The voices of adults with a learning disability and a carer on their orthopaedic and trauma hospital care in the UK

A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Professional Doctorate in Health and Wellbeing.Introduction: People with learning disabilities have a greater prevalence of musculoskeletal conditions and injuries than the general population and these have significant impacts on wellbeing. Despite this, orthopaedic and trauma hospital care has not been investigated with this group who seldom have their voices heard or their experiences valued and interpreted. This study contributes to the existing evidence base by exploring the experiences of people with a learning disability who have received orthopaedic and trauma hospital care. Aim: To understand the orthopaedic and trauma hospital experiences from the perspective of adults with a learning disability. Methods: A qualitative approach, focusing on peoples’ lived experiences, was utilised. A purposive sample of five participants was recruited and one-to-one, semi-structured interviews were undertaken. Analysis of the interviews employed an interpretative phenomenological analytical framework. Findings: Findings from each participant in the study was discussed in relation to their orthopaedic and trauma hospital care. A cross-case comparison was then undertaken and the themes below represent common experiences across participants: • Communication challenges • Lack of person-centred care • Issues related to pain management • Lack of confidence in hospital care • The valuable support and expertise of carers • Incompetence of hospital staff • Isolation and loneliness Discussion & conclusions: This study contributes to the evidence base by being the first to specifically focus on and provide experiential findings pertaining to the orthopaedic or trauma hospital experiences of adults with learning disabilities. There were significant shortcomings in the orthopaedic and trauma hospital experiences of adults with learning disabilities who perceived they were unsupported and received poor care in orthopaedic and trauma hospital settings. Recommendations and implications for practice: Person-centred care for adults with learning disabilities in orthopaedic and trauma hospital settings is needed along with specific education and training which includes close liaison with the experts by experience - people with learning disabilities and their carers as well as the specialists in learning disabilities

Naturally occurring highly pathogenic avian influenza virus H5N1 clade 2.3.4.4b infection in three domestic cats in North America during 2023

The Eurasian strain of highly pathogenic avian influenza (HPAI) H5N1 is a devastating pathogen for birds that also has the capacity to infect mammals. This report describes the presentation, clinical case findings (including haemogram and serum biochemistry), gross and microscopic lesions and virus detection in three HPAI H5N1-infected domestic cats from the USA in 2023. All three cats presented with neurological abnormalities and were euthanized due to a poor prognosis within 2 days (two cats) or 10 days (one cat) of known clinical disease onset. Necropsy consistently revealed pulmonary congestion and oedema, and cerebrocortical malacia with haemorrhage was also seen in the cat that survived for 10 days. On histology, all cats had necrotizing encephalitis and interstitial pneumonia with pulmonary congestion, oedema, vasculitis and vascular thrombosis. One cat also had microscopic multifocal necrosis in the liver, pancreas and an adrenal gland. To our knowledge, this report is the first to detail pathological findings in HPAI H5N1 naturally-infected cats during the widespread outbreak in North America beginning in 2021, and that describes a cat surviving for 10 days after onset of HPAI H5N1 encephalitis

A cross-case comparison of the trauma and orthopaedic hospital experiences of adults with intellectual disabilities using interpretative phenomenological analysis

© 2020 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1002/nop2.693Aim: To present the cross-case comparison component of a qualitative study exploring and describing the experiences of adults with an intellectual disability who have received trauma and orthopaedic hospital care for musculoskeletal conditions or injuries in the United Kingdom. Design A qualitative, exploratory study was conducted using 1:1 semi-structured interviews to describe the lived experiences of trauma and orthopaedic hospital care from the perspectives of people with intellectual disabilities and a carer of a person with profound and multiple intellectual disabilities. The data was analysed using interpretative phenomenological analysis. The Standards for Reporting Qualitative Research guidelines were applied. Results: There were common and interconnected experiences across the five participants: Communication challenges; lack of person-centred care; issues related to pain management; lack of confidence in hospital care; the valuable support and expertise of carers; incompetence of hospital staff and isolation and loneliness. Discussion: Although adults with intellectual disabilities are seldom included as participants in health research studies, their unique experiences provided valuable insights and informs the evidence base in relation to trauma and orthopaedic hospital care. Conclusions: This study revealed poor quality and unsafe trauma and orthopaedic hospital experiences as described by people with intellectual disabilities and a carer. Health care providers, commissioners and staff require urgent education and training to ensure that a person-centred approach, incorporating reasonable and achievable adjustments, is implemented to meet the currently unmet needs of adults with intellectual disabilities

Successful strategies for including adults with an intellectual disability into a research study using interpretative phenomenological analysis (IPA)

This is an accepted manuscript of an article published by RCN in Nurse Researcher on 5 August 2021. The accepted version of the publication may differ from the final published version.Background: Adults with intellectual disabilities are not regularly recruited as participants in health research which may be due to perceptions regarding their inability to participate meaningfully with or without significant support and anticipated difficulty in gaining ethical approval because of issues around consent and mental capacity. This means that the voices of people with an intellectual disability are often missing within health research and their experiences and views are unexplored. Aim: To share successful strategies for accessing, recruiting and collecting data from a purposive sample of adults with an intellectual disability using interpretative phenomenological analysis (IPA). Discussion: Interpretative Phenomenological Analysis was a person-centred, flexible and creative approach to adopt. Meaningful collaboration with people with intellectual disabilities, their families, carers, advocacy group managers, specialists within intellectual disability services and research supervisors was vital to the success of conducting this study. Practical strategies for including people with an intellectual disability in a study from the perspective of a novice researcher, an outsider to the field of intellectual disability, have been shared. A limitation is that participants were not included in all stages of the research process. Conclusion: Inclusion of participants with an intellectual disability in research studies is important and achievable for healthcare researchers. A framework to support researchers outside of the specialist field of intellectual disabilities has been presented. Implications for practice: Adults with intellectual disabilities often receive poor healthcare and have poorer outcomes which is perpetuated if their input into research is not facilitated. People with intellectual disabilities make valuable contributions to the evidence base; personal views and perceptions of healthcare are important if health services are to meet individual needs

An integrative review of the hospital experiences of people with an intellectual disability: Lack of orthopaedic and trauma perspectives.

This is an accepted manuscript of an article published by Elsevier in International Journal of Orthopaedic and Trauma Nursing on 29/07/2020, available online: https://doi.org/10.1016/j.ijotn.2020.100795 The accepted version of the publication may differ from the final published version.Aims To review the empirical literature relating to the orthopaedic and trauma hospital experiences of people with intellectual disabilities (PWID). Design: An integrative review was conducted following the steps advocated by Whittemore and Knafl (2005). Primary research studies from 2007- 2020 which included the hospital experiences of adults with intellectual disabilities were reviewed. Data sources: The literature searches were undertaken in 2014, 2015, 2018 and May 2020. Review Methods: The following electronic databases were searched: Academic Search Complete, Nursing and Allied Health, British Nursing Index and RCN Library archive, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE) Psychological Information Database (PsychINFO), the Cochrane Collaboration Database and Google Scholar. Results: Despite the high prevalence of musculoskeletal problems for adults with intellectual disabilities, the review found no specific literature related to orthopaedic or trauma hospital experiences. Nine studies related to PWIDs’ experiences of general hospital care were included. Conclusion: There is a gap in the empirical literature relating to orthopaedic or trauma hospital experiences of PWID. General hospital experiences of adults with an intellectual disability were poor overall

The voices of people with an intellectual disability and a carer about orthopaedic and trauma hospital care in the UK: An interpretative phenomenological study

This is an accepted manuscript of an article published by Elsevier in International Journal of Orthopaedic and Trauma Nursing on 07/11/2020, available online: https://doi.org/10.1016/j.ijotn.2020.100831 The accepted version of the publication may differ from the final published version.Introduction People with intellectual disabilities (PWID) have a greater prevalence ofmusculoskeletal conditions and injuries than the general population. Orthopaedic andtrauma hospital care has not been investigated with this group who seldom have theirvoices heard or their experiences valued and interpreted. Aim To understand theorthopaedic and trauma hospital experiences from the perspective of PWID. Methods A qualitative approach, focusing on peoples’ lived experiences, was utilised. Apurposive sample of five participants was recruited and one-to-one, semi-structuredinterviews were undertaken. Analysis of the interviews employed an interpretative phenomenological analytical framework. Findings There were communicationchallenges, a lack of person-centred care, issues with pain management, a lack ofconfidence in hospital care, valuable support and expertise of carers, incompetence ofhospital staff and isolation and loneliness. Discussion and conclusions There weresignificant shortcomings as PWID and a carer perceived they were unsupported andreceived poor care. Recommendations for practice: Person-centred care is neededalong with specific education and training, including close liaison with the experts byexperience – PWID, their carers as well as the specialists in intellectual disability

The pains and pleasures of using Orthopaedic Patient Reported Outcome Measures (PROMS) in clinical assessment and evaluation

Aim This paper aims to explore the usefulness of PROMS in the clinical assessment and evaluation of patients undergoing orthopaedic interventions such as total hip and knee arthroplasty. Also to discuss some of the challenges in the use of PROMS with patients with multiple comorbidities or learning/ communication difficulties. Abstract Health care globally requires the measurement of outcome before and following procedures such as total hip and knee replacement to demonstrate the intervention has resulted in an improvement in the patient’s condition and/or functional status (Jester, Santy & Rogers 2011). Outcome can be assessed from the clinician perspective in a number of ways including: measures of function, clinical investigations such as x-ray or MRI scan and direct observation such as gait analysis. However this does not capture the patient’s perspective of the impact of the disease and subsequent effectiveness of an intervention/s. Patient Reported Outcome Measures (PROMS) have become increasingly used in Orthopaedics to capture the patient’s perspective. One of the most frequently used PROMS used with patients undergoing THR and TKR are the Oxford Hip and Knee Scores. These scores are frequently included in initial clinical assessment to ascertain how patients perceive the severity of their symptoms and the impact on various activities. Subsequently the tools are administered at regular intervals following THR/TKR and compared to the baseline scores to assess improvement in symptoms and function. Oxford hip and knee scores have been used extensively over the last 20 years in the UK and internationally and form part of the data collected for a number of national joint registers. They have been tested extensively to demonstrate their reliability, validity and sensitivity and are minimally influenced by patient co-morbidity (Murray et al, 2007). However there is very little research on the patient’s experience and satisfaction with these scores (Wylde et al, 2005). This presentation will discuss the difficulties patients with co-morbidities, multiple joint involvement and learning or communication difficulties have in completing these scores and the impact this may have during clinical assessment and evaluation of outcome

Novel Anti-Campylobacter Compounds Identified Using High Throughput Screening of a Pre-selected Enriched Small Molecules Library

Campylobacter is a leading cause of foodborne bacterial gastroenteritis worldwide and infections can be fatal. The emergence of antibiotic-resistant Campylobacter spp. necessitates the development of new antimicrobials. We identified novel anti-Campylobacter small molecule inhibitors using a high throughput growth inhibition assay. To expedite screening, we made use of a “bioactive” library of 4,182 compounds that we have previously shown to be active against diverse microbes. Screening for growth inhibition of Campylobacter jejuni, identified 781 compounds that were either bactericidal or bacteriostatic at a concentration of 200 µM. Seventy nine of the bactericidal compounds were prioritized for secondary screening based on their physico-chemical properties. Based on the minimum inhibitory concentration against a diverse range of C. jejuni and a lack of effect on gut microbes, we selected 12 compounds. No resistance was observed to any of these 12 lead compounds when C. jejuni was cultured with lethal or sub-lethal concentrations suggesting that C. jejuni is less likely to develop resistance to these compounds. Top 12 compounds also possessed low cytotoxicity to human intestinal epithelial cells (Caco-2 cells) and no hemolytic activity against sheep red blood cells. Next, these 12 compounds were evaluated for ability to clear C. jejuni in vitro. A total of 10 compounds had an anti-C. jejuni effect in Caco-2 cells with some effective even at 25 µM concentrations. These novel 12 compounds belong to five established antimicrobial chemical classes; piperazines, aryl amines, piperidines, sulfonamide and pyridazinone. Exploitation of analogues of these chemical classes may provide Campylobacter specific drugs that can be applied in both human and animal medicine

Changes in Clinical Context for Kaposi's Sarcoma and Non-Hodgkin Lymphoma Among People With HIV Infection in the United States

The biology of HIV-associated cancers may differ depending on immunologic and virologic context during development. Therefore, an understanding of the burden of Kaposi's sarcoma (KS) and non-Hodgkin lymphoma (NHL) relative to antiretroviral therapy (ART), virologic suppression, and CD4 count is important

Contribution of TAT System Translocated PhoX to Campylobacter jejuni Phosphate Metabolism and Resilience to Environmental Stresses

Campylobacter jejuni is a common gastrointestinal pathogen that colonizes food animals; it is transmitted via fecal contamination of food, and infections in immune-compromised people are more likely to result in serious long-term illness. Environmental phosphate is likely an important sensor of environmental fitness and the ability to obtain extracellular phosphate is central to the bacteria's core metabolic responses. PhoX is the sole alkaline phosphatase in C. jejuni, a substrate of the TAT transport system. Alkaline phosphatases mediate the hydrolytic removal of inorganic phosphate (Pi) from phospho-organic compounds and thereby contribute significantly to the polyphosphate kinase 1 (ppk1) mediated formation of poly P, a molecule that regulates bacterial response to stresses and virulence. Similarly, deletion of the tatC gene, a key component of the TAT system, results in diverse phenotypes in C. jejuni including reduced stress tolerance and in vivo colonization. Therefore, here we investigated the contribution of phoX in poly P synthesis and in TAT-system mediated responses. The phoX deletion mutant showed significant decrease (P<0.05) in poly P accumulation in stationary phase compared to the wild-type, suggesting that PhoX is a major contributor to the inorganic phosphate pool in the cell which is essential for poly P synthesis. The phoX deletion is sufficient for a nutrient stress defect similar to the defect previously described for the ΔtatC mutant. Additionally, the phoX deletion mutant has increased resistance to certain antimicrobials. The ΔphoX mutant was also moderately defective in invasion and intracellular survival within human intestinal epithelial cells as well as in chicken colonization. Further, the ΔphoX mutant produced increased biofilm that can be rescued with 1 mM inorganic phosphate. The qRT-PCR of the ΔphoX mutant revealed transcriptional changes that suggest potential mechanisms for the increased biofilm phenotype