• A preliminary study of violent incidents in a special hospital (Rampton)

      Larkin, Emmet P.; Murtagh, Sylvester; Jones, Sue (1988)
      A six-month prospective study of violent incidents was carried out in a Special Hospital (Rampton). Comparisons were made with results from earlier studies in general psychiatric hospitals. As might be expected, incidents occurred more frequently in the Special Hospital. These incidents were also more serious in nature and resulted in greater injury. Although more patients in the Special Hospital were involved in incidents, only a small number of patients accounted for the majority of these. Female patients, who comprised 25% of the Special Hospital population, were involved in 75% of the incidents. Nursing staff were three times as likely to be assaulted as patients.
    • An investigation of the prevalence of psychological morbidity in burn-injured patients

      Tedstone, Josephine E. (1997)
      Research on the psychological impact of burn injuries has concentrated on major burns, while small burns have been largely neglected. In a prospective study, 45 patients with burn injuries ranging from 1 per cent or less up to 40 per cent total body surface area were assessed using semi-structured interviews within 2 weeks of sustaining the burn, and followed-up at approximately 3 months postburn to investigate the prevalence of mental health problems. The prevalence of clinically significant levels of anxiety, intrusions and avoidance remained similar at 2 weeks and 3 months postburn, however, the prevalence of depression and Post Traumatic Stress Disorder (PTSD) increased 6- and 4-times, respectively, by 3 months. Patients with small burn injuries of 1 per cent or less also experienced clinically significant levels of psychological difficulties postburn. The implications for the identification of patients at risk of future psychological morbidity are discussed.;
    • An investigation of the factors associated with an increased risk of psychological morbidity in burn injured patients

      Tedstone, Josephine E. (1998)
      Previous research aimed at identifying factors that increase the risk of major burns patients experiencing psychological problems post-burn has generally ignored the potential role of psychological factors. In a prospective study, patients with burn injuries ranging from < 1 per cent up to 40 per cent were interviewed within 2 weeks of sustaining the burn and followed up at ca 3 months post-burn in order to assess the effects of both non-psychological and psychological factors on their subsequent mental health. The factors investigated included burn related information, demographic information, previous psychiatric history, levels of psychological morbidity at 2 weeks post-burn, responsibility for the injury, previous life events, compensation claims and factors from the coping literature including appraisal, coping strategies and coping efficacy. Forward stepwise multiple regression analyses were used to investigate the relationships between these factors and subsequent mental health. Post-burn psychological morbidity was strongly associated with psychological factors including levels of psychological morbidity in the first 2 weeks of sustaining the injury and factors from the coping literature.;
    • Thinking falls - taking action: A guide to action for falls prevention

      Robertson, Kate; Challands, Linda (2010)
      Clinical guidelines and research papers help clinicians measure and understand the risk of falling in their older clients but very few provide the assessor with recommendations as to which intervention they can use to reduce the risk of a fall. The Guide to Action for Falls Prevention tool (GtA) was developed to help professionals from a broad range of organisations to recognise factors that might increase falls risk and know which actions to take to lessen that risk. Twenty four professionals tested the GtA in a clinical setting and found it quick (15 mins) and easy to complete. The GtA needs further evaluation to test whether it is a practical way of delivering a falls prevention intervention.
    • The impact of injuries study. Multicentre study assessing physical, psychological, social and occupational functioning post injury - A protocol

      Barker, Marcus; Morriss, Richard K.; Rowley, Emma (2011)
      Background: Large numbers of people are killed or severely injured following injuries each year and these injuries place a large burden on health care resources. The majority of the severely injured are not fully recovered 12-18 months later. Psychological disorders are common post injury and are associated with poorer functional and occupational outcomes. Much of this evidence comes from countries other than the UK, with differing health care and compensation systems. Early interventions can be effective in treating psychological morbidity, hence the scale and nature of the problem and its impact of functioning in the UK must be known before services can be designed to identify and manage psychological morbidity post injury. Methods/Design: A longitudinal multi-centre study of 680 injured patients admitted to hospital in four areas across the UK: Nottingham, Leicester/Loughborough, Bristol and Surrey. A stratified sample of injuries will ensure a range of common and less common injuries will be included. Participants will complete a baseline questionnaire about their injury and pre-injury quality of life, and follow-up questionnaires 1, 2, 4, and 12 months post injury. Measures will include health and social care utilisation, perceptions of recovery, physical, psychological, social and occupational functioning and health-related quality of life. A nested qualitative study will explore the experiences of a sample of participants, their carers and service providers to inform service design. Discussion: This study will quantify physical, psychological, social and occupational functioning and health and social care utilisation following a range of different types of injury and will assess the impact of psychological disorders on function and health service use. The findings will be used to guide the development of interventions to maximise recovery post injury. © 2011 Kendrick et al; licensee BioMed Central Ltd.
    • Keeping children safe at home: Protocol for three matched case-control studies of modifiable risk factors for falls

      Stewart, Jane (2012)
      Background Childhood falls result in considerable morbidity, mortality and health service use. Despite this, little evidence exists on protective factors or effective falls prevention interventions in young children. Objectives To estimate ORs for three types of medically attended fall injuries in young children in relation to safety equipment, safety behaviours and hazard reduction and explore differential effects by child and family factors and injury severity. Design Three multicentre case-control studies in UK hospitals with validation of parental reported exposures using home observations. Cases are aged 0-4 years with a medically attended fall injury occurring at home, matched on age and sex with community controls. Children attending hospital for other types of injury will serve as unmatched hospital controls. Matched analyses will use conditional logistic regression to adjust for potential confounding variables. Unmatched analyses will use unconditional logistic regression, adjusted for age, sex, deprivation and distance from hospital in addition to other confounders. Each study requires 496 cases and 1984 controls to detect an OR of 0.7, with 80% power, 5% significance level, a correlation between cases and controls of 0.1 and a range of exposure prevalences. Main outcome measures Falls on stairs, on one level and from furniture. Discussion As the largest in the field to date, these case control studies will adjust for potential confounders, validate measures of exposure and investigate modifiable risk factors for specific falls injury mechanisms. Findings should enhance the evidence base for falls prevention for young children.
    • Understanding and meeting information needs following unintentional injury: Comparing the accounts of patients, carers and service providers

      Regel, Stephen (2015)
      Objective: To explore information needs of unintentional injury patients and their carers over time, across services, and how such needs are met from the perspectives of patients, carers and service providers.; Methods: Qualitative nested study within a multi-centre longitudinal study quantifying psycho-social, physical, occupational outcomes and service use and costs following a range of unintentional injuries. Semi-structured interviews conducted with 45 patients during the first year post injury, 18 of their carers and 40 providers of services.; Results: Patients and carers needed information about the nature and severity of injury, prognosis, self-management and further services. Information needs changed over time with the biggest difficulties being during transfer from primary to secondary care. Barriers to information provision included service providers' time limitations and uncertainty around information provision, and patients' reluctance to ask for information or inability to process it. Suggested improvements included provision of reassurance as well as factual information, information about further services, earlier follow-up, increased appointment times and greater involvement of families where appropriate.; Conclusions: The information needs of patients and carers post injury change with time and there are a number of ways to remove gaps and barriers in current provision to meet such needs.; Practice Implications: Providing information on injury management, prognosis and available services and reassurance at each stage of the recovery process in secondary care and when transferring to primary care would be helpful for patients and carers. A follow-up contact soon after discharge and the opportunity to ask questions could be beneficial. Better information about the patient's needs and ways they can help could help carers fulfil their caring role.; Copyright © 2015 Elsevier Ltd. All rights reserved.
    • Modifiable risk factors for scald injury in children under 5 years of age: A multi-centre case-control study

      Stewart, Jane (2016)
      OBJECTIVE: To determine the relationship between a range of modifiable risk factors and medically attended scalds in children under the age of 5 years. METHODS: Multicentre matched case-control study in acute hospitals, minor injury units and GP practices in four study centres in England. Cases comprised 338 children under 5 presenting with a scald, and 1438 control participants matched on age, gender, date of event and study centre. Parents/caregivers completed questionnaires on safety practices, safety equipment use, home hazards and potential confounders. Odds ratios were estimated using conditional logistic regression. RESULTS: Parents of cases were significantly more likely than parents of controls to have left hot drinks within reach of their child (adjusted odds ratio (AOR) 2.33, 95%CI 1.63 to 3.31; population attributable fraction (PAF) 31%). They were more likely not to have taught children rules about climbing on kitchen objects (AOR 1.66, 95%CI 1.12 to 2.47; PAF 20%); what to do or not do when parents are cooking (AOR 1.95, 95%CI 1.33 to 2.85; PAF 26%); and about hot things in the kitchen (AOR 1.89, 95%CI 1.30 to 2.75; PAF 26%). CONCLUSIONS: Some scald injuries may be prevented by parents keeping hot drinks out of reach of children and by teaching children rules about not climbing on objects in the kitchen, what to do or not do whilst parents are cooking using the top of the cooker and about hot objects in the kitchen. Further studies, providing a more sophisticated exploration of the immediate antecedents of scalds are required to quantify associations between other hazards and behaviours and scalds in young children.
    • Improving patients' experience of dressing removal in practice

      Reevell, Geraldine; Anders, Tessa (2016)
      Repeated application/removal of adhesive dressings and tapes can cause skin stripping in and around wounds, resulting in pain, increased wound size, delayed healing, inflammation and increased risk of infection. Adhesive tapes and dressings are also used widely in many care settings to secure tubes, monitors and drains, while the more fragile skin of children and the elderly is at increased risk of epidermal stripping when adhesive dressings are removed. Here, the authors use a series of case studies to demonstrate how Appeel® Sterile Liquid Sachet and Spray applications (CliniMed Ltd), part of the Appeel Sterile Medical Adhesive Remover range, help with adhesive removal, reducing pain and trauma. This article examines how Appeel Sterile removes dressings, tapes and other medical adhesive appliances quickly and easily from both intact and broken skin, resulting in reductions in pain, trauma, use of analgesia, infection risk, cost of dressings and nursing time. |
    • The Falls In Care Home study: A feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes

      Robertson, Kate (2016)
      Objective: To explore the feasibility of implementing and evaluating the Guide to Action Care Home fall prevention intervention.; Design: Two-centre, cluster feasibility randomized controlled trial and process evaluation.; Setting: Purposive sample of six diverse old age/learning disability, long stay care homes in Nottinghamshire, UK.; Subjects: Residents aged over 50 years, who had fallen at least once in the past year, not bed-bound, hoist-dependent or terminally ill.; Interventions: Intervention homes (n = 3) received Guide to Action Care Home fall prevention intervention training and support. Control homes (n = 3) received usual care.; Outcomes: Recruitment, attrition, baseline and six-month outcome completion, contamination and intervention fidelity, compliance, tolerability, acceptance and impact.; Results: A total of 81 of 145 (56%) care homes expressed participatory interest. Six of 22 letter respondent homes (27%) participated. The expected resident recruitment target was achieved by 76% (52/68). Ten (19%) residents did not complete follow-up (seven died, three moved). In intervention homes 36/114 (32%) staff attended training. Two of three (75%) care homes received protocol compliant training. Staff valued the training, but advised greater management involvement to improve intervention implementation. Fall risks were assessed, actioned and recorded in care records. Of 115 recorded falls, 533/570 (93%) of details were complete. Six-month resident fall rates were 1.9 and 4.0 per year for intervention and control homes, respectively.; Conclusions: The Guide to Action Care Home is implementable under trial conditions. Recruitment and follow-up rates indicate that a definitive trial can be completed. Falls (primary outcome) can be ascertained reliably from care records.; © The Author(s) 2015.
    • The impact of psychological factors on recovery from injury: A multicentre cohort study

      Morriss, Richard K. (2016)
      PURPOSE: Unintentional injuries have a significant long-term health impact in working age adults. Depression, anxiety and post-traumatic stress disorder are common post-injury, but their impact on self-reported recovery has not been investigated in general injury populations. This study investigated the role of psychological predictors 1 month post-injury in subsequent self-reported recovery from injury in working-aged adults. METHODS: A multicentre cohort study was conducted of 668 unintentionally injured adults admitted to five UK hospitals followed up at 1, 2, 4 and 12 months post-injury. Logistic regression explored relationships between psychological morbidity 1 month post-injury and self-reported recovery 12 months post-injury, adjusting for health, demographic, injury and socio-legal factors. Multiple imputations were used to impute missing values. RESULTS: A total of 668 adults participated at baseline, 77% followed up at 1 month and 63% at 12 months, of whom 383 (57%) were included in the main analysis. Multiple imputation analysis included all 668 participants. Increasing levels of depression scores and increasing levels of pain at 1 month and an increasing number of nights in hospital were associated with significantly reduced odds of recovery at 12 months, adjusting for age, sex, centre, employment and deprivation. The findings were similar in the multiple imputation analysis, except that pain had borderline statistical significance. CONCLUSIONS: Depression 1 month post-injury is an important predictor of recovery, but other factors, especially pain and nights spent in hospital, also predict recovery. Identifying and managing depression and providing adequate pain control are essential in clinical care post-injury.
    • Management of a patient with a coccyx ulcer in a nursing home

      Anders, Tessa (2017)
      Older people are at increased risk of developing pressure ulcers. They are also more likely to have comorbidities that increase the challenges of managing such a wound. This article reviews a complex case in which a 77-year-old woman with dementia and incontinence developed an ulcer on her coccyx. The ulcer became infected several times and proved resistant to several types of treatment before negative pressure wound therapy with Nanova was instigated.
    • Improved healing rates for simple venous leg ulcers in the community setting

      Wilson, Annabel (2018)
      Background: The need for improvements in leg ulcer management has finally been recognised, following Guest et al (2015) Burden of wounds study and the launch of the new best practice statement from Wounds UK. The study highlighted unsafe practice taking place within primary care and the need for a change in the training and education of leg ulcer management across the National Health Service (NHS). Aims: Prior to making any improvements within the Trust, data showed the average healing rate across the Trust to be a disappointing 41%, further reflecting the data found in Guest et al study. The goal set within the Trust for healing simple venous leg ulcers is a 75% healing rate within 20 weeks. In order to improve practice, patient outcomes and achieve the goal set within the Trust, the Tissue Viability team implemented 6 key steps within the Trust. The 6 key steps comprise of an online interactive leg ulcer theory training package, Video’s demonstrating how to perform compression bandaging and an ABPI Doppler assessment, Updated Leg ulcer handbook, Algorithm, Updated assessment and care plan templates and Leg Ulcer clinic co-ordinator meetings have been commenced. Method: The data collected for the healing rates within the Trust will validate whether the changes implemented have been successful in overall improving practice and patient outcomes. Results: The latest data shows 90 -100% healing rate since the training has been embedded into practice alongside a quality improvement plan. Conclusions: The training is already demonstrating improvements in clinical practice, patient outcomes and a better use of resources. This will result in cost savings for the NHS and free up healthcare professionals valuable time.
    • Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study

      Beck, Lyndsay (2019)
      Objective To explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia.Design This is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis.Setting Community-based falls and memory assessment services in the East Midlands, UK.Participants Nurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1).Results Three substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients’ poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia.Conclusions Healthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.
    • Axonal degeneration and demyelination following traumatic spinal cord injury: A systematic review and meta-analysis

      Shokraneh, Farhad (2019)
      The pathophysiology of spinal cord injury (SCI) related processes of axonal degeneration and demyelination are poorly understood. The present systematic review and meta-analysis were performed such to establish quantitative results of animal studies regarding the role of injury severity, SCI models and level of injury on the pathophysiology of axon and myelin sheath degeneration. 39 related articles were included in the analysis. The compiled data showed that the total number of axons, number of myelinated axons, myelin sheath thickness, axonal conduction velocity, and internode length steadily decreased as time elapsed from the injury (P<sub>for trend</sub>&lt;0.0001). The rate of axonal retrograde degeneration was affected by SCI model and severity of the injury. Axonal degeneration was higher in injuries of the thoracic region. The SCI model and the site of the injury also affected axonal retrograde degeneration. The number of myelinated axons in the caudal region of the injury was significantly higher than the lesion site and the rostral region. The findings of the present meta-analysis show that the pathophysiology of axons and myelin sheath differ in various phases of SCI and are affected by multiple factors related to the injury.<br/>Copyright &#xa9; 2019 Elsevier B.V.
    • Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial

      das Nair, Roshan (2019)
      Objective: To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury. Design: Multicentre, pragmatic, observer-blinded, randomized controlled trial in England. Setting: Community. Participants: People with memory problems following traumatic brain injury, aged 18–69 years, able to travel to group sessions, communicate in English, and give consent. Interventions: A total of 10 weekly group sessions of manualized memory rehabilitation plus usual care (intervention) vs. usual care alone (control). Main measures: The primary outcome was the patient-reported Everyday Memory Questionnaire (EMQ-p) at six months post randomization. Secondary outcomes were assessed at 6 and 12 months post randomization. Results: We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: –2.1, 95% confidence interval (CI): –6.7 to 2.5, p = 0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient’s everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised. Conclusion: This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. Further research will need to examine who benefits most from such interventions. © The Author(s) 2019.
    • A randomised controlled trial of an exercise intervention promoting activity, independence and stability in older adults with mild cognitive impairment and early dementia (PrAISED) - A Protocol

      Smith, Helen; das Nair, Roshan (2019)
      BACKGROUND: People with dementia progressively lose cognitive and functional abilities. Interventions promoting exercise and activity may slow decline. We developed a novel intervention to promote activity and independence and prevent falls in people with mild cognitive impairment (MCI) or early dementia. We successfully undertook a feasibility randomised controlled trial (RCT) to refine the intervention and research delivery. We are now delivering a multi-centred RCT to evaluate its clinical and cost-effectiveness. METHODS: We will recruit 368 people with MCI or early dementia (Montreal Cognitive Assessment score 13-25) and a family member or carer from memory assessment clinics, other community health or social care venues or an online register (the National Institute for Health Research Join Dementia Research). Participants will be randomised to an individually tailored activity and exercise programme delivered using motivational theory to promote adherence and continued engagement, with up to 50 supervised sessions over one year, or a brief falls prevention assessment (control). The intervention will be delivered in participants' homes by trained physiotherapists, occupational therapists and therapy assistants. We will measure disabilities in activities of daily living, physical activity, balance, cognition, mood, quality of life, falls, carer strain and healthcare and social care use. We will use a mixed methods approach to conduct a process evaluation to assess staff training and delivery of the intervention, and to identify individual- and context-level mechanisms affecting intervention engagement and activity maintenance. We will undertake a health economic evaluation to determine if the intervention is cost-effective. DISCUSSION: We describe the protocol for a multi-centre RCT that will evaluate the clinical and cost-effectiveness of a therapy programme designed to promote activity and independence amongst people living with dementia. TRIAL REGISTRATION: ISRCTN, ISRCTN15320670. Registered on 4 September 2018.
    • Clinical and ethical challenges in undertaking LIMPRINT in vulnerable populations

      Bussey, Rachel; Whiston, Siobhan (2019)
      Background and Study Objective: To estimate the prevalence of chronic edema (CO) and wounds within two vulnerable populations, a male high security prison in the East Midlands (United Kingdom) and residential and nursing homes in the United Kingdom and Australia. Methods and Results: Methods for screening for CO and wounds were adapted from the main LIMPRINT methodology. Prison Population: In total, 195 inmates were recruited with 22 (11%) having CO. While the majority were white Caucasian (156/83.4%) a further 20 (10.7%) were dark skinned with 11 (5.95%) from other minority populations. Comorbidities included 123 (63%) smokers, 22 (11%) alcohol dependant, 60 (31%) with mental health problems, and 35 (18%) a history of self-harm. Only three had a current wound with 30 (16%) having had a traumatic stab wound. Residential and Nursing Homes (United Kingdom and Australia): In the United Kingdom, the total population available for inclusion was 189 with only 137 (73%) recruited. Seventy-two of the 137 (52%) suffered from CO and a further 16 (23%) had a history of cellulitis. Results from the Australian residential care facilities have been published in full. In summary, of the 37 participants 20 (54%) experienced CO with 25 (68%) having comorbidities and 11 (30%) having a concurrent wound. Conclusion: Obtaining an accurate picture of the prevalence and impact of CO in vulnerable populations is extremely challenging due to issues of access and consent. Lack of reliable data for these populations will contribute to poor service provision.
    • Early general hypothermia improves motor function after spinal cord injury in rats; a systematic review and meta-analysis

      Shokraneh, Farhad (2020)
      IntroductionThere is still controversy about the effect of early hypothermia on the outcome of spinal cord injury (SCI). The aim of this review article is to investigate the effect of local or general hypothermia on improving the locomotion after traumatic SCI.MethodsElectronic databases (Medline and Embase) were searched from inception until May 7, 2018. Two independent reviewers screened and summarized the relevant experimental studies on hypothermia efficacy in traumatic SCI. The data were analyzed and the findings were presented as pooled standardized mean difference (SMD) and 95% confidence interval (95% CI).Results20 papers containing 30 separate experiments were included in meta-analysis. The onset of hypothermia varied between 0 and 240 minutes after SCI. Administration of hypothermia has a positive effect on locomotion following SCI (SMD=0.56 95% CI: 0.18-0.95, p=0.004). Subgroup analysis showed that general hypothermia improves locomotion recovery (SMD =0.89, 95% CI: 0.42 to 1.36; p <0.0001), while local hypothermia does not have a significant effect on motor recovery (SMD=0.20, 95 % CI: -0.36-0.76, p=0.478). In addition, general hypothermia was found to affect motor recovery only if its duration was between 2 and 8 hours (SMD=0.89; p<0.0001) and the target temperature for induction of hypothermia was between 32 and 35° C (SMD=0.83; p<0.0001).ConclusionWe found that general hypothermia improves locomotion after SCI in rats. Duration of induction and the target temperature are two essential considerations for general therapeutic hypothermia.