum re-imagined: A critical evaluation of the UK Palliative Medicine Syllabus

      Abel, J.; Kellehear, Allan (2018-05)
      The UK Palliative Medicine Syllabus is critically evaluated to assess its relationship and relevance to contemporary palliative care policy and direction. Three criteria are employed for this review: (1) relevance to non-cancer dying, ageing, caregivers, and bereaved populations; (2) uptake and adoption of well-being models of public health alongside traditional illness and disease models of clinical understanding; and (3) uptake and integration of public health insights and methodologies for social support. We conclude that the current syllabus falls dramatically short on all 3 criteria. Suggestions are made for future consultation and revision.
    • Pandora box: The eurozone and the euro crisis

      McIntosh, Bryan; Ferretti, F. (2015)
      The global economy has experienced considerable turbulence since 2007. The financial crisis has been viewed as the trigger for a prolonged period of economic decline. This decline remains an issue for all member states of the European Union, the eurozone and beyond. We argue genesis of this crisis lies in the integration negotiations of 1991, ratified in 1992. These produced a flawed economic model within the eurozone. Given the seeds of decay were planted at origin; we argue the solution can be found through a reconstructed eurozone via looser integration, where countries less equipped to deal with the realities of closer integration will be economically independent.
    • Paper 1: Conceptualizing the Transition from Advanced to Consultant Practitioner: Career Promotion or Significant Life Event?

      Hardy, Maryann L.; Nightingale, J. (2014-12)
      Background The diversification of nursing and allied health profession (AHP) roles has seen unprecedented growth as organizations have sought to optimize limited health care resources. Within the UK health care system, the nonmedical consultant is viewed as the pinnacle of the clinical career ladder. Yet, nearly 15 years after their introduction, recruitment to these positions remains slow. Criticisms of nonmedical consultant practice include a lack of role clarity, a failure to work across the four domains of consultant practice, a lack of suitable applicants, and poor preparedness of new appointments. Although there is evidence exploring the nature and effectiveness of established consultant roles, little research addresses the development phase of aspiring consultants. Objectives To explore the transitional journey experienced by trainee consultant radiographers as they move from advanced to consultant practitioner within a locally devised consultant development programme. Design Longitudinal qualitative enquiry. Methods and Settings Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. Results A challenging journey was recounted involving five key emotional stages that occurred in a consistent and predictable order (ie, elation, denial, doubt, crisis, and recovery). The identified stages had close parallels with Hopson's Life Events model, suggesting that transition to consultant practice is a significant life event rather than a straightforward job promotion. Conclusions Current emphasis on the four domains of practice, although providing a clear framework for expected external role outcomes, overlooks the importance of the internal or subjective career development on the perceived success or failure of the role. Employers, educators, and professional bodies have a responsibility to facilitate aspirational consultants to explore and enhance their internal career development, offering more time to define themselves and their role with support to guide them through the transition journey.
    • Paper 2: Conceptualizing the Transition from Advanced to Consultant Practitioner: Role Clarity, Self-perception, and Adjustment

      Hardy, Maryann L.; Nightingale, J. (2014-12)
      Interest in the influence of emotions on behaviour, decision making, and leadership has accelerated over the last decade. Despite this, the influence of emotions on career advancement and behaviour within radiography and radiotherapy has largely been ignored. The ease of transition from one work role to another within an individual's career may be influenced by previous experience, personal characteristics, organizational environment, culture, and the nature of the role itself. Consequently, the transition from the often well-defined role of advanced or specialist practitioner to the more fluid role of consultant practitioner is associated with changing emotions as reported in the first part of this two-part series. What remains unexplored are the emotional triggers that pre-empt each stage in the transition cycle and how our understanding of these might support the successful implementation of consultant practitioner roles. To explore the emotional triggers that pre-empted each stage in the transitional journey of trainee consultant radiographers as they moved from advanced to consultant practitioner within a locally devised consultant development program. Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. Although all trainee consultant radiographers experienced the emotional events described in the first part of this two-part series in a predictable order (ie, elation, denial, doubt, crisis, and recovery), the timing of the events was not consistent. Importantly, four emotional triggers were identified, and the dominance of these and the reaction of individuals to them determined the emotional well-being of the individual over time. This study provides a unique and hitherto unexplored insight into the transition journey from advanced or specialist practitioner. Importantly, the findings suggest that commonly adopted supportive change interventions may, in fact, trigger the negative emotions they are intended to alleviate and disable rather than enable role transition.
    • Parenting practices and mothers behavioural and demographic factors influencing their 2 year old child's physical activity.

      Horne, Maria; Bingham, D.D.; Nagy, Liana C.; Clemes, S.; Barber, Sally E. (2015-06)
      To identify maternal factors that influence physical activity behaviour in 2 year old children.