• Knowledge and attitude of healthcare professionals to frailty screening in primary care: a systematic review protocol

      Okpechi, Ijeoma; Randhawa, Gurch; Hewson, David; University of Bedfordshire (BMJ Publishing Group, 2020-07-02)
      Introduction 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.
    • Knowledge and practice of organ donation among police personnel in Tamil Nadu: a cross-sectional study

      Thyagarajan, Ishwarya; Shroff, Sunil; Vincent, Britzer Paul; Rajendran, Juhija; Kanvinde, Hemal; Shankar, Siva; Aneesh, Kavitha; MOHAN Foundation; Madras Medical Mission Hospital; University of Bedfordshire (Wolters Kluwer Medknow Publications, 2020-07-06)
      Context: Police officers are one of the key stakeholders involved in the process of deceased organ donation. In India, as road traffic accidents account for the majority of brain deaths, the police play an important role to ensure legal and ethical practices of organ donation. In many instances, the undue delays in the inquest and postmortem lead to difficulties in completing the donation and also cause distress among the family members who have said yes to organ donation despite their grief. Aim: This study aims to assess the police officers' knowledge of the organ donation process and their practice toward it. Design and Subjects and Methods: This cross-sectional survey was conducted among 627 police officers in the state of Tamil Nadu in India within a period of 18 months. A structured questionnaire with multiple choice questions was used. Microsoft Excel and SPSS version 21 were used to compile and statistically analyze the data collected. The knowledge level and willingness of the officers to follow certain practices were analyzed. Results: It was found that 95.5% of the participants were aware of organ donation. Further analysis revealed that 86.6% of the police personnel were aware of brain death, but only 35.6% were aware of the transplant law, 12.1% knew about the green corridor, and 20.7% about the donor card. Very few participants (9.6%) had experience in processing brain deaths and organ donation cases. Knowledge about postmortem formalities and inquest protocols was unsatisfactory. A significant association between work experience and the knowledge and awareness about organ donation was noted. Conclusions: Including modules on organ donation awareness, transplant law, and hospital protocols in the training syllabus for the recruited personnel, followed by regular refresher courses on the subject, would be the key to enhance the knowledge and work practices of this important group to help ease pain points in the medicolegal cases where organ donation consent is provided by the relatives. A change in the attitude of police officers while handling organ donation cases would have an overall positive impact on the program.
    • Knowledge, attitudes, and behavior of Nigerian students toward organ donation

      Ibrahim, Musa Saulawa; Randhawa, Gurch; University of Bedfordshire (Elsevier, 2017-09-18)
      The Nigerian transplantation program is evolving but is currently over-reliant on living donors. If deceased donation is to be viable in Nigeria, it is important to ascertain the views of the public. The objective of the study was to explore the knowledge, attitudes, and behavior of Nigerian international students toward organ donation. A cross-sectional study was conducted among Nigerian international students of the University of Bedfordshire through the use of a modified self-administered questionnaire. The participants were recruited by means of purposive sampling. Of the 110 questionnaires distributed, 103 were returned fully completed (response rate = 93.6%). A significant majority (93.2%) of the participants are aware of organ donation, and 76.7% have a good knowledge on the subject. Furthermore, more than half (52.8%) of the participants have a positive attitude toward organ donation, and less than half (42.8%) have favorable behavior toward it. Higher knowledge does not correlate to either positive attitude or behavior, but a positive attitude is correlated with favorable behavior toward donation. The attitudes and behavior of the respondents toward organ donation is not commensurate with the level of knowledge they possess. This highlights the urgent need for well-structured educational programs on deceased organ donation. BACKGROUND METHODS RESULTS CONCLUSIONS
    • Lessons learned from recruiting nursing homes to a quantitative cross-sectional pilot study

      Tzouvara, Vasiliki; Papadopoulos, Chris; Randhawa, Gurch; King’s College London; University of Bedfordshire (RCN Publishing, 2016-03-21)
      Recruitment strategies Previous Next Lessons learned from recruiting nursing homes to a quantitative cross-sectional pilot study Vasiliki Tzouvara Research associate, Florence Nightingale School of Nursing and Midwifery, King’s College London, UK Chris Papadopoulos Senior lecturer, Institute for Health Research, University of Bedfordshire, Luton, UK Gurch Randhawa Professor of diversity in public health, Institute for Health Research, University of Bedfordshire, Luton, UK Background A growing older adult population is leading to increased admission rates to long-term care facilities such as nursing homes and residential care homes. Assisted healthcare services should be flexible, integrated, and responsive to older adults’ needs. However, there is a limited body of empirical evidence because of the recruitment challenges in these settings. Aim To describe the barriers and challenges faced in recruiting to a recent pilot study, consider previously implemented and proposed recruitment strategies, and propose a new multi-method approach to maximising recruitment of care homes. Discussion The proposed multi-method approach harnesses key recruitment strategies previously highlighted as effective in navigating the many challenges and barriers that are likely to be encountered, such as mistrust, scepticism and concerns about disruption to routines. This includes making strategic use of existing personal and professional connections within the research team, engaging with care homes that have previously engaged with the research process, forming relationships of trust, and employing a range of incentives. Conclusion Implementing carefully planned recruitment strategies is likely to improve relationships between nursing homes and researchers. As a consequence, recruitment can be augmented which can enable the production of rigorous evidence required for achieving effective nursing practice and patient wellbeing.
    • Life after prostate cancer: a systematic literature review and thematic synthesis of the post-treatment experiences of Black African and Black Caribbean men

      Bamidele, Olufikayo; McGarvey, Helen E.; Lagan, Briege M.; Ali, Nasreen; Chinegwundoh, Frank; Parahoo, K.; McCaughan, Ellis (Wiley, 2017-10-16)
      Evidence shows that there are significant ethnic variations in prostate cancer prevalence and outcomes. Specifically, Black African and Black Caribbean men may encounter different post-treatment experiences than Caucasian men due to their disproportionately higher risk of being diagnosed with advanced prostate cancer. But to date, no review of these experiences has been undertaken. This review synthesised findings from existing literature on the post-treatment experiences of Black African and Black Caribbean men with prostate cancer and identified pertinent issues which may be useful to inform practice and future research. Seven databases were systematically searched using developed search terms. Four qualitative studies were identified and critically appraised. Findings are summarised under four main themes: symptom experience, healthcare experience, marital and social relationships and coping strategies. Cultural definitions of masculinity influenced the meanings men gave to their post-treatment experiences. While men's experiences of healthcare varied, the provision of professional support to address their post-treatment distress was lacking. Men derived most support from wives, peers and church communities. A culturally sensitive approach which recognises diversity among Black African and Black Caribbean populations and treats individuals within their religious and socio-cultural contexts could potentially improve men's post-treatment experiences. Areas for further research were also identified.
    • Loneliness and self-stigma among older adults with mental health problems in care homes

      Tzouvara, Vasiliki; Papadopoulos, Chris; Randhawa, Gurch (2016-10-06)
    • Longitudinal evaluation of balance quality using a modified bathroom scale: usability and acceptability

      Duchêne, Jacques; Hewson, David (SAGE, 2011-12-31)
      We adapted a commercial bathroom scale in order to acquire the raw data from the weight sensors and then to send them to a server via a mobile phone. We investigated the usability and acceptability of the device in a long-term experiment with 22 elderly users that produced more than 5000 weight recordings. Four basic variables were extracted from the vertical force measurements and the stabilogram. The technology was accepted unreservedly, presumably because it did not differ from devices usually encountered in the home. The quantitative results showed a high variability of day-to-day measurement, which was countered by taking a moving average. A balance index was able to identify changes in balance over time. The preliminary results appear promising.
    • Mapping transitional care pathways among young people discharged from adolescent forensic medium secure units in England

      Livanou, Maria; Singh, Swaran P.; Liapi, Fani; Furtado, Vivek; ; Kingston University; University of Warwick; Birmingham and Solihull Mental Health NHS Foundation Trust; Birmingham and Solihull Mental Health NHS Foundation Trust; University of Bedfordshire (SAGE, 2019-11-10)
      This 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.
    • Mass-gathering events: the role of advanced nurse practitioners in reducing referrals to local health care agencies

      Kemp, Anthony (Cambridge University Press, 2016-01-06)
      Introduction The introduction of advanced practitioner roles has challenged the traditional boundaries of health care. While studies have been undertaken to understand the role of physicians in respect of mass-gathering medicine, the role of advanced nurse practitioners (ANPs) has not been investigated. Problem Does the presence of an ANP reduce the referral rates of patients presenting for medical care at mass-gathering events to external health care resources? Methods A prospective observational study was undertaken to determine whether the presence of an ANP would reduce the patient referral rate to external health care services by first aiders and paramedics working within an event medical team. Patients identified as requiring referral were reviewed by an ANP as part of the on-site medical provision for four mass-gathering events in the south of England. Additionally, information was gathered identifying which patients would have been transported to hospital by ambulance compared to those actually transported following ANP review. Statistical analysis was undertaken for three key measures (referrals to all local health resources, referrals to hospital-based acute services, and transfers to hospital by ambulance). Results A rounded total of 842,000 people attended four mass-gathering events held over 14 days. Of these, 652 presented for medical care, many self-referring. Using a one-tailed Fisher’s Exact Test and Phi analysis, this study demonstrated statistically significant reductions in the overall referral of patients to all external health care resources (P<.001; φ=0.44), to the emergency department (ED; P<.001; φ=0.43), and a reduction in ambulance transport (P<.001; φ=0.42). Effect size analysis demonstrated a medium-sized effect evident for all of the above, which was also demonstrated in economic terms. The event medical team would have referred 105 (16.3%) of the 652 patient presentations to external health care services; 47 (7.2%) would have been transported by ambulance. In comparison, the ANP referred 23 patients (3.5%) with 11 (1.7%) being transported by ambulance. It also was noted that the first aiders and paramedics could be more selective in their referral habits that were focused primarily on the ED. Conclusions Appropriately trained and experienced ANPs working within event medical teams have a positive impact on referral rates from mass-gathering events.
    • Maternal and perinatal risk factors for childhood cancer: record linkage study

      Bhattacharya, Sohinee; Beasley, Marcus; Pang, Dong; Macfarlane, Gary J.; University of Aberdeen; University of Bedfordshire (BMJ, 2014-01-06)
      Objective To investigate maternal and perinatal risk factors for childhood cancer. Study design Case–control analysis of linked records from the Aberdeen Maternity and Neonatal Databank with the Scottish Cancer Registry and the General Registry of Births and Deaths in Scotland was carried out. Setting Aberdeen, Scotland. Participants Cases (n=176) comprised children diagnosed with cancer under 15 years or recorded as having died of cancer. Four controls per case were matched by age and gender. Risk factors tested Maternal age, body mass index, social class, marital status and smoking as well as pre-eclampsia, antepartum haemorrhage and previous miscarriage, gestational age, birth weight and Apgar scores were compared between groups to test for association with cancer. ORs with 95% CIs were calculated using conditional logistic regression in univariable and multivariable models. Results Of the maternal characteristics tested, mother's age at delivery (cases mean 28.9 (SD 5.6) years vs controls mean 30.2 (SD 4.6), p=0.002) and smoking status (38.6% smokers among cases, 29.7% among controls, p=0.034) were found to be different between groups. Of the perinatal factors tested, low Apgar score at 5 min (adjusted OR (AOR) 4.59, 95% CI 1.52 to 13.87) and delivery by caesarean section (AOR 1.95, 95% CI 1.30 to 2.92) showed statistically significant associations with childhood cancer in the multivariable model. Conclusions Younger maternal age, maternal smoking, delivery by caesarean section and low Apgar score at 5 min were independently associated with increased risk of childhood cancer. These general findings should be interpreted with caution as this study did not have the power to detect any association with individual diagnostic categories of childhood cancer. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
    • Maternity care experiences of ethnic minority women born in the United Kingdom: perceptions of mothers and health care providers

      Puthussery, Shuby; Twamley, Katherine; Macfarlane, Alison; Harding, Seeromanie (Oxford University Press (OUP), 2006-12-31)
    • Me, my, more, must: a values-based model of reflection

      Wareing, Mark; University of Bedfordshire (Taylor and Francis, 2017-01-05)
      This paper will describe the theoretical and conceptual framework that underpins a new model of reflection designed for health and social care students in practice-based learning settings and qualified professionals engaged in work-based learning. The Me, My, More, Must approach has been designed to help learners consider who they are and what impact their values might have before a description of the particular experience, situation or incident. The paper outlines the influence of movements that have emerged to support the adoption of values-based approaches to clinical practice and the development of values-based reflection. A values-based approach to the delivery of healthcare has emerged in response to several high-profile ‘moral catastrophes’, such as the public inquiry led by Sir Robert Francis QC which described poor standards of care at Stafford Hospital;and the abuse inflicted on residents at the Winterbourne View unit. Re-conceptualisations of the purpose of reflection and initiatives such as the 6Cs (compassion, caring, communication, competence, courage and commitment) are influencing a post-Francis era where values are not only determining selection and recruitment of students and staff,but the nature of practice through the emergence of values-based reflection.
    • Measurement of patella displacement

      Moss, Richard A. (Centor Publishing Ltd, 2009-10-01)
      The article focuses on the establishment and effectiveness of ultrasonography in measuring patella displacement. Ultrasound scanning was first created in 1958 and became the most notable diagnostic technique in sports medicine. Experts say that the technique offers an effective tool to assess patella position. It acknowledges that ultrasonography is still out of reach to many therapists, therefore many of them used simple taping measurements in measuring sports related injuries.
    • Measuring grip strength in older adults: comparing the grip-ball with the Jamar dynamometer

      Vermeulen, Joan; Neyens, Jacques C.L.; Spreeuwenberg, Marieke D.; van Rossum, Erik; Hewson, David; de Witte, Luc P. (Wolters Kluwer, 2015-12-31)
      Decreased grip strength is a predictor of adverse outcomes in older adults. A Grip-ball was developed that can be used for home-based self-monitoring of grip strength to detect decline at an early stage. The purpose of this study was to evaluate the reliability and validity of measurements obtained with the Grip-ball in older adults. Forty nursing home patients and 59 community-dwelling older adults 60 years or older were invited to participate in this study. Grip strength in both hands was measured 3 consecutive times during a single visit using the Grip-ball and the Jamar dynamometer. Test-retest reliability was described using intraclass correlation coefficients. Concurrent validity was evaluated by calculating Pearson correlations between the mean Grip-ball and Jamar dynamometer measurements and between the highest measurements out of 3 trials. Known-groups validity was studied using t tests. Eighty eight participants (33 men) with a mean age of 75 (SD = 6.8) years were included. Intraclass correlation coefficients for the Grip-ball were 0.97 and 0.96 for the left and right hands, respectively (P < .001), and those for the Jamar dynamometer were 0.97 and 0.98 for the left and right hands, respectively (P < .001). Pearson correlations between the mean scores of the Grip-ball and the Jamar dynamometer were 0.71 (P < .001) and 0.76 (P < .001) for the left and right hands, respectively. Pearson correlations between the highest scores out of 3 trials were 0.69 (P < .001) and 0.78 (P < .001) for the left and right hands, respectively. The t tests revealed that both the Grip-ball and the Jamar dynamometer detected grip strength differences between men and women but not between nursing home patients and community-dwelling older adults. Grip-ball measurements did not confirm higher grip strength of the dominant hand whereas the Jamar dynamometer did. The Grip-ball provides reliable grip strength estimates in older adults. Correlations found between the Grip-ball and Jamar dynamometer measurements suggest acceptable concurrent validity. The Grip-ball seems capable of detecting "larger" grip strength differences but might have difficulty detecting "smaller" differences that were detected by the Jamar dynamometer. The Grip-ball could be used in practice to enable home-based self-monitoring of grip strength in older adults. However, for implementation of the Grip-ball as a screening and monitoring device in practice, it is important to gain insight into intersession reliability during home-based use of the Grip-ball and clinical relevance of changes in grip strength. BACKGROUND AND PURPOSE METHODS RESULTS CONCLUSIONS
    • Meeting the challenge of diabetes in ageing and diverse populations: a review of the literature from the UK

      Wilkinson, Emma; Waqar, Muhammad; Sinclair, Alan J.; Randhawa, Gurch; University of Bedfordshire; Foundation for Diabetes Research in Older People (Hindawi Publishing Corporation, 2016-10-17)
      The impact of type 2 diabetes on ageing societies is great and populations across the globe are becoming more diverse. Complications of diabetes unequally affect particular groups in the UK older people, and people with a South Asian background are two population groups with increased risk whose numbers will grow in the future. We explored the evidence about diabetes care for older people with South Asian ethnicity to understand the contexts and mechanisms behind interventions to reduce inequalities. We used a realist approach to review the literature, mapped the main areas where relevant evidence exists, and explored the concepts and mechanisms which underpinned interventions. From this we constructed a theoretical framework for a programme of research and put forward suggestions for what our analysis might mean to providers, researchers, and policy makers. Broad themes of cultural competency; comorbidities and stratification; and access emerged as mid-level mechanisms which have individualised, culturally intelligent, and ethical care at their heart and through which inequalities can be addressed. These provide a theoretical framework for future research to advance knowledge about concordance; culturally meaningful measures of depression and cognitive impairment; and care planning in different contexts which support effective diabetes care for aging and diverse populations.
    • The mental health of sexually trafficked survivors in Nepal

      Rimal, Retina; Papadopoulos, Chris (SAGE, 2016-06-03)
      Background: Despite further recent research into the consequences associated with human sex trafficking, scant evidence associated with the mental health outcomes among victims of sex trafficking remains, including within Nepal where trafficking continues to be a growing problem. Aim: To investigate the prevalence and explanatory factors of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms among female survivors being housed and supported by two non-governmental organisations (NGOs) in Nepal. Methods: A total of 66 female sex trafficking survivors being housed by two NGOs were purposively sampled. Anxiety and depression symptomatology were measured using the Hopkins Symptoms Checklist–25 instrument and PTSD symptomatology was measured using the PTSD Checklist–Civilian Version. Results: In all, 87%, 85.5% and 29.7% of the sample scored above anxiety, depression and PTSD thresholds, respectively. HIV-positive status and length of workday during trafficking period significantly associated with at least one outcome measure. Conclusion: The results contribute further evidence of how damaging sex trafficking can be to victims, particularly in terms of being at risk of clinical depression and/or anxiety. Continued efforts to prevent trafficking from occurring as well as effective, timely intervention for survivors are needed.
    • Methodological and practical viewpoints of qualitative-driven mixed method design: The case of decentralisation of primary healthcare services in Nepal

      Regmi, Krishna (Cambridge University Press, 2017-09-11)
      Background Although considerable attention has been paid to the use of quantitative methods in health research, there has been limited focus on decentralisation research using a qualitative-driven mixed method design. Decentralisation presents both a problematic concept and methodological challenges, and is more context-specific and is often multi-dimensional. Researchers often consider using more than one method design when researching phenomena is complex in nature. Aim To explore the effects of decentralisation on the provision of primary healthcare services. Methods Qualitative-driven mixed method design, employing three methods of data collections: focus group discussions (FGDs), semi-structured interviews (SSIs) and participant observations under two components, that is, core component and supplementary components were used. Four FGDs with health service practitioners, three FGDs with district stakeholders, 20 SSIs with health service users and 20 SSIs with national stakeholders were carried out. These were conducted sequentially. NVivo10, a data management program, was utilised to code the field data, employing a content analysis method for searching the underlying themes or concepts in the text material. Findings Both positive and negative experiences related to access, quality, planning, supplies, coordination and supervision were identified. Conclusion This study suggests some evidence of the effects of decentralisation on health outcomes in general, as well as filling a gap of understanding and examining healthcare through a qualitative-driven mixed methods approach, in particular. Future research in the area of qualitative in-depth understanding of the problems (why decentralisation, why now and what for) would provoke an important data set that benefits the researchers and policy-makers for planning and implementing effective health services.
    • A mixed methods evaluation of the Northwest London Integrated Care Pilot

      Harris, Matthew; Pappas, Yannis; Mastellos, Nikolas; Soljak, Michael; Gunn, Laura H.; Cecil, Elizabeth; Greaves, Felix; Car, Josip; Majeed, Azeem; Imperial College London; et al. (Ubiquity Press, 2016-12-16)
    • Mobile phone involvement, beliefs, and texting while driving in Ukraine

      Hill, Tetiana; Sullman, M.J.M.; Stephens, A.; University of Bedfordshire; University of Nicosia; Monash University (Elsevier Ltd, 2019-02-08)
      There is extensive evidence that using a mobile phone whilst driving is one of the biggest contributors to driver distraction, which in turn increases the risk of motor vehicle collisions. Whilst most of the developed countries have been trying to deter this behaviour through legislation, enforcement and educational campaigns, in Ukraine, where the road fatality rate is the highest in Europe, this issue has only recently become publicised. The present study examined psychological factors that are associated with hand-held mobile phone use while driving among a sample of Ukrainian drivers, in particular writing or reading a text message while driving. This included drivers’ behavioural, normative, and control beliefs relating to mobile phone use while driving, as well as the degree to which using a mobile phone is integral to one's everyday life (measured using the Mobile Phone Involvement Questionnaire; MPIQ). Almost one quarter to one third of the sample reported using their phone on a daily basis to write (22.2%) or read (38.2%) text messages while driving. A binary logistic regression showed that gender, higher MPIQ scores, perceived approval from family members, lower perceived likelihood of receiving traffic fines and less demanding traffic conditions were all significantly associated with mobile phone use while driving. These results suggest that dependence upon a mobile phone in everyday life may be an important factor to consider when developing interventions to reduce hand-held mobile phone use while driving.