• Techniques d’évaluation à domicile de la qualité de l’équilibre et de la force de préhension chez la personne âgée en perte d’autonomie ; Devices analysing balance quality and autonomy level

      Michel-Pellegrino, Valerie; Li, Ke; Hewson, David; Hogrel, Jean-Yves; Duchêne, Jacques; Université de technologie de Troyes; Institut de myologie (Elsevier, 2009-11-24)
      Performing a movement from an initial stable posture requires the person to create disequilibrium. The forces of gravity that the person is subjected to would tend to make them fall. To counteract these problems, it is necessary to develop mechanisms of balance in order to move about. The degeneration of mechanisms of balance control has been largely measured in elderly subjects. The balance decline, the appearance of fear of falling, and the resulting loss of autonomy, constitute a major problem for public health. The IDéAS research group (UTT) addresses these critical issues by specialising in the development of innovative devices that enable the capacity of elderly to live autonomous to be evaluated in their own homes. The devices used have been designed in order to perform frequent evaluation of the quality of balance and grip strength. These technologies consist of a balance quality tester and the Grip-ball.
    • Telephone consultations for the management of alcohol-related disorders

      Kazeem, Ayodele; Car, Josip; Pappas, Yannis (Cochrane Collaboration, 2015-11-23)
      This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of telephone consultations for managing patients with alcohol-related disorders across healthcare settings.
    • Theme D: sensors, wearable devices, intelligent networks and smart homecare for health

      Campo, E.; Hewson, David; Gehin, C.; Noury, N.; CNRS; Université de Toulouse; Université de Technologie de Troyes; University of Lyon (Elsevier, 2013-02-11)
      This paper presents the activities of the research group in sensors, wearable devices, intelligent networks and smart homecare for health inside the GdR STIC-Santé. Four research fields are covered: sensors, clothing, housing and networks, to allow better monitoring of health parameters and quality of life. Several events were organized or co-organized during the period 2011–2102. They were devoted to the issue of the autonomy of people with a particular focus on the needs and expectations and also the embedded technologies developed to enable monitoring of health parameters and activities in their living environment. Future projects will try to complete the knowledge of the current work on frailty and the risks incurred, in particular falls, and identify opportunities to share the achievements of the research teams to respond to National or European projects calls.
    • A theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers: an acceptability and feasibility experimental study using mixed methods

      Lim, Rosemary; Courtenay, Molly; Deslandes, Rhian; Farriday, Rebecca; Gillespie, David; Hodson, Karen; Reid, Nicholas; Thomas, Neil; Chater, Angel M.; ; et al. (BMJ, 2019-08-18)
      Introduction: Nurse and pharmacist independent prescribers manage patients with respiratory tract infections and are responsible for around 8% of all primary care antibiotic prescriptions. A range of factors influence the prescribing behaviour of these professionals, however, there are no interventions available specifically to support appropriate antibiotic prescribing behaviour by these groups. The aims of this paper are to describe (1) the development of an intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers and (2) an acceptability and feasibility study designed to test its implementation with these prescribers. METHOD AND ANALYSIS: Development of intervention: a three-stage, eight-step method was used to identify relevant determinants of behaviour change and intervention components based on the Behaviour Change Wheel. The intervention is an online resource comprising underpinning knowledge and an interactive animation with a variety of open and closed questions to assess understanding. Acceptability and feasibility of intervention: nurse and pharmacist prescribers (n=12-15) will use the intervention. Evaluation includes semi-structured interviews to capture information about how the user reacts to the design, delivery and content of the intervention and influences on understanding and engagement, and a pre-post survey to assess participants' perceptions of the impact of the intervention on knowledge, confidence and usefulness in terms of application to practice. Taking an initial inductive approach, data from interview transcripts will be coded and then analysed to derive themes. These themes will then be deductively mapped to the Capability, Opportunity, Motivation-Behaviour model. Descriptive statistics will be used to analyse the survey data, and trends identified.
    • Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurses and pharmacists: intervention development and feasibility study protocol.

      Courtenay, Molly; Lim, Rosemary; Deslandes, Rhian; Ferriday, Rebecca; Gillespie, David; Hodson, Karen; Reid, Nicholas; Thomas, Neil; Chater, Angel M.; Cardiff University; et al. (BMJ, 2019-08-18)
      Introduction Nurse and pharmacist independent prescribers manage patients with respiratory tract infections and are responsible for around 8% of all primary care antibiotic prescriptions. A range of factors influence the prescribing behaviour of these professionals, however, there are no interventions available specifically to support appropriate antibiotic prescribing behaviour by these groups. The aims of this paper are to describe (1) the development of an intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers and (2) an acceptability and feasibility study designed to test its implementation with these prescribers. Method and analysis Development of intervention: a three-stage, eight-step method was used to identify relevant determinants of behaviour change and intervention components based on the Behaviour Change Wheel. The intervention is an online resource comprising underpinning knowledge and an interactive animation with a variety of open and closed questions to assess understanding. Acceptability and feasibility of intervention: nurse and pharmacist prescribers (n=12–15) will use the intervention. Evaluation includes semi-structured interviews to capture information about how the user reacts to the design, delivery and content of the intervention and influences on understanding and engagement, and a pre-post survey to assess participants’ perceptions of the impact of the intervention on knowledge, confidence and usefulness in terms of application to practice. Taking an initial inductive approach, data from interview transcripts will be coded and then analysed to derive themes. These themes will then be deductively mapped to the Capability, Opportunity, Motivation-Behaviour model. Descriptive statistics will be used to analyse the survey data, and trends identified
    • Time, timing, talking and training: findings from an exploratory action research study to improve quality of end of life care for minority ethnic kidney patients

      Wilkinson, Emma; Randhawa, Gurch; Brown, Edwina; Gane, Maria da Silva; Stoves, John; Warwick, Graham; Mir, Tahira; Magee, Regina; Sharman, Sue; Farrington, Ken; et al. (Oxford University Press (OUP), 2017-02-16)
      Background. With an ageing and increasingly diverse population at risk from rising levels of obesity, diabetes and cardiovascular disease, including kidney complications, there is a need to provide quality care at all stages in the care pathway including at the end of life and to all patients. Aim. This study purposively explored South Asian patients’ experiences of kidney end of life care to understand how services can be delivered in a way that meets diverse patient needs. Methods. Within an action research design 14 focus groups (45 care providers) of kidney care providers discussed the recruitment and analysis of individual interviews with 16 South Asian kidney patients (eight men, eight women). Emergent themes from the focus groups were analysed thematically. The research took place at four UK centres providing kidney care to diverse populations: West London, Luton, Leicester and Bradford. Results. Key themes related to time and the timing of discussions about end of life care and the factors that place limitations on patients and providers in talking about end of life care. Lack of time and confidence of nurses in areas of kidney care, individual attitudes and workforce composition influence whether and how patients have access to end of life care through kidney services. Conclusion. Training, team work and time to discuss overarching issues (including timing and communication about end of life) with colleagues could support service providers to facilitate access and delivery of end of life care to this group of patients.
    • Towards the glocalisation of complementary and alternative medicine: homeopathy, acupuncture and traditional Chinese medicine practice and regulation in Brazil and Portugal

      Almeida, Joana; Siegel, Pâmela; de Barros, Nelson Felice (Palgrave Macmillan, 2018-03-27)
      Complementary and alternative medicine (CAM) has been presented in the sociological literature as a global phenomenon. Yet CAM has simultaneously been shaped by different ‘civic epistemologies’, or national cultures, and re-embedded into local contexts. This ‘glocalism’ of CAM, in turn, is a result of intercultural exchanges over time. This chapter compares CAM practice and regulation in two countries with a long-standing relationship—Brazil and Portugal. Homeopathy, acupuncture and traditional Chinese medicine have been chosen as case studies. We show how Brazil and Portugal, despite their participation in CAM’s global culture, have presented differing national projects on the subject, as well as how these projects have resulted from intercultural hybridism over time. This chapter highlights the glocalism and interculturalism of CAM, a perspective largely absent from its sociological analysis to date.
    • Training interventions for improving telephone consultation skills in clinicians (Review)

      Vaona, A.; Pappas, Yannis; Grewal, Rumant S.; Ajaz, Mubasshir; Majeed, Azeem; Car, Josip (John Wiley and Sons Ltd, 2017-01-04)
      Since 1879, the year of the first documented medical telephone consultation, the ability to consult by telephone has become an integral part of modern patient-centred healthcare systems. Nowadays, up to a quarter of all care consultations are conducted by telephone. Studies have quantified the impact of medical telephone consultation on clinicians’ workload and detected the need for quality improvement. While doctors routinely receive training in communication and consultation skills, this does not necessarily include the specificities of telephone communication and consultation. Several studies assessed the short-term effect of interventions aimed at improving clinicians’ telephone consultation skills, but there is no systematic review reporting patient-oriented outcomes or outcomes of interest to clinicians.
    • Triangulation in healthcare research: what does it achieve?

      Regmi, Krishna (Sage, 2014-01-01)
      In 2007 I started my PhD to examine to what extent health sector decentralisation would improve access to and utilisation of health services, and the challenges faced, if any, while accessing the essential health services using a qualitative paradigm within the primary healthcare context in Nepal. I involved a range of qualitative research methods – interviews, discussions and observations with health service users, providers, policy-planners and decision-makers – to capture the wider picture of the research process, content and context. Triangulation was one method used while reviewing, synthesising and interpreting field data. Triangulation has been advocated as a methodological technique not only to enhance the validity of the research findings but also to achieve ‘completeness’ and ‘confirmation’ of data using multiple methods or approaches, so as to minimise one method's weaknesses or challenges by the strengths of other methods. Is that always the case? This case study provides a broad picture considering what triangulation in research really is; what sort of evidence can be used as a basis for practice; why triangulation is important in research and the researching process; and how triangulation would contribute to make research findings ‘convincing’. I draw on my personal, as well as professional, perspectives and experiences.
    • UK Pakistani views on the adverse health risks associated with consanguineous marriages

      Ajaz, Mubasshir; Ali, Nasreen; Randhawa, Gurch; University of Bedfordshire (Springer Verlag, 2015-02-06)
      This is a qualitative study exploring the perceptions of members from the Pakistani/Kashmiri community living in Luton, UK, on the adverse health risks associated with consanguineous marriages. Rates of stillbirths and infant mortality are higher than the national average in Luton and the existing evidence base suggests that these higher rates may be associated with consanguinity (especially first cousin marriages) in highly consanguineous populations, such as the Pakistani/Kashmiri ethnic group. This qualitative study included 9 focus groups and 10 one to one in-depth interviews (n = 58) with members from the Pakistani/Kashmiri community in Luton during 2012. Audio-recorded transcripts were analysed using framework analysis. Emerging themes included a limited knowledge, opposition to evidence and need for a more culturally sensitive health services approach. Findings from the focus group and interview discussions indicated that participants had a limited and varied understanding of genetic risk and indicated a lack of discussion within the community regarding genetic risk. They also opposed evidence that may link consanguineous marriages with infant mortality, stillbirth or genetic disorders that led to disability. The participants stressed the need for culturally sensitive and locally constructed services for information on genetic risk and services. These findings may be used to address higher rates of infant mortality and adverse health impacts associated with higher rates of consanguinity in Luton and elsewhere, through a partnership approach, improve upon current services and develop culturally appropriate services.
    • UK Polish migrant attitudes toward deceased organ donation: findings from a pilot study

      Sharp, Chloe; Randhawa, Gurch (Springer New York LLC, 2014-07-03)
      There is a critical shortage of transplantable organs in the UK. At present, there is no literature on Polish migrants’ (the fastest growing community in the UK) attitudes toward organ donation. This is the first study to explore the views of the Polish community towards organ donation in the UK. There were 31 participants that took part in semi-structured interviews or small focus groups to discuss organ donation for approximately 1½–2 h. Interviews were transcribed and analysed using grounded theory methods to elicit thematic categories and sub-categories. Overall, participants had a positive attitude towards organ donation but demonstrated a lack of knowledge about the organ donation systems and processes in the UK and wanted to learn more about these issues. As little detailed data on ethnicity is collected on the NHS Organ Donor Register and on the active transplant waiting list, it is currently unclear as to how organ donation affects the Polish community living in the UK. However, the findings of the study highlight the Polish community could benefit from tailored education for a clearer understanding of organ donation processes and systems in the UK and registering as an organ donor.
    • Under-mask beard cover (Singh Thattha technique) for donning respirator masks in COVID-19 patient care

      Singh, R.; Safri, H.S.; Singh, S.; Ubhi, B.S.; Singh, G.; Alg, G.S.; Randhawa, Gurch; Gill, S.; Sikh Doctors & Dentists Association; Sikh Doctors Association; et al. (W.B. Saunders Ltd, 2020-10-03)
      Tight-fitting filtering facepiece (FFP3) face masks are essential respiratory protective equipment during aerosol-generating procedures in the coronavirus disease 2019 (COVID-19) environment, and require a fit test to assess mask–face seal competency. Facial hair is considered to be an impediment for achieving a competent seal. We describe an under-mask beard cover called the Singh Thattha technique, which obtained a pass rate of 25/27 (92.6%) by qualitative and 5/5 (100%) by quantitative fit test in full-bearded individuals. Sturdier versions of FFP3 were more effective. For individuals for whom shaving is not possible, the Singh Thattha technique could offer an effective solution to safely don respirator masks.
    • Understanding continuous professional development participation and choice of mid-career general dental practitioners

      Brown, T.; Wassif, Hoda; Health Education Yorkshire and Humber; University of Bedfordshire (Wiley, 2015-12-10)
      Participating in continuing professional development (CPD) activities is a requirement for dental practitioners to keep their skills and knowledge up to date. Understanding the ways dental practitioners engage with professional development and the impact on practice is not fully known (Eaton et al. 2011, http://www.gdc-uk.org/Aboutus/policy/Documents/Impact Of CPD In Dentistry.pdf). The aim of this study was to gain insights into the ways that dentists reflect on their professional development and what may be influencing their choices. Empirical qualitative data were collected by semi-structured interviewing of five mid-career dentists. Using grounded theory, the data were analysed for themes about CPD choice and participation. Three themes were identified as influences to dentists' choices of CPD with pragmatic considerations of how new learning could benefit their patients and their practices. Dental practitioners were influenced by the requirements of external regulatory bodies which they did not consider to necessarily improve practice. Dentists working in primary care in the UK are undertaking CPD which is influenced by the pragmatic requirements of running a small business and to meet regulatory requirements. In this sample, dentists are not critically reflecting on their education needs when choosing their CPD activity. Protected learning time and organisational feedback and support are recommended as a way to promote more meaningful reflection on learning and to improve professional development. OBJECTIVE METHOD RESULTS CONCLUSION
    • Understanding failings in patient safety: lessons from the case of surgeon Ian Paterson

      Milligan, Frank; University of Bedfordshire (RCN Publishing, 2021-06-01)
      While rare, incidents of inappropriate and/or unnecessary surgery do occur, so effective surveillance of surgical practice is required to ensure patient safety. This article explores the case of Ian Paterson, a consultant surgeon who was sentenced to 20 years in prison in 2017 for wounding with intent and unlawful wounding, primarily by undertaking inappropriate or unnecessary mastectomies. The article details the main points of the Paterson case, with reference to the subsequent government-commissioned inquiry and its recommendations. It also outlines various strategies for enhancing patient safety, including applying human factors theory, improving auditing, and rationalising NHS and private healthcare. The author concludes that nurses have a crucial role in the surveillance of surgical practice and that combined reporting of surgeons' practice across NHS and private healthcare organisations is required.
    • Understanding healthcare self-referral in Nigeria from the service users' perspective: a qualitative study of Niger state

      Koce, Francis George; Randhawa, Gurch; Ochieng, Bertha; University of Bedfordshire; De Montfort University (Biomed Central, 2019-04-02)
      Background The by-pass of the primary level of care to the referral facilities has continued to raise concerns for the healthcare delivery system. About 60–90% of patients in Nigeria are reported to self-refer to a referral level of care. Thus, this study sought to identify the factors that influence service-users’ decision to self-refer to the secondary healthcare facilities in Nigeria by exploring the perceptions and experiences of the service-users. Methods Twenty-four self-referred service-users were interviewed from three selected secondary healthcare facilities (general hospitals) in Niger state, Nigeria. The interviews were tape-recorded, each lasting 20 min on average. This was subsequently transcribed and framework analysis was employed for the analysis. Results Various reasons were identified to have resulted in the bypass of the primary healthcare facilities in favour of the secondary level of care. The identified themes were organised based on the predisposing, enabling and need component of Andersen’s model. These themes included: patients understanding of the healthcare delivery system; perceptions about the healthcare providers; perceptions about healthcare equipment/ facilities; advice from relatives and friends; service-users’ expectations; access to healthcare facilities; regulations/ policies; medical symptoms; perceptions of severity of medical symptoms. Conclusions The findings from this study call for an evaluation of the current healthcare referral system, particularly in developing settings like Nigeria and consequently the need for developing a contextual model as applicable to individual settings. Therefore, a multifaceted approach is needed to address the current concerns to ensure patients utilise the appropriate level of care. This will ensure the primary healthcare facilities are not undermined and allow the referral levels of care to live up to their mandate.
    • Understanding physician behaviour in the 6-8 weeks hip check in primary care: a qualitative study using the COM-B

      Chater, Angel M.; Milton, Sarah; Green, Judith; Gilworth, Gill; Roposch, Andreas; ; University of Bedfordshire; King's College London; University College London; Great Ormond Street Hospital for Children (BMJ Publishing Group, 2021-03-19)
      A compulsory hip check is performed on an infant at 6-8 weeks in primary care for the detection of developmental dysplasia of the hip (DDH). Missed diagnoses and infants incorrectly labelled with DDH remain an important problem. The nature of physician behaviour as a likely source of this problem has not been explored. The aims of this study were to make a behavioural diagnosis of general practitioners (GPs) who perform these hip checks, and identify potential behavioural change techniques that could make the hip checks more effective. Qualitative study with in-depth semistructured interviews of 6-8 weeks checks. We used the Capability, Opportunity, Motivation and Behaviour model in making a behavioural diagnosis and elicited factors that can be linked to improving the assessment. Primary care. 17 GPs (15 female) who had between 5 and 34 years of work experience were interviewed. Capability related to knowledge of evidence-based criteria and skill to identify DDH were important behavioural factors. Both physical (clinic time and space) and social (practice norms), opportunity were essential for optimal behaviour. Furthermore, motivation related to the importance of the 6-8 weeks check and confidence to perform the check and refer appropriately were identified in the behavioural diagnosis. Aspects of capability, opportunity and motivation affect GPs' diagnosis and referral behaviours in relation to DDH. The findings from this work extend current knowledge and will inform the development of an intervention aimed at improving the diagnosis of DDH.
    • Understanding the consumption of folic acid during preconception, among Pakistani, Bangladeshi and white British mothers in Luton, UK: a qualitative study

      Garcia, Rebecca; Ali, Nasreen; Griffiths, Malcolm; Randhawa, Gurch; University of Bedfordshire; Luton and Dunstable Hospital (Springer Nature, 2018-06-15)
      To review the similarities and differences in Pakistani, Bangladeshi and White British mothers health beliefs (attitudes, knowledge and perceptions) and health behaviour regarding their consumption of folic acid pre-conception, to reduce the risk of neural tube defects. Our study used a descriptive qualitative research approach, implementing face-to-face focus group discussions with Pakistani, Bangladeshi or White British mothers (normal birth outcomes and mothers with poor birth outcomes) and semi-structured interviews or focus groups with service providers using semi-structured topic guides. This method is well suited for under-researched areas where in-depth information is sought. There were three sample groups: 1. Pakistani, Bangladeshi and White British mothers with normal birth outcomes (delivery after 37 weeks of gestation, in the preceding 6 to 24 months, weighing 2500 g and living within a specified postcode area in Luton, UK). 2. Pakistani Bangladeshi and white British bereaved mothers who had suffered a perinatal mortality (preceding 6 to 24 months, residing within a specificied postcode area). 3 Healthcare professionals working on the local maternity care pathway (i.e. services providing preconception, antenatal, antepartum and postpartum care). Pakistani, Bangladeshi and White British mothers with normal birth outcomes (delivery after 37 weeks of gestation, in the preceding 6 to 24 months, weighing 2500 g and living within a specified postcode area in Luton, UK). Pakistani Bangladeshi and white British bereaved mothers who had suffered a perinatal mortality (preceding 6 to 24 months, residing within a specificied postcode area). Healthcare professionals working on the local maternity care pathway (i.e. services providing preconception, antenatal, antepartum and postpartum care). Transcribed discussions were analysed using the Framework Analysis approach. The majority of mothers in this sample did not understand the benefits or optimal time to take folic acid pre-conception. Conversely, healthcare professionals believed the majority of women did consume folic acid, prior to conception. There is a need to increase public health awareness of the optimal time and subsequent benefits for taking folic acid, to prevent neural tube defects.
    • Understanding the disproportionate effects of COVID-19 on nurses from ethnic minority backgrounds

      Qureshi, Irtiza; Garcia, Rebecca; Ali, Nasreen; Randhawa, Gurch; University of Bedfordshire; Open University (RCN Publishing, 2021-07-12)
      People from ethnic minority backgrounds in the UK have been disproportionately affected by coronavirus disease 2019 (COVID-19), with higher death rates and suboptimal health outcomes compared with those from white ethnic backgrounds. This trend is reflected in healthcare staff from ethnic minority backgrounds, including nurses, who are disproportionately affected by COVID-19 and have higher death rates from the disease. The theory of intersectionality contends that social categorisations such as gender, race and class can contribute to discrimination and result in disadvantages. In this article, the authors outline several intersecting factors that could be contributing to the disproportionate effects of COVID-19 among nurses from ethnic minority backgrounds, as well as making recommendations for further research in this area.
    • Understanding the risk and protective factors associated with obesity amongst Libyan adults - a qualitative study

      Lemamsha, Hamdi Abdulla A.; Papadopoulos, Chris; Randhawa, Gurch; University of Omar Al-Mukhtar; University of Bedfordshire (BMC, 2018-04-13)
      BACKGROUND: There are a range of multifaceted behavioural and societal factors that combine to contribute to the causes of obesity. However, it is not yet known how particularly countries' cultural norms are contributing to the global obesity epidemic. Despite obesity reaching epidemic proportions in Libya, since the discovery of oil in 1959, there is a lack of information about obesity in Libyan adults. This study sought to explore the views of key informants about the risk and protective factors associated with obesity among Libyan men and women. METHODS: A series of qualitative semi-structured interviews were conducted with Libyan healthcare professionals and community leaders. RESULTS: Eleven main themes (risk and protective factors) were identified, specifically: socio-demographic and biological factors, socioeconomic status, unhealthy eating behaviours, knowledge about obesity, social-cultural influences, Libya's healthcare facilities, physical activity and the effect of the neighbourhood environment, sedentary behaviour, Libyan food-subsidy policy, and suggestions for preventing and controlling obesity. CONCLUSIONS: Key recommendations are that an electronic health information system needs to be implemented and awareness about obesity and its causes and consequences needs to be raised among the public in order to dispel the many myths and misconceptions held by Libyans about obesity. The current political instability within Libya is contributing to a less-active lifestyle for the population due to security concerns and the impact of curfews. Our findings have implications for Libyan health policy and highlight the urgent need for action towards mitigating against the obesity epidemic in Libya.