Recent Submissions

  • The Acute VertEbRal AugmentaTion (AVERT) study: protocol for a randomised controlled, feasibility trial of spinal medial branch nerve block in hospitalised older patients with vertebral fragility fractures.

    Fakis, Apostolos
    INTRODUCTION: Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fracture found in older people, resulting in increasing morbidity and excess mortality. These fractures can cause significant pain, requiring admission to hospital. Vertebroplasty (VP) is effective in reducing pain and allowing early mobilisation in hospitalised patients. However, it may be associated with complications such as cement leakage, infection, bleeding at the injection site and fracture of adjacent vertebrae. It is also costly and not readily accessible in many UK hospitals.A recent retrospective study reported that spinal medial branch nerve block (MBNB), typically used to treat facet arthropathy, had similar efficacy in terms of pain relief compared with VP for the treatment of painful VFF. However, to date, no study has prospectively compared MBNB to VP. We therefore propose a prospective feasibility randomised controlled trial (RCT) to compare the role of MBNB to VP, in hospitalised older patients. METHOD: A parallel, two-arm RCT with participants allocated on a 1:1 ratio to either standard care-VP or MBNB in hospitalised patients aged over 70 with acute osteoporotic vertebral fractures. Follow-up will be at weeks 1, 4 and 8 post intervention. The primary objective is to determine the feasibility and design of a future trial, including specific outcomes of recruitment, adherence to randomisation and safety. Embedded within the trial will be a health economic evaluation to understand resource utilisation and implications of the intervention and a qualitative study of the experiences and insights of trial participants and clinicians. Secondary outcomes will include pain scores, analgesia requirements, resource use and quality of life data. ETHICS AND DISSEMINATION: Ethical approval was granted by the Yorkshire & the Humber Research Ethics Committee (reference 21/YH/0065). AVERT (Acute VertEbRal AugmentaTion) has received approval by the Health Research Authority (reference IRAS 293210) and is sponsored by Nottingham University Hospitals NHS Trust (reference 21HC001). Recruitment is ongoing. Results will be presented at relevant conferences and submitted to appropriate journals for publication on completion. TRIAL REGISTRATION NUMBER: ISRCTN18334053.
  • The Patient Journey

    Rawson, Beth; Jo, Morley (2014)
  • The Role of Chronic Inflammation in Polycystic Ovarian Syndrome-A Systematic Review and Meta-Analysis.

    James, Cathryn
    Although the current literature associates polycystic ovarian syndrome (PCOS) with chronic inflammation, the evidence for this link remains inconclusive and its causal nature remains unclear. The purpose of this systematic review was to assess the inflammatory status in PCOS women and to determine whether it is related to PCOS or to its associated adiposity. We searched electronic databases including PUBMED, EMBASE and MEDLINE, SCOPUS, DynaMed plus, TRIP, ScienceDirect and Cochrane Library, for studies investigating C-reactive protein (CRP) and other inflammatory makers in PCOS women versus healthy controls. Quality and risk of bias for selected studies were assessed using the modified Newcastle-Ottawa scale. CRP data were extracted and pooled using RevMan for calculation of the standardized mean difference (SMD) and 95% confidence interval (CI). Eighty-five eligible studies were included in the systematic review, of which 63 were included in the meta-analysis. Pooled analysis of the 63 studies revealed significantly higher circulating CRP in PCOS women (n = 4086) versus controls (n = 3120) (SMD 1.26, 95%CI, 0.99, 1.53). Sensitivity meta-analysis of 35 high quality studies including non-obese women showed significantly higher circulating CRP in PCOS women versus controls (SMD 1.80, 95%CI, 1.36, 2.25). In conclusion, circulating CRP is moderately elevated in PCOS women independent of obesity, which is indicative of low-grade chronic inflammation.
  • Exploring the role of effective nurse leadership during COVID-19.

    Scales, Susanna
    The role of leadership in nursing and healthcare is continuously being examined, and has undergone increasing public and media scrutiny due to the coronavirus disease 2019 (COVID-19) pandemic. This article details a project that brought together five final-year nursing students and two experienced nurses who had all worked as part of the early response to the pandemic. Meeting regularly online, the participants sought to explore the literature on nursing leadership as well as their own clinical experience and personal reflections of leadership during the pandemic. This process, which took place over a period of four months, also enabled the participants to examine their own leadership style. Four themes emerged from the group discussions: learning about and building on the history of nursing, the participants' role in nursing leadership, effective leadership during times of uncertainty and the role of communication in effective leadership.
  • Rostering in a pandemic: Sustainability is key

    Goddard, Andrew (2020-10)
    In preparation for the peak of the first wave of COVID-19, many healthcare organisations implemented emergency rotas to ensure they were adequately staffed. These rotas - while addressing the acute issues - are in many cases not sustainable. As we move past the peak and services start resuming, many organisations need to reassess their rotas. There are considerable wellbeing benefits to optimal rostering. In this article we discuss how best to achieve this and suggest a number of key principles, including the following: involvement of staff affected by the rota; taking into account individual circumstances; building in flexibility and adequate time for rest; and designing rotas for different grades of staff together to create stable teams.
  • Improving confidence in completing ReSPECT forms

    Wall, Jillian; Jones, David (2020-01)
  • Highlighting Risk in Sponsored Studies: A Risk Categorisation Tool

    Skirrow, Sarah; Thornhill, Joanne; Jones, Michael (2019)
  • Building a Positive Culture Around Exception Reporting

    Bhat, Snobar (2018-12)
    In this new case study, we find out how University Hospitals of Derby and Burton NHS Foundation Trust built a positive culture around exception reporting. Exception reporting benefits both junior doctors and employers. The process enables any issues to be highlighted, giving employers the chance to address them early in the placement. This means a safer working environment and a better educational experience for junior doctors. The case study outlines how the trust has embedded exception reporting processes and shares top tips for other organisations.
  • A clinical evaluation of Algivon® Plus manuka honey dressings for chronic wounds.

    Reynolds, Tim (2017-11)
    This study reviews the literature on manuka honey and presents the results of an evaluation of Algivon® Plus with 100% medical grade manuka honey with a superabsorbent, secondary (Eclypse®) or foam dressing. Data were collected on the frequency of dressing changes and the products used. Dressing changes were performed by the tissue viability nurse consultant on days 1, 7, 14, 28, 35, 42, 49 and 56. Inpatient dressing assessments were performed twice weekly. Patients discharged to the community were assessed every Monday. The TIME framework was used to assess periwound skin, maceration, dermatitis and inflammation. All wounds were photographed. The volume, colour and odour of exudate were recorded using Likerttype scales and the wound pH was measured. Patient outcomes measured were pain, sleep, exudate odour and impact on quality of life. Following the use of Algivon® Plus, debridement to a clean wound bed generally occurred by day 7, with healing starting from day 14. The pH of the wound tissue was found to relate to the tissue type present. Patients slept for longer and were less affected by exudate and its associated odour as the study progressed. The dressings used were endorsed by best practice and resulted in positive clinical outcomes of healing or progression to healing.
  • Quantitative analysis of qualitative information from interviews: A systematic literature review

    Fakis, Apostolos (2014-04)
    Background: A systematic literature review was conducted on mixed methods area. Objectives: The overall aim was to explore how qualitative information from interviews has been analyzed using quantitative methods. Methods: A contemporary review was undertaken and based on a predefined protocol. The references were identified using inclusion and exclusion criteria and specific key terms in 11 search databases. Results: Evidence was synthesized from 14 references that included the methods used for quantifying qualitative information, analyzing it statistically and the rationale behind this. Gaps in the existing literature and recommendations for future research were identified. Conclusions: This review highlights the need for a new mixed method based on advanced statistical modeling method that will explore complex relationships arising from qualitative information.
  • Pierre Bourdieu: Expanding the scope of nursing research and practice

    Nairn, Stuart; Pinnock, David (2017-10)
    Bourdieu is an important thinker within the sociological tradition and has a philosophically sophisticated approach to theoretical knowledge and research practice. In this paper, we examine the implication of his work for nursing and the health sciences more broadly. We argue that his work is best described as a reflexive realist who provides a space for a nonpositivist approach to knowledge that does not fall into the trap of idealism or relativism. We emphasize that Bourdieu was not an abstract theorist, but only utilized theories to understand and explain the social world in all its empirical complexity. Theory is emphasized over method without denying the importance of method. We then provide a brief overview of some of his key concepts: habitus, field and capital. His work is a scientifically astute practice that has an emancipatory purpose, with particular resonance to the problems of nursing as a social practice. Some have criticized Bourdieu for undermining agency and we briefly address this issue, but argue that his conceptual framework helps us to understand what endures in social practice and why change is often problematic. In short, this paper argues that Bourdieu's work is a fruitful resource for critiquing existing nursing approaches that are preoccupied with agency over structure.
  • How does role transition affect the experience of trainee Advanced Clinical Practitioners: Qualitative evidence synthesis

    Moran, Gregory; Nairn, Stuart (2018-02)
    BackgroundAdvanced Clinical Practitioners have been developed to address current and future gaps in the medical workforce. Insight into problems associated with Advanced Clinical Practitioner transition may help present and future trainees adapt to their changing and demanding health environment.AimsTo identify potential problems experienced by trainee Advanced Clinical Practitioners during transition and what the implications might be for workforce planning.DesignA qualitative evidence synthesis to examine the issue of role transition for Advanced Clinical Practitioners.Data sourcesThe electronic databases accessed (1997-2016) were MEDLINE,EMBASE,CINAHL,BNI,AMED and PubMed and also included Researchgate, thesis publications, hand searching and NHS staffing reports.Review methodsEleven studies were identified between 1997 - 2016. Thematic synthesis was undertaken, creating codes, descriptive and analytical themes. Quality appraisal of individual studies was conducted using the tool of Walsh and Downe.FindingsSix analytical themes were identified that addressed the key issues of transition discussed in the 11 articles and which were directly related to the proposed research project: experience of change, orientation to role, mentorship, clinical skills, clinical supervision and Masters' level education.ConclusionsFindings from all 11 articles were similar. Where these six themes were ignored, there was often either a failure to reach expected goals or resignation from the role. Future employers must ensure that they establish a comprehensive orientation and education programme to be certain that qualified Advanced Clinical Practitioners are suitably prepared for their
  • Knowledge, attitude and barriers towards research in the national health service (NHS)

    Ahmed, Mansoor; Boswell, Stephanie (2014-10)
    In the 21st century, healthcare professionals know a great deal about health, disease and medicine. However, much remains uncertain and continued investment in research aims to find better ways of managing patients, improving public health, reducing health inequalities and keeping people in a state of good health. Clinical Research Networks are well established across the NHS to ensure that all patients and clinicians are able to share the benefits of participating in clinical research. Barriers to research can deter healthcare professionals from contributing towards useful research projects. Aim To ascertain knowledge and attitude towards research and identify barriers amongst healthcare professionals in a district general hospital setting. Methods All the healthcare professionals were emailed a questionnaire via 'survey monkey' in March 2014. An email reminder to non-respondents was sent 2 weeks later. Questions focussed on participant's knowledge and attitude towards research and identifying perceived barriers to undertaking research. Results 87 responses were received (26 doctors and 61 allied health professionals). Following table outlines key study findings in %. Conclusions Majority of participants perceived time commitment and bureaucracy as barrier to research. Dedicated time allocated in the job plan and administrative support would be imperative in improving research outcomes leading to innovative treatments that can significantly improve patient health in future.
  • Non-adherence to treatment of chronic wounds: patient versus professional perspectives.

    Keeley, Vaughan; Murray, Susan (2017-08)
    The reasons for the non-adherence to treatment for wound healing are complex and fall into unintentional and intentional categories. This study explored intentional and unintentional non-adherence to treatment from patient/carer and health care professional perspectives. Patients with wounds receiving ALLEVYN Life dressings (n = 20) and patients not receiving ALLEVYN Life dressings who were deemed to be non-adherent to treatment regimes (n = 6) took part in semi-structured interviews to explore their experiences of living with a wound, treatment and intentional and unintentional non-adherence. Three focus groups of health care professionals explored issues surrounding non-adherence to treatment regimes. Groups included nurses and doctors (n = 25). We found that relationships between participants and health care professionals varied in character across the groups. All participants expressed reasons for both intentional and unintentional adherence. Many reasons for intentional non-adherence are related to comfort and working the regime around patients' lives. Health care professionals considered the most common form of non-adherence to be unintentional. However, patients describe the most common form of non-adherence as being intentional. The relationship between patients and health care professionals varied in character between the groups. Discrepancies between professional and patient perspectives need to be reconciled and addressed to improve adherence to treatment regimes
  • We must not repeat the mistakes of Mid Staffs

    Moss, Stephen (2017-03)
    These are exceptionally tough times for everyone providing care and treatment across NHS settings. Colleagues on the front line face unprecedented pressure day in, day out, without any respite and often with limited resources. As a nurse it distresses me greatly to see graphic images of older, frail patients waiting for long periods on trolleys in overcrowded emergency departments.
  • Measuring the impact of information skills training: A survey of health libraries in England

    Toft, Suzanne (2014-08)
    Background: The lack of robust research measuring the impact of NHS based information skills training prompted the West Midlands Regional Trainers’ Forum to conduct a post-training survey. Methods: This is a multi-centred study which collected data from over 60 separate organisations. Survey questionnaires were completed by learners a few weeks after the training event. Results: Five hundred and thirty-four responses were received. 82% of information skills training recipients indicated that they had implemented learning or changed practice as a result of the training. 70% of recipients indicated there had been an impact on patient care. Discussion: The beneficial results from information skills training manifest in a multitude of ways. The results of this study indicate that the learning from information skills training is being used to reduce problems and address the key issues in modern health care. Conclusion: The results clearly demonstrate the value of information skills training and its beneficial impact on patient care, lifelong learning and other key NHS functions. This study shows information skills training as an important activity which supports the information literacy agenda, and has a positive impact across the four key functions of library and knowledge services within the NHS.

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