• Radical actions to address UK organ shortage, enacting Iran’s paid donation programme: A discussion paper

      Timmins, Rebecca; Sque, Magi (Sage, 2019-02-21)
      Globally there is a shortage of organs available for transplant resulting in thousands of lives lost as a result. Last year in the United Kingdom (UK) 457 people died as a result of organ shortage1. NHS Blood and Transplant suggest national debates to test public attitudes to radical actions to increase organ donation should be considered in addressing organ shortage. The selling of organs for transplant in the UK is prohibited under the Human Tissue Act 2004. This discussion paper considers five ethical objections raised in the UK to paid donation, and discusses how these objections are managed within the only legal and regulated paid living unrelated renal donation programme in the world in Iran, where its kidney transplant list was eliminated within two years of its commencement. This paper discusses whether paid living unrelated donation in Iran increases riskier donations, and reduced altruistic donation as opponents of paid donation claim. The paper debates whether objections to paid donation based upon commodification arguments only oppose enabling financial ends, even if these ends enable beneficent acts. Discussions in relation to whether valid consent can be given by the donor will take place, and will also debate the objection that donors will be coerced and exploited by a paid model. This paper suggests that exploitation of the paid donor within the Iranian model exists within the legally permitted framework. However paid living kidney donation should be discussed further and other models of paid donation considered in the UK as a radical means of increasing donation.
    • Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial

      Parker, Christopher C; James, Nicholas D; Brawley, Christopher D; Clarke, Noel W; Hoyle, Alex P; Ali, Adnan; Ritchie, Alastair W S; Attard, Gerhardt; Chowdhury, Simon; Cross, William; et al. (The Lancet, 2018-10-21)
      Background Based on previous findings, we hypothesised that radiotherapy to the prostate would improve overall survival in men with metastatic prostate cancer, and that the benefit would be greatest in patients with a low metastatic burden. We aimed to compare standard of care for metastatic prostate cancer, with and without radiotherapy. Methods We did a randomised controlled phase 3 trial at 117 hospitals in Switzerland and the UK. Eligible patients had newly diagnosed metastatic prostate cancer. We randomly allocated patients open-label in a 1:1 ratio to standard of care (control group) or standard of care and radiotherapy (radiotherapy group). Randomisation was stratified by hospital, age at randomisation, nodal involvement, WHO performance status, planned androgen deprivation therapy, planned docetaxel use (from December, 2015), and regular aspirin or non-steroidal anti-inflammatory drug use. Standard of care was lifelong androgen deprivation therapy, with up-front docetaxel permitted from December, 2015. Men allocated radiotherapy received either a daily (55 Gy in 20 fractions over 4 weeks) or weekly (36 Gy in six fractions over 6 weeks) schedule that was nominated before randomisation. The primary outcome was overall survival, measured as the number of deaths; this analysis had 90% power with a one-sided α of 2·5% for a hazard ratio (HR) of 0·75. Secondary outcomes were failure-free survival, progression-free survival, metastatic progression-free survival, prostate cancer-specific survival, and symptomatic local event-free survival. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. The primary outcome analysis was by intention to treat. Two prespecified subgroup analyses tested the effects of prostate radiotherapy by baseline metastatic burden and radiotherapy schedule. This trial is registered with ClinicalTrials.gov, number NCT00268476. Findings Between Jan 22, 2013, and Sept 2, 2016, 2061 men underwent randomisation, 1029 were allocated the control and 1032 radiotherapy. Allocated groups were balanced, with a median age of 68 years (IQR 63–73) and median amount of prostate-specific antigen of 97 ng/mL (33–315). 367 (18%) patients received early docetaxel. 1082 (52%) participants nominated the daily radiotherapy schedule before randomisation and 979 (48%) the weekly schedule. 819 (40%) men had a low metastatic burden, 1120 (54%) had a high metastatic burden, and the metastatic burden was unknown for 122 (6%). Radiotherapy improved failure-free survival (HR 0·76, 95% CI 0·68–0·84; p<0·0001) but not overall survival (0·92, 0·80–1·06; p=0·266). Radiotherapy was well tolerated, with 48 (5%) adverse events (Radiation Therapy Oncology Group grade 3–4) reported during radiotherapy and 37 (4%) after radiotherapy. The proportion reporting at least one severe adverse event (Common Terminology Criteria for Adverse Events grade 3 or worse) was similar by treatment group in the safety population (398 [38%] with control and 380 [39%] with radiotherapy). Interpretation Radiotherapy to the prostate did not improve overall survival for unselected patients with newly diagnosed metastatic prostate cancer.
    • Radiotherapy to the prostate for men with metastatic prostate cancer in the UK and Switzerland: Long-term results from the STAMPEDE randomised controlled trial

      Parker, Chris C; James, Nicholas D; Brawley, Christopher D; Clarke, Noel W; Ali, Adnan; Amos, Claire L; Attard, Gerhardt; Chowdhury, Simon; Cook, Adrian; Cross, William; et al. (Public Library of Science, 2022-06-07)
      Background STAMPEDE has previously reported that radiotherapy (RT) to the prostate improved overall survival (OS) for patients with newly diagnosed prostate cancer with low metastatic burden, but not those with high-burden disease. In this final analysis, we report long-term findings on the primary outcome measure of OS and on the secondary outcome measures of symptomatic local events, RT toxicity events, and quality of life (QoL). Methods and findings Patients were randomised at secondary care sites in the United Kingdom and Switzerland between January 2013 and September 2016, with 1:1 stratified allocation: 1,029 to standard of care (SOC) and 1,032 to SOC+RT. No masking of the treatment allocation was employed. A total of 1,939 had metastatic burden classifiable, with 42% low burden and 58% high burden, balanced by treatment allocation. Intention-to-treat (ITT) analyses used Cox regression and flexible parametric models (FPMs), adjusted for stratification factors age, nodal involvement, the World Health Organization (WHO) performance status, regular aspirin or nonsteroidal anti-inflammatory drug (NSAID) use, and planned docetaxel use. QoL in the first 2 years on trial was assessed using prospectively collected patient responses to QLQ-30 questionnaire. Patients were followed for a median of 61.3 months. Prostate RT improved OS in patients with low, but not high, metastatic burden (respectively: 202 deaths in SOC versus 156 in SOC+RT, hazard ratio (HR) = 0·64, 95% CI 0.52, 0.79, p < 0.001; 375 SOC versus 386 SOC+RT, HR = 1.11, 95% CI 0.96, 1.28, p = 0·164; interaction p < 0.001). No evidence of difference in time to symptomatic local events was found. There was no evidence of difference in Global QoL or QLQ-30 Summary Score. Long-term urinary toxicity of grade 3 or worse was reported for 10 SOC and 10 SOC+RT; long-term bowel toxicity of grade 3 or worse was reported for 15 and 11, respectively. Conclusions Prostate RT improves OS, without detriment in QoL, in men with low-burden, newly diagnosed, metastatic prostate cancer, indicating that it should be recommended as a SOC.
    • Raised salivary testosterone in women is associated with increased attraction to masculine faces.

      Welling, L.L.M.; Jones, B.C.; DeBruine, L.M.; Conway, C.A.; Law Smith, M.J.; Little, A.C.; Feinberg, D.R.; Sharp, Martin A.; Al-Dujaili, E.A.S. (Elsevier Science Direct, 2007)
      Women's preferences for masculinity in men's faces, voices and behavioral displays change during the menstrual cycle and are strongest around ovulation. While previous findings suggest that change in progesterone level is an important hormonal mechanism for such variation, it is likely that changes in the levels of other hormones will also contribute to cyclic variation in masculinity preferences. Here we compared women's preferences for masculine faces at two points in the menstrual cycle where women differed in salivary testosterone, but not in salivary progesterone or estrogen. Preferences for masculinity were strongest when women's testosterone levels were relatively high. Our findings complement those from previous studies that show systematic variation in masculinity preferences during the menstrual cycle and suggest that change in testosterone level may play an important role in cyclic shifts in women's preferences for masculine traits.
    • Raising awareness, facilitating access, creating opportunity, enabling achievement

      Felce, Alison; Claridge, Michelle (FACE - Forum for Access and Continuing Education, 2016-07)
      The University of Wolverhampton is known within the higher education sector as a post-1992 university with an excellent reputation for widening participation. It is committed to being ‘the Opportunity University – renowned for our creativity and innovation…connected with our local, national and global communities delivering opportunity and academic excellence’ (University of Wolverhampton, 2015a) and to ‘recognis[ing] learning wherever and whenever it occurs’ (Felce, 2015). As part of this commitment the university accepts a broad range of entry qualifications including accepting learners who have no formal qualifications but who show, through interview or work experiences, that they are capable of succeeding at university-level study. This recognition of prior learning (RPL) extends to recognising learning at levels equivalent to those in higher education in order to allow exemptions from study which may be applied to individuals or cohorts, depending on the circumstances. This chapter presents the University of Wolverhampton’s approach to its engagement with Her Majesty’s Armed Forces and for the RPL for those within, and allied to, the Forces. Principles for RPL and why they are relevant to the university and the Armed Forces are set out. The university’s approach to raising awareness, facilitating access, creating opportunities and enabling achievement is also explained. The chapter concludes with a case study outlining the application of these four principles to enable readers to consider how this approach could be transferred to their own practice.
    • Raising regional academic voices (alongside data) in higher education (HE) debate

      Hayes, Sarah; Jopling, Michael; Hayes, Dennis; Westwood, Andy; Tuckett, Alan; Barnett, Ronald (Springer Science and Business Media LLC, 2020-05-13)
      As agendas for data-driven measures of excellence dominate policy in UK Higher Education (HE), we argue that the generic structure of national policy frameworks virtually silences regional voices. This furthers a territorially agnostic discourse about universities, downplays institutional history and purpose, risks concealing innovative practices, and fails to tackle entrenched inequalities. In response, we point to the value of live, place-based debate in HE institutions to highlight distributional inequity, raise local voices and connect these with national policy. Yet even as we compiled this article about HE debate, the Covid-19 pandemic took hold globally, cancelling face-to-face meetings, by necessity. We therefore draw on a postdigital perspective, as we share our individual dialogues in support of debate, via collective writing, against this new backdrop of social distancing and widespread uncertainty. We may not currently be able to convene our Midlands HE Policy Network (MHEPN) debates in person, but we can voice the essential part that regional universities play in connecting global technological and biological change, with local social projects, citizens and industry. Postdigital theory offers one route to understanding that Covid-19 does not sit apart from other political economic challenges in HE and beyond, that we need to debate simultaneously.
    • Raising the stakes: classroom observation in the further education sector in England

      O'Leary, Matt; Brooks, Val (Taylor & Francis, 2013-12-09)
      Successive governments in England have regarded classroom observation as an essential tool for monitoring and improving teacher performance. Despite its importance in national policy for teacher development, the impact of classroom observation on individual teachers, and on improving quality and standards in teaching and learning, remain under-researched areas. Further education (FE) in general, and FE teachers in particular, have received sparse attention. This paper adopts a theoretical framework grounded in aspects of assessment theory to explore some of the consequences of using observation to assess, monitor and raise standards of classroom performance in the FE workforce. It draws on findings from a mixed-methods study, involving questionnaires and semi-structured interviews, conducted in 10 FE colleges situated across the West Midlands region of England. The paper concludes by situating the findings against the broader backdrop of research into teachers’ continuing professional development and, in so doing, raises questions about the fitness for purpose of prevailing observation assessment regimes in FE and the extent to which these systems are able to achieve their purported goals.
    • Re-visualising international relations: audio-visual projects and direct encounters with the political in security studies

      Obradovic-Wochnika, Jelena; Hayes, Sarah (Palgrave, 2017-09-01)
      In this paper we discuss how an innovative audio-visual project was adopted to foster active, rather than declarative learning, in critical International Relations (IR). First, we explore the aesthetic turn in IR, to contrast this with forms of representation that have dominated IR scholarship. Second, we describe how students were asked to record short audio or video projects to explore their own insights through aesthetic and non-written formats. Third, we explain how these projects are understood to be deeply embedded in social science methodologies. We cite our inspiration from applying a personal sociological imagination, as a way to counterbalance a ‘marketised’ slant in higher education, in a global economy where students are often encouraged to consume, rather than produce knowledge. Finally, we draw conclusions in terms of deeper forms of student engagement leading to new ways of thinking and presenting new skills and new connections between theory and practice.
    • Re: Clinical anatomy and biomechanics of the ankle in dance.

      Day, Helen (2009)
      Abstract The ankle is an important joint to understand in the context of dance because it is the connection between the leg and the foot that establishes lower extremity stability. Its function coordinates with the leg and foot and, thus, it is crucial to the dancer’s ability to perform. Furthermore, the ankle is one of the most commonly injured body regions in dance. An understanding of ankle anatomy and biomechanics is not only important for healthcare providers working with dancers, but for dance scientists, dance instructors, and dancers themselves. The bony architecture, the soft tissue restraints, and the locomotive structures all integrate to allow the athletic artistry of dance. Yet, there is still much research to be carried out in order to more completely understand the ankle of the dancer.
    • Reactions to unsolicited violent, and sexual, explicit media content shared over social media: Gender differences and links with prior exposure

      Nicklin, Laura; Swain, Emma; Lloyd, Joanne (MDPI, 2020-06-16)
      While there has been extensive research into consumption of “traditional” forms of explicit sexual and violent media (within pornography, videogames and movies), the informal exchange and viewing of explicit real-world violent and sexual content via social media is an under-investigated and potentially problematic behaviour. The current study used an online survey (n= 225: 169f, 55m, 1x, mean age 30.61 (SD 12.03)) to explore self-reported reactions to unsolicited explicit violent and sexual content that participants had received from friends or contacts. In line with our predictions based on previous studies of fictional explicit content, we found effects of both gender and prior exposure on these reactions. Specifically, females rated both sexual and violent explicit content as significantly less funny and exciting and more disturbing than males did. Amongst males, those with high previous exposure rated violent content as more exciting than those with lower or no prior experience. Regardless of gender, participants with higher exposure to sexual content rated it as funnier than those with mild or no exposure, and those with higher exposure to violent content rated it as more amusing and more exciting. However, contrary to what desensitization theories would predict, prior exposure did not attenuate how disturbing explicit content (of either a sexual or a violent nature) was rated. Multiple avenues for further investigation emerged from this preliminary cross-sectional study, and we suggest priorities for further qualitative or longitudinal work on this novel topic.
    • Reading for meaning

      Clarke, Karen (University of Wolverhampton, 2007)
      This research was developed from a previous CELT project (2003/04 Focussed seminar groups, Clarke, 2004) in which students were asked to read a specific article and then discuss it in a seminar situation. It was noted was that students approached reading in different ways but in the main interacted with the text by marking it in particular ways. However, from working with different groups of undergraduate students, and discussing this with colleagues, the general feeling is that many students balk at reading academic literature. This is affirmed in research undertaken by Mateos et al. (2007) who found 93% of students on three different degree courses stated that the main source of accessing information came through oral exposition from the lecturer. In addition to the previous CELT research, a separate piece of research was undertaken as part of a CETL project which looked at how level 1 students approach academic writing (Clarke and French, 2007). Clearly, the link between efficient reading and appropriate levels of academic writing is undisputed; Wyse (2006:4) suggests that ‘(we) must learn to read like writers.’ Consequently, researching the process by which students assimilate their reading and apply it to their work seemed to be a natural evolution from the previous research projects.
    • Reading Reader Identities: Stories about Young Adults Reading.

      Kendall, Alex (Lancaster: Lancaster University, RaPAL / Stevenage: Avantibooks, 2007)
      Alex Kendall is Associate Dean for Education at the University of Wolverhampton. Whilst this role involves her in a broad range of educational work, her focus as a teacher educator and research lies in the areas of initial teacher education and continuing professional development programmes for adult literacy specialists. Background In 2002 The Times Higher Education supplement ran a report which challenged and reoriented my thinking about reading and readers and had a profound impact on the theorising I then was immersed in as part of the PhD research process. The report sought to re-present a selection of the findings from a reading habits survey I had (tentatively) presented to the British Educational Research conference a few weeks previously. The report entitled 'Books lose out to tabloids' read, "Half of the FE students taking English courses in a deprived part of the Midlands rarely or never read for pleasure, according to a survey of students aged sixteen to nineteen at seven colleges in the Black Country. Their most popular reading matter is tabloid newspapers and magazines. Four out of five of the 340 students surveyed were studying for A-levels and three-quarters were female, yet 15 per cent said they never read for pleasure and 34 per cent did not do so regularly. The rest read for pleasure at least once or twice a week but only 3 per cent did so every day. Most preferred to socialise and watch TV. The findings were presented to last week's British Educational Research Association conference by Alex Kendall of the University of Wolverhampton. They supported views of college teachers who told her many A-level students had "poor reading skills and weak vocabulary" and few read beyond their coursework." (Passmore, 2002: 32) Some months later the press office at my University was contacted by a BBC Radio researcher who had come across the BERA abstract via the TES article and wanted to invite me to contribute to a late night BBC radio discussion programme addressed to the BBC' Big Read' campaign. The "students don't read novels" quote in the TES article had caught the researcher's eye and I was invited to share my knowledge about the 'illiteracy’ of young people and also to identify a high consuming or idiosyncratic reader who might also join the discussion. The research seemed 'instinctively’ to be making a connection between students choices about not to read novels and the degree to which they were or weren't 'literate'. And indeed it was not implied that the 'interesting' reader might be found amongst the student participants.
    • Reclaiming student voice(s): Constituted through process, or embedded in practice?

      Hall, Valerie (Taylor & Francis, 2019-08-16)
      Removal of the student numbers cap, reductions in funding, and an accompanying need to generate revenue, has driven education towards neo-capitalism and managerialism; students equate to income. An associated growth in performativity measures incorporates student voice as one of these benchmarking requirements. Aiming to explore and challenge assumptions about the role of student voice in post-compulsory education, this paper identified a missing viewpoint in the wider research; perceptions from those engaged in teacher education. This paper presents research undertaken with 24 participants (teacher educators, student teachers, and quality assurance managers) across 3 post-compulsory institutions in the UK. It explores perceptions about how student voice is espoused, enacted and experienced within the institutions, and whether this enables a democratic approach within education. The research considers questions raised about power, dialogue and engagement; and the impact of marketisation and consumerism on student-institutional relationships.
    • RECOGNISING THE GIFT OF ORGAN AND TISSUE DONATION: AN EVIDENCE-BASED APPROACH

      Walker, Wendy; Sque, Magi (4th ELPAT Congress, Organ Transplantation: Ethical, Legal and Psychosocial Aspects: Global Challenges, 2016)
      Objectives 1. To describe the meaning of recognition for donor families. 2. To illustrate the creation of a public memorial, from conception to design. Method This presentation draws on the findings of a qualitative study, designed to elicit donor families’ views and preferences on appropriate ways of personally and publicly recognising the gift of organ and tissue donation. To our knowledge, this was one of the first studies to examine this important issue in detail. Our study sample comprised bereaved, adult family members, who gave consent to organ and/or tissue donation from a deceased relative at an Acute NHS Trust in the Midlands, UK. Three participants from two donor families participated in a face-to-face interview. Two donor families provided a written response to pre-determined interview questions. Data were subjected to conventional content analysis. This involved a systematic process of applying codes to the text and grouping the data into categories and themes. The study received ethical approval. Results The findings of our exploratory investigation established the meaning of recognition for participant donor families and identified ways in which recognition may be realised. Donor families indicated unanimous support for organ and tissue donation to be formally recognised by the hospital where their relative died. An interesting observation was the extent to which families represented their experience of donation when deciding on the physical, emotional and relational qualities of a memorial design. For example, an association with nature seemed contiguous with the symbolism of life, and several of the participants were of the opinion that the memorial should transmit a sense of joy and pride. Participants identified three functions of a public memorial; recognition, remembrance and raising public awareness about organ and tissue donation. Facilitators of the donation process were identified as also worthy of recognition. Conclusion The concept of recognition has an important functional meaning in the context of deceased donation. Involving donor families in the design of a public memorial provides a means of expressing recognition and ensures a fitting tribute. Further research is recommended to test the efficacy of the different forms of recognition in the public domain.
    • Recognising the gift of organ and tissue donation: an evidence-based approach

      Walker, Wendy; Sque, Magi; Carpenter, Benedict; Roberts, Suzanne (2017-09)
      Introduction: Transplantation would not be possible without public commitment and support. In 2008, the UK Organ Donation Taskforce1 advocated formal means of honouring the gift of donation. A key recommendation was the need for research to establish the means of recognition that most donor families would appreciate.1 This paper presents the findings of a qualitative study designed to elicit donor families’ views and preferences on appropriate ways of personally and publicly recognising the gift of organ and tissue donation. To our knowledge, this was one of the first studies to examine this important issue in detail. Method: We carried out an exploratory study over 12 months. Our study sample comprised bereaved adult family members who gave consent to organ and/or tissue donation from a deceased relative at an Acute National Health Service Trust in the Midlands, UK. Three participants from two donor families participated in a face-to-face interview. Two donor families provided a written response to pre-determined interview questions. Data were subjected to conventional content analysis2 to form categories and themes. The study received ethical approval. Results: Our investigation established the meaning of recognition and identified ways in which recognition may be realised. Donor families indicated unanimous support for organ and tissue donation to be formally recognised by the hospital where their relative died. Although there was no real consensus of opinion or superior choice about the exact item of recognition, participants shared an inclination for convention, and their ideas helped to establish communal preferences regarding the nature, design and location of the object. An interesting observation was the extent to which participants symbolised their experience of donation when deciding on the physical, emotional and relational qualities of the artwork. Participants identified three functions of a public memorial; recognition, remembrance and raising public awareness about organ and tissue donation. Facilitators of the donation process were identified as also worthy of recognition. Conclusion: The concept of recognition has an important functional meaning in the context of deceased donation. Involving donor families in the design of a public memorial provides a means of expressing recognition and ensures a fitting tribute. Further research is recommended to test the efficacy of the different forms of recognition in the public domain.
    • Reconceptualising well-being: social work, economics and choice

      Simpson, Graeme; Murr, Ani (2014-10-01)
      In this paper we examine the intersection of well-being, agency and the current political and economic structures which impact on social work with adults and in doing so contribute to ‘interpreting and mapping out the force fields of meaning production’ (Fornäs, Fredriksson & Johannisson 2011: 7). In it we draw upon Sointu’s (2005) work which identified the shift from conceptualising well-being in terms of ‘the body politic’ to conceptualising it in terms of ‘the body personal’ and identified parallels with understanding well-being in English social work. There has been a shift in the nature of social work in the United Kingdom in how the question of agency has been addressed. For many years this was through the traditional notion of autonomy and self-determination (Biestek 1961) and later collective approaches to welfare and services (Bailey & Brake 1975). The development of paradigms of mainly personal empowerment in the 1980s and 1990s (Braye & Preston-Shoot 1995) saw social work become less associated with collective engagement in welfare and more concerned with the enhancement of individual well-being (Jordan 2007). Whilst the rhetoric of well-being, in contemporary English social work, continues to include autonomy and self-determination, this is focused primarily upon the narrower concepts of independence and choice (Simpson 2012). The UK Department of Health’s A Vision for Adult Social Care: Capable Communities and Active Citizens (DoH 2010) is the template for national social care policy to which all Local Authorities in England had to respond with an implementation plan. This paper draws on a documentary analysis of two such plans drafted in 2012 in the wake of an ‘austerity budget’ and consequent public expenditure reductions. The analysis considers the effect of economic imperatives on the conceptualisation of individual choices and needs in the context of Local Authorities’ responsibilities to people collectively. A concept of ‘reasonableness’ emerges, which is used to legitimize a re-balancing of the ‘body personal’ and the ‘body politic’ in the concept of well-being with the re-emergence of an economic, public construction. Our discussion considers why this is happening and whether or not a new synthesised position between the personal and political is being developed, as economists and policy makers appropriate well-being for their ends.
    • Recruitment, retention and compliance of overweight inactive adults with intermediate hyperglycaemia to a novel walking intervention

      Faulkner, Maria; McNeilly, Andrea; Davison, Gareth; Rowe, David; Hewitt, Allan; Nevill, Alan; Duly, Ellie; Trinick, Tom; Murphy, Marie (MDPI, 2021-07-05)
      This study evaluated the effectiveness of strategies used to recruit and retain overweight, inactive adults with intermediate hyperglycaemia (IHG) to a novel walking programme. Participant compliance to the nine-month randomised controlled trial (RCT) is also presented. Inactive overweight (BMI ≥ 25 kg/m2) adults (N = 42; n = 19 male, n = 23 female) aged between 18–65 years, with IHG were identified via three recruitment strategies (NHS database reviews, diabetic clinics, and a University population). Participants were randomly assigned to either Intervention Group (IG n = 22; n = 11 male, n = 11 female) or Usual Care (UC n = 20; n = 8 male, n = 12 female). IG followed a nine-month novel behaviour change intervention where they walked in accordance with physical activity guidelines using the beat of music to maintain appropriate cadence. UC received standard physical activity advice. Recruitment, retention, and intervention compliance were calculated using descriptive statistics (means or frequencies). Recruiting from a University population was the most successful strategy (64.2% response rate) followed by NHS database reviews (35.8%) and then diabetic clinics (0%). Study retention was ≥80% in both groups throughout the RCT. Intervention compliance was highest from baseline to four months (70.1 ± 39.2%) and decreased as the study progressed (43.4 ± 56.1% at four to six months and 37.5 ± 43.5% at follow-up). In total, 71.4% of IG walking completed throughout the study was at least moderate intensity. A novel walking intervention incorporating the use of music along with behaviour change techniques appears to positively influence the recruitment, retention, and walking compliance of this population.
    • Redefining overweight and obesity in rheumatoid arthritis patients

      Stavropoulos-Kalinoglou, Antonios; Metsios, Giorgos S.; Koutedakis, Yiannis; Nevill, Alan M.; Douglas, Karen M. J.; Jamurtas, Athanasios Z.; van Zanten, J.; Labib, M.; Kitas, George D. (BMJ Publishing, 2007)
      OBJECTIVES: To assess whether body mass index (BMI) and body fat (BF) differ between rheumatoid arthritis (RA) patients, patients with non-inflammatory arthritis (osteoarthritis, OA) and healthy individuals, and whether disease specific measures of adiposity are required to accurately reflect BF in these groups. METHODS: 641 individuals were assessed for BMI (kg/m(2)) and BF (bioelectrical impedance). Of them, 299 (174 RA, 43 OA and 82 healthy controls (HC)) formed the observation group and 342 (all RA) the validation group. RA disease characteristics were collected. RESULTS: ANOVA revealed significant differences between disease groups for BMI (p<0.05) and BF (p<0.001). ANCOVA showed that age accounted for the differences in BMI (F(1,294) = 5.10, p<0.05); age (F(1,293) = 22.43, p<0.001), sex (F(1,293) = 380.90, p<0.001) and disease (F(2, 293) = 18.7, p<0.001) accounted for the differences in BF. For a given BF, patients with RA exhibited BMI levels reduced by 1.83 kg/m(2) (p<0.001) compared to HC; there were no significant differences between OA and HC. A predictive model for BF was developed (R(2) = 0.769, p<0.001) and validated using limits of agreement Analysis against measured BF in the validation group (95%LIM(AG) = 6.17; CV = 8.94). CONCLUSIONS: In individuals with RA, BMI cut-off points should be reduced by 2 kg/m(2) (that is, to 23 kg/m(2) for overweight and 28 kg/m(2) for obesity). The equation developed can be used to accurately predict BF from BMI in RA patients. These findings may be important in the context of the cardiovascular comorbidity of RA.
    • Reducing readmission rates through a discharge follow-up service

      Vernon, Duncan; Brown, James E; Griffiths, Eliza; Nevill, Alan M; Pinkney, Martha (Royal College of Physicians, 2019-06-01)
      Approximately 15% of elderly patients are readmitted within 28 days of discharge. This costs the NHS and patients. Previous studies show telephone contact with patients ­post-discharge can reduce readmission rates. This service ­evaluation used a cohort design and compared 30-day emergency readmission rate in patients identified to receive a community nurse follow-up with patients where no attempt was made. 756 patients across seven hospital wards were ­identified; 303 were identified for the intervention and 453 in a ­comparison group. Hospital admission and readmission data was extracted over 6 months. Where an attempt to contact a patient was made post-discharge, the readmission rate was 9.24% compared to 15.67% where no attempt to ­contact was made (p=0.011). After adjustment for ­confounding using logistic regression, there was evidence of reduced readmissions in the ‘attempt to contact’ group odds ratio = 1.93 (95% c­onfidence interval = 1.06–3.52, p=0.033). Of the patients who community nurses attempted to contact, 288 were contacted, and 202 received a home visit with general practitioner ­referral and medications advice being the most common ­interventions initiated. This service evaluation shows that a simple intervention where community nurses attempt to contact and visit geriatric patients after discharge causes a significant reduction in 30-day hospital readmissions.