• 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.
    • Understanding the role of primary care in the diabetes care pathway: the views of service providers caring for South Asian populations in the UK

      Wilkinson, Emma; Randhawa, Gurch (2013-09-01)
      Exploring the experiences of service providers who look after South Asian and white European people with diabetes is a necessary step in achieving culturally competent services and in helping to reduce inequalities in outcomes for South Asian people. This qualitative study sought to explore how service providers viewed the progress made in improving access to quality primary care for South Asian and White European people with recently diagnosed diabetes. Service providers were recruited from three UK study sites (Luton, West London and Leicester). A semi-structured qualitative interview was conducted with 14 staff members, and a thematic analysis of the data produced is reported. It was found that services had developed through different approaches at each of the three study sites to improve access for different ethnic groups; however, the role and responsibility of primary care, and in particular GPs, was emphasised. Although national quality improvement initiatives for diabetes have contributed to local service improvements, they have not maximised all opportunities to improve access within primary care. Service provider research can highlight areas that can be developed to improve quality diabetes care across all ethnic groups.
    • Univariate and bivariate empirical mode decomposition for postural stability analysis

      Amoud, Hassan; Snoussi, Hichem; Hewson, David; Duchêne, Jacques; University of Technology of Troyes (Springer, 2008-03-23)
      The aim of this paper was to compare empirical mode decomposition (EMD) and two new extended methods of Open image in new windowEMD named complex empirical mode decomposition (complex-EMD) and bivariate empirical mode decomposition (bivariate-EMD). All methods were used to analyze stabilogram center of pressure (COP) time series. The two new methods are suitable to be applied to complex time series to extract complex intrinsic mode functions (IMFs) before the Hilbert transform is subsequently applied on the IMFs. The trace of the analytic IMF in the complex plane has a circular form, with each IMF having its own rotation frequency. The area of the circle and the average rotation frequency of IMFs represent efficient indicators of the postural stability status of subjects. Experimental results show the effectiveness of these indicators to identify differences in standing posture between groups.
    • User-centered development and testing of a monitoring system that provides feedback regarding physical functioning to elderly people

      Vermeulen, Joan; Neyens, Jacques C.L.; Spreeuwenberg, Marieke D.; van Rossum, Erik; Sipers, Walther; Habets, Herbert; Hewson, David; de Witte, Luc P. (Dove Press, 2013-12-31)
      PURPOSE: To involve elderly people during the development of a mobile interface of a monitoring system that provides feedback to them regarding changes in physical functioning and to test the system in a pilot study. METHODS AND PARTICIPANTS: The iterative user-centered development process consisted of the following phases: (1) selection of user representatives; (2) analysis of users and their context; (3) identification of user requirements; (4) development of the interface; and (5) evaluation of the interface in the lab. Subsequently, the monitoring and feedback system was tested in a pilot study by five patients who were recruited via a geriatric outpatient clinic. Participants used a bathroom scale to monitor weight and balance, and a mobile phone to monitor physical activity on a daily basis for six weeks. Personalized feedback was provided via the interface of the mobile phone. Usability was evaluated on a scale from 1 to 7 using a modified version of the Post-Study System Usability Questionnaire (PSSUQ); higher scores indicated better usability. Interviews were conducted to gain insight into the experiences of the participants with the system. RESULTS: The developed interface uses colors, emoticons, and written and/or spoken text messages to provide daily feedback regarding (changes in) weight, balance, and physical activity. The participants rated the usability of the monitoring and feedback system with a mean score of 5.2 (standard deviation 0.90) on the modified PSSUQ. The interviews revealed that most participants liked using the system and appreciated that it signaled changes in their physical functioning. However, usability was negatively influenced by a few technical errors. CONCLUSION: Involvement of elderly users during the development process resulted in an interface with good usability. However, the technical functioning of the monitoring system needs to be optimized before it can be used to support elderly people in their self-management.
    • Using a blended format (videoconference and face to face) to deliver a group psychosocial intervention to parents of autistic children

      Lodder, Annemarie; Papadopoulos, Chris; Randhawa, Gurch; University of Bedfordshire (Elsevier, 2020-08-26)
      Background Parents and carers of autistic children report poor mental health. Autism stigma is a strong contributing factor to poor parental mental health, yet there are currently no interventions available that are evidenced to improve parents' mental health in part through increasing resilience to stigma. Childcare and travel are well known barriers to attendance and attrition rates for this population are high. Methods A blended format psychosocial group support intervention was developed with the aim to improve parental mental health. Three sessions were delivered face to face, and five sessions via videoconference. A secret Facebook group was set up to support the intervention and increase retention rates. Mixed methods were used to assess the feasibility and acceptability of this mode of delivery for both the facilitator and service users. Attendance rates, fidelity and implementation issues are discussed. A qualitative focus group was conducted (n = 9) to explore the acceptability to the participants. Framework analysis was used to analyse the findings. Results Attendance rates were high with the online sessions having significantly higher attendance rates than the face to face sessions. The findings of the qualitative evaluation suggest that participants are positive about videoconferencing for a group support intervention. The facilitator reported sound quality, background distractions and late arrivals as challenges; the participants on the other hand, reported that the benefits far outweighed the negatives. Suggestions for improvement are made. Conclusions The results suggest that videoconference is a well-received method to provide a group support intervention to parents. Only preliminary conclusions can be drawn, owing to the small sample size.
    • Using patient data for patients' benefit

      Banerjee, Amitava; Mathew, David; Rouane, Katherine; University College London; University of Bedfordshire (BMJ, 2017-09-29)
      Editorial
    • Using Twitter™ to drive research impact: a discussion of strategies, opportunities and challenges

      Schnitzler, Katy; Davies, Nigel; Ross, Fiona; Harris, Ruth; ; Kingston University; University of Bedfordshire; St George's, University of London; Leadership Foundation for Higher Education; King's College London (Elsevier Ltd, 2016-02-16)
      Researchers 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.
    • Validation of a smartphone gait analysis system

      Hammoud, Ali; Duchêne, Jacques; Abou-Ghaida, Hussein; Mottet, Serge; Goujon, Jean-Marc; Hewson, David; University of Technology of Troyes (Springer, 2015-12-31)
      This paper presents a validation study of a smartphone for detection of heel strike and foot flat during gait, in comparison with a validated in-shoe plantar pressure system. The aim of the study is to produce a smartphone gait analysis system that is able to estimate gait parameters in a non-controlled environment such as the home. The smartphone system using the built-in tri-axial accelerometer of the phone, and provides a reliable estimation of the number of steps and the stride-to-stride interval (ISI). Comparison with the results produced by an F-Scan mobile system showed an excellent relationship (R2=0.97). When Detrended Fluctuation Analysis was applied to the ISI calculated for each system, no significant differences were observed for a paired t-test. These findings open the way for other gait features such as gait velocity, walking distance and step length to be calculated using smartphones. Such a technique could be used to detect the loss of complexity in signals due to advanced age or disease in order to assess frailty and risk of falls in the elderly in ecological conditions.
    • Validation of balance-quality assessment using a modified bathroom scale

      Hewson, David; Duchêne, Jacques; Hogrel, Jean-Yves; Université de Technologie de Troyes (Institute of Physics, 2015-01-13)
      The balance quality tester (BQT), based on a standard electronic bathroom scale has been developed in order to assess balance quality. The BQT includes automatic detection of the person to be tested by means of an infrared detector and bluetooth communication capability for remote assessment when linked to a long-distance communication device such as a mobile phone. The BQT was compared to a standard force plate for validity and agreement. The two most widely reported parameters in balance literature, the area of the centre of pressure (COP) displacement and the velocity of the COP displacement, were compared for 12 subjects, each of whom was tested on ten occasions on each of the 2 days. No significant differences were observed between the BQT and the force plate for either of the two parameters. In addition a high level of agreement was observed between both devices. The BQT is a valid device for remote assessment of balance quality, and could provide a useful tool for long-term monitoring of people with balance problems, particularly during home monitoring.
    • Variability of competitive performance of distance runners

      Hopkins, William G.; Hewson, David (Wolters Kluwer, 2001-09-30)
      PURPOSE: The typical variation in an athlete's performance from race to race sets a benchmark for assessing the utility of performance tests and the magnitude of factors affecting medal prospects. We report here the typical variation in competitive performance of endurance runners. METHODS: Repeated-measures analysis of log-transformed official race times provided the typical within-athlete variation in performance as coefficients of variation (CV). The types of race were cross-country runs (4 races over 9 wk), summer road runs (5 races over 4 wk), winter road runs (4 races over 9 wk), half marathons (3 races over 13 wk and 2 races over 22 wk), and marathons (2 races over 22 wk). RESULTS: Typical variation of times for the fastest quartile of male runners was 1.2-1.9% in the cross-country and road runs, 2.7% and 4.2% in half marathons, and 2.6% in marathons. Times for the slower half of runners in most events were more variable than those of the faster half (ratio of slower/faster CV, 1.0-2.3). Times of younger adult runners were more variable than times of older runners (ratio of younger/older CV, 1.1-1.8). Times of male runners were generally more variable than those of female runners (ratio of male/female CV, 0.9-1.7). CONCLUSION: Tests of endurance power suitable for assessing the smallest worthwhile changes in running performance for top runners need CV < or = 2.5% and < or = 1.5% for tests simulating half or full marathons and shorter running races, respectively. Most of the differences in variability of race times between types of race, ability groups, age groups, and sexes probably arise from differences in competitive experience and attitude toward competing.