• Achieving provider engagement: providers' perceptions of implementing and delivering integrated care

      Ignatowicz, Agnieszka M.; Greenfield, Geva; Pappas, Yannis; Car, Josip; Majeed, Azeem; Harris, Matthew; University of Birmingham; Imperial College London; University of Bedfordshire (SAGE, 2014-12)
      The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda.
    • Alcohol misuse and cognitive impairment in older people

      Wadd, Sarah; Randall, James; Thake, Anna; Edwards, Kim; Galvani, Sarah; McCabe, Louise; Coleman, Alan; University of Bedfordshire; Bedford Community Mental Health Team for Older People; South Essex Partnership NHS Foundation Trust; et al. (Alcohol Research UK, 2013-12)
      The main objectives of this study were to explore: The extent and nature of cognitive impairment in older people (aged 55 and over) attending substance misuse services in the UK for alcohol problems. The difficulties which substance misuse services face when working with clients with cognitive impairment and how treatment can be modified to take account of cognitive difficulties. The extent to which older people attending substance misuse services find screening with the Montreal Cognitive Assessment (Nasreddine, et al., 2005) acceptable. The extent to which older people with a diagnosis of mild cognitive impairment or early stage dementia can be screened for alcohol problems using standard alcohol screening tools. The extent to which NHS memory assessment services are screening their clients for alcohol problems and the challenges they face in doing so.
    • Alcohol, other drugs and sight loss: a scoping study

      Galvani, Sarah; Livingston, Wulf; Morgan, Hannah; Wadd, Sarah; Manchester Metropolitan University; University of Bedfordshire; Glyndwr University; Lancaster University (Alcohol Research UK, 2014-12)
      The research team and Thomas Pocklington Trust have produced a guide for professionals working in substance use and sight loss.
    • The antecedents of violence and aggression within psychiatric in-patient settings

      Papadopoulos, Chris; Ross, J.; Stewart, D.; Dack, C.; James, K.; Bowers, Len; University of Bedfordshire; University College London; King's College London (2012-06)
    • Are happier people, healthier people? The relationship between perceived happiness, personal control, BMI and health preventive behaviours

      Cook, Erica Jane; Chater, Angel M.; University of Bedfordshire (Taylor & Francis (Routledge), 2010)
    • Are religious communities useful in promoting the organ donation debate: Lessons from the United Kingdom.

      Randhawa, Gurch; Blocklehurst, Anna; Pateman, Ruth; Kinsella, Suzannah; Parry, Vivienne (Editrice Compositori Srl, 2010-03)
    • Assessing patients' experience of integrated care: a survey of patient views in the North West London Integrated Care Pilot

      Mastellos, Nikolaos; Gunn, Laura H.; Harris, Matthew; Majeed, Azeem; Car, Josip; Pappas, Yannis; Imperial College London; Stetson University; University of Bedfordshire (Igitur publishing, 2014-04)
      Despite the importance of continuity of care and patient engagement, few studies have captured patients' views on integrated care. This study assesses patient experience in the Integrated Care Pilot in North West London with the aim to help clinicians and policymakers understand patients' acceptability of integrated care and design future initiatives.
    • Assessing students’ written work: experience of a student practice lecturer in the UK

      Regmi, Krishna (Taylor and Francis, 2010)
      Assessment is one of the most important tools in teaching and learning in any academic institution, but it is rarely measured in effort, time and effectiveness. As a student practice lecturer, I faced many challenges as well as learning opportunities while working in higher education in the UK. In this paper, I explore some of the important concepts and issues to be considered while assessing or marking students’ written work – academic essays and reports – by reflecting on my own experience of learning at a UK university. This paper concludes that providing appropriate advice and guidance, i.e. feedback, would help students develop strategies for improving their learning and performance.
    • Assessing the impact of diabetes on the quality of life of older adults living in a care home: validation of the ADDQoL Senior

      Speight, J.; Sinclair, Alan J.; Browne, J. L.; Woodcock, A.; Bradley, C.; Australian Centre for Behavioural Research in Diabetes; Deakin University; AHP Research; Bedfordshire and Hertfordshire Postgraduate Medical School; Royal Holloway, University of London (Wiley, 2013-01)
      Aims  Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior*. Methods  Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study. Results  The life domains most impacted by diabetes were ‘independence’ and ‘freedom to eat as I wish’. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach’s alpha = 0.924). Domain scores were, as expected, significantly intercorrelated. Conclusions  The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.
    • Athlete compliance to therapist requested contraction intensity during proprioceptive neuromuscular facilitation.

      Sheard, Peter W.; Smith, Paul M.; Paine, Tim J.; University of Bedfordshire (Elsevier, 2009-10)
      Contraction intensities between 10 and 100% maximal voluntary contraction (MVC) have been proposed in varying muscle energy technique (MET) and proprioceptive neuromuscular facilitation (PNF) post-isometric relaxation (PIR) protocols. The current study was undertaken to determine if athletes were able to comply with differing therapist requested contraction intensities during (PNF) stretching protocols. Thirty-six university athletes were recruited and MVC was established at hip extension, hip adduction, and horizontal shoulder adduction. Target PIR contractions were set at 20, 50 and 100% MVC and monitored throughout the contractions with a strain gauge dynamometer. Athletes were not able to match the target contraction values at 20 and 100% MVC (P< or =0.001). When examined for consistency across the three component contractions within each of the three PIR protocols, the athletes demonstrated widely variable scores (coefficient of variation (CV)=23.2-36.4% at 20% MVC; CV=19.3-29.4% at 50% MVC; and, CV=9.4-14.5% at 100% MVC). Our findings indicate that this group of athletes displayed a poor level of compliance to varying therapist requested contraction intensities with respect to both accuracy and consistency.
    • Attitude measures, personality characteristics and the role of persuasion in organ donation

      Baluch, Bahman; Randhawa, Gurch (Pabst Science Publishers, 1998)
    • Attitudes towards organ donation and kidney disease among Black African, Black Caribbean and Asian population in Lambeth, Southwark and Lewisham, London, UK.

      Clarke-Swaby, S.; Sharp, Chloe; Randhawa, Gurch; King's College Hospital; University of Bedfordshire (ETCO and EDC, 2011-03)
      This study outlines a 'snapshot' picture of the attitudes held by Black Caribbean, Black Africa and Asian communities in Lambeth, Southwark and Lewisham in London. Findings from the study informed recommendations for health campaigns.
    • Automated telephone communication systems for preventive healthcare and management of long-term conditions

      Cash-Gibson, Lucinda; Felix, Lambert M.; Minorikawa, Nami; Pappas, Yannis; Gunn, Laura H.; Majeed, Azeem; Atun, Rifat; Car, Josip (Wiley, 2012)
      The objectives are as follows: • To assess the effects of automated telephone communication systems (ATCS) compared with usual care, for improving primary preventive healthcare and management of long-term conditions in terms of: 1) behavioural change; 2) clinical outcomes; 3) process outcomes; 4) cognitive outcomes; and 5) adverse outcomes. • To determine which type of ATCS is most effective for primary preventive healthcare and management of long-term conditions. • To explore which interventional design components may contribute to positive consumer behavioural change.
    • Awareness and attitudes towards organ donation and transplantation among the Asian population. A preliminary survey in Luton, UK

      Darr, Aamra; Randhawa, Gurch; University of Luton (Wiley-Blackwell, 1999)
      Currently the demand for transplant organs, particularly kidneys, far outstrips the supply in the UK. This problem is particularly severe for the Asian population, which has been shown to have a disproportionately large representation on kidney-transplant waiting lists in some regions of the UK. The situation is clear: there is an urgent need to address the number of Asians requiring a kidney transplant, otherwise the human and economic costs will be very high. An exploratory qualitative study was therefore undertaken with the aim of assessing current awareness of organ donation and transplantation and to explore attitudes towards these issues in a cross section of the Asian population in Luton. It was found that nearly half of the respondents in this survey did not know what a donor card was used for, and approximately half of these had never seen one; only 6 of the 64 people interviewed had heard of the National Donor Register. Of the three people who carried a donor card, two had an immediate family member who had received a transplant. This suggests that media campaigns aimed at attracting donors from the Asian population have had limited success thus far. It appears that the vast majority of the Asian population is at the initial stage of the process of making a decision about donating their organs, that of simply knowing that transplantation takes place. Very little debate of pertinent issues seems to have taken place, which is essential for reaching a decision on whether or not to donate an organ. The study should be seen as exploratory but is nonetheless an important initial step towards the establishment of a greater knowledge and understanding of the issues affecting the low donation rate in the Asian population.
    • Awareness of kidney disease in west London South Asians

      Randhawa, Gurch; Waqar, Muhammad; Jetha, Champa; Gill, Barbir; Paramasivan, Sangeetha; Lightstone, Elizabeth (Hayward Group plc., 2010)
      The seminal report Tackling Health Inequalities: A Programme for Action has revitalised national interest in reducing inequalities. Provision of coronary heart disease, mental health and diabetes services for minority ethnic groups has become a particularly important area of concern, in part due to the high rates of these conditions within particular minority ethnic groups.
    • Barriers and facilitators to using NHS Direct: a qualitative study of ‘users’ and ‘non-users’

      Cook, Erica Jane; Randhawa, Gurch; Large, Shirley; Guppy, Andy; Chater, Angel M.; Ali, Nasreen; University of Bedfordshire (BioMed Central, 2014-10-25)
      Background NHS Direct, introduced in 1998, has provided 24/7 telephone-based healthcare advice and information to the public in England and Wales. National studies have suggested variation in the uptake of this service amongst the UK¿s diverse population. This study provides the first exploration of the barriers and facilitators that impact upon the uptake of this service from the perspectives of both `users¿ and `non- users¿. Methods Focus groups were held with NHS Direct `users¿ (N?=?2) from Bedfordshire alongside `non-users¿ from Manchester (N?=?3) and Mendip, Somerset (N?=?4). Each focus group had between five to eight participants. A total of eighty one people aged between 21 and 94 years old (M: 58.90, SD: 22.70) took part in this research. Each focus group discussion lasted approximately 90 minutes and was audiotape-recorded with participants¿ permission. The recordings were transcribed verbatim. A framework approach was used to analyse the transcripts. Results The findings from this research uncovered a range of barriers and facilitators that impact upon the uptake of NHS Direct. `Non-users¿ were unaware of the range of services that NHS Direct provided. Furthermore, `non-users¿ highlighted a preference for face-to face communication, identifying a lack of confidence in discussing healthcare over the telephone. This was particularly evident among older people with cognitive difficulties. The cost to telephone a `0845¿ number from a mobile was also viewed to be a barrier to access NHS Direct, expressed more often by `non-users¿ from deprived communities. NHS Direct `users¿ identified that awareness, ease of use and convenience were facilitators which influenced their decision to use the service. Conclusions An understanding of the barriers and facilitators which impact on the access and uptake of telephone-based healthcare is essential to move patients towards the self-care model. This research has highlighted the need for telephone-based healthcare services to increase public awareness; through the delivery of more targeted advertising to promote the service provision available
    • Barriers to extended nurse prescribing among practice nurses

      Kelly, Amber; Neale, Jo; Rollings, Rhona; Churchfield Medical Centre, Luton (McMillan-Scott Plc., 2010-01)
      Practice nurses are defined as those nurses who work in general practices and are employed by GPs. This includes nurses who have gained further qualifications and are working as nurse practitioners and minor illness specialist nurses. Despite the success of nurseled services in primary care, the move into extended nurse prescribing has not been as high as predicted. A questionnaire survey of all 251 practice nurses in one southern English county was conducted in order to ascertain current roles and responsibilities, prescribing qualifications (both actual and planned), and perceived barriers to acquiring a nurse independent prescriber qualification. The findings identified what local practice nurses perceive to be barriers to nurse prescribing with issues of age, salary, support and training all playing a part in discouraging the uptake of this qualification.
    • The behaviour of young children with social communication disorders during dyadic interaction with peers

      Murphy, Suzanne; Faulkner, Dorothy; Farley, Laura R. (Springer, 2014-02)
      Children with social communication disorders are known to experience more problematic peer relations than typically-developing children. However, detailed observation of their behaviour and communication during interaction with peers has not previously been undertaken. Micro-analytic observational methods were used to analyse the audio-taped interaction of children (N = 112) selected from mainstream schools (ages 5-6 years-old) on a computerised dyadic collaborative task. Comparisons were made between children with average-to-high- and low-pragmatic language skill as measured by the Test of Pragmatic Skills. Dyads were composed of an average-to-high-skilled child plus a low-skilled child (32 dyads), or of two average-to-high-skilled children (24 dyads). Consistently with their pragmatic language scores, low-skilled children were more likely to ignore other children's questions and requests than were average-to-high-skilled children. When average-to-high-skilled children worked with low-skilled children, as opposed to with other average-to-high-skilled children, they showed some sensitivity and adaptation to these children's difficulties; they used significantly more directives, clarification and provided more information. However, there was a cost in terms of the emotional tone of these interactions; when working with low-skilled children, the average-to-high-skilled children expressed considerably more negative feelings towards their partners than with another average-to-high-skilled child. In conclusion, observation of the interaction of average-to-high- and low-skilled children suggests promise for peer-assisted interventions and specifies which communicative behaviours could be targeted. However, care should be taken to manage the affective climate of these interactions for the benefit of all children involved.
    • Biochemical and spectroscopic studies of human melanotransferrin (MTf): electron-paramagnetic resonance evidence for a difference between the iron-binding site of MTf and other transferrins

      Farnaud, Sébastien; Amini, Maryam; Rapisarda, Chiara; Cammack, Richard; Bui, Tam; Drake, Alex F.; Evans, Robert W.; Rahmanto, Yohan Suryo; Richardson, Des R.; University of Westminster; et al. (Elsevier, 2008-01)
      Melanotransferrin (MTf) is a member of the transferrin (Tf) family of iron (Fe)-binding proteins that was first identified as a cell-surface marker of melanoma. Although MTf has a high-affinity Fe-binding site that is practically identical to that of serum Tf, the protein does not play an essential role in Fe homeostasis and its precise molecular function remains unclear. A Zn(II)-binding motif, distinct from the Fe-binding site, has been proposed in human MTf based on computer modelling studies. However, little is known concerning the interaction of its proposed binding site(s) with metals and the consequences in terms of MTf conformation. For the first time, biochemical and spectroscopic techniques have been used in this study to characterise metal ion-binding to recombinant MTf. Initially, the binding of Fe to MTf was examined using 6 M urea gel electrophoresis. Although four different iron-loaded forms were observed with serum Tf, only two forms were found with MTf, the apo-form and the N-monoferric holo-protein, suggesting a single high-affinity site. The presence of a single Fe(III)-binding site was also supported by EPR results which indicated that the Fe(III)-binding characteristics of MTf were unique, but somewhat comparable to the N-lobes of human serum Tf and chicken ovo-Tf. Circular dichroism (CD) analysis indicated that, as for Tf, no changes in secondary structure could be observed upon Fe(III)-binding. The ability of MTf to bind Zn(II) was also investigated using CD which demonstrated that the single high-affinity Fe-binding site was distinct from a potential Zn(II)-binding site.