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Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators
Get PDFObjectives Quantitatively examine the content of National Health Service Health Check (NHSHC), patient–practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators.
Design RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation.
Setting and participants Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40–74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients’ age, gender and ethnicity.
Methods Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management.
Results 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8–38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01–12.48 vs QRISK2 M=7.44%, CI: 5.29–9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44–3.97 vs QRISK2=2.35%, CI: 1.89–2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92–42.17).
Conclusions There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences
Adopting an appreciative inquiry approach to propose change within a national talent development system
Get PDFThe subject of talent in sport continues to fascinate and intrigue as organisations seek to identify and deliver an effective talent development programme in an effort to ensure systemic success. In the quest to deliver an optimal national governing body talent development programme, this paper investigates the role that Appreciative Inquiry can play in addressing change within a complex landscape. The coaches (12 talent coaches) and researcher (Head of Performance) utilised an Appreciative Inquiry framework to identify a ‘routemap’ for change within the programme. Results highlighted the challenges and benefits of adopting a strengths-based approach to programme development within sport, particularly the generative capacity of Appreciative Inquiry amongst coaches. Results also indicate some complexities of strength-based collaborative change, namely the need for time to break through semantics and coaching rhetoric. Through the design and delivery of an Appreciative Inquiry summit, key themes for an optimal development environment were identified. Namely, coaches felt that when at its best the programme adopts a mastery focus. Findings indicate that to achieve this, participants felt that for the programme to become optimal, the themes of leadership, coach-athlete relationships and player autonomy were integral elements to build on going forward
Age differences in anticipatory and executory mechanisms of gait initiation following unexpected balance perturbations
Get PDFPurpose. An age-related decline in anticipatory postural mechanisms has been reported during gait initiation; however, it
is unclear whether such decline may jeopardize whole-body stability following unexpected balance perturbations. This
study aimed to compare young and older individuals’ ability to generate postural responses and preserve stability in
response to external waist perturbations delivered within gait initiation.
Methods. Ten young and ten older participants performed 10 gait initiation trials followed by 48 unperturbed and 12
perturbed trials in a random order. A stereophotogrammetric system and three force platforms were used to quantify
mechanical parameters from the preparatory phase (e.g., timing and amplitude of postural adjustments) and from the
stepping phase (e.g., step characteristics and dynamic stability). Activation patterns of lower leg muscles were determined
by surface electromyography.
Results. Older participants responded to perturbation with lower increase in both magnitude (p<0.001; η
2
p=0.62) and
duration of (p=0.001; η
2
p=0.39) preparatory parameters and soleus muscle activity (p<0.001; η
2
p=0.55), causing shorter
(p<0.001; η
2
p=0.59) and lower (p<0.001; η
2
p=0.43) stepping, compared to young participants. Interestingly, young
participants showed greater correlations between preparatory phase parameters and dynamic stability of the first step than
older participants (average r of -0.40 and -0.06, respectively).
Conclusion. The results suggest that young participants took more time than older to adjust the anticipatory biomechanical
response to perturbation attempting to preserve balance during stepping. In contrast, older adults were unable to modify
their anticipatory adjustments in response to perturbation and mainly relied on compensatory mechanisms attempting to
preserve stability via a more cautious stepping strategy
Application of the European Tourism Indicator System (ETIS) for Sustainable Destination Management. Lessons from County Clare
Get PDFPurpose – Despite indicators being regarded as ideal tools to help achieve sustainability in tourism, their application within Ireland remains under researched. Therefore, the purpose of this paper is to advance the knowledge base in the hospitality and tourism field by presenting baseline research from the first application of all forty-three of the indicators that make up the ETIS in County Clare, Ireland.
Design/methodology/approach - This study utilised the pre-existing visitor, enterprise and resident surveys that accompany the ETIS indicator system in a number of honey pot destinations within County Clare. This approach was complemented further through desk research to gather the necessary data on all forty-three core indicators of the ETIS.
Findings – While the application of the ETIS in County Clare constitutes a significant advancement towards evidence informed planning for tourism. There does exist a number of information gaps relating to specific core indicators of the ETIS. Which, if not monitored and benchmarked over time, could have serious ramifications for the future sustainability of tourism in Ireland.
Originality/value – This paper not only discuss the findings from the application of all forty-three core indicators of the ETIS in one specific destination, but also develops new knowledge on the use of tourism indicators and the move towards evidence informed planning for tourism. Furthermore, this study contributes significantly to the theoretical development of our field, as the ETIS has not been applied in its entirety throughout Europe
Effects of combining physical activity with psychotherapy on mental health and well-being: A systematic review
Get PDFObjective
: Despite a vast evidence-base advocating the psychological benefits of physical activity, relatively little is understood about how combining physical activity with psychological therapies may influence these positive effects. The aim of this paper is to systematically analyse evidence from studies adopting a combined approach, and identify potential mechanisms of action on clinical outcomes.
Methods
: The Embase, PsycINFO and Medline (PubMed and OVID) databases were searched for applicable trials published up to December 2018. Relevant data was extracted from eligible studies, and the Effective Public Health Practice Project (EPHPP) tool was utilised to objectively assess the quality of each study.
Results
: Twenty-two studies met the inclusion criteria, seven of which were rated as methodologically `strong'. Combining physical activity with psychological therapy consistently engendered positive effects on outcomes compared with treatment as usual. Similar improvements in psychological outcomes were observed in most (7/8) groups receiving physical activity alone. Increased levels of physical activity were observed in psychologically-informed interventions, however this effect was unrelated to changes in psychological outcomes.
Limitations
: Clinical and methodological heterogeneity precluded meta-analyses of results, while risk of bias detected in the studies may compromise overall validity of the findings.
Conclusions
: Physical activity interventions may be a viable alternative to psychological therapies, provided psychological approaches are incorporated into the implementation design (i.e. behavioural activation). Improved psychological outcomes may be observed regardless of `dose' received, however further research is required to ascertain whether psychosocial mechanisms of change mediate positive effects
Iliocaval venous obstruction, cardiac preload reserve, and exercise limitation
Get PDFCardiac output during exercise increases by as much as five-fold in the untrained man, and by as much as eight-fold in the elite athlete. Increasing venous return is a critical but much overlooked component of the physiological response to exercise. Cardiac disorders such as constrictive pericarditis, restrictive cardiomyopathy and pulmonary hypertension are recognised to impair preload and cause exercise limitation, however the effects of peripheral venous obstruction on cardiac function have not been well described. This manuscript will discuss how obstruction of the iliocaval venous outflow can lead to impairment in exercise tolerance; how such obstructions may be diagnosed, the potential implications of chronic obstructions on sympathetic nervous system activation, and relevance of venous compression syndromes in heart failure with preserved ejection fraction
Smart Systems and Collaborative Innovation Networks for Productivity Improvement in SMEs
Get PDFThe adoption of Smart Manufacturing Systems in manufacturing companies is often seen as a strategy towards achieving improvements in productivity. However, there is little evidence to indicate that UK manufacturing SMEs are prepared for the implementation of such systems. Through the employment of a triangulation research approach involving the detailed examination of 36 UK manufacturing SMEs from three manufacturing sectors, this study investigates the level of awareness and understanding within SMEs of Smart Manufacturing Systems. The development of a profiling tool is shown and is subsequently used to audit company awareness and understanding of the key technologies, collaborative networks and systems of SMS. Further information obtained from semi-structured interviews and observations of manufacturing operations provide further contextual information. The findings indicate that whilst the priority technologies and systems differ between manufacturing sectors, the key issues around the need for developing appropriate collaborative networks and knowledge management systems are common to all sectors
Blockchain: A Panacea for Trust Challenges In Public Services? A Socio-technical Perspective
Get PDFTrust in
corporations,
governments and public services
has been
steadily
declining
over the last few decades.
L
ack of transparency and
auditability has been a key
driver for this decline.
Blockchain technology has been co
mmended
as a
solution
that can h
elp
with
disintermediat
ion
and fill
ing
the
consistently increasing trust
challenges faced by
the
corporate and public s
ector
s
.
Public services are
seeking solutions that can help establish trust
and
increase
transpar
e
n
c
y with its citizens and b
usinesses are undertaking extensive
business analysis to determine the need and effectiveness of blockchain
-
like platforms as the basis for transforming their existing
platforms. Due to the decisive nature, most of the analysis results thus indicate that if a trusted third party is an option,
then blockchain
should not be used. Here we
highlight the challenges a
nd
opportunities
of establishing trust and
how
blockchain technology can help
public services bridge the trust gap
with its
citizens
. We argue that
all information technology systems rely on a suite of technologies
,
thus
blockchain should be added to the
c
urrent
technology stack rather than taking an
‘
all or nothing
’
approach. We also argue that
analysing the effectiveness of futuristic technology like blockchain with industrial age methodology and mindset may limit th
e realisation
of its
impact on society
and economy
. Therefore, we propose to take a heuristic approach
,
where different properties of blockchain
technology need to be mapped against different aspects of current business process with a futuristic view in mind. Taking Com
panies
House
–
a governme
nt organisation that holds over
4
million UK
-
based companies
’
records
–
as an example, we demonstrate how
certain business processes in Companies House can benefit from
adapting
a blockchain
-
based solution
Using thermal imaging to measure changes in breast cancer-related lymphoedema during reflexology
Get PDFBackground
Reflexology lymph drainage (RLD) for breast cancer related lymphoedema (BCRL) may have a positive impact on arm swelling and pain. Thermal imaging is a means of tracking temperature change by visual images.
Aims
To explore the use of thermal imaging in treatment for BCRL.
Method
The swollen arms of two participants with BCRL were photographed using a thermal imaging camera during a single RLD treatment. Limb Volume Circumferential Measurement (LVCM) of both arms was taken before, after and the next day. The images were examined for visual changes, and temperature data were extracted.
Findings
Images showed differences in temperature within the affected hand and arm over 45 minutes. LVCM data indicated a loss of limb volume in the affected arm in both cases, which continued to decrease over 24 hours.
Conclusion
Thermal imaging may be useful in tracking temperature change during treatment for BCRL
Motivations and barriers to engagement with a technology-enabled community wide physical activity intervention
Get PDFPrevious physical activity interventions have failed to create population change and an alternative approach is needed to support a World Health Organization target of a 15% reduction in global levels of inactivity by 2030. There is growing evidence that gamification-based interventions can reach substantial portions of the community. However, to date, these studies have been predominantly quantitative and as such there is a paucity of research in the area on motivations and barriers to engagement with these programs. Four focus groups conducted with N = 26 players who participated in a gamification-based intervention ‘Beat the Street’ revealed several varied motives to engagement, including collective reward; social influence; game reinvention; exploration; accessibility and awareness. However, several barriers specific to the Beat the Street intervention and outdoor gamification interventions more generally were also identified. This study provides novel insight into the motives which engage individuals into physical activity interventions and the design principles which need to be considered when implementing interventions of this nature