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Don't throw the baby out with the bathwater: preserving children's undergraduate nurse education in the move towards genericism in nursing
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A systematic review comparing the effective radiation dose of musculoskeletal cone beam computed tomography to other diagnostic imaging modalities
Get PDFYesPurpose: Cone-Beam CT (CBCT) is well established in orofacial diagnostic imaging and is currently expanding into musculoskeletal applications. This systematic review sought to update the knowledge base on radiation dose comparisons between imaging modalities in MSK imaging and consider how research studies have reported dose measures.
Methods: This review utilised a database search and an online literature tool. Studies with potential relevance were screened then before full text review, each performed by two independent reviewers, with a third independent reviewer available for conflicts. Data was extracted using a bespoke tool created within the literature tool.
Results: 21 studies were included in the review which compared CBCT with MSCT (13), conventional radiography (1), or both (7). 19 studies concluded that CBCT provided a reduced radiation dose when compared with MSCT: the factor of reduction ranging from 1.71 to 50 with an average of 12. Studies comparing CBCT to DR found DR to have an average dose reduction of 4.55.
Conclusions: The claims that CBCT produces a lower radiation dose than MSCT is borne out with most studies confirming doses less than half that of MSCT. Fewer studies include DR as a comparator but confirm that CBCT results in a higher effective dose on average, with scope for CBCT to provide an equivalent radiation dose. This review highlighted a need for consistency in methodology when conducting studies which compare radiation dose across different technologies. Potential solutions lie outside the scope of this review, likely requiring multi-discipline approach to ensure a cohesive outcome
Factors that influence the quality of the clinical supervision experience in a first contact physiotherapy (FCP) role - The perspectives of supervisors and supervisees – A qualitative analysis
Get PDFYesPurpose: First contact practitioner (FCP) roles have been developed to supplement the primary care workforce in managing the burden of musculoskeletal conditions. In order to quality assure and standardise capability of these clinicians an educational framework was developed by NHS England. The Roadmap to Practice (2020) was the curriculum designed to support and develop capability for FCP roles. This secondary analysis of a broader research project aimed to understand the factors affecting the supervisory experience from both a supervisor and supervisee perspective.
Methods: A qualitative design using group interviews and an online survey was utilised to examine the experiences of these clinicians on their journey navigating and supporting the Roadmap to Practice portfolio process.
Findings: Three principal themes were identified that affected the supervisory process; preparation of both supervisors and supervisee; the person (supervisor) and the practicalities associated with supervision.
Conclusion: There were numerous factors influencing the quality of clinical supervision. Adequate preparation of the supervisor and supervisee is critical to success. The attributes of the supervisor were important in the enhancing the quality of supervisory process. Time afforded to undertake supervision and access to appropriate supervisors need to be adequate and accounted for in workforce planning. A paradigm shift in workplace culture is required so clinical supervision is seen as an integral component in maintaining quality and assuring patient safety.The original project was funded by NHS England formerly Health Education England
The micro-dynamics of peace and conflict
Get PDFYesThe study of micro-dynamics has grown over the last two decades, emerging now as a mainstay in research on peace and conflict. The focus on micro-dynamics, and other micro-level approaches, challenges the primacy of state-centric research. Yet despite the growing literature around the micro-dynamics of conflict and peacebuilding, the term remains opaque. Its use has evolved beyond a sweeping indicator for ‘subnational’, yet the field of study has seen limited development of the definitional parameters of the term and why the term retains utility. In this article we explore the deployment of the concept in distinct literatures, provide a working definition, and assess its application to the study of peace and conflict. We argue that micro-dynamics are simultaneously a unit of analysis, a social phenomenon and a sense-making tool for understanding human relations in the broader societal ecosystem. We contend that a micro-dynamics approach contributes to peace and conflict studies, offering insight into how individuals get on with their lives in conflict-affected areas. By providing multilayered insights of complex scenarios based upon thick, empirically led inductive analysis, the micro-dynamics lens generates a granular understanding of (i) how individuals and groups live and perceive boundaries and (ii) the shifting and malleable nature of inter- and intragroup relations in conflict-affected societies. A micro-dynamics lens, moreover, evidences (iii) the interconnected nature of the micro- and other scalar levels of analysis, elucidating understanding of what we characterize as the peace and conflict ecosystem.Economic and Social Research Council Grant (UKRI), ES/V013432/1, Getting on with it: Understanding the micro-dynamics of Post-Accord Intergroup Social Relations
Incivility experiences of racially minoritised hospital staff, consequences for them and implications for patient care: An international scoping review
Get PDFYesWorkplace incivility is a pervasive complex problem within health care. Incivility manifests as subtle disrespectful behaviours, which seem inconsequential. However, evidence demonstrates that incivility can be harmful to targets and witnesses through negative emotions, poorer mental health, reduced job satisfaction, diminished performance and compromised patient care. It is unclear to what extent existing research critically explores how ethnicity, culture and racism influence how hospital staff experience incivility. This global scoping review systematically analysed existing research exploring the specific ways incivility manifests and impacts racially minoritised hospital workers. Of 2636 academic and 101 grey literature articles, 32 were included. Incivility experiences were categorised into four themes: (1) Cultural control, (2) Rejection of work contributions, (3) Disempowerment at work and (4) Managerial indifference. The included articles highlighted detrimental consequences, such as negative emotions, silencing, withdrawal and reduced support-seeking behaviours. Few studies presented evidence regarding the negative impacts of incivility on patient care. Racialisation and racial dynamics are a significant factor for hospital-based incivility. Currently we do not know the extent to which racialised incivility is associated directly or, perhaps either via burnout or disengagement, indirectly with poorer care. This knowledge can inform the creation of comprehensive, evidence-based interventions to address this important issue.National Institute for Health Research Yorkshire and Humber Patient Safety Research Collaboratio
Developing a research community within an online healthcare feedback platform
Get PDFYesCare Opinion is an online feedback platform supporting patients to author stories about their care. It is not known whether authors would be willing to be involved in improving care through research. The aims of this study were to explore the views and preferences of Care Opinion authors about joining an online research community and to pilot new research community functionality.
Five hundred and nine Care Opinion authors were invited to take part in an online survey in June 2019. Survey items included questions about participants' willingness to take part in research and their preferences for supporting processes. Data were analysed descriptively. Authors were invited to consent to join a research community and were asked to participate in three pilot studies.
One hundred and sixty-three people consented to take part in the survey (32%). Participants indicated they would like to know the time commitment to the project (146, 90%), details about the organization carrying out the research (124, 76%) and safeguarding information (124, 76%). Over half indicated that they did not know how to get involved in healthcare research (87, 53%). Subsequently, 667 authors were invited to join the research community, 183 (27%) accepted, and three studies were matched to their expressed preferences for project attributes or organization type.
Many people who leave online feedback about their experiences of healthcare are also willing to join a research community via that platform. They have strong preferences for supporting University and NHS research. Eligibility and acceptance rates to join pilot research studies varied. Further work is needed to grow the research community, increase its diversity, and create relevant and varied opportunities to support research.
Four members of the Safety In Numbers patient and public involvement and engagement (PPIE) group advised about survey development.National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC
Propeller-induced jet impact on vegetated flow field: Complex coupled effect towards velocity profile
Get PDFYesThe failure of swirling ship propellers in marine environments can lead to huge repair costs. One of the main causes of such failure is when propellers tangle with vegetation, especially in shallow flow environments like ports, harbours, or shipyards. In order to understand the above-mentioned issue, this study proposes an analytical approach to explore efficient predictions and provide a flow guideline with respect to the co-existence of vegetation and propeller swirling effects. More specifically, we intend to investigate the full-depth theoretical velocity profile to represent propeller-induced flow under submerged vegetation conditions. This paper first investigates the modified logarithmic law approach to determine its suitability to represent the regional vegetated flow zone before implementing it into a three-layer analytical model. It was found, using the benchmark of literature measurements, that the modified log law improved the near-bed velocity calculation by nearly 70% when compared to an existing model. A propeller jet impact computation coupled into the vegetation analytical model was then investigated in different locations within the vegetated flow, i.e., at free-flow, water–vegetation interface, and vegetation-hindered zones, to study their complex velocity distribution patterns. The results demonstrate adequate validation with the vegetated flow and measured propeller jet data from the literature. This proves the potential of the proposed analytical approach in representing a real-world propeller jet event submerged in water flow with the existence of vegetation. The proposed novel method allows costless computation, i.e., as compared to conventional numerical models, in representing the complex interaction of the propeller jet and vegetated flow
Nomenclature of the symptoms of head and neck cancer: a systematic scoping review
Get PDFYesIntroduction: Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients’ clinical problems more effectively and risk stratify the patient.
Method: The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms.
Results: There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings.
Discussion: Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician’s decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign.National Institute for Health and Care Research Programme Grant for Applied Research NIHR 202862
Floodwaters and vehicle hydrodynamics: A deep dive into risk mitigation unraveling vehicle stability in floods
Get PDFYesVehicles are frequently impacted objects during floods, susceptible to being washed away when the flow velocity and water depth surpass specific thresholds. Thus, understanding the characteristics of vehicle instability in floodwaters is crucial for establishing effective safety guidelines. This paper presents a comprehensive review, delving into previous studies on flooded vehicle stability during flood events and assessing progress in guideline formulation spanning from 2010 to 2023. According to the literature, 78 % of the previous investigations focused on the stability of static vehicles, while only 22 % considered vehicles in motion. Previous studies on vehicle stability during tsunamis have not been well-explored. Moreover, emergency vehicles, including police cars, fire trucks, and ambulances, received little attention and were only considered in two studies. On the other hand, extensive research has been conducted on defining the critical vehicle orientation with respect to incoming flow, which is reported to occur when the flow direction is perpendicular to the longitudinal vehicle axis. However, it is expected that this review will serve as a foundational resource, inspiring researchers to identify areas requiring attention and delve deeper into producing general safety guidelines. The ultimate goal is to prevent fatalities related to flooded vehicles and contribute to the broader field of flood risk mitigation
Inhaled dry powder liposomal azithromycin for treatment of chronic lower respiratory tract infection
Get PDFYesA dry powder inhaled liposomal azithromycin formulation was developed for the treatment of chronic respiratory diseases such as cystic fibrosis and bronchiectasis. Key properties including liposome size, charge and encapsulation efficiency powder size, shape, glass transition temperature (Tg), water content and in vitro respiratory deposition were determined. Antimicrobial activity against cystic fibrosis (CF) respiratory pathogens was determined by MIC, MBC and biofilm assays. Cytotoxicity and cellular uptake studies were performed using A549 cells. The average liposome size was 105 nm, charge was 55 mV and encapsulation efficiency was 75 %. The mean powder particle size d[v,50] of 4.54 µm and Mass Median Aerodynamic Diameter (MMAD) was 5.23 µm with a mean Tg of 76˚C and water content of 2.1 %. These excellent physicochemical characteristics were maintained over one year. Liposomal loaded azithromycin demonstrated enhanced activity against P. aeruginosa clinical isolates grown in biofilm. The formulation was rapidly delivered into bacterial cells with > 75 % uptake in 1 h. Rapid uptake into A549 cells via a cholesterol-dependent endocytosis pathway with no cytotoxic effects apparent. These data demonstrate that this formulation could offer benefits over current treatment regimens for people with chronic respiratory infection