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A fusion-based approach to identify the phases of the sit-to-stand test in older peopleAutomated clinical tests that assess quality of geriatric screening tests such as the Five-Times-Sit- To-Stand (5STS) and the Timed-Up-and-Go (TUG) are being designed to assess the decline in functional ability of elderly. The existing techniques to assess the quality of these physical activities include sensor-based techniques including body mounted sensors, force sensors and, vision and imaging sensors. These sensors have their own advantages and disadvantages towards the task of clinical assessment. In this work, we introduce a fusion- based technique to combine multiple sensors leveraging advantages of individual sensors, in such a way that the resulting assessment is more accurate. We evaluate our technique for 5STS test using a fusion of a chair and RGB sensors. In a test of 15 older people, there was no significant difference in performance between the two sensors, obtaining 76% and 73% for the RGB and chair, respectively. However, a significant improvement was obtained for the fusion technique, with 90% accuracy for all the phases of the STS test. The proposed fusion technique was observed to be better than the individual sensor assessment.
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'Would you like to join the NHS Organ Donor Register?' a general practice feasibility studyBACKGROUND: A shortage of organ donors exists in the UK and targeting family consent is key for increasing donation consent rates. Registration on the NHS Organ Donor Register (NHS ODR) facilitates this, as it guides families on their loved ones donation preference. In general practice, an opportunity to register is provided, however only to new patients. To improve access to registration opportunities, an intervention was designed where general practice staff asked their patients if they wished to register as an organ donor. AIM: To assess an organ donation registration intervention for feasibility and acceptability in a UK general practice setting. METHOD: One general practice, in Luton, UK, conducted the intervention for 3 months (April to July 2018). Training was held in March 2018, and leaflets and posters were displayed for the 3-month period. An embedded experimental mixed-methods design was used, with data collected via SystmONE questionnaires, surveys and focus groups. RESULTS: The intervention was found to be feasible and acceptable to conduct with some patients by some staff members. During the 3 months, patients were asked in 12.4% of face-to-face consultations (n=812). Nurses and healthcare assistants were more able to conduct the intervention than doctors. Lack of time, telephone consultations, and it not being appropriate were the most common reasons for not asking. Finally, 244 patients joined the NHS ODR; 30.4% of those asked. CONCLUSION: This study demonstrates that general practice could be a feasible location in which an intervention designed to increase NHS ODR registration could be conducted.
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Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis - protocolIntroduction The need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a lower number of organ donors. Studies have been carried out among people of Indian origin living globally to understand the reasons for the low donation rate, but there has been no systematic review that has integrated all of these studies to synthesise the current literature. Therefore, the purpose of this review is to examine the barriers towards organ donor registration and consent among Indians living globally. Methods and analysis A systematic search will be conducted using the following relevant databases namely CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Grey literature. Studies from 1994 that satisfy our inclusion criteria will be included. Two reviewers will conduct the screening, data extraction and quality assessment of the studies; in event of any disagreement between the two reviewers at any stage, the third reviewer will reconcile any disagreements and consensus will be made. Ethics and dissemination As this study includes only secondary data, ethical approval for secondary data usage has been sought. This study will use Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to report and the study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various non-governmental organisations globally which are working with this particular community; following which further research can be developed based on this evidence and also helps in building a culturally competent strategy. PROSPERO registration number CRD42019155274.
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Improving access to organ donor registration in general practice: a feasibility studyBackground Organ donor registration helps guide decision making for families. UK general practice provides the facility to register on the NHS Organ Donor Register, but only to new patients. An intervention was developed to present a registration opportunity to existing patients in this setting. Aim To assess the feasibility and acceptability of an organ donation intervention implemented in UK general practice. Design and setting The intervention ran in a large practice in Luton in the UK, for 3 months in 2018. A single practice feasibility study was conducted using an embedded experimental mixed methods design. Method Staff were trained to ask patients in consultations if they wished to join the register, and leaflets and posters were displayed in the waiting room. Data on feasibility and acceptability were captured using SystmONE questionnaires, surveys, and focus groups. Results Over 3 months, in 12.4% of face-to-face consultations, patients were asked if they would like to join the register (812 of 6569), and 244 (30.0%) of these patients joined the register. Common reasons staff did not ask patients were due to telephone consultations, lack of time, and it not being appropriate. Nurses and healthcare assistants performed prompted choice more than doctors (23.4%, 17.1%, and 1.6% respectively). Certain clinic types, such as phlebotomy or routine clinics, facilitated asking compared to those where patients presented with unknown or more serious issues. Conclusion The intervention was found to be feasible and acceptable by some staff and patients. Feasibility criteria were met; therefore, the intervention can progress to further testing.
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Knowledge and attitude of healthcare professionals to frailty screening in primary care: a systematic review protocolIntroduction Frailty is an increasingly common condition in which physiological decline as a result of accumulated deficits renders older people more vulnerable to adverse outcomes. An increasing range of frailty screening programmes have been introduced in primary care to identify frail older people in order to deliver appropriate interventions. However, limited information on the knowledge and attitude of healthcare professionals (HCPs) with respect to frailty screening is known. The aim of this systematic review is to provide evidence on the knowledge and attitude of HCP in terms of frailty screening, and potentially identify barriers and facilitators to frailty screening to improve implementation of frailty screening in primary care. Methods/design A systematic review of qualitative research will be conducted. Databases searched will be MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Web of Science from January 2001 to August 2019. Methods will be reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Population, interest, context and study design methodology was used to develop inclusion and exclusion criteria with HCPs as population, frailty screening as interest and knowledge or attitude of HCPs to frailty screening as context. Studies with a qualitative methodology or a mixed-method design where the qualitative component is analysed separately will also be included. Quality appraisal will be carried out using the Joanna Briggs Institute appraisal tool for qualitative studies. Data will be extracted from each selected study with thematic framework analysis used to synthesise findings. Ethics and dissemination This systematic review does not require ethical approval as primary data will not be collected. The findings will be disseminated at conferences and in a relevant academic journal. This review will assist HCPs and relevant stakeholders to tackle the challenges of frailty screening in primary care. PROSPERO registration number CRD42019159007.
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Exploration of mindfulness in relation to compassion, empathy and reflection within nursing educationBackground: This article will look at the viability of the inclusion of mindfulness into the nursing curriculum. In nursing, the environment rarely allows the time for contemplation, though reflection is encouraged specifically in regard to the care we confer on our patients and how that impacts on us professionally. Student nurses are taught to hide their feelings to a point where they cannot find it themselves under their professional armour. Mindfulness is a possible way of bridging this gap. Discussion: Our nursing code is geared to safeguard the patient from any harm as well as our colleagues but little is done or said in support of our own personal psychological or emotional health. The helping professions are restricted by legislation which has had an impact of fostering caution and fearfulness. In using mindfulness it can be seen as a possibility in building a bridge between what actually happens in a nurse's professional life and the possibility of reengaging with that internal emotional space. If student nurses begin to incorporate mindfulness techniques, in reality this should make a difference. This was experienced with students doing these exercises, who reported anecdotally feeling more centred. As they have progressed in the course feedback from the students using the techniques has been positive not only for the students but also for them using the skills in a clinical setting, benefiting patients. Conclusion: Mindfulness has been used as a part of the modality of health care. It is clear that mindfulness is another way of dealing with the stressors of the modern heath service in which the students are being introduced. Incorporating this coping strategy into the curriculum ensures that students will have the tools to deal with the stressors of the course, which in turn will enhance the student experience.
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Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case studyIntroduction: Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. Theory and methods: The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach. Findings: Three themes are presented: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. Discussion and conclusions: A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other’s roles and build relationships and trust.
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Using Twitter™ to drive research impact: a discussion of strategies, opportunities and challengesResearchers have always recognised the importance of disseminating the findings of their work, however, recently the need to proactively plan and drive the impact of those findings on the wider society has become a necessity. Firstly, this is because funders require evidence of return from investment and secondly and crucially because national research assessments are becoming powerful determinants of future funding. In research studies associated with nursing, impact needs to be demonstrated by showing the effect on a range of stakeholders including service users, patients, carers, the nursing workforce and commissioners. Engaging these groups is a well-known challenge influenced by lack of access to academic journals, lack of time to read long complex research papers and lack of opportunities to interact directly with the researchers. This needs to be addressed urgently to enable nursing research to increase the impact that it has on health delivery and the work of clinical practitioners. Social media is potentially a novel way of enabling research teams to both communicate about research as studies progress and to disseminate findings and research funders are increasingly using it to publicise information about research programmes and studies they fund. A search of the healthcare literature reveals that advice and guidance on the use of social media for research studies is not well understood or exploited by the research community. This paper, therefore, explores how using social networking platforms, notably Twitter™ offers potential new ways for communicating research findings, accessing diverse and traditionally hard-to-reach audiences, knowledge exchange at an exponential rate, and enabling new means of capturing and demonstrating research impact. The paper discusses approaches to initiate the setup of social networking platforms in research projects and considers the practical challenges of using Twitter™ in nursing and healthcare research. The discussion is illuminated with examples from our current research. In summary, we suggest that the use of social media micro-blogging platforms is a contemporary, fast, easy and cost effective way to augment existing ways of disseminating research which helps drive impact.
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Acute exposure to a hot ambient temperature reduces energy intake but does not affect gut hormones in men during restThis study examined the effect of ambient temperature on energy intake, perceived appetite and gut hormone responses during rest in men. Thirteen men (age 21.5 (SD 1.4) years; BMI 24.7 (SD 2.2) kg∙m-2) completed three, 5.5-h conditions in different ambient temperatures: i) cold (10˚C), ii) thermoneutral (20˚C), and iii) hot (30˚C). A standardised breakfast was consumed after fasting measures, and an ad libitum lunch provided at 4 to 4.5 h. Blood samples (analysed for plasma acylated ghrelin, total peptide tyrosine-tyrosine (PYY) and total glucagon-like peptide (GLP-1) concentrations), perceived appetite and thermoregulatory responses were collected throughout. Linear mixed models were used for statistical analyses. Ad libitum energy intake was 1243 (SD 1342) kJ higher in 10˚C and 1189 (SD 1219) kJ higher in 20˚C versus 30C (P = 0.002). Plasma acylated ghrelin, total PYY and GLP-1 concentrations did not differ significantly between the conditions (P ≥ 0.303). Sensitivity analyses for the 4-h pre-lunch period showed that perceived overall appetite was lower in both 30˚C and 10C when compared with 20˚C (P ≤ 0.019). In conclusion, acutely resting in a hot compared with a thermoneutral and cold ambient temperature reduced lunchtime ad libitum energy intake in healthy men. Suppressed perceived appetite may have contributed to the reduced energy intake in the hot compared with thermoneutral ambient temperature, whereas gut hormones did not appear to play an important role.
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A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39Abstract: Background: Interprofessional education (IPE) aims to bring together different professionals to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients. Given its potential for improving collaboration and care delivery, there have been repeated calls for the wider-scale implementation of IPE across education and clinical settings. Increasingly, a range of IPE initiatives are being implemented and evaluated which are adding to the growth of evidence for this form of education. Aim: The overall aim of this review is to update a previous BEME review published in 2007. In doing so, this update sought to synthesize the evolving nature of the IPE evidence. Methods: Medline, CINAHL, BEI, and ASSIA were searched from May 2005 to June 2014. Also, journal hand searches were undertaken. All potential abstracts and papers were screened by pairs of reviewers to determine inclusion. All included papers were assessed for methodological quality and those deemed as “high quality” were included. The presage–process–product (3P) model and a modified Kirkpatrick model were employed to analyze and synthesize the included studies. Results: Twenty-five new IPE studies were included in this update. These studies were added to the 21 studies from the previous review to form a complete data set of 46 high-quality IPE studies. In relation to the 3P model, overall the updated review found that most of the presage and process factors identified from the previous review were further supported in the newer studies. In regard to the products (outcomes) reported, the results from this review continue to show far more positive than neutral or mixed outcomes reported in the included studies. Based on the modified Kirkpatrick model, the included studies suggest that learners respond well to IPE, their attitudes and perceptions of one another improve, and they report increases in collaborative knowledge and skills. There is more limited, but growing, evidence related to changes in behavior, organizational practice, and benefits to patients/clients. Conclusions: This updated review found that key context (presage) and process factors reported in the previous review continue to have resonance on the delivery of IPE. In addition, the newer studies have provided further evidence for the effects on IPE related to a number of different outcomes. Based on these conclusions, a series of key implications for the development of IPE are offered.
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Driving anger in Ukraine: appraisals, not trait driving anger, predict anger intensity while drivingTrait driving anger is often, but not always, found to predict both the intensity of anger while driving and subsequent crash-related behaviours. However, a number of studies have not found support for a direct relationship between one's tendency to become angry and anger reported while driving, suggesting that other factors may mediate this relationship. The present self-report study investigated whether, in anger provoking driving situations, the appraisals made by drivers influence the relationship between trait and state anger. A sample of 339 drivers from Ukraine completed the 33-item version of the Driver Anger Scale (DAS; Deffenbacher et al.; 1994) and eight questions about their most recent experience of driving anger. A structural equation model found that the intensity of anger experienced was predicted by the negative evaluations of the situation, which was in turn predicted by trait driving anger. However, trait driving anger itself did not predict anger intensity; supporting the hypothesis that evaluations of the driving situation mediate the relationship between trait and state anger. Further, the unique structure of the DAS required to fit the data from the Ukrainian sample, may indicate that the anger inducing situations in Ukraine are different to those of a more developed country. Future research is needed to investigate driving anger in Ukraine in a broader sample and also to confirm the role of the appraisal process in the development of driving anger in both developed and undeveloped countries.
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A qualitative study of healthcare professionals’ experiences of providing maternity services for Muslim women in the UKBackground: A growing Muslim population in the UK suggests the need for healthcare professionals (HCPs) to gain a better understanding of how the Islamic faith influences health related perceptions and healthcare seeking behaviour. Although some researchers have explored the experiences of Muslim women as recipients of healthcare, little attention has been paid to the challenges HCPs face as service providers on a day-to-day basis whilst caring for Muslim women. The aim of this study was to investigate HPCs lived experiences of providing maternity care for Muslim women. Method: Data was collected through twelve semi-structured one-to-one qualitative interviews with HCPs in a large National Health Service (NHS) maternity unit located in the North West of England. Interview participants included Community and specialist clinic (e.g. clinic for non-English speakers), Midwives in a variety of specialist roles (7), Gynaecology Nurses (2), Breastfeeding Support Workers (2) and a Sonographer (1). The audio-recorded interviews were transcribed and analysed thematically. Results: The majority of participants expressed an understanding of some religious values and practices related to Muslim women, such as fasting the month of Ramadhan and that pregnant and breastfeeding women are exempt from this. However, HCPs articulated the challenges they faced when dealing with certain religious values and practices, and how they tried to respond to Muslim women’s specific needs. Emerging themes included: 1) HCPs perceptions about Muslim women; 2) HCPs understanding and awareness of religious practices; 3) HCPs approaches in addressing and supporting Muslim women’s religious needs; 4) Importance of training in providing culturally and religiously appropriate woman-centred care. Conclusion: Through this study we gained insight into the day-to-day experiences of HCPs providing care provision for Muslim women. HCPs showed an understanding of the importance of religious and cultural practices in addressing the needs of Muslim women as part of their role as maternity care providers. However, they also identified a need to develop training programmes that focus on cultural and religious practices and their impact on women’s health care needs. This will help support HCPs in overcoming the challenges faced when dealing with needs of women from different backgrounds.
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Health impact assessment in Nigeria: an initiative whose time has comeHealth Impact Assessment (HIA) is increasingly applied in many developed countries as a tool for advancing healthy public policy. This research was carried out to obtain a HIA situation report for Nigeria and to assess ways of enhancing the use of HIA to promote healthy public policy. Semi structured questionnaires were administered both online and by hand to health and nonhealth professionals in Nigeria. Inferential statistics was used in the analysis of the 510 responses that were received. Only 29% of the respondents had ever heard about HIA; similarly, only 19.3% of those who were aware of HIA had received any form of HIA training. However, 93.2% of respondents were convinced that HIA would be beneficial to the Nigerian health system. Using the approach of SWOT Analysis to discuss the findings, this research concludes that the time has now come, and the right conditions are in place, for the integration of Health Impact Assessment into public policy in Nigeria. Raising awareness and political commitment are the two major strategies to help drive this agenda forward.
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Designing an experimental and a reference robot to test and evaluate the impact of cultural competence in socially assistive roboticsThe article focusses on the work performed in preparation for an experimental trial aimed at evaluating the impact of a culturally competent robot for care home assistance. Indeed, it has been estabilished that the user's cultural identity plays an important role during the interaction with a robotic system and cultural competence may be one of the key elements for increasing capabilities of socially assistive robots. Specifically, the paper describes part of the work carried out for the definition and implementation of two different robotic systems for the care of older adults: a culturally competent robot, that shows its awareness of the user's cultural identity, and a reference robot, non culturally competent, but with the same functionalities of the former. The design of both robots is here described in detail, together with the key elements that make a socially assistive robot culturally competent, which should be absent in the non-culturally competent counterpart. Examples of the experimental phase of the CARESSES project, with a fictional user are reported, giving a hint of the validness of the proposed approach.
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Do predictors of mental health differ between home and international students studying in the UK?Purpose Previous research has found that international students can experience poor mental health, low levels of life satisfaction, self-esteem and high levels of loneliness when studying in a foreign country. No study has directly compared these between international and home students studying in the UK. The paper aims to discuss these issues. Design/methodology/approach A total of 247 students completed an online survey at the University of Bedfordshire. Findings The hypothesis that international students experience higher loneliness, lower self-esteem, lower life satisfaction and poorer general mental health than home students was rejected. Home students had significantly lower self-esteem, life satisfaction and general mental health scores. Black ethnicity and home student status significantly predicted general mental health and self-esteem in regression analyses. The predictive utility of home student status was maintained when other variables were controlled for in regression models. Originality/value This research suggests that the UK universities should ensure that both home and international students are adequately supported for their mental health.
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The development of a stigma support intervention to improve the mental health of family carers of autistic children: suggestions from the autism communityParents and family carers of autistic children report poorer mental health than any other parents. Stigma surrounding autism plays a significant role in the mental health of family carers of autistic children, often leaving families feeling isolated. Yet there are currently no interventions available to support families with stigma. In order to guide the design and development of an intervention to improve the psychological well-being of parents and carers of autistic children by addressing the stigma they may experience, we surveyed the autism community (n = 112) about their views and suggestions to make such intervention more successful. The thematic analysis of the qualitative responses revealed that respondents wished for public awareness to be raised and suggested that education would be the key to this. Respondents also – recommended that parental self-esteem and self-compassion skills should be increased and that they would benefit from ‘ready-made’
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Impact of Covid-19 on the experiences of parents and family carers of autistic children and young people in the UKA new study led by the Institute of Education at University College London, in collaboration with the University of East London and the University of Bedfordshire, has shed light on the experiences of the parents and carers of autistic children and young people during lockdown in the UK. The findings reveal that many families feel let down by the government and that they have had to face the lockdown tackling new struggles, often with significantly reduced support. However, parents and carers also experienced a number of positives, providing important lessons for support and health services and education providers in the future.
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An economic–business approach to clinical risk managementThis paper introduces risk factors in the field of healthcare and discusses the clinical risks, identification, risk management methods, and tools as well as the analysis of specific situations. Based on documentary analysis, an ecient and coherent methodological choice of an informative and non-interpretative approach, it relies on “unobtrusive” and “non-reactive” information sources, such that the research results are not influenced by the research process itself. To ensure objective and systematical analysis, our research involved three macro-phases: (a) the first involved a skimming (a superficial examination) of the documents collected; (b) the second reading (a thorough examination) allowed a selection of useful information; (c) the third phase involved classification and evaluation of the collected data. This iterative process combined the elements of content and thematic analysis that categorised the information into di erent categories which were related to the central issues for research purposes. Finally, from the perspective of safety analysis and risk management, we suggest that comprehensive control and operation should be conducted in a holistic way, including patient safety, cost consumption, and organizational responsibility. An organizational strategy that revolves around a constant and gradual risk management process is an important factor in clinical governance which focuses on the safety of patients, operators, and organizations.
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Mapping transitional care pathways among young people discharged from adolescent forensic medium secure units in EnglandThis study tracked young offenders transitioning from national adolescent forensic medium secure units to adult services in the UK within a six-month period. We used a mapping exercise to identify eligible participants moving during the study period from all national adolescent forensic medium secure units in England. Young people older than 17.5 years or those who had turned 18 years (transition boundary) and had been referred to adult and community services were included. Of the 34 patients identified, 53% moved to forensic adult inpatient services. Psychosis was the most prevalent symptom among males (29%), and emerging personality disorder symptomatology was commonly reported among females (18%) followed by learning disability (24%). The mean time for transition to adult mental-health services and community settings was eight months. There were no shared transition or discharge policies, and only two hospitals had discharge guidelines. The findings highlight the need for consistency between policy and practice among services along with the development of individualised care pathways. Future qualitative research is needed to understand and reflect on young people's and carers' experiences to improve transition service delivery.
