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P247 ‘Adult bronchiectasis patients’ perceptions of exercise: a qualitative study’
No full textIntroduction: Bronchiectasis is a chronic respiratory condition characterised by abnormally dilated airways leading to increases in, and pooling of, respiratory secretions. Approximately 5 in every 1,000 adults in the United Kingdom have bronchiectasis. Exercise reduces dyspnoea, increases exercise tolerance and improves quality of life in patients with chronic respiratory disease and is an effective method of secretion clearance.Patients with bronchiectasis have reduced exercises tolerance and are less active than the general population. Many do not participate in pulmonary rehabilitation but the reasons for this are unclear. No evidence currently exists regarding the attitudes of bronchiectasis patients towards exercise, and barriers to compliance. In order to introduce effective measures to increase adherence to exercise, reasons for poor adherence and potential barriers need to be identified.Aim: To explore the views of adult bronchiectasis patients towards exercise.Method: A qualitative study was carried out, consisting of semi-structured interviews with ten adult patients with bronchiectasis at a single site in the north west of England. Perceptions of exercise, potential barriers to exercise and potential facilitators of exercise were explored. Thematic analysis was used to code the data and identify themes.Findings: Five main themes were identified following the analysis:Facilitators to exercise e.g. enjoyment, pacing and adaptation, self–motivation.Barriers to exercise e.g. embarrassment regarding symptoms, breathlessness, fear of exacerbating symptoms.Exercise has a positive impact on health and life expectancyGrief regarding loss of abilityDefinitions of exerciseConclusion: These findings suggest that there are a number of shared facilitators and barriers to exercise between bronchiectasis patients. Participants recognised that exercise was positive, but had differing perceptions on what ‘exercise’ actually entailed. Future research needs to further explore potential barriers and facilitators to exercise in this patient group on a larger scale. This could then lead to the use of behaviour change models to aid participation in exercise. These findings indicate that healthcare professionals should consider bronchiectasis patients holistically in order to aid compliance with exercise. Healthcare professionals need to reflect on their role in exercise advice and prescription, and the language used when doing so
General practice tasters for foundation doctors
No full textBackground: General practice (GP) is currently not viewed positively as a career choice, compared with other specialties, with GP training programmes struggling to fill posts. Opportunities to change this mindset in the early years of training are limited. Trainees may find themselves applying for entry into GP specialty training just 3–4 months after completing Foundation Year 1 (FY1), yet there are few GP attachments during FY1 that can provide experience of primary care and positively inform career choice. Context: To help ameliorate the current crisis in GP, recruitment and retention initiatives are needed to provide relevant experience of GP early in medical careers so that more doctors can make an informed decision to choose GP as a career. Innovation: FY1 doctors have been given the opportunity to shadow final-year GP specialty trainees (GPST3) in clinical practice (for between 3 and 5 days). The voluntary scheme has run successfully since 2014. This paper describes the taster programme and its evaluation. The programme has been positively received by both FY1s and GPST3 mentors. The GPST3s are enthusiastic about GP, which appeared to ‘rub off’ on the FY1s. FY1s find it helpful to have a trainee's perspective, gaining an overview of what to expect, including the opportunities available to them. General practice is currently not viewed positively as a career choice. Implications: Using GPST3 trainees as mentors for FY1 doctors is educational for both groups and can have a positive impact on GP recruitment. The taster demonstrated how varied GP is, and challenged some negative perceptions of primary care. GPST3s gained confidence in their knowledge about GP and greater insight into educational roles.</p
The use of interactive tables in promoting wellbeing in specific user groups
No full textDementia is estimated to affect 50 million people worldwide [1]. A significant proportion of residents in residential homes are people with moderate to severe dementia [2, 3]. Apathy amongst them is a major issue [3-5]. Tovertafel is an in-teractive table that was designed to reduce apathy and to facilitate play for people with moderate to severe dementia [6].This mixed methods study has three aims; firstly to explore the Tovertafels’ impact upon the wellbeing of people with moderate to severe dementia in a residential care home from the professional carers’ perspective; secondly to explore the impact of Tovertafel on the wellbeing of these carers; and thirdly to explore whether Tovertafel has any impact on the quality and quantity of visits by the family of the residents. Semi-structured interviews were conducted with 12 carers and The Work Related Quality of Life Scale (WRQoL) [7] was used to explore carers’ perspective of the extent to which Tovertafel improved their own wellbeing and the quality of their working life.Some key findings indicate that visiting families interacted more with their loved-one when they are using the Tovertafel. Residents do use Tovertafel when it is switched on, but many needed to be initially prompted by staff. Tovertafel did have a positive impact upon residents’ mood during the time it was used and a short time after. Tovertafel also had an impact on improving interaction between carers and residents when it was on. Tovertafel’s most successful games are reported as being the bubbles and puzzles, and carers also stressed the importance of identifying an appropriate location for the Tovertafel, to enable optimum usage
Musculoskeletal (MSK) Practitioners in Primary Care:An evaluation of a MSK core capabilities framework and review process
Get PDFThe General Practice Contract 2019/20 established first contact musculoskeletal (MSK) physiotherapists in primary care. This paper describes an evaluation exploring the feasibility of using the MSK Core Capabilities Framework and a peer review process to evidence capability. It discusses how this process may be developed to ensure MSK practitioners are able to evidence the level of practice required within the complex environment of primary care. MSK practitioners were supported to evidence their capabilities against the MSK Framework. Twenty-two participants took part in the evaluation of this intervention via semi-structured interviews. A robust and iterative process of qualitative data analysis was undertaken. The findings are framed in terms of Davis’ Technology Acceptance Model of evaluation (i.e. user perceptions). There were a range of perceived benefits of the Framework including as a means of quality assurance, career progression, the promotion of knowledge consolidation and reflective practice. There were however, a number of ‘translation into practice’ issues. Given the newness of the MSK Framework, it is perhaps not surprising there is a need for refinement. This evaluation highlights key enablers for reviewing capabilities of MSK practitioners: a curriculum; educational supervision; and accreditation. Learning also applies more widely to other emerging role opportunities
The use of Qualitative Behavioural Assessment in zoo welfare measurement and animal husbandry change
No full textZoological institutions have come a long way over the past 20 years in their measurement and evaluation of animal behaviour and welfare. Environments that enable the performance of biologically relevant activity patterns, which increase behavioural diversity and ensure appetitive behaviours can be completed in full, are commonplace in zoos globally. The use of species-specific environmental enrichment (EE) techniques, where the effect of EE is evaluated and refined, further enhance the opportunities for species to experience positive welfare in zoos. What is still required is evaluation of the lasting effect of such husbandry and housing changes that provide meaningful long-term welfare improvements. To provide evidence for best practice management, benchmarks at a species-specific level are required that are comparable across husbandry and management regimes, as well as across environmental conditions in which captive populations occur. One such method for addressing individual-level welfare state is Qualitative Behavioural Assessment (QBA), an approach increasingly used in domestic animal industries to measure the individual's perception of the situation it finds itself within. This paper provides an outline of the relevance of QBA to those working in the field of zoo animal husbandry to show how valid and objective measurements of welfare state can be taken of individuals living in zoos in a range of different situations. An evaluation of the current literature shows the depth and breadth of QBA application and the paper provides suggestions for future areas of research investigation and a practical usage in the zoo. It is shown how QBA can be used to target the application of EE to meet specific husbandry needs or promote key welfare-positive behaviour. The paper evaluates the relevance of positive challenge "eustress" to captive species and identifies areas for the wider application of QBA across captive population and institutions to further support the key aims of the modern zoo. The paper provides coverage of literature on QBA in the domestic animal field and attempts to apply these methods to a zoo-based example. The paper concludes by evaluating why zoos need to consider the results of qualitative, multi-institution studies and how the results of this can be utilised to improve husbandry and animal experiences in the zoo
An investigation into keeper opinions of great ape diets and abnormal behaviour
No full textZoos are evidencing a shift in great ape diets to cultivated fruit-free to achieve a more wild-type nutritional composition (lower sugar, higher fibre). This study aimed to ascertain great ape keeper knowledge and opinions on the removal of cultivated fruit from great ape diets, to investigate feeding regimes currently in use and to understand the prevalence and frequency of abnormal behaviour and health conditions within captive great apes that may be related to diet. Keepers from 11 collections in the British Isles participated by completing a standardised questionnaire; this provided information on 20 great ape groups. Keepers report, two thirds of great ape groups were fed cultivated fruit, but zoos intended that half of these go cultivated fruit-free in future. All groups were fed multiple times a day using multiple feeding strategies. Significantly more groups were fed using eight feeding strategies, very few groups were fed using less than seven feeding strategies (P=0.001). Most keepers (whether their apes were fed a cultivated fruit-free diet or were fed cultivated fruit) believed their apes’ diets were not comparable to the wild. However, all keepers, irrespective of diet type, agreed or agreed strongly that their great apes were in good health and were motivated by their diet. Fifteen abnormal behaviours were noted by keepers across all groups; regurgitation and reingestion, regurgitation, and coprophagy were reported significantly more than other abnormal behaviours (P=0.045) but no significant differences (in prevalence or frequency) were reported for these behaviours between cultivated fruit free and cultivated fruit-eating groups. Keeper-reported prevalence of spinning (P=0.001) and self-patting (P=0.001) were significantly higher in groups fed a cultivated fruit-free diet compared to those fed cultivated fruit; however, prevalence of hyper-aggression was significantly higher in groups fed cultivated fruit (P=0.001). Keepers reported abnormal behaviours were significantly more prevalent in gorillas given the average performance across all three species (P<0.001) while chimpanzees showed a tendency to perform abnormal behaviours more frequently. Further research into keeper opinions on primate diets, nutritional analysis between diets (cultivated fruit-free versus cultivated fruit-containing), and experimental data pre- and post-removal of cultivated fruit from primate diets is required
Lactate monitoring in droplet microfluidics: a cautionary tale in assay miniaturisation.
No full textWe present the development of a droplet-based device for real-time continuous lactate measurement, highlighting how protocols from long-established homogeneous enzymatic assays require careful re-optimisation before their migration into miniaturised droplet-based microfluidics
How consistent and effective are current repositioning strategies for pressure ulcer prevention?
No full textAimTo examine the inter-practitioner variability of repositioning for pressure ulcer prevention, the effectiveness of the intervention, and whether the provision of written guidance influenced the repositioning technique.MethodsA pre-test post-test study design was utilised. Descriptive data regarding the work history of participants was collected. Participants were invited to reposition a healthy volunteer before and after reviewing guidance detailing the 30° side-lying technique. The researchers measured the resulting turn angles and assessed offloading of bony prominences.ResultsThe repositioning technique varied considerably in the sample of nurse participants. Turn angles decreased following the guidance, but offloading of body sites vulnerable to pressure damage remained sporadic.ConclusionPressure ulcer prevention training should include practical demonstrations of repositioning. Clear guidance regarding the optimal repositioning technique for pressure ulcer prevention is needed