• A comparative study on the clinical decision making processes of nurse practitioners versus medical doctors using scenarios within a secondary care environment

      Barratt, Julian; Moorley, Calvin; Thompson, Stephen (Wiley, 2017-04-07)
      Subjects This study was conducted from May 2012 to January 2013.Aim To investigate the decision-making skills of secondary care nurse practitioners compared to those of medical doctors.Background A literature review was conducted, searching for articles published from 1990 to 2012. The review found that nurse practitioners are key to the modernisation of the National Health Service. Studies have shown that compared to doctors, nurse practitioners can be efficient and cost-effective in consultations.Design Qualitative research design. Methods The information processing theory and think-aloud approach were used to understand the cognitive processes of 10 participants (5 doctors and 5 nurse practitioners). One nurse practitioner was paired with one doctor from the same speciality, and they were compared using a structured scenario-based interview. To ensure that all critical and relevant cues were covered by the individual participating in the scenario, a reference model was used to measure the degree of successful diagnosis, management and treatment.Results The data were processed for 5 months, from July to November 2012. The two groups of practitioners differed in the number of cue acquisitions obtained in the scenarios. In our study, nurse practitioners took three minutes longer to complete the scenarios. Conclusion This study suggests that nurse practitioner consultations are comparable to those of medical doctors within a secondary care environment in terms of correct diagnoses and therapeutic treatments. The information processing theory highlighted that both groups of professionals had similar models for decision-making processes.
    • A History of World Cup Posters 1930-2014

      Williams, Jean (Berg, 2017)
      The historical development of official World Cup posters provides a fascinating means of considering the growth of the world’s most popular sport. There are important continuities with the history of the modern Olympic Games, which were inaugurated in 1896 in Athens. From 1908 the Olympic Games staged a small but influential football tournament, out of which the World Cup eventually developed. At the London 1908 Olympic Games, the Football Association (FA) organised the competition, though it remained contested whether representative players were entirely amateur. Formed in 1863, the FA had agreed to tolerate professionalism since 1885, and the entirely professional Football League was formed in 1888. Friendly international football rivalries against other national teams has begun in 1872, and were instantly popular with spectators and the media alike.
    • A large scale examination of the effectiveness of anonymous marking in reducing group performance differences in higher education assessment

      Hinton, Danny; Higson, Helen (PLOS, 2017-08)
      The present research aims to more fully explore the issues of performance differences in higher education assessment, particularly in the context of a common measure taken to address them. The rationale for the study is that, while performance differences in written examinations are relatively well researched, few studies have examined the efficacy of anonymous marking in reducing these performance differences, particularly in modern student populations. By examining a large archive (N = 30674) of assessment data spanning a twelve-year period, the relationship between assessment marks and factors such as ethnic group, gender and socio-environmental background was investigated. In particular, analysis focused on the impact that the implementation of anonymous marking for assessment of written examinations and coursework has had on the magnitude of mean score differences between demographic groups of students. While group differences were found to be pervasive in higher education assessment, these differences were observed to be relatively small in practical terms. Further, it appears that the introduction of anonymous marking has had a negligible effect in reducing them. The implications of these results are discussed, focusing on two issues, firstly a defence of examinations as a fair and legitimate form of assessment in Higher Education, and, secondly, a call for the re-examination of the efficacy of anonymous marking in reducing group performance differences.
    • A low-protein, high-carbohydrate diet increases browning in perirenal adipose tissue but not in inguinal adipose tissue

      Pereira, Mayara P.; Ferreira, Laís A.A.; da Silva, Flávia H.S.; Christoffolete, Marcelo A.; Metsios, George S.; Chaves, Valéria E.; de França, Suélem A.; Damazo, Amílcar S.; Flouris, Andreas D.; Kawashita, Nair H. (Elsevier, 2017-05-31)
    • A multicentre community-based study of dementia cases and subcases in older people in China--the GMS-AGECAT prevalence and socio-economic correlates.

      Chen, Ruoling; Ma, Ying; Wilson, Ken; Hu, Zhi; Sallah, David; Wang, Jiaji; Fan, Lihua; Chen, Ruo-Li; Copeland, John R (Wiley, 2011-09-21)
      Previous studies indicated overall relatively low prevalence of dementia in older people in China, which may be biased by studied samples or methods. We determined the prevalence of dementia cases and subcases in China and examined their socio-economic correlates. Using the Geriatric Mental State interview, we examined random samples of 2917 participants aged ≥ 65 years in urban and rural Anhui, China in 2001-2003, and 3327 in four other provinces in 2008-2009. Dementia cases and subcases were diagnosed by Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy. Age-standardised prevalence for cases and subcases of dementia in the Anhui elders was 7.20% (95%CI 6.29%-8.20%) and 10.5% (9.38%-11.6%), and in the four provinces, 9.86% (8.80%-10.9%) and 8.51% (7.51%-9.52%). The matched figures among the participants who were literate were 3.05% (2.08%-4.02%) and 10.0% (8.38%-11.6%), and 4.92% (3.89%-5.96%) and 6.76% (5.55%-7.96%), respectively. There were higher prevalence rates of dementia cases and subcases in the rural elders than in the urban. Both the Anhui and four-province studies showed an obvious association of dementia with higher and lower incomes among elders who had lower educational levels or had the lowest occupational class. The highest risk of dementia was found in those who were illiterate but had the highest income or had the job of business/nonmanual labouring. People in China have a higher prevalence of dementia than previously reported. Its U-shaped relationship with income and the excess subcases prevalence predicates a significant burden of disease, both now and for the future, suggesting preventive strategy for dementia in China.
    • A National Learning Entitlement: Moving Beyond University Tuition Fees

      Tuckett, Alan (LLAKES Research Papers, 2018-01)
      The paper sets out a proposal for a National Learning Entitlement as a means of supporting all post-secondary students. The proposal takes the debate beyond the current narrow focus on university education and student debt, to a broader and more inclusive system which would encourage learning at all ages by a diverse range of students, at a lower cost than the abolition of university fees. The proposal is for a national learning entitlement which would enable free access to publicly provided, or publicly recognised, education and training for the equivalent of two years for all those aged 18 and above. It would be valid for further and adult education colleges as well as higher education. The entitlement would be pitched at around £5K per year, but could be used flexibly for part-time study, and spread over a lifetime. By going beyond university students the NLE spreads public subsidy far more equitably and efficiently. It brings into play the other 50% of the youth cohort, as well as adults who have missed out first time round. It strongly encourages diversity of provision and so matches supply better to demand. It wins on fairness, efficiency and future orientation.
    • A new quality of life consultation template for patients with venous leg ulceration

      Green, J.; Jester, R.; McKinley, R.; Pooler, A.; Mason, S.; Redsell, S.; Lecturer, School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG; Professor, Faculty of Health and Social Care, London South Bank University, London, SE1 0AA.; Professor of Education in General Practice, Keele University Medical School, Staffordshire, ST5 5BG.; Lecturer, School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG; Clinical Lead Tissue Viability, Staffordshire and Stoke on Trent Partnership Trust, Bradwell Hospital, Chesterton, Newcastle-under-Lyme, ST5 7NJ; Professor of Public Health, Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge (MA Healthcare Ltd, 2015-03-02)
      OBJECTIVE: Chronic venous leg ulcers (CVLUs) are common and recurrent, however, care for patients predominantly has a focus which overlooks the impact of the condition on quality of life. The aim of this study was to develop a simple, evidence-based consultation template, with patients and practitioners, which focuses consultations on quality of life themes. METHOD: A nominal group was undertaken to develop a new consultation template for patients with CVLUs based on the findings of earlier qualitative study phases. RESULTS: A user-friendly two-sided A4 template was designed to focus nurse-patient consultations on the quality of life challenges posed by CVLUs. CONCLUSION: CVLUs impact negatively on the quality of life of the patient but this receives inadequate attention during current consultations. This new template will help to ensure that key concerns are effectively raised, explored and addressed during each consultation. DECLARATION OF INTEREST: The NHS West Midlands Strategic Health Authority funded this study. The authors have no conflicts of interest to declare.
    • A Policy pathway to reducing teenage pregnancy in Africa

      Odejimi, O; Bellingham-Young, Denise (Journal of Human Growth and Development, 2014-06)
      Background: Teenage pregnancy remains an important and complex issue around the world, with reports indicating that Africa has higher rates than other continents. Studies have indicated that social and economic determinants are associated with these higher rates. Therefore this study aims to identify the social and economic influencers of teenage pregnancy which would help develop a best-practice approach to reduce its incidence in Africa. Methods: Data sets from the World Bank Organisation between 2008 and 2010 specific to 51 Africa countries were obtained to conduct this study, based on availability. Independent t-test, Spearman’s correlation and regression analysis were performed. The eight social and economic variables used in this study are: GDP per capita, GINI index, Female Literacy rate, Health expenditure, Unemployed female rate, Gender equality, Contraceptive prevalence and urban population rate. Results: Independent t-test revealed that in countries where teenage pregnancy rate is high, Literacy rate, contraceptive prevalence rate and Healthcare expenditure rate was low. Spearman correlation indicated that female literacy rate, Healthcare expenditure, GDP per capita and Contraceptive prevalence had a significant inverse relationship with teenage pregnancy rate. Logistic regression indicates that Female Literacy rate is the best predictor of teenage pregnancy in Africa. Conclusion: Result suggest that a practical approach to reduce teenage pregnancy rate in Africa is to implement strategies and policies aimed at improving female literacy rate, Health care expenditure and the GDP per capita of a country. Additionally, an increase in female literacy rate would concurrently increase Contraceptive prevalence rate.
    • A qualitative study of self-evaluation of junior doctor performance: is perceived ‘safeness’ a more useful metric than confidence and competence?

      Roland, Damian; Matheson, David; Coats, Timothy; Martin, Graham (BMJ, 2015-11-04)
      Objectives: The terms confidence and competence have been poorly defined and are often misused by junior doctors. Given safe practice relies on healthcare professionals being aware of their own skill sets improving self-assessment of confidence and competence is important. The aim of this work was to explore junior doctors’ understanding of how they perceive their own performance in respect of managing feverish children in an emergency department. Setting: A children’s emergency department in a tertiary hospital in the East Midlands, UK. Participants: 22 Junior doctors volunteered to undertake focus groups via a meta-planning methodology over 2 years (14 participants in the first year and 8 in the second). Results: Although doctors were aware of the difference between confidence and competence they were not able to distinguish between them in practical terms. The feeling of being ‘safe’ emerged as a term in which there was a shared understanding compared to reported confidence and competence. Conclusions: A perception of ‘safeness’ is a concept that may aid self-evaluation and we present a matrix that might be used by supervisors and educators to examine this and its relationship with confidence and competence.
    • A survey of engagement and competence levels in interventions and activities in a community mental health workforce in England.

      Lang, Linda; Orton, Sophie; Sallah, David; Hewitt-Moran, Teresa; Zhang, Dongmei; Cullen, Sean; Dixon, Sheila; Bell, Brian; Bell, David; Meeson, Lesley; Chen, Ruoling (Biomed Central, 2011-12-29)
      National Health Service (NHS) mental health workforce configuration is at the heart of successful delivery, and providers are advised to produce professional development strategies. Recent policy changes in England have sharpened the focus on competency based role development. We determined levels of intervention activities, engagement and competence and their influencing factors in a community-setting mental health workforce. Using a modified questionnaire based on the Yorkshire Care Pathways Model we investigated 153 mental health staff working in Coventry and Warwickshire NHS Trust. A median score of competence was computed across 10 cluster activities. Low engagement and competence levels were examined in a logistic regression model. In 220 activities, Monitoring risk was the highest rate of engagement (97.6%) and Group psychological therapy/Art/Drama therapy was the lowest engagement (3.6%). The median competence level based on all activities was 3.95 (proficient). There were significant differences in the competence level among professional groups; non-qualified support group (3.00 for competent), Counsellor/Psychologist/Therapist (3.38), Occupational therapists (3.76), Nurses (4.01), Medical staff (4.05), Social workers (4.25) and Psychologists (4.62 for proficient/expert). These levels varied with activity clusters; the lowest level was for Counsellor/Psychologist/Therapist in the accommodation activity (1.44 novice/advance beginner) and the highest for Occupational therapists in personal activity (4.94 expert). In a multivariate analysis, low competence was significantly related to non-qualified community support professions, late time of obtaining first qualification, more frequencies of clinical training, and training of cognitive behavioural therapy. The associations were similar in the analysis for 10 activity clusters respectively. There was a reasonable competence level in the community-setting mental health workforce, but competence varied with professional groups and cluster activities. New staff and other non-qualified support professions need to receive efficient training, and the training content is more important than frequency to increase level of competence.
    • A systematic review of the association between emotions and eating behaviour in normal and overweight adult populations

      Devonport, Tracey J; Nicholls, Wendy; Fullerton, Christopher (SAGE Publications, 2017-03-20)
      A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of four electronic databases (2004–2015) yielded 60,017 articles, of which 29 met inclusion criteria. Included studies performed poorly on data quality analysis in terms of randomisation and controlling for confounding factors. Participant’s body mass index scores range from 19.73 (standard deviation = 1.54) to 28.4 (standard deviation = 1.4) kg/m2. Where positive and negative affects were compared, food was more likely to be consumed in response to positive affect. With regard to discrete emotions; stress, depression and sadness consistently elicited eating behaviours that fall outside of nutritional recommendations (e.g. increased food intake or poor nutritional food choices). The role of moderators including individual differences in dietary restraint and emotional eating, as well as methodological considerations, such as means of eliciting and measuring emotions, may account for equivocality with regard to some emotion and eating associations. This article concludes with recommendations for future research and implications for practice
    • A Systematic Review of the Association between Emotions and Eating Behaviour in Normal and Overweight Adult Populations

      Devonport, Tracey; Nicholls, Wendy; Fullerton, Christopher L. (Sage Publications LTD, 2017-03-01)
      A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of four electronic databases (2004-2015) yielded 60017 articles, of which 29 met inclusion criteria. Included studies performed poorly on data quality analysis in terms of randomization and controlling for confounding factors. Participant’s BMI scores range from 19.73 (SD = 1.54) to 28.4 (SD = 1.4) kg/m2. Where positive and negative affect were compared, food was more likely to be consumed in response to positive affect. With regards to discrete emotions; stress, depression, and sadness consistently elicited eating behaviours that fall outside of nutritional recommendations (e.g., increased food intake, poor nutritional food choices). The role of moderators including individual differences in dietary restraint and emotional eating, as well as methodological considerations, such as means of eliciting and measuring emotions, may account for equivocality with regards to some emotion and eating associations. The paper concludes with recommendations for future research and implications for practice.
    • A systematic review of the traits and cognitions associated with use of and belief in complementary and alternative medicine (CAM).

      Galbraith, Niall; Moss, Tim; Galbraith, Victoria; Purewal, Satvinder (Taylor & Francis, 2018-02-22)
      Complementary and alternative medicine (CAM) use is widespread despite the controversy over its effectiveness. Although previous reviews have examined the demographics and attitudes of CAM users, there is no existing review on the traits or cognitions which characterise either CAM users or those who believe in CAM effectiveness. The current systematic review set out to address these gaps in the literature by applying a narrative synthesis. A bibliographic search and manual searches were undertaken and key authors were contacted. Twenty-three papers were selected. The trait openness to experience was positively associated with CAM use but not CAM belief. Absorption and various types of coping were also positively associated with CAM use and belief. No other trait was reliably associated with CAM use or belief. Intuitive thinking and ontological confusions were positively associated with belief in CAM effectiveness; intuitive thinking was also positively associated with CAM use. Studies researching cognitions in CAM use/belief were mostly on non-clinical samples, whilst studies on traits and CAM use/belief were mostly on patients. The quality of studies varied but unrepresentative samples, untested outcome measures and simplistic statistical analyses were the most common flaws. Traits and cognition might be important correlates of CAM use and also of faith in CAM.
    • A Test and Extension of Lane and Terry’s (2000) Conceptual Model of Mood-Performance Relationships using a Large Internet Sample

      Lane, Andrew M; Terry, Peter C.; Friesen, Andrew P; Devonport, Tracey J.; Totterdell, Peter (Frontiers iMedia, 2017-04-18)
      The present study tested and extended Lane and Terry’s (2000) conceptual model of mood-performance relationships using a large dataset from an online experiment. Methodological and theoretical advances included testing a more balanced model of pleasant and unpleasant emotions, and evaluating relationships among emotion regulation traits, states and beliefs, psychological skills use, perceptions of performance, mental preparation, and effort exerted during competition. Participants (N = 73,588) completed measures of trait emotion regulation, emotion regulation beliefs, regulation efficacy, use of psychological skills, and rated their anger, anxiety, dejection, excitement, energy, and happiness before completing a competitive concentration task. Post-competition, participants completed measures of effort exerted, beliefs about the quality of mental preparation, and subjective performance. Results showed that dejection associated with worse performance with the no-dejection group performing 3.2% better. Dejection associated with higher anxiety and anger scores and lower energy, excitement, and happiness scores. The proposed moderating effect of dejection was supported for the anxiety-performance relationship but not the anger-performance relationship. In the no-dejection group, participants who reported moderate or high anxiety outperformed those reporting low anxiety by about 1.6%. Overall, results showed partial support for Lane and Terry’s model. In terms of extending the model, results showed dejection associated with greater use of suppression, less frequent use of re-appraisal and psychological skills, lower emotion regulation beliefs, and lower emotion regulation efficacy. Further, dejection associated with greater effort during performance, beliefs that pre-competition emotions did not assist goal achievement, and low subjective performance. Future research is required to investigate the role of intense emotions in emotion regulation and performance.
    • A Voice of Travail from A Chronic Pain Patient: The Lived-Experience of A Withdrawn Disability Living Allowance

      Taiwo, Abigail Olubola (Centre for Health and Social Care Improvement, University of Wolverhampton, 2018-02)
      This study described the lifeworld of one ‘chronic pain patient’, Shelly whose disability living allowance (DLA) was withdrawn. The aim is to explicate the existential impact of this withdrawal when she presented her lived experience of this phenomenon in her narration. As I listened to Shelly’s problem soaked narratives through a relatively unstructured interview, an emerged behind the scene voice of travail became louder through the narratives. The existential phenomenological analysis reveals an experience of erosion of Shelly’s sense of identity, a daily toil and laborious lived body in the context of her life activities and relationships. The narratives also revealed the patriarchal approach of ‘the system that be’ that were compounding and even making the voice of travail louder, eroding autonomy, promoting feeling of helplessness and suffering. These findings were discussed in the context of previous studies. Following the discussion, a reflexive account of the research relationship and how the process of analysis has impacted on this researcher was provided to promote a more transparent accounting of the relational centred methodology and how I came to my interpretation. Findings from this research lend support to the idea of the ontology that fully embodied and integrate with our being in the world, bridging the gap and weaving together a new way of understanding the body-subject and how it experiences and copes with its vulnerability in the world
    • The ability of adults of different size to egress through confined space apertures

      Stewart, Arthur; Nevill, Alan M.; Johnson, Christopher (Sage, 2018-12-31)
      Absolute body size is a strong predictor of minimum wall aperture transit in adults. Key anatomical dimensions scale to egress capability, but men and women exhibit subtle differences. Wherever clearance space is restricted, transit capability is likely to become increasingly limited by enlarged body size associated with increased obesity prevalence.
    • Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy

      James, Nicholas D.; de Bono, Johann S.; Spears, Melissa R.; Clarke, Noel W.; Mason, Malcolm D.; Dearnaley, David P.; Ritchie, Alastair W.S.; Amos, Claire L.; Gilson, Clare; Jones, Rob J.; Matheson, David; Millman, Robin; Attard, Gerhardt; Chowdhury, Simon; Cross, William R.; Gillessen, Silke; Parker, Christopher C.; Russell, J. Martin; Berthold, Dominik R.; Brawley, Chris; Adab, Fawzi; Aung, San; Birtle, Alison J.; Bowen, Jo; Brock, Susannah; Chakraborti, Prabir; Ferguson, Catherine; Gale, Joanna; Gray, Emma; Hingorani, Mohan; Hoskin, Peter J.; Lester, Jason F.; Malik, Zafar I.; McKinna, Fiona; McPhail, Neil; Money-Kyrle, Julian; O’Sullivan, Joe; Parikh, Omi; Protheroe, Andrew; Robinson, Angus; Srihari, Narayanan N.; Thomas, Carys; Wagstaff, John; Wylie, James; Zarkar, Anjali; Parmar, Mahesh K.B.; Sydes, Matthew R. (Massachusetts Medical Society, 2017-07-27)
      BACKGROUND Abiraterone acetate plus prednisolone improves survival in men with relapsed prostate cancer. We assessed the effect of this combination in men starting long-term androgen-deprivation therapy (ADT), using a multigroup, multistage trial design. METHODS We randomly assigned patients in a 1:1 ratio to receive ADT alone or ADT plus abiraterone acetate (1000 mg daily) and prednisolone (5 mg daily) (combination therapy). Local radiotherapy was mandated for patients with node-negative, nonmetastatic disease and encouraged for those with positive nodes. For patients with nonmetastatic disease with no radiotherapy planned and for patients with metastatic disease, treatment continued until radiologic, clinical, or prostate-specific antigen (PSA) progression; otherwise, treatment was to continue for 2 years or until any type of progression, whichever came first. The primary outcome measure was overall survival. The intermediate primary outcome was failure-free survival (treatment failure was defined as radiologic, clinical, or PSA progression or death from prostate cancer). RESULTS A total of 1917 patients underwent randomization from November 2011 through January 2014. The median age was 67 years, and the median PSA level was 53 ng per milliliter. A total of 52% of the patients had metastatic disease, 20% had node-positive or node-indeterminate nonmetastatic disease, and 28% had node-negative, nonmetastatic disease; 95% had newly diagnosed disease. The median follow-up was 40 months. There were 184 deaths in the combination group as compared with 262 in the ADT-alone group (hazard ratio, 0.63; 95% confidence interval [CI], 0.52 to 0.76; P<0.001); the hazard ratio was 0.75 in patients with nonmetastatic disease and 0.61 in those with metastatic disease. There were 248 treatment-failure events in the combination group as compared with 535 in the ADT-alone group (hazard ratio, 0.29; 95% CI, 0.25 to 0.34; P<0.001); the hazard ratio was 0.21 in patients with nonmetastatic disease and 0.31 in those with metastatic disease. Grade 3 to 5 adverse events occurred in 47% of the patients in the combination group (with nine grade 5 events) and in 33% of the patients in the ADT-alone group (with three grade 5 events). CONCLUSIONS Among men with locally advanced or metastatic prostate cancer, ADT plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than ADT alone. (Funded by Cancer Research U.K. and others; STAMPEDE ClinicalTrials.gov number, NCT00268476, and Current Controlled Trials number, ISRCTN78818544.)