• Wardopoly: game-based experiential learning in nurse education

      Henderson, Bernadette; Kofinas, Alexander K.; Clements, Andrew James; Webb, Melanie; James, Alison; Nerantzi, Chrissi; University of Bedfordshire; University of Winchester; Manchester Metropolitan University (Palgrave Macmillan, 2019-03-27)
    • Wavelet transform analysis of the power spectrum of centre of pressure signals to detect the critical point interval of postural control

      Singh, Neeraj Kumar; Snoussi, Hichem; Hewson, David; Duchêne, Jacques; Université de Technologie de Troyes (Springer, 2010-12-31)
      The aim of this study was to develop a method to detecting the critical point interval (CPI) when sensory feedback is used as part of a closed-loop postural control strategy. Postural balance was evaluated using centre of pressure (COP) displacements from a force plate for 17 control and 10 elderly subjects under eyes open, eyes closed, and vibration conditions. A modified local-maximum-modulus wavelet transform analysis using the power spectrum of COP signals was used to calculate CPI. Lower CPI values indicate increased closed-loop postural control with a quicker response to sensory input. Such a strategy requires greater energy expenditure due to the repeated muscular interventions to remain stable. The CPI for elderly occurred significantly quicker than for controls, indicating tighter control of posture. Similar results were observed for eyes closed and vibration conditions. The CPI parameter can be used to detect differences in postural control due to ageing.
    • What are the biomechanical modifications created by sensorial degradations when stepping up?

      Michel-Pellegrino, Valerie; Hewson, David; Duchêne, Jacques (Taylor & Francis, 2008-07-29)
    • What are user perspectives of exoskeleton technology? A literature review

      Hill, Deborah; Holloway, Catherine Sarah; Ramirez, Dafne Zuleima Morgado; Smitham, Peter; Pappas, Yannis; Jersey General Hospital; University College London; University of Bedfordshire (Cambridge University Press, 2017-08-29)
      Objectives: Exoskeletons are electromechanical devices that are worn by a human operator to increase their physical performance. Several exoskeletons have been developed to restore functional movements, such as walking, for those with paralysis due to neurological impairment. However, existing exoskeletons have limitations with respect to affordability, size, weight, speed, and efficiency, which may reduce their functional application. Therefore, the aim of this scoping review is to collect and narratively synthesize the perspectives of users of exoskeleton technology.Methods: A systematic literature search was conducted across several healthcare related online databases.Results: A total of 4,619 articles were identified, of which 51 were selected for full review. Only three studies were identified that met the inclusion criteria. Of these, one showed an incongruence between users' expectations and experiences of device use; another reported perspectives on potential rather than actual device use, ranking design features in order of perceived importance; and the other reported ratings of ease of device use in training.Conclusions: The heterogeneity of studies included within this review, leave the authors unable to suggest consensus as to user perspectives of exoskeleton technology. However, it is apparent that users are able to suggest priorities for exoskeleton design and that users' perspectives of exoskeleton technology might change in response to experience of use. The authors, therefore, suggest that exoskeleton design should be an iterative process, whereby user perspectives are sought, incorporated and refined by tangible experience, to ensure that devices developed are acceptable to and usable by the populations they seek to re-enable.
    • What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? A realist evaluation protocol

      Harris, Ruth; Sims, Sarah; Levenson, Ros; Gourlay, Stephen; Ross, Fiona; Davies, Nigel; Brearley, Sally; Favato, Giampiero; Grant, Robert; King's College London; et al. (BMJ Publishing Group, 2017-01-09)
      Intentional rounding (IR) is a structured process whereby nurses in hospitals carry out regular checks, usually hourly, with individual patients using a standardised protocol to address issues of positioning, pain, personal needs and placement of items. The widespread implementation of IR across the UK has been driven by the recommendations of the Francis Inquiry although empirical evidence of its effectiveness is poor. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff. The study will be conducted in four phases. Phase 1: theory development using realist synthesis to generate hypotheses about what the mechanisms of IR may be, what particular groups may benefit most or least and what contextual factors might be important to its success or failure which will be tested in subsequent phases of the study. Phase 2: a national survey of all NHS acute trusts to explore how IR is implemented and supported across England. Phase 3: case studies to explore how IR is implemented 'on the ground', including individual interviews with patients, family members and staff, non-participant observation, retrieval of routinely collected patient outcomes and cost analysis. Phase 4: accumulative data analysis across the phases to scrutinise data for patterns of congruence and discordance and develop an overall evaluation of what aspects of IR work, for whom and in what circumstances. The study has been approved by NHS South East Coast-Surrey Research Ethics Committee. Findings will be published in a wide range of outputs targeted at key audiences, including patient and carer organisations, nursing staff and healthcare managers. INTRODUCTION METHODS AND ANALYSIS ETHICS AND DISSEMINATION
    • What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

      Bescos, C.; Westerteicher, C.; Pauws, S.; Schonenberg, H.; Sokoreli, I.; Natsiavas, P.; Filos, D.; Maramis, C.; Chouvarda, I.; Maglaveras, N.; et al. (ACT, 2015-10-08)
      The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes.
    • What's the worry with diabetes? : learning from the experiences of White European and South Asian people with a new diagnosis of diabetes

      Wilkinson, Emma; Randhawa, Gurch; Singh, Maninder; University of Bedfordshire (Elsevier Ltd, 2014-09-01)
      AIMS: An exploration of diabetes diagnosis from the patient perspective is important for understanding inequalities in access and developing quality care through the diabetes care pathway. METHODS: South Asian and White European patients over 16 years with a recent (<1 year) diagnosis of diabetes were recruited from 18 GP practices in three UK locations--Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 47 patients, 28 South Asian and 19 White European. Interview transcripts were analysed thematically and comparisons made between the White and South Asian groups. RESULTS: People expressed a range of emotions at diagnosis. Although many participants were familiar with diabetes through family and friends and were undergoing monitoring for comorbidities, they were surprised and upset to be diagnosed. In contrast, a small number reported how they did not worry about their diabetes diagnosis and others highlighted the different public perceptions, which exist about the seriousness of diabetes in relation to a diagnosis of cancer. CONCLUSIONS: Attitudes to diagnosis of diabetes varied on an individual basis and not directly by ethnicity. Practitioners need to be adaptable to work with individuals in order to facilitate access and support diverse populations.
    • Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks

      Cook, Erica Jane; Sharp, Chloe; Randhawa, Gurch; Guppy, Andy; Gangotra, Raj; Cox, Jonathon (BioMed Central Ltd., 2016-09-01)
      Background NHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual’s ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme. Methods NHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis. Results The overall uptake rate for Luton was 44 %, markedly lower that the set target of 50–75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with ‘White British’ ‘Black Caribbean’ and ‘Indian’ patients most likely to take up a NHS Health Check. However, patients from ‘Any Other White Background’ and ‘Black African’ were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method. Conclusions The findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities.
    • Who's opting-in? a demographic analysis of the U.K. NHS Organ Donor Register

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; University of Bedfordshire (PLOS, 2019-01-02)
      The NHS Organ Donor Register (NHS ODR) is a centralised database for U.K. residents wishing to be organ donors. Opt-in membership to the NHS ODR demonstrates an expression of a wish to donate, which can be key in decisions made by family members at time of death. By examining the demographic breakdown of the 24.9 million registrants, campaigns can be better targeted to increase membership among those groups underrepresented on the NHS ODR. Data from the NHS ODR (as of March 2017) was analysed using Chi2 Goodness of Fit analyses and Chi2 Test of Independence for the categorical variables of gender, nation of residency at time of registration, ethnicity, organ preference, registration age and age at registration. Goodness of fit analyses showed significant differences between demographic representation on the NHS ODR compared to the U.K. population. Cramer's V showed significant associations were only of note (above 0.1) for age, ethnicity in the U.K. as a whole and ethnicity in England. Older (70+) and younger people (0-14) were underrepresented and those of White Ethnicity overrepresented on the NHS ODR. Although association strength was weak, more women and less residents of England were present compared to the U.K. population. Tests of independence showed significant differences between age at registration and current age on the register and cornea donation preferences. These results indicate areas for targeting by campaigns to increase NHS ODR membership. By understanding the strength of these associations, resources can be utilised in areas where underrepresentation is larger and will have the most impact to demographics of the NHS ODR. Additionally, by identifying which groups are over and underrepresented, future research can explore the reasons for this in these demographic groups.
    • Why we should understand the patient experience: clinical empathy and medicines optimisation

      Jubraj, Barry; Barnett, Nina L.; Grimes, Lesley; Varia, Sneha; Chater, Angel M.; Auyeung, Vivian (Wiley, 2016-04-21)
      Objectives To critically discuss the need for pharmacists to underpin their consultations with appropriate ‘clinical empathy’ as part of effective medicines optimisation. Methods Use of literature around empathy, consultation and pharmacy practice to develop a case for greater clinical empathy in pharmacy consultations. Key findings Clinical empathy is defined from the literature and applied to pharmacy consultations, with a comparison to empathy in other clinical professions. Historical barriers to the embedding of clinical empathy into pharmacy consultations are also explored. Conclusions We challenge the pharmacy profession to consider how clinical empathy should underpin consultations with a series of introspective questions and provide some sample questions to support pharmacy consultations. We also make the case for appropriate education and professional development of consultation skills at undergraduate and postgraduate level. We contend that patients’ relationships with practitioners are critical, and a lack of empathy can impact the effectiveness of care.
    • Women's experiences of living with albinism in Taiwan and perspectives on reproductive decision making: a qualitative study

      Huang, Mei-Zen; Chen, Li-Li; Hung, Shu-Ling; Puthussery, Shuby; National Tainan Junior College of Nursing; National Taipei University of Nursing and Health Sciences; University of Bedfordshire (Routledge, 2020-12-21)
      People with Albinism tend to face multiple adverse physical, psychological and social consequences. Very little is known about experiences of women with Albinism and their deliberations whilst making reproductive decisions. This study aimed to explore lived experiences of women with Albinism and to understand their perspectives on reproductive decision making. Qualitative in-depth semi-structured interviews were conducted with ten women with Albinism in Taiwan. Five key themes emerged from the accounts which were centred around the sense of discrimination that they felt whilst growing up, their strive for normality, making difficult choices in their reproductive decisions, desire to protect children from harm and reflections of parenting struggles from own experiences and the experiences of their parents. We call for global and national policy makers and practitioners to introduce explicit measures to challenge the myths, stereotypes and prejudices associated with Albinism including specific interventions towards supporting women in pregnancy decision making.
    • Women’s experiences of disrespect and abuse in maternity care facilities in Benue State, Nigeria

      Orpin, Joy; Puthussery, Shuby; Davidson, Rosemary; Burden, Barbara; University of Bedfordshire (SpringerNature, 2018-06-05)
      Background: Disrespect and abuse (D&A) of women in health facilities continues to be a prevailing public health issue in many countries. Studies have reported significantly high prevalence of D&A among women during pregnancy and childbirth in Nigeria, but little is known about women’s perceptions and experiences of D&A during maternity care in the country. The aim of this study was to explore: 1) how women perceived their experiences of D&A during pregnancy, childbirth, and in the postnatal period in Benue, Nigeria; and 2) how women viewed the impact of D&A on the future use of health facilities for maternity care. Method:  Five focus group discussions with a sample of 32 women were conducted as part of a qualitative phenomenological study. All the women received maternity care in health facilities in Benue state, Nigeria and had experienced at least one incident of disrespect and abuse. Audio-recorded discussions were transcribed and analysed using a six-stage thematic analysis using NVivo11.  Results: The participants perceived incidents such as being shouted at  and the use of abusive language as a common practice. Women described these incidents as devaluing and dehumanising to their sense of dignity. Some women perceived that professionals did not intend to cause harm by such behaviours. Emerged themes included: (1) ‘normative’ practice; (2) dehumanisation of women; (3) no harm intended and (4) intentions about the use of maternity services in future. The women highlighted the importance of accessing health facilities for safe childbirth and expressed that the experiences of D&A may not impact their intended use of health facilities. However, the accounts reflected their perceptions about the inherent lack of choice and an underlying sense of helplessness.   Conclusion: Incidents of D&A that were perceived as commonplace carry substantial implications for the provision of respectful maternity care in Nigeria and other similar settings.  As a country with one of the highest rates of maternal deaths, the findings point to the need for policy and practice to address the issue urgently through implementing preventive  measures  including empowering women to reinforce their right to be treated with dignity and respect, and sensitising health care professionals.
    • Working towards integration: Advancing Care Coordination & TeleHealth Deployment (ACT) Programme

      Davidson, Rosemary; Bescos, Cristina; Newman, Stanton; City University; Phillips Healthcare (Ubiquity Press, 2014-11-01)
      This poster gives a summary of the ACT Programme, the sites participating, diseases covered, numbers of patients, project timetable and the aim to provide a ‘toolbox’ of best practice. ACT programmes fall within five broad areas: CC of Management of Chronic and Multimorbid long-term conditions; Management of Chronic and Multimorbid long-term conditions with telehealth; Active patient/prevention/Education; Elderly at home; and Transitional care/post discharge. The number of patients recruited to ACT programmes varied considerably, from the small scale (e.g. Scotland’s REACT project for those over 75 and Groningen’s eDiabetes programme, both with 15-20 patients) to much larger scale (e.g. Lombardy’s Chronic patients with 37,000). Most Programmes (14 out of 17) recruit people with chronic conditions and in some cases these are specified such as Congestive Heart Failure and Diabetes. Patients in recovery or rehabilitation were the second most cited group (12 out of 17). Patients in the preventative category were least likely to enter Programmes (5 out of 17). Some Programmes accept patients at multiple key stages. For example, Groningen’s Effective Cardio Programme accepts patients at the preventative, newly diagnosed, disease management, recovery/rehabilitation, at risk, chronic and palliative stages, in addition to those on new medication. All Programmes reported clear lines of responsibility for the provision of patient care. General Practitioners/Primary Care took responsibility in nine of the 17 Programmes. Elsewhere, specialist nurses held responsibility (e.g. Groningen’s Effective Cardio) or chest physicians (e.g. Groningen’s asthma/COPD Telehealth service). Other Programmes apportioned responsibility at a broader level via a Programme Management Working Group and local managers (Basque Country’s Active Patients) for example, or with a National diabetes standard and regional guidelines (Groningen’s eDiabetes) or with defined care pathways (Scotland’s three Programmes). Further details of the Organisational aspects of the participants in the ACT programme will be presented in the Poster
    • 'Would you like to join the NHS Organ Donor Register?' a general practice feasibility study

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; Asghar, Zeeshan; ; University of Bedfordshire; NHS Blood and Transplant (Royal College of General Practitioners, 2020-06-18)
      BACKGROUND: A shortage of organ donors exists in the UK and targeting family consent is key for increasing donation consent rates. Registration on the NHS Organ Donor Register (NHS ODR) facilitates this, as it guides families on their loved ones donation preference. In general practice, an opportunity to register is provided, however only to new patients. To improve access to registration opportunities, an intervention was designed where general practice staff asked their patients if they wished to register as an organ donor. AIM: To assess an organ donation registration intervention for feasibility and acceptability in a UK general practice setting. METHOD: One general practice, in Luton, UK, conducted the intervention for 3 months (April to July 2018). Training was held in March 2018, and leaflets and posters were displayed for the 3-month period. An embedded experimental mixed-methods design was used, with data collected via SystmONE questionnaires, surveys and focus groups. RESULTS: The intervention was found to be feasible and acceptable to conduct with some patients by some staff members. During the 3 months, patients were asked in 12.4% of face-to-face consultations (n=812). Nurses and healthcare assistants were more able to conduct the intervention than doctors. Lack of time, telephone consultations, and it not being appropriate were the most common reasons for not asking. Finally, 244 patients joined the NHS ODR; 30.4% of those asked. CONCLUSION: This study demonstrates that general practice could be a feasible location in which an intervention designed to increase NHS ODR registration could be conducted.