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Publication History View all

  • Medical Engineering & Physics 02/2013; DOI:10.1016/j.medengphy.2012.12.016
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    ABSTRACT: Breast cancer-related lymphoedema (BCRL) affects 24-42% of patients following treatment for breast cancer. The gold standard method of measuring hand swelling associated with BCRL is to use water displacement (volumeter). This is not always possible in the clinical setting and the figure-of-eight method, which involves wrapping a simple measuring tape around the hand in a specific way, may be an alternative. The aim of the study was to examine the reliability and validity of the figure-of-eight method of measuring hand size in women with BCRL. Twenty-four patients with hand swelling associated with BCRL participated. Two novice testers performed three 'blinded' figure-of-eight measurements and three volumetric measurements of each hand. In terms of intertester (between-tester) and intratester (within-tester) reliability, the intraclass correlation coefficients were all greater than 0.8 indicating high intra- and intertester reliability for the figure-of-eight method. For validity, a Pearson's moment correlation computed between the figure-of-eight and volumetric methods highlighted a statistically significant correlation of 0.7 between the methods for both testers. The figure-of-eight method was found to be a valid and reliable method of measuring hand swelling in this population.
    European Journal of Cancer Care 01/2013; 22(2). DOI:10.1111/ecc.12024
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    ABSTRACT: End of life care is an important aspect of acute stroke nursing because stroke mortality rates remain high, despite advances in care. There is a national drive to improve the quality of end of life care in all clinical areas, including for stroke patients. Patients who have had a stroke should not be excluded from acute stroke care at the end of life. Stroke care should incorporate multidisciplinary working, anticipatory care planning and prescribing, and effective communication with patients and families. The use of end of life care pathways is widely recommended as best practice. Palliative care specialists may provide support where patients' needs are complex, while decisions to withhold cardiopulmonary resuscitation should be avoided immediately following stroke. Spiritual care extends beyond religious care and is the responsibility of the multidisciplinary team. Although more research is required about stroke care at the end of life, providing high-quality, patient-centred services for patients who have had a stroke and their families during this time is achievable.
    Nursing standard: official newspaper of the Royal College of Nursing 03/2012; 26(27):42-6. DOI:10.7748/ns2012.03.26.27.42.c8985
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    ABSTRACT: The care of patients with inflammatory bowel disease (IBD) frequently falls short of the highest standards. This is noted in several publications, including national standards, despite nursing students being taught the importance of listening to and understanding patients. Teaching staff at the University of Glasgow primarily responsible for teaching third year undergraduate nursing students undertook a radical rethink of the planning, delivery and assessment of lectures on IBD. The subject had previously been delivered in a modified lecture format. Although the topic could be included in the end-of-year exams, there was little evidence to show whether this traditional teaching method had any effect on students' clinical practice. In a novel approach to learning and assessment, students were invited to research and produce an information leaflet for newly diagnosed patients with IBD. The leaflets were then assessed and grades awarded by an expert panel of patients and carers. Such enquiry based learning (EBL) intended to demonstrate in practice, the key role patients can play in both undergraduate nurse education and in service planning and delivery in the National Health Service (NHS). The panel found the exercise both interesting and insightful, while the students reported being invigorated and felt the expert assessment meant they were forced to achieve a higher level of work.
    Nurse education today 12/2011; 32(2):139-45. DOI:10.1016/j.nedt.2011.11.002
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    ABSTRACT: To determine what influences the decision to insert an indwelling urinary catheter in acute stroke patients. A prospective casenote review and semi-structured interviews were conducted and corporate catheterization policy in the study sites was investigated. Three teaching hospitals, typical of stroke service provision in most developed countries. Casenotes from 70 consecutive acute stroke admissions; 50 doctors, nurses and physiotherapists working in acute stroke units and medical receiving units. Stroke patients were catheterized for output monitoring, relief of urinary retention or, especially for older patients, continence-related issues. Half of all catheterizations occurred in acute stroke units. Continence and catheterization were considered less important than other aspects of acute stroke care. No catheterization policy or standardized continence assessment tool was in use. Documentation was often lacking. Patients and relatives were not fully involved in the decision to catheterize. Continence assessment and catheterization practices varied widely. Complex unwritten rules relating to gender proliferated. Such rules demonstrated heuristic problem-solving could potentially cause conflict. Decisions to catheterize 'belonged' to doctors or nurses depending upon clinical indications. Clinical assessment and specialist referrals were often seen as 'not my job'. Clear corporate policy on catheterization is required to direct practice. Use of standardized continence assessment tools is recommended to set and monitor standards of care. Documentation relating to urinary catheterization needs to improve.
    Clinical Rehabilitation 11/2011; 26(5):470-9. DOI:10.1177/0269215511426160
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    ABSTRACT: The purpose of this study was to investigate the use and perceived benefit of complimentary and alternative medicine (CAM) and physiotherapy treatments tried by people with chronic fatigue syndrome (CFS) to ease painful symptoms. This study used a descriptive, cross-sectional design. People with CFS who experienced pain were recruited to this study. Participants were asked during a semistructured interview about the treatments they had tried to relieve their pain. Each interview was conducted in the home of the participant. Fifty participants were recruited, of which, 10 participants were severely disabled by CFS. Eighteen participants were trying different forms of CAM treatment for pain relief at the time of assessment. Three participants were currently receiving physiotherapy. Throughout the duration of their illness 45 participants reported trying 19 different CAM treatments in the search for pain relief. Acupuncture was reported to provide the most pain relief (n=16). Twenty-seven participants reported a total of 16 different interventions prescribed by their physiotherapist. The results of this study suggest some physiotherapy and CAM treatments may help people manage painful CFS symptoms. Future research should be directed to evaluating the effectiveness of interventions such as acupuncture or gentle soft tissue therapies to reduce pain in people with CFS.
    Physiotherapy Theory and Practice 11/2010; 27(5):373-83. DOI:10.3109/09593985.2010.502554
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    BMJ (online) 06/2010; 340:c2845. DOI:10.1136/bmj.c2845
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    ABSTRACT: Deficits in motor functioning, including walking, and in cognitive functions, including attention, are known to be prevalent in multiple sclerosis (MS), though little attention has been paid to how impairments in these areas of functioning interact. This study investigated the effects of performing a concurrent cognitive task when walking in people with MS. Level of task demand was manipulated to investigate whether this affected level of dual-task decrement. Eighteen participants with MS and 18 healthy controls took part. Participants completed walking and cognitive tasks under single- and dual-task conditions. Compared to healthy controls, MS participants showed greater decrements in performance under dual-task conditions in cognitive task performance, walking speed and swing time variability. In the MS group, the degree of decrement under dual-task conditions was related to levels of fatigue, a measure of general cognitive functioning and self-reported everyday cognitive errors, but not to measures of disease severity or duration. Difficulty with walking and talking in MS may be a result of a divided attention deficit or of overloading of the working memory system, and further investigation is needed. We suggest that difficulty with walking and talking in MS may lead to practical problems in everyday life, including potentially increasing the risk of falls. Clinical tools to assess cognitive-motor dual-tasking ability are needed.
    Multiple Sclerosis 09/2009; 15(10):1215-27. DOI:10.1177/1352458509106712
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    ABSTRACT: This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign. Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care. An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants. Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service. People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care.
    Journal of Advanced Nursing 05/2009; 65(7):1432-41. DOI:10.1111/j.1365-2648.2009.05003.x
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    ABSTRACT: To compare gait parameters of older people with diabetes and no peripheral neuropathy (DM) and people with diabetes and diabetic peripheral neuropathy (DPN) and to investigate the effect of a secondary motor or cognitive task on their gait. Thirty subjects were recruited: 15 with DPN (mean age 69 +/- 3.0 years) and 15 with diabetes and no neuropathy (70 +/- 2.9 years). The temporal and spatial parameters of gait were determined using the GAITRite walkway. Subjects undertook four walks: under normal walking conditions (single task); four times while simultaneously undertaking an additional motor task, carrying a tray with cups of water (dual task); and four times whilst undertaking a cognitive dual task, counting backwards in sevens. This arithmetic task was also completed sitting. For all gait variables, there was a statistically significant difference between the groups. Subjects with DPN walked more slowly and with smaller steps compared with those with DM. In general, the secondary task had a significant and adverse effect on the gait parameters and this effect was greater for those with DPN in both absolute and relative terms. Both groups had poorer arithmetic ability when walking compared with sitting. Patients with DPN have different gait parameters to diabetic patients without neuropathy. Problems with divided attention when walking were more evident in the DPN group and may increase their risk of falls.
    Diabetic Medicine 04/2009; 26(3):234-9. DOI:10.1111/j.1464-5491.2008.02655.x
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