bluuebunny/crossref_metadata_2025 huggingface dataset:
Lived experiences of adult community nurses delivering palliative care to children and young people in rural areas
Authors: Reid Fiona Cathryn
Published: May 2014

The anticipated death of a child or young person is a relatively rare occurrence in the Western world. Many families receive support from children's health-care services until the late stages of palliation, with adult community nurses being involved in just an occasional end-of-life care episode in the home during their entire career. This creates challenges in nurses’ experiential reflection, development of knowledge and skills, and building of nurse–family relationships. Individual semi-structured interviews were conducted with 10 adult community nurses from a rural part of Scotland to explore their experiences of providing palliative care to children. The material was analysed using a qualitative phenomenological thematic approach. Four key themes emerged: emotional preparedness, navigating the professional ‘road’, becoming part of the family, and it's everybody's business. Significant issues were highlighted in relation to nurses’ coping, with implications for practice. Recommendations are made for further research into rural contextual dilemmas.
Research roundup
Authors: Nicholson Craig
Published: May 2014

These pages provide brief synopses of a selection of recently published research articles of relevance to palliative care.
WHOQOL Pain and Discomfort Module: development and validity testing of the Italian version
Authors: Boero Maria Elena , Melegari Anna L , Vizzuso Paola , Braida Vanda , Panetta Valentina , Skevington Suzanne M , Mason Victoria
Published: May 2014

Background:

The World Health Organization Quality of Life scale Pain and Discomfort Module (WHOQOL PDM) was designed to assess quality of life (QoL) in adults with chronic pain. It comprises 16 items covering four facets of pain: relief, anger/frustration, vulnerability/fear/worry, and uncertainty.

Aim:

The purpose of this study was to validate the Italian version of the WHOQOL PDM.

Methods:

Chronic pain was assessed in 400 patients using the WHOQOL PDM and other pain scales, together with scales measuring associated symptoms, depression, anxiety, and QoL.

Results:

The WHOQOL PDM shows good internal consistency, concurrent validity (it was significantly associated with all the WHOQOL BREF domains), construct validity (it was significantly associated with other pain scales), and discriminant validity (there were significant differences among different groups of patients).

Conclusions:

The Italian version of the WHOQOL PDM is a brief, useful, and valid tool for assessing chronic pain and its impact on patients’ QoL.
Aggressive behaviour in older people: a review of the issues
Authors: Winn Helen
Published: May 2014

The occurrence of aggressive behaviour in health care is increasing, as is the risk of injury to health-care professionals following an attack from a patient. Such behaviour, which can be physical or verbal, is severely challenging and may be caused by a variety of reasons, which include mental illness and seeking attention.

This article provides a review of the relevant literature regarding the possible causes of aggressive behaviour in older people. It outlines the management strategies designed to prevent this challenging behaviour, which take into consideration that the client should be able to express his or her feelings or distress.
Durability of manual wheelchairs: A review
Authors: Fitzgerald Shirley G , Kelleher Annmarie
Published: May 2014

The aim of this article is to explain the differences between the three main categories of manual wheelchairs and describe the durability characteristics of each type. Findings are presented from several research studies that have compared wheelchair durability across these wheelchair classifications.

Results indicate that the most durable type of manual wheelchair (ultralightweight) weigh less than 13.6 kg and are completely adjustable. These wheelchairs are made out of lightweight materials such as titanium and have been shown to last longer, with fewer catastrophic repairs than their heavier counterparts. Recommendations are also provided regarding how to obtain an ultralightweight wheelchair.
Improving the delivery of electronic assistive technology to disabled people
Authors: Williams Emlyn
Published: May 2014

Medical intervention can increase longevity and improve the quality of life – yet for many people, assistive technology, environmental improvements and carer support are equally important.
A guide to evaluating different wheelchair seat cushions
Authors: Rithalia Shyam
Published: May 2014

Over the years, there has been a considerable increase in the number and variety of wheelchair seat cushions. People required to select a cushion are faced with a confusing and often misleading array of commercial literature. The cost of these products range from less than £100 to several hundred pounds, so the importance of a logical approach to their selection cannot be overstated. Inappropriate selection not only wastes capital resources, but it can also be very harmful to the patient.

Although the effectiveness of a wheelchair cushion is best evaluated through clinical trials, these are expensive to conduct and in the case of new products, such evidence is not readily available. In order to overcome this drawback, researchers have developed experimental methods of evaluation based upon existing knowledge of pressure ulcer aetiology. This article describes the most common methods, along with a new technique known as pressure relief index.
Development of a foundation degree in health and social care
Authors: Cochrane A , Chambers A , Duffy A , Harrison L , Stewart H , Selfe J , Ingman E
Published: May 2014

Health care in the UK is at present experiencing a shortfall of qualified health-care professionals. One initiative that has been proposed is to provide foundation degrees, which meet the needs of employers in a range of health and welfare settings and prepares students to support clients in maximizing their independence within a programme of care.

This article describes the development of the foundation degree in health and social care at the University of Central Lancashire, UK. A two-stage consultative exercise with practitioners was undertaken in the form of focus groups. These were multidisciplinary and grouped according to practice area. This form of consultation has enabled clinicians to feel valued for their skills and opinions and has ensured a curriculum that is relevant and current to the needs of practice.
Enhancing student support to facilitate workforce development
Authors: Watson Jo
Published: May 2014

Reforms of the NHS incorporate an ambition to expand the occupational therapy (OT) workforce by increasing the number of funded student places by 40% by 2004 (College of Occupational Therapists (COT), 2003). The aim is not only to increase numbers, but to develop a recruitment base that more closely reflects the cultural diversity of both society and NHS service users (Department of Health (DoH), 2000).
Influence of unilateral neglect on independence in activities of daily living after stroke
Authors: Pomeroy Caroline HC
Published: May 2014

This article summarizes a systematic literature review conducted to establish whether the phenomenon of unilateral neglect (UN) has a substantial impact upon an individual's independence in activities of daily living after stroke. The literature was scrutinized to ensure compatibility with pre-established inclusion criteria and to generate themes for discussion. Consistency of critique methodology was structured through the use of set questions.

Findings of the review were more complex than anticipated, not least because of the influence of additional perceptual and cognitive deficits existing alongside UN. Activities conducted outside personal space were found to be less impaired by UN than those within it, despite agreement not being reached over whether neglect can exist in different areas of space. It has also been suggested that load and familiarity have a strong influence upon ability, which leads existing rehabilitation techniques to be brought into question.

Inconsistencies are great throughout defining, detecting and treating UN. Decreasing these would go a long way towards improving effective and integrated stroke services, as required by the National Service Framework for Older People. Recommendations have been made for areas in need of research and implications for future practice are discussed.
Moving and handling patients safely: A product guide
Authors: Finucane Caroline
Published: May 2014

Buying suitable equipment for moving and handling people is essential, as manual lifting can place a severe strain on those assisting and put them at risk of developing a work-related musculoskeletal injury.

This article offers information on the different types of mobility aids and hoists available and provides contact details for the manufacturers and suppliers of such equipment. It aims to provide a useful guide for therapists and carers involved in handling people, and for those who are able to independently transfer with the use of the right mechanical aid.
Occupation focused assessment and intervention for clients with anorexia
Authors: Abeydeera Kumari , Willis Suzie , Forsyth Kirsty
Published: May 2014

Anorexia nervosa is widely described as a severe and enduring illness, characterized by repeated relapses (Lay et al, 2002; Carter et al, 2004; Richard et al, 2005). Nosological classification of anorexia does not indicate the severe and multifaceted difficulty experienced by sufferers in all areas of occupational functioning (Henderson, 1998). Lim and Agnew (1994) proposed that alongside treating psychological issues and weight restoration, treatment intervention in anorexia should involve facilitating a change in lifestyle, with adaptive participation in meaningful life occupations.
Advancing rehabilitation clinical trials design
Authors: Bernhardt Julie
Published: May 2014

The randomized controlled trial (RCT), while not the only methodology that can be employed to help answer important questions about treatment efficacy represents ‘gold standard’ trial design. The past decade has seen exponential growth in the number of RCT’s conducted by therapists.
Choosing a manual wheelchair: The options
Authors: Fernandes Tanya
Published: May 2014

There are a variety of manual wheelchairs available on the market designed to help individuals with mobility difficulties to carry out daily living tasks as independently as possible. Participation in such activities is crucial in enabling users to integrate into society and prevent isolation as a result of a disability.

A holistic approach to assessment should take into account all aspects of individual need and will result in the selection of the most appropriate piece of equipment, which in turn may result in an improvement in the quality of life for any individual with an impairment of function.

This article will look at the considerations that need to be taken into account when prescribing manual wheelchairs as well as highlighting some of the options available on the market.
The test-retest reliability of a battery of new occupational performance assessments
Authors: Ikiugu Moses N , Anderson Angela , Manas Diane
Published: May 2014

Aims: The purpose of this pilot study was to investigate the test-retest reliability of a set of newly developed occupational performance assessment instruments based on the philosophy of pragmatism and the complexity theory. These instruments were: the Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy (AIIIOT), the Daily Occupational Inventory (DOI), and the Occupational Performance Calculation Guide (OPCG).

Method: An experimental study with a non-experimental test-retest design was adopted to quantify observations, and to determine the ability of the instruments to produce stable scores on repeated testing.

Findings: The AIIIOT was found to have low test-retest reliability, probably owing to a very small sample. The occupational performance scores as calculated on the OPCG had reliability coefficients that approached statistical significance. Adequacy, Satisfaction, and Belief scores on the AIIIOT were found to be good predictors of the frequency of engagement in occupations perceived to be important for achievement of personal mission in life.

Conclusions: These assessments have promise as clinical instruments for measuring occupational performance in occupational therapy. Further research with more robust samples is indicated to validate the instruments conclusively.
Focus group methodology Part 1: Considerations for design
Authors: Plummer-D'Amato Prudence
Published: May 2014

There is a strong tradition of quantitative research in the health sciences, but qualitative research designs are now being used more frequently to investigate certain areas of rehabilitation, such as patients' views of health care services, and how clinicians make decisions during evaluations and treatment. Many qualitative approaches are available for conducting these types of inquiries, such as interviews, participant observation, and focus groups.

Focus groups are unique because they combine interviewing, participant observation, and group interaction. Focus groups are therefore particularly useful when the researcher wants to investigate people's thoughts because the interaction between participants can elicit data and ideas that might not be uncovered in one-on-one questioning. To optimize the data obtained from focus groups, careful attention must be paid to the composition and number of groups, as well as the selection and training of the moderator, and the development of the question route.

This article will review these components of focus group research design, as well as highlight other important considerations for planning and conducting focus groups. Issues specific to analysis and trustworthiness of focus group data will be addressed in Part 2.
Acute phase functional electrical stimulation for the upper limb after cervical spinal cord injury
Authors: Wallace Leslie , McQueen Jean
Published: May 2014

Aims

Anecdotal evidence suggests that early treatment with functional electrical stimulation (FES) to specific upper limb muscles and muscle groups may improve functional outcome and long-term independence in the high-level tetraplegic patient. This improvement may lead to increased independence in daily life. The authors aimed to investigate these assertions using a case study design, and encourage further work on this treatment strategy.

Methods

The implementation of FES at an early stage post-injury in one cervical spinal cord-injured patient is described. FES was applied with the aim of improving functional use of upper limbs. Muscle strength was assessed, using manual muscle testing with the Oxford scale, at commencement and cessation of FES treatment. Independence in activities of daily living was also recorded.

Findings

This case study suggests that use of FES applied during the acute phase following injury can have a positive effect on both physical and psychological outcomes.

Conclusions

Further work is recommended to strengthen the evidence for this intervention.
Understanding children's play in Hong Kong: A perspective for therapists
Authors: Chow Susanna MK , Cheung Phoebe PP , Hong Chia Swee
Published: May 2014

Children learn about themselves and their world through play. Play-based activities are used in therapy for improving attention, enhancing the development of play and facilitating playfulness (Case-Smith, 2005). In many highly urbanized areas in the world, the only outdoor play space accessible for the majority of children is their neighbourhood playgrounds. This is particularly so for children living in government subsidized housing. This editorial will report on and discuss a piece of pilot research, undertaken in 2006, which explored children's preferences for—;and their interaction with—;the playground equipment and environment.
Systematic reviews in clinical practice: Evaluating evidence for management of acute whiplash-associated disorder
Authors: Wright Chris , Rushton Alison , Gamlin Jill , Farrell Derek
Published: May 2014

Introduction

The methodology of systematic review (SR) has developed considerably in recent years. The SR is rated as providing the highest level of evidence as it applies rigour in combining fi ndings from original evidence. However, concern has been expressed regarding the quality of some SRs. Critical evaluation of SRs is essential to ensure that they provide best evidence to inform management decisions in practice.

Content

A background to SRs illustrates their development and importance to informing decisions for best practice, especially for the busy clinical practitioner. The characteristics of a SR are evaluated using an illustrated example of the development of a SR method to evaluate conservative physical management of patients with acute whiplash-associated disorder grade II.

Discussion and Conclusions

Understanding the key components of a SR enables effective critique of a published review. This in turn facilitates effi cient use of the SR fi ndings within clinical decision making in practice.
Self-management techniques for bipolar disorder in a sample of New Zealand Chinese
Authors: Wang Grace , Tse Samson , Michalak Erin E.
Published: May 2014

Aims

The aim of the study presented in this article was to consider how New Zealand Chinese with bipolar disorder manage their condition, regain and maintain wellness through the use of self-management techniques.

Methods

Nine New Zealand Chinese with bipolar disorder type I or II who had reasonable performance in role functioning were interviewed. Data analysis was guided by the inductive approach.

Findings

In contrast to Western psychosocial interventions, which emphasize the individual's independence, self-advocacy and self-identity, New Zealand Chinese are more likely to value themselves through relationships with others. Most participants emphasized the importance of harmony with self and others, and adopted passive and nature-oriented attitudes encouraged by Taoism to deal with life stress. Strategies of ‘taking it easy’ and ‘looking at problems in others’ shoes' were frequently used when dealing with interpersonal conflicts.

Conclusions

The concepts of health and life as part of traditional Chinese culture were found to be the fundamental elements influencing the participants' coping patterns. There is a strong need for facilitating the connection between health professionals and clients. This study indicates that to do this, health professionals must be aware of the importance of cultural sensitivity when delivering health care in a multicultural environment.
Communication and quality of life in individuals receiving home mechanical ventilation
Authors: Laakso Katja , Markström Agneta , Hartelius Lena
Published: May 2014

Aims

While in clinical reality many ventilator-supported individuals have been observed to experience difficulties with their communication, research in this area is still scarce. The article aims to address this gap by looking at communicative activity and participation and health-related quality of life (HRQL) in individuals receiving home mechanical ventilation (HMV). The study focuses on how patients themselves experience their communicative participation and HRQL, and whether there might be a relationship between demographic factors, HRQL, and communicative activity and participation.

Methods

Nineteen individuals receiving HMV via tracheostomy (n=17) or non-invasive means (n=2) participated in the study. Three different questionnaires were used: the generic Sickness Impact Profile, the disease-specific Severe Respiratory Insufficiency questionnaire, and the Living with Dysarthria questionnaire measuring communicative participation. Communicative activity was assessed in terms of speech intelligibility.

Findings

The study found that speech intelligibility is decreased in individuals receiving HMV and that these individuals experience high levels of dysfunction in their communication. Still, communicative participation was not severely impaired. The study did not demonstrate any significant correlation between quality of life measures and communicative participation or intelligibility.

Conclusions

Communication was one of the areas of HRQL with which the participants experienced difficulties. Nevertheless, the results of the study show that communicative participation and intelligibility levels do not contribute independently to the reduced HRQL.
The 14th International Forum on Quality and Safety in Health Care 2009
Authors: Craig Kim , Ions Rhiannon
Published: May 2014

The International Forum on Quality and Safety in Health Care, organized jointly by the Institute for Health Care Improvement in the USA and the British Medical Journal Group UK, took place on 17-20 March in Berlin. Nearly 2000 delegates met for the 14th Forum, the aim of which is to support the movement for health care improvement by presenting the best thinking and work on quality improvement from across the globe, and by providing a forum where practitioners, educationalists, academics and leaders can meet and learn from each other.
Interviewing in qualitative research: The one-to-one interview
Authors: Ryan Frances , Coughlan Michael , Cronin Patricia
Published: May 2014

Background

The one-to-one interview is a commonly used data collection method in health and social research. Increasing attention has been given in the literature to the process of conducting an interview, particularly with respect to the role of the interviewer and the relationship between the interviewer and interviewee. The individual interview is a valuable method of gaining insight into people's perceptions, understandings and experiences of a given phenomenon and can contribute to in-depth data collection. However, the interview is more than a conversational interaction between two people and requires considerable knowledge and skill on behalf of the interviewer.

Content

Interviews vary in type and structure depending on their philosophical orientation. This article examines the process of conducting the interview from a generic point of view, while making reference to different approaches. Considerations are also raised regarding interviewing in challenging situations.

Conclusions

Several important stages need to be followed when conducting an interview. The nature of the questions, questioning techniques, listening and the interviewer-interviewee interactions are crucial to obtaining a successful outcome. Similarly, ethical considerations and the protection of participants are fundamental aspects of interviewing. Although interview data may be used as evidence about people's perceptions and understanding, it is pertinent to remember that responses may be shaped by variables such as if and how the interviewer has influenced the interviewee, and the level of trust and rapport between the two people. Hence, it is essential that interviewers are cognisant of the various techniques underpinning the interview process to maximize results.
The synthesis: An innovative approach to student research
Authors: Molineux Matthew
Published: May 2014

Background

Although there is an expectation for health practitioners to be able to use research to inform their practice, opportunities for students to actually plan, conduct and report a research project are diminishing. Students are less able to gain first-hand experience of research as a result of demands to include more in curricula, and increasingly rigorous and time-consuming ethical review procedures. It is important, therefore, for health educators to explore different research methods and approaches.

Content

This article proposes the synthesis, an entirely literature-based approach, as a method to enable students to plan and conduct a research project. It is more than a literature review in that it requires students to synthesize material from two previously unrelated fields. As a result it is possible to shine a new light on issues facing health-care professionals and their patients/clients, by bringing new ways of thinking to issues.

Conclusions

Although the synthesis is a nascent concept in student health professional education, it has the potential to offer students first-hand experience of the research process, and so contribute to their development as research aware professionals.
An approach to implementing international diabetes guidelines
Authors: Gagliardino Juan José , Colagiuri Stephen
Published: May 2014

Diabetes is a common, costly and ever-increasing health problem, with chronic complications that result in a heavy socioeconomic burden for people with the disease, the health care system and society (Ringborg et al, 2009). Chronic complications, the major cause of morbidity, premature mortality and costs of diabetes, can be significantly reduced by control of blood glucose and associated cardiovascular risk factors (Ray et al, 2009). The cost of these treatments is within the range of currently accepted preventative interventions (Gæde et al, 2008). Despite the available evidence, prevention strategies have not been widely incorporated into clinical practice and the care received by many people with diabetes is less than optimal worldwide (Chan et al, 2009).
The journey back to effective cognitive function after brain injury. A patient perspective
Authors: Thomas Dai
Published: May 2014

A male consultant physician aged 60 years, myself, suffered a severe brain injury in a road traffic accident in May 2008. I suffered from post-traumatic amnesia for 10 weeks. During this time I was unaware I was having therapy. When I developed insight, I found I became more receptive in therapy sessions. When the brain was not capable of paying full attention it was a considerable obstacle to effective understanding, learning and recall. In my experience, appropriate staff support and my resolve to improve this through personal strategies made a significant difference. My strategy was to see myself as a junior pupil requiring essential education from expert, sympathetic teachers – a ‘being at school’ strategy. I think this enabled me to get the most out of the therapy, nursing and medical services available.
A scheme to support the recruitment and retention of allied health professionals to hard to fill posts in rural areas
Authors: Solowiej Kazia , Upton Penney , Upton Dominic
Published: May 2014

Background

This article follows on from the previous issue, where the Allied Health Professions (AHP) Support and Development Scheme was introduced. The scheme was put in place in order to aid in the recruitment, retention and career development of Allied Health Professionals (AHPs) in hard to fill posts in NHSScotland.

Contents

The last issue looked at how the scheme developed newly qualified practitioners' skills. This article looks at the scheme's impact on recruitment and retention. Financial incentives were provided for both the teams with hard to fill posts and the individuals who were recruited to support the recruitment, retention and career development of AHPs. The evaluation of the scheme aimed to assess the impact on recruitment, retention, career development and successful outcomes for individuals and teams of AHPs in NHSScotland. The scheme was found to have had a positive impact on recruitment and retention of AHPs to hard to fill posts.

Conclusions

Overall, 75% of managers had successfully recruited new team members as a result of the scheme. However the majority of new recruits (68%) reported that the financial incentive had not influenced their decision to accept the posts. Many of these recruits had remained in post and their appointment was reported to have had a positive impact on service provision. Overall the majority of AHPs (89%) would recommend the scheme to other teams with hard to fill posts
Experiences of the voluntary physiotherapist role in developing nations
Authors: Humphreys Katy , Carpenter Christine
Published: May 2014

Aim

Voluntary work is considered to be of benefit both to the community receiving services and to the practitioner providing them. However, much of the current understanding of the physiotherapy volunteer experience is anecdotal. The aim of this qualitative study was to explore the experience of volunteering as a physiotherapist in a developing country in terms of the impact on the volunteer, the nature of the role, and the benefits to the patients as perceived by the participants.

Methods

In-depth telephone interviews were conducted with a purposive sample of five physiotherapists. The interviews were taped and transcribed manually and verbatim. A framework was used to guide the thematic analytic process.

Findings

There were four main themes: barriers to practice, adapting to culture, impact on self, and impact on community. These characterize the rewards and challenges of volunteering in developing countries from a physiotherapist perspective.

Conclusions

The study findings suggest that voluntary physiotherapy in developing nations is most effective and meaningful when there is a genuine interest in the culture, and there is a balance of skill exchange between the foreign and native physiotherapist. Implications for practice and further research are discussed.
Training speech-language pathology graduate clinicians to administer the National Institutes of Health Stroke Scale
Authors: I Zraick Richard , C O'Neill Ashley , C Robinson Gregory , K McWeeny Elizabeth , J Hutton Terri
Published: May 2014

Aims

The National Institutes of Health Stroke Scale (NIHSS) is an 11-item assessment measuring the severity of an individual's stroke. Though neurologists, emergency room physicians, nurses, occupational therapists and physical therapists have completed the certification process for NIHSS administration, no study to date has examined whether speech-language pathologists (SLPs), or those in training, can be certified to administer the NIHSS. The aim of this study was to examine whether SLP graduate student-clinicians could be certified to administer the NIHSS.

Methods

Twenty student clinicians achieved Group A certification from the NIHSS training DVD, then were subsequently tested on NIHSS scoring for six patient vignettes from Group B of the training DVD.

Findings

No student achieved certification for the Group B patients.

Conclusions

The results of this study suggest that basic NIHSS training is not sufficient to ensure certification. In addition, the minimum requirements for NIHSS certification may not be adequate for any individual to reliably and accurately administer the scale. Measures to facilitate certification are discussed, including the need for extensive clinical exposure to stroke patients.
Overcoming the long-term effects of stroke: qualitative perceptions of involvement in a group rehabilitation programme
Authors: Schouten Linda , Murray Carolyn , Boshoff Kobie
Published: May 2014

Linda Schouten, Carolyn Murray, Kobie Boshoff

Aims: This article describes a study evaluating a stroke rehabilitation group programme from multiple perspectives, at a community based day therapy centre in South Australia. The group programme involved goal directed exercise and functional/cognitive activities for one hour a week, over eight weeks.

Methods: The study used an interpretive qualitative approach aimed to explore group member and facilitator perceptions about their involvement in the programme. In depth interviews were used for four group members with stroke, and three staff clinicians involved in the programme facilitation. The interview questions used for both types of participants were the same. In-depth thematic analysis was undertaken to interpret and combine the data from the interviews.

Findings: Six themes emerged: ‘a place to go’, ‘diversity of the group’, ‘the art of group design’, ‘awareness of abilities through doing’, ‘it's about relationships’, and ‘over and above’.

Conclusions: These findings support the use of a group approach to rehabilitation aiming to address the long-term effects of stroke. Psychosocial benefits emerged which were beyond the expected functional aims of the programme. Some recommendations are made about group structure and design based on the evaluation.
Influences on women's completion of a cardiac rehabilitation programme
Authors: Sherwood Sarah A , Povey Rachel C
Published: May 2014

Sarah A Sherwood (née Pullen), Rachel C Povey

Aims: This article describes a study investigating patient and programme factors influencing women's completion of a cardiac rehabilitation (CR) programme.

Methods: A qualitative cross-sectional design was adopted. Semi-structured interviews were conducted with five women who had completed and five women who did not complete the CR programme. An interpretative phenomenological analysis was conducted on the reviews; both individually and within the two groups (‘completers’ and ‘non-completers’). This entire process was also undertaken by a second researcher, and led to the emergence of a list of both individual themes and master themes for each group.

Findings: Positive influences on completion included a correct medical understanding, successful behavioural changes in terms of lifestyle control, approach-focused coping, addressing support needs and positive recognition for the role of CR. Negative influences on completion included incorrect medical understanding, limited lifestyle changes, emotion focused coping, high degree of concern on the impact of significant others and lack of perceived consistent value of CR.

Conclusions: In order to improve completion rates for CR programmes among women with heart disease, it is important to clarify their initial medical understanding and beliefs, and to continually reassess their perceptions during programme delivery. Incorporating individual support, flexibility, and bespoke programmes for different age groups may enhance attendance at cardiac rehabilitation programmes.
The role of spirituality through adaptive sport in the identity adaptation of wounded Service personnel
Authors: Green Sarah
Published: May 2014

Background:

Traumatic, life-changing injuries often require a re-adjustment of identity, but we have yet to explore the impact that adaptive sport may have on the identity adaptation and the meaning of life for wounded Service personnel post traumatic injury.

Content:

By presenting an analysis of adaptive sport as a tool for dealing with post-traumatic injury, this article will focus on some of the reasons why participation in adaptive sport may benefit identity adaptation and have spiritual, existential meaning.

Conclusion:

It is clear that more work needs to be done to assess the impact of traumatic injuries and how they affect the identity and the meaning of life for wounded Service personnel. The spiritual, existential experience of adaptive-sport-rehabilitation can be recognised as a therapy to bring back meaning to the lives of the wounded and help them adjust to their newly defined identity by providing purpose and achievement.
Evaluation of clinical guidelines for contracted (frozen) shoulder 12–18 months after publication
Authors: Hanchard Nigel , Goodchild Lorna , Thompson Jackie , O'Brien Tracey , Richardson Chris , Watson Helen
Published: May 2014

Background/aim:

To obtain an early indication of the dissemination of evidence-based physiotherapy guidelines for contracted (frozen) shoulder and to explore how the guidelines’ recommendations correspond with practice.

Methods:

The authors monitored downloads of the guidelines for the 18 months after publication. This study also used a self-administered, anonymous online questionnaire survey, which targeted UK-based physiotherapists who had accessed the guidelines by 12–18 months after publication. The survey's questions required ‘yes’ or ‘no’ responses and ‘yes’ responses activated questions asking whether practice had changed. With ethics clearance, and following piloting, the survey was advertised electronically. Analysis was by frequency counts.

Results:

There were 6 185 de-replicated UK downloads of the guidelines, most via the Chartered Society of Physiotherapy website. There were 366 survey responses. The median correspondence between the guidelines’ recommendations and practice was 66%, mostly reflecting validation of practice, but some change of practice. Notably among the diagnosis and assessment recommendations, passive external rotation was widely used as a pathognomonic test (75%). The proposed pain-predominant/stiffness-predominant classification was widely adopted (66%), and 88% of those who asked their patients said those patients found this terminology meaningful. Only 34% of responders reported using validated outcome measures. Correspondence of practice with the guidelines’ treatment recommendations was high for out-patient physiotherapy and injection but low for shortwave diathermy.

Conclusion:

The wide distribution and survey results suggest that the guidelines’ development was worthwhile. There were some areas of poor implementation of the guidelines’ recommendations, explicable by known obstacles; however, the findings provide a timely indication of where supplementary efforts should be targeted, e.g. using validated outcome measures.
Physical activity and sedentary behaviour in outpatients with schizophrenia: A systematic review and meta-analysis
Authors: Soundy Andrew , Wampers Martien , Probst Michel , De Hert Marc , Stubbs Brendon , Vancampfort Davy , Attux Cecelia , Leutwyler Heather , Ströhle Andreas
Published: May 2014

Aims:

To identify, appraise and synthesise evidence on the level of physical inactivity or activity and its moderators in outpatients with schizophrenia.

Method:

A systematic search strategy was undertaken and included eight electronic databases. Searches were undertaken using a subject and text-word search strategy between the dates from each databases' inception to September 2012. Two independent reviewers determined study eligibility. Data extraction detailed the level and time spent in physical activity.

Results:

One hundred and sixty three records were screened, and 12 studies (n=628) met the inclusion criteria. A meta-analysis identified higher levels of sedentary activity (N=2; n=140; z=44.1; P<0.001) and low categories of physical activity (N=2; n=140; z=147,306; P<0.001), and lower levels of moderate (N=3; n=300; z=-5.1; P<0.001) and vigorous (n=3; n=220; z=-3.2; P=0.001) physical activity categories when comparing patients with schizophrenia to healthy age- and gender-matched controls. Meta-regression found no significant association between moderate and vigorous physical activity with age (P=0.08; P=0.14 respectively) and gender (P=0.08; P=0.14 respectively) as the moderators.

Conclusion:

The current study is the first to provide meta-analytic evidence for the sedentary behaviour and lack of physical activity in outpatients with schizophrenia.
Workforce innovation through mentoring: An action research approach to programme evaluation
Authors: Akhurst Jacqueline , Lawson Sally
Published: May 2014

Background:

The North East Neurosciences Network Workforce Innovations Programme used mentoring to develop neuro-practitioners’ specialist skills and efficacy in health and social care settings. The programme aimed to improve services and outcomes for and with people living with long-term neurological conditions by enhancing practice and partnership building. This study used action research to evaluate the programme’s impact over an 18 month period, in collaboration with a group of 10 mentors, their mentees, and the programme’s steering group.

Content:

This study describes the action research undertaken for evaluating this 18-month mentoring programme, showing how the research questions, data collection and analysis evolved. It demonstrates how the approach facilitated participants’ reflections, enabling them to evaluate and improve their practice. The evaluation shows how the programme equipped participants with skills for partnership and community-based approaches. The participants’ experiences of using action research in this way are explored; and the challenges that arose in the context of a rapidly-changing health service are described.

Conclusions:

Noteworthy features of the programme include its evolving collaborative nature, the integration of action research from the start, and the coherence of action research with other elements of the delivery. Changes in participants’ approaches illustrate the potential contributions of this type of programme within a community of practice, to develop personal efficacy in a context broader than a ‘specialism’ and as an alternative to traditional in-service training. Improved ways of working impacted on inter-collegial practice, service delivery and outcomes, translating policy into action.
Prescribing for a successful quit
Authors: Croghan Emma
Published: May 2014

Smokers will often seek advice and support from nurses on ways to stop.
Aid work: Your guide to volunteering
Authors: Wild Sarah
Published: May 2014

The recent Asian tsunami highlighted the work of nurse volunteers within aid agencies.
How to tackle fibromyalgia
Authors: McCabe Candy
Published: May 2014

Graded exercise can help people who suffer from this condition.
How gene therapy can help patients now and in future
Authors: Beirne Debbie
Published: May 2014

Gene therapy is currently experimental but is likely to offer new treatment options in future.
Dealing with polypharmacy
Authors: Newbury Amanda
Published: May 2014

Understanding how drugs can interact will help to ensure safer prescribing.
Alexander technique
Authors: Ernst Edzard
Published: May 2014

Apotentially useful adjunct to usual care.
Expanding the nursing workforce
Authors: Andalo Debbie
Published: May 2014

Recruiting nurses from disadvantaged backgrounds may boost numbers and promote diversity.
There's no need to panic
Authors: Hardcastle Mark
Published: May 2014

Panic attacks can be extremely distressing.
Developments in diabetes
Authors: Polak Monika
Published: May 2014

Researchers are making exciting therapeutic advances in diabetes.
Antihypertensives - Making the right choice
Authors: Morris David
Published: May 2014

Treating hypertension usually involves more than one drug.
Care for the elderly should join up
Authors: Banks Penny
Published: May 2014

Will plans to align PCTs with local authorities help create integrated services for older people.
Diagnosing renal disease
Authors: Turner Neil
Published: May 2014

Early identification and treatment improves patient outcomes.
Treating COPD patients at home
Authors: Davis Carol
Published: May 2014

A nurse-led scheme in primary care is halving hospital admissions and improving patients' lives.
Managing obesity in primary care
Authors: Croghan Emma
Published: May 2014

Primary care has a key role in weight loss.
Coping with inappropriate behaviour from patients
Authors: Le Saux Katrina
Published: May 2014

Action to prevent unwanted contact during patient consultations should be taken before problems develop.
Being aware of ovarian cancer
Authors: Winning Julie M
Published: May 2014

March is ovarian cancer awareness month. Julie Winning examines the role of primary care in managing this disease.
Bite prevention key in malaria
Authors: Wilson-Howarth Jane
Published: May 2014

The best way to prevent malaria is to avoid being bitten.
Case Study: When mild asthma might kill
Authors: Matthews Heather
Published: May 2014

Sudden uncontrolled asthma attack followed one patient's exposure to a new trigger.
Offering a tailored care service
Authors: Croghan Emma
Published: May 2014

The how, when and why of conducting a health needs assessment.
Prescribing for childhood atopic eczema
Authors: Morris David
Published: May 2014

The symptoms of atopic eczema in children vary in their severity, and a range of treatments is available.
In-flight thrombosis risk explained
Authors: Kahn Farrol
Published: May 2014

Air travellers can develop thrombosis. Farrol Khan explores the risk factors and preventive measures
Classifying sleep disorders
Authors: King Martin
Published: May 2014

In part two of his series on sleep disorders, Martin King outlines common sleep problems
What nurses need to know about integrated care records
Authors: Barr Fiona
Published: May 2014

The roll-out of integrated electronic patient records begins next year. But what are they and how will they affect nurses?
Prescribing opioids for chronic non-cancer pain
Authors: Heafield Ruth
Published: May 2014

There is wide debate about the use of opioid painkillers for the treatment of chronic pain.
The pros and cons of herbalism
Authors: Ernst Edzard
Published: May 2014

Our occasional series on complementary therapies continues, as Professor Edzard Ernst investigates herbal medicine
Opinion: Care must be equal with treatment
Authors: Sawbridge Yvonne
Published: May 2014

Criticism of nurses ‘failing to care‘ will continue unless staffing and pay levels rise.
Factors to consider in pain management for older people
Authors: Schofield Pat , Dunham Margaret
Published: May 2014

Managing pain in older people can be tricky for a number of reasons, explain Dr Pat Schofield and Margaret Dunham
How pollution can adversely affect health
Authors: White Caroline
Published: May 2014

Environmental pollution may cause more illness than we realise. Caroline White looks at what is being done to promote awareness of this major issue
Using massage as a therapy
Authors: Ernst Edzard
Published: May 2014

Massage is increasingly used as a complementary therapy.
Agenda for Change: the review process
Authors: Adkins Colin
Published: May 2014

Nurses who disagree with the Agenda for Change pay band allocated to them should know when and how to seek a review.
Primary care provision of pulmonary rehabilitation
Authors: Henderson Yvonne
Published: May 2014

Existing pulmonary rehabilitation services do not meet demand.
Mixed results from latest research
Authors: Polak Monika
Published: May 2014

New results from trials investigating treatment of heart disease
Opinion: District nursing focuses on its future
Authors: Cook Rosemary
Published: May 2014

A review aims to define the values and attributes that make community nursing different.
Care home pilot cuts A&E visits
Authors: Wild Sarah
Published: May 2014

Two pioneering nurses are improving the access that care home residents have to healthcare.
Statin prescribing in primary care
Authors: Pittard John
Published: May 2014

The choice of statin will depend on each patient's individual needs.
Spotting psychosis early
Authors: Hardcastle Mark
Published: May 2014

Early recognition and timely intervention can make all the difference in psychotic illnesses.
Make plans by playing games
Authors: Wild Sarah
Published: May 2014

Learning disability nurses are finding innovative ways of helping clients develop Health Action Plans.
Management tips for nurses
Authors: Applebee Kathie
Published: May 2014

Nurses rarely receive formal management training, but some simple rules can help you improve your skills.
When to refer in cases of chest pain
Authors: McIntyre Hugh F
Published: May 2014

Dr Hugh F McIntyre highlights new guidance on referral to rapid access clinics
Managing Parkinson's disease
Authors: Handley Jacqui
Published: May 2014

Parkinson's disease is a distressing condition and effective management requires the expertise of all the care team.
Ten steps to X-ray referrals
Authors: Young Ghislaine
Published: May 2014

Nurse practitioners and radiologists in Bradford are working together to improve care.
Palliative care is not just for cancer patients
Authors: Charlton Rodger
Published: May 2014

Hospice care has traditionally focused on people with cancer, but palliative treatment is equally helpful for people with other terminal conditions.
Case History: Cough and fever
Authors: Townend Mike
Published: May 2014

Any flu-like illness in a returning traveller must be carefully investigated, as it may be serious.
Case History: What to look for with jaundice
Authors: Townend Mike
Published: May 2014

Jaundice is most likely to indicate hepatitis, says Dr Mike Townend in part four of his returning traveller series
Evaluating the treatment of earwax
Authors: Wicke Dorothy
Published: May 2014

Research evidence on how to deal with earwax is not conclusive. Dorothy Wicke outlines how her practice is comparing effectiveness of two methods