• Management and outcomes of the small pupil in cataract surgery: iris hooks, Malyugin ring or phenylephrine?

      Balal, Shafi; Jbari, Ahmed Said; Cook, Erica Jane; Akhtar, Wasim Akhtar; Din, Nizar; Sharma, Anant; Nitiahpapand, Rynda; Moorfields Eye Clinic at Bedford Hospital; Royal Free NHS Foundation Trust; University of Bedfordshire; et al. (Springer Nature, 2021-11-12)
      Purpose To investigate outcomes for small versus large pupils in cataract surgery using different pupil expansion techniques. Methods Retrospective case-series reviewing 20,175 patients’ cataract surgery electronic medical records at Moorfields Eye Clinic in Bedford Hospital NHS Trust from January 2010 to April 2020. Outcomes such as visual acuity (VA), intraocular pressure, intraoperative, post-operative complications were recorded and small pupil expansion device outcome. Results One thousand, four hundred twenty-six patients were identified as having small pupil (SP). Of these, 1110 patients (77.8%) had interventions to expand the pupil including 447 (31.3%) with intracameral phenylephrine (IC PE) alone, 194 (13.6%) with iris hooks and 469 (32.9%) with a Malyugin ring. The large pupil (LP) group had a statistically significant greater gain in VA than the SP group (p < 0.05). SPs had a significantly higher rate of intraocular complications including posterior capsular rupture (PCR) with vitreous loss (OR 2.75, p < 0.001). There was also a significantly higher rate of post-operative complications such as corneal oedema (OR 2.64, p < 0.001) and anterior uveitis (OR 2.11, p < 0.001) in the SP group. However, VA improvement and complications between the different pupil expansion groups showed no significant differences (p > 0.05) except for a greater rate of iris tears in the Malyugin group (p < 0.05). Conclusion To date, this is the largest reported case-series comparing Malyugin rings and iris hooks with other pupil expansion techniques. The various techniques to expand pupil size appear to be safe and equally effective in improving VA with a similar rate of complications except for a greater rate of iris tears with Malyugin ring.
    • 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.
    • Mentoring at times of crises: personal reflections on mentoring relationships during COVID-19

      Wassif, Hoda; Wake, Charlotte; University of Bedfordshire (Wiley, 2022-05-06)
      COVID-19 presented a huge challenge for practice, education and all interactions, and mentorship was no different. The purpose of this commentary is to reflect on the juxtaposition between mentors and mentees in dental education during COVID-19. This commentary will focus on the interaction between mentor/mentee outside clinical practice and in relation to supporting and mentoring dental practitioners in the context of postgraduate education. The aim is to share our learning from this experience with other dental educators beyond COVID-19.
    • 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.
    • Modified bathroom scale and balance assessment: a comparison with clinical tests

      Duchêne, Jacques; Hewson, David; Rumeau, Pierre; University of Technology of Troyes; University of Bedfordshire; Gérontopôle (Springer, 2016-04-18)
      Frailty and detection of fall risk are major issues in preventive gerontology. A simple tool frequently used in daily life, a bathroom scale (balance quality tester: BQT), was modified to obtain information on the balance of 84 outpatients consulting at a geriatric clinic. The results computed from the BQT were compared to the values of three geriatric tests that are widely used either to detect a fall risk or frailty (timed get up and go: TUG; 10 m walking speed: WS; walking time: WT; one-leg stand: OS). The BQT calculates four parameters that are then scored and weighted, thus creating an overall indicator of balance quality. Raw data, partial scores and the global score were compared with the results of the three geriatric tests. The WT values had the highest correlation with BQT raw data (r = 0.55), while TUG (r = 0.53) and WS (r = 0.56) had the highest correlation with BQT partial scores. ROC curves for OS cut-off values (4 and 5 s) were produced, with the best results obtained for a 5 s cut-off, both with the partial scores combined using Fisher's combination (specificity 85 %: <0.11, sensitivity 85 %: >0.48), and with the empirical score (specificity 85 %: <7, sensitivity 85 %: >8). A BQT empirical score of less than seven can detect fall risk in a community dwelling population.
    • A narrative review of the theoretical foundations of loneliness

      Tzouvara, Vasiliki; Papadopoulos, Chris; Randhawa, Gurch; University of Bedfordshire (Mark Allen Group, 2015-07-01)
      Loneliness has been found to relate to a wide range of harmful health outcomes. The adverse effects of loneliness upon people’s lives emphasise the importance of understanding its nature and process. A number of theoretical and conceptual foundations have been proposed by scholars and are discussed and reflected upon in this article. The discussion and understanding of loneliness theoretical foundations provide useful insights toward the interpretation of its occurrence.
    • National survey of commissioners' and service planners' views of public health nursing in the UK

      Davies, Nigel; Donovan, Helen; University of Bedfordshire; Royal College of Nursing (Elsevier B.V., 2016-10-27)
      Improving public health is a key policy area both in the United Kingdom (UK) and internationally. The governments across the four UK countries each have specific strategies to guide improvements in public health services, promote greater emphasis on how people can best be helped to live healthier lives and to help address the unprecedented challenges of both an increasing population and financial austerity. Nurses are often ideally suited and uniquely placed to respond to public health challenges as they understand the particular risks of individuals but also know the population and the communities they work in. Traditionally in the UK public health nurses have been seen as those in specialist community roles such as health visitors, school nurses and occupational health nurses and in some cases specialist practitioners. However, there is an increasing need for all nurses to embrace the contribution they can have to make every contact count. During 2015 the Royal College of Nursing in the UK (RCN) undertook a programme of work building on a previous project2 to showcase public health nursing (see www.nurses4PH.org.uk). As part of this wider RCN programme, a survey was conducted to explore the views of commissioners and others involved in designing and planning public health services about the nursing and midwifery contribution to public health. The aims were to explore the perceived value of nursing in public health, to better understand the roles of nurses and midwives in public health, how these roles were valued, and what and where the gaps were in public health nursing knowledge and education.
    • Negotiating difference and belonging in families from mixed racial, ethnic and faith backgrounds in Britain: Implications for mental health

      Puthussery, Shuby; Caballero, Chamion; Edwards, Rosalind (Oxford University Press, 2008-09-30)
      Poster presentations: abstracts Key points * Mixed-parent couples in Britain were often in sustained relationships, and a high proportion were middle class. * The couples interviewed used three typical approaches to instil a sense of belonging in their children; particular approaches were not associated with particular racial or faith combinations: o Individual: children's sense of belonging was not seen as rooted in their mixed background. o Mix: children's mixed background was understood as a factual part of their identity; all aspects were emphasised. o Single: one aspect of children's mixed background was stressed. * Couples whose approach differed in giving their children a sense of belonging were not necessarily in conflict. For some, divergent approaches were complementary. Others saw difficulties between them as humanistic, political or personality choices. * Parents identified supportive or constraining resources and relationships in creating a sense of belonging, including neighbourhoods, schools, travel, languages, grandparents and children themselves. What some regarded as supportive, others saw as drawbacks. * Mixed-parent couples can be more concerned with other issues, such as children's safety and health, unity over discipline and financial security. * The researchers conclude that it is important that family support, health, education and social services do not make assumptions about mixed families. Families who seem to share a form of mixing can differ from each other. 'Mixedness' may be insignificant for some, compared to other issues. Mixed families would benefit from policies and practice that further tackle prejudice based on race and faith.
    • Nonlinear chaotic component extraction for postural stability analysis

      Snoussi, Hichem; Hewson, David; Duchêne, Jacques (IEEE, 2009-11-13)
      This paper proposes a nonlinear analysis of the human postural steadiness system. The analyzed signal is the displacement of the centre of pressure (COP) collected from a force plate used for measuring postural sway. Instead of analyzing the classical nonlinear parameters on the whole signal, the proposed method consists of analyzing the nonlinear dynamics of the intrinsic mode functions (IMF) of the COP signal. Based on the computation of the IMFs Lyapunov exponents, it is shown that pre-processing the COP signal with the Empirical Mode Decomposition allows an efficient extraction of its chaotic component.