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From Healer to Healthcare Professional, Women’s Evolving Role in Medicine: A Social Historical Review.
Full text linkBackground: Women have historically always played large roles in healthcare, but they were barred from practicing medicine until the mid-nineteenth century. Much like the rest of history, which has traditionally been written about men, their role within medicine has largely been overlooked.
Methods: This study aimed to establish the evolution of women’s role in medicine since the 14th century through social historical review. This qualitative study consisted of searching databases and archives to collate primary and secondary sources, which were then thematically analysed. Three major themes emerged which focused on the female stereotype in medicine, women as medical professionals, and women in the medical workplace. Through these, several subthemes emerged.
Results: Initially, medicine was largely provided by Abbesses and nuns in monasteries, but the 14th century saw the establishment of laws to prevent women from practicing medicine, despite many having greater skills than their male colleagues. Several women continued to practice forms of healthcare, including lay medicine which was passed down through female social circles. The majority of people accused of witchcraft in the European witch-hunts were women, but only a small percentage of these were classed as being healers or midwives. It was not until the nineteenth century where several pioneering women were admitted to medical schools through their continued petitioning and determination. They were forced to create job opportunities for themselves, lobbying medical colleges to grant them licence to practice. They also established medical schools so future generations of women could more easily qualify. Despite this, women were still discouraged from entering medicine. To this day, women still experience several forms of discrimination once qualified.
Conclusions: There is still large discrepancy between the number of women in senior medical roles compared to the number of women in medicine on the whole. To counter this, there needs to be more support for women to balance their career and caring responsibilities, as well as addressing microaggressions and gender bias. The history of women in medicine provides us with information we can use to establish fairer practice for future generations
Elbow Dislocation with No Associated Fractures: A Systematic Review of the Current Practice
Full text linkBackground: A simple elbow dislocation (SED) is defined as an elbow dislocation with no associated fracture. It is the second most dislocated joint after the shoulder and represents 25% of all elbow injuries. Currently, treatment protocols are varied and yield inconsistent outcomes. The objective of this study was to conduct a systematic review on published literature to analyse the clinical outcomes of different rehabilitation protocols in both conservative and surgical treatments, aiming to identify which approach yields the best clinical outcomes.
Methods: The systematic review was conducted using protocols from PRISMA for systematic reviews and Cochrane Handbook for Systematic Review of Interventions. Following PICO analysis and identification of Medical Subject Headings (MeSH), keywords were used with Boolean operators to search for literature from online medical databases. Studies were selected using title-abstract and full-text screening based on inclusion-exclusion criteria. Only peer-reviewed literature was included. Quality assessment methods including Cochrane Risk of Bias tool, Coleman score, MINORS, and AMSTAR were used to validate the methodology of the included studies. Data extracted included outcome measures such as clinical outcome scores (MEPS, OES, Q-DASH), elbow range of motion (ROM), time return to work, pain scores. Outcomes were categorised into conservative or surgical and further subdivided based on time of immobilisation and incorporation of physiotherapy. Data illustration was performed in Excel and followed by comparative analysis.
Results: A total of 18 studies, involving 3,278 patients were included. Studies were primarily retrospective cohort studies and systematic reviews. Quality of evidence for non-randomised studies ranged from moderate to high, low-quality studies were excluded from the data extraction and analysis. Randomised studies had low risk of bias. The conservative management group comprised of 2,629 patients, 904 had early mobilisation at ≤ 7 days and 1,725 were mobilised at > 7 days. This was followed with variations in use of physiotherapy. Respectively, mean MEP score was 95.3 and 93.7, with mean elbow flexion-extension ROM of 135.7° and 133.1°. Surgical treatment was ligament repair or reconstruction and comprised of 649 patients. Post-surgery 282 had variations of early physiotherapy and 367 without. Respectively, mean MEP score was 93.4 and 91.6, with mean elbow flexion-extension ROM of 129.7° and 120°. Given inadequate reporting and varying follow-up durations between studies, the impact on recovery time was not established.
Conclusions: Shorter durations of immobilisation consistently demonstrated the most favourable outcomes, particularly when coupled with physiotherapy. Regardless, all treatment groups demonstrated good functional outcomes, suggesting management should be tailored according to patient needs and personal recovery goals. Future research should adopt unified reporting methods, particularly in follow-up timing and outcome measurement units. Additional data is needed to evaluate the impact of rehabilitation protocols after surgical treatment for SEDs. 
ᎣᏓᎵ ᎦᎵ ᎡᏗᏲᎭ (O-da-li Ga-li E-di-yo-ha) : Mountain Climber, We Are All Looking For It
No full textThe Cherokee people have had a long relationship with the medicinal plants American ginseng (Panax quinquefolius) and Dwarf ginseng (Panax trifolius). The sacred relationship between the Cherokee people and ginseng is explored through consideration of traditional Cherokee story, language, as well as the impact of forced removal and differing ecological systems between our homelands and reservation. This paper will provide a brief ethnobotanical portrait of the North American varieties of ginseng, an overview of an ongoing ginseng establishment project within the Cherokee Nation in Northeastern Oklahoma, as well as discussion of the relevant ecological and sociocultural relationships that may inform the trajectory of the Cherokee Nation ginseng project. Current and potential future impacts of climate change across the multiple levels and scales of human and more-than-human relationships that ginseng shares within the Cherokee Nation in Oklahoma are also discussed. 
RoboKin and Technovation in Cherokee Speculative Fiction
Full text linkThis essay reflects on how two Cherokee novels, Blake Hausman’s Riding the Trail of Tears (2011) and Daniel Wilson’s Robopocalypse (2011), interrogate dogmatic beliefs in technology as social progress. Hausman imagines a VR experience where customers virtually re-enact the Trail of Tears, and Wilson details a global robot takeover staged in a dystopic future. This essay argues that the novels’ commentary on artificial intelligence, technology, and grounded knowledge build on a long history of Cherokee technological innovation, what I term Cherokee technovation, meaning Cherokee peoples’ ability to take technological innovations not necessarily created to support Indigenous self-determination and creatively repurpose and adapt them in modes that are grounded in Cherokee ways of being and nurture Cherokee lifeways and worldviews. Hausman and Wilson interrogate twenty-first-century fetishization of the emancipatory power of technology using longstanding Cherokee discourses that demand a more nuanced and careful approach than dominant modes of inquiry. They invite their Cherokee and non-Cherokee readers alike to reflect on the necessity of nurturing ethical relationships to technology that view technology as part of an already-interrelated ecosystem, not as cultural salve, savior, or villain
Are there significant differences in the gut microbiome of East Kent patients before and after they undergo cholecystectomy in the last year? A Prospective Cohort Study.
Full text linkBackground: The role of the gut microbiome in gallstone disease remains a growing area of research. Previous research into this area includes small scale studies but the current knowledge of specific microbial species and functional pathways leading to gallstone disease is still limited. Since gallstone disease remains a significant problem in the NHS, leading to debilitating symptoms and partially caused by environmental and social factors, which continue to become more challenging in the UK, this research aimed to address this area of concern. This type of research could potentially lead to microbial dysbiosis becoming a recognised risk factor for gallstone disease and being considered when formulating management plans for patients.
Methods: The methods used for this study involved obtaining stool samples from patients scheduled for cholecystectomy, samples from the same patients after cholecystectomy as well as six months after cholecystectomy. The DNA extraction protocol included with PureLink Microbiome DNA Purification Kit was followed to extract and purify microbial DNA from these samples. This purified DNA underwent PCR to amplify the amount of 16S microbial DNA before undergoing gel electrophoresis to verify the presence of bacterial DNA. The DNA was then sent for sequencing and statistical analysis using Muther and QIIME2 software was used to investigate patterns in the results.
Results: The results showed values of DNA concentrations from the extraction products as well as a comparison of DNA concentration values at three different time points: before, after and 6 months after cholecystectomy. They revealed a high degree of variability in these values. The results also show the change in DNA yield across the three time points and a comparison of the DNA yield before and after using Phosphate-Buffered Saline (PBS) to optimise the DNA extraction protocol, as well as a figure showing a gel.
Conclusions: This figure demonstrated the presence of 16S DNA, demonstrating that the DNA extraction was successful
The effects of physical activity on life satisfaction amongst older adults with comorbidities: A Scoping Review
Full text linkBackground: The average life expectancy is rising worldwide alongside the prevalence of comorbidities. Physicalactivity may be an important determinant of life satisfaction for older adults with comorbidities but many studies focus solely on its relationship with comorbidity. This scoping review aimed to explore the current depth of existing literature regarding the association between physical activity and life satisfaction amongst older adults with comorbidities and identify gaps in current knowledge that require further research.
Methods: A comprehensive search of literature published between 2013-2024 was performed using the electronic Ovid databases Medline, Embase and Psychinfo. The manual screening process identified 16 relevant publications, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist.
Results: Six major themes were generated from the 16 studies using thematic analysis. The themes discussed werethe interplay of physical activity and comorbidities; diverse modalities of physical activity; association with functional mobility; varied approaches in assessment; factors influencing exercise engagement and impact on health.
Conclusions: There is limited evidence focused explicitly on the effects of physical activity on life satisfaction amongst older adults with comorbidities. This scoping review provides a rationale for greater research in this area. Many older adults also do not meet recommendations for physical activity, which has repercussions on healthcare systems. Consequently, addressing barriers to exercise may prove an effective strategy to increase physical activity levels and in turn, ensure improved life satisfaction throughout aging
The Diagnosis and Treatment of Non-Epithelial Ovarian Cancer in Pregnancy: A Systematic Review
Full text linkBackground: Ovarian cancer can be classified into epithelial ovarian cancer (EOC) and non-epithelial ovarian cancer (NEOC). NEOC accounts for 10% of ovarian cancers; however, it has a high prevalence inyoung women and adolescents. The prevalence of ovarian cancer co-existing with pregnancy is expected to rise in developed countries due to the delay in the age of childbearing. The complications that can arise due to NEOC in pregnancy include, spontaneous abortion, ventriculomegaly, respiratory distress syndrome, alongwith maternal and foetal loss of life. The aim of the report was to conduct a systematic review to identify the most efficacious diagnostic tool and management strategies for the early identification of NEOC in pregnancy to improve foetal-maternal outcomes.
Methods: Two electronic web-based databases were searched for relevant literature (PubMed and Embase). The search was conducted within a 5-year limit from January 2019 to January 2024 using the following searchterms: “pregnan*” AND “non-epithelial ovarian cancer” AND “diagnos*” AND “manage*”. The words with a “*” means they were truncated to find variations of the same word in the literature.
Results: There were 4 articles found in the literature between the years 2019 – 2021 that discussed the diagnosis and management of NEOC in pregnancy. Of these, there was a total of 44 cases that reported NEOC in pregnancy. Thirty-four of the 44 cases were diagnosed with NEOC in the International Federation of Gynaecology and Obstetrics (FIGO) stage I of the disease identified using ultrasonography during the routine ultrasound scans of pregnancy. The majority of cases diagnosed in Stage I received a unilateral salpingo-oophorectomy, a fertility-sparing surgical treatment, in combination with adjuvant platinum-based chemotherapy.
Conclusions: There are no standardised guidelines on the management of NEOC in pregnancy due to thevarious factors involved in the management, such as FIGO staging, gestational age and maternal decision making. Routine ultrasonography during the stages of pregnancy was found to be an effective tool for the initial identification of NEOC in pregnancy, with most patients being asymptomatic before scanning. Fertility-sparing surgery, along with adjuvant platinum-based chemotherapy can be considered as the best treatment combination for pregnant women who want to continue their current pregnancy and may want children later in life; permitted only if the NEOC is in FIGO stage I of the disease
What are the Workplace Training Experiences of Healthcare Professionals to Assist Them to Identify Female Genital Mutilation?
Full text linkBackground: Female Genital Mutilation (FGM) is illegal in the United Kingdom (UK) and involves the removal of parts of the female external genitalia for non-medical purposes. Therefore, FGM is a safeguarding concern and healthcare professionals (HCPs) have a legal duty to report these cases and duty of care to ensure affected patients receive the necessary care and support they require. Due to the sensitive nature of this topic, there is a growing body of research regarding the knowledge and awareness of HCPs surrounding FGM. The literature indicates there to be inadequate FGM training in the workplace, and a subsequent lack of confidence and knowledge amongst HCPs, of the care requirements for this patient group (Surico et al., 2015; Lane et al., 2015; Sheerin et al., 2023). This study aimed to explore the experiences of UK HCPs regarding their FGM training and how this influences HCP competence and confidence in identifying patients subjected to FGM and females who could be at risk of FGM.
Methods: HCPs completed an anonymous semi-structured questionnaire, which was published online via social media platforms. The questionnaire was live on the survey platform, JISC, for 10 weeks. The questionnaire included open and closed structured questions, collecting data from participants regarding the following categories: demographics, work experience, workplace FGM training, workplace experience of FGM survivors, those at risk of FGM and provision of care for these patients.
Results: A total of 66 HCPs working in 29 different healthcare specialities, across 16 disclosed job roles participated in this survey. The results showed that 59.1% of HCPs had previously received FGM training during their career, 30.3% of HCPs had never received workplace FGM training, with 10.6% unable to remember if they came across any sort of FGM training at all. The data illustrated that 34.8% and 19.7% of HCPs respectively, had clinical encounters with patients who had experienced FGM and females who were at risk of FGM. HCPs who had received workplace FGM training were more confident at providing care to patients affected by FGM, in comparison to HCPs without workplace FGM training.
Conclusions: HCPs in this study are proficient in identifying patients who have experienced FGM, however, identifying at risk individuals proved more challenging. HCPs are aware of the physical and psychological requirements of these patients and desire additional FGM training to increase their knowledge. There were mixed levels of confidence in caring for FGM patients across all specialities. Although, HCPs who had previous clinical FGM experience and training were more confident in providing care. This research demonstrates that although some HCPs have received FGM training, there was a lack of training standardisation across specialities, as well as differences found in training received for similar job roles
Patient engagement: What are the barriers to direct care in ethnic minority/patients of ethnic origins? A systematic review.
Full text linkBackground: Patient engagement (PE) in healthcare operates at different levels, with direct care PE being the most common in everyday healthcare. Engagement at this level involves activities like medication adherence, attending appointments, and managing own health through proactive behaviours such as seeking information. Despite its importance, ethnic minority (EM) patients may face barriers to direct care PE and the reasons for this are unclear. Studies have shown that increased direct care PE is linked to better health outcomes, highlighting the need to identify the barriers that exist to direct care patient engagement in ethnic minority patients/patients of ethnic origin.
Methods: A systematic review (SR) was conducted with thematic analysis to elicit the barriers. It was conducted following the guidance of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist. A comprehensive search was conducted on Embase, MEDLINE, Web of Science and Cochrane from 2004 to 2024 to obtain studies identifying barriers in direct care patient engagement in ethnic minorities. The included studies underwent quality assessment, after which thematic analysis was utilised to identify the barriers. Ethics approval was not required for this systematic review.
Results: 3034 articles were initially identified from the appropriate database searches. After the removal of duplicates, 2197 articles were sourced and subjected to a review of their titles and abstracts. Subsequently, 24 relevant full text articles were retrieved for eligibility screening, of which 3 met the inclusion criteria and were included in this study. Additionally, 4 articles were identified through reference searching and subjected to title and abstract screening, with 1 article meeting the inclusion criteria and thus included in this study. Eventually, a total of 4 articles were included in this study: 3 articles from database search and 1 article from reference search. Barriers reported were based on patients’ perceptions and were thematically grouped. Racial and ethnic discrimination emerged as the dominant barrier, while other significant barriers included language proficiency and culture. Health literacy and education were also reported as barriers.
Conclusions: Barriers identified in this review impeded direct care patient engagement in ethnic minority/patients of ethnic origin. Language proficiency and culture contributed to the racial and ethnic discrimination reported by participants. Awareness of these barriers is crucial for improving the poorer health outcomes already experienced by ethnic minority/patients of ethnic origin. Further research collecting primary data would be ideal for additional evidence of the barriers affecting direct care patient engagement and their impact on health outcomes. The role of artificial intelligence can also be explored further to mitigate language proficiency as a barrier
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