Illness representations, treatment beliefs and the relationship to self-care in heart failure

Purpose The purpose of this study was to explore the beliefs people with heart failure hold about their illness and its treatment and to determine any relationships between these beliefs and self-care using the Common Sense Model (CSM) of illness cognitions and behaviour as the theoretical framework (Leventhal et al, 1980). Methods Using a mixed methodology (Creswell and Plano Clark, 2007), findings from patient interviews were used to adapt the Revised Illness Perception Questionnaire (IPQ-R) (Moss-Morris et al, 2002) and the Beliefs about Medicines Questionnaire (BMQ) (Horne et al, 1999) in order to make them illness-specific. A questionnaire assessing self-care was developed based on the European Heart Failure Self-care Behaviour Scale (EHFScBS) (Jaarsma et al, 2003), the interview findings and a nominal group technique with specialist heart failure nurses. These questionnaires were used to determine beliefs and the relationship to behaviour in a cross-sectional survey of 169 patients with heart failure. Results A number of statistically significant correlations were found between beliefs and self-care. Most notably, perceived medication knowledge (r = 0.51, p ≤ 0.01), beliefs about the necessity of medication (r = 0.45, p ≤ 0.01) and illness coherence (r = 0.39, p ≤ 0.01). Multiple regression analysis revealed that 46% of the variance in self-care could be explained by illness representations and treatment beliefs (Adj. R2 = 0.46, F = 9.93, p = 0.00). Three factors were significant predictors of self-care - medication knowledge (β = 0.319, p = 0.003), a belief in the illness having serious consequences (β = 0.258, p = 0.008) and the impact of medication use on lifestyle (β = -0.231, p = 0.03). Discussion The exploration of illness representations revealed a realistic picture of heart failure with a cluster of beliefs around a chronic illness with serious consequences and a high number of symptoms. There was a strong belief in the necessity of medication but for some, medication use had a negative impact on daily life. Patients were confident in their knowledge of medication but this was reduced when family members took control of medication management. A number of beliefs were predictive of self-care, suggesting that interventions designed to maximise these beliefs and correct any misconceptions may enhance self-care and potentially improve clinical outcomes in this population

Mesh refinement in a two-dimensional large eddy simulation of a forced shear layer

A series of large eddy simulations are made of a forced shear layer and compared with experimental data. Several mesh densities were examined to separate the effect of numerical inaccuracy from modeling deficiencies. The turbulence model that was used to represent small scale, 3-D motions correctly predicted some gross features of the flow field, but appears to be structurally incorrect. The main effect of mesh refinement was to act as a filter on the scale of vortices that developed from the inflow boundary conditions

Time-accurate simulations of a shear layer forced at a single frequency

Calculations are presented for the forced shear layer studied experimentally by Oster and Wygnanski, and Weisbrot. Two different computational approaches are examined: Direct Numerical Simulation (DNS) and Large Eddy Simulation (LES). The DNS approach solves the full three dimensional Navier-Stokes equations for a temporally evolving mixing layer, while the LES approach solves the two dimensional Navier-Stokes equations with a subgrid scale turbulence model. While the comparison between these calculations and experimental data was hampered by a lack of information on the inflow boundary conditions, the calculations are shown to qualitatively agree with several aspects of the experiment. The sensitivity of these calculations to factors such as mesh refinement and Reynolds number is illustrated

A qualitative study of older adults’ experiences of transitioning from secure forensic services – The TOPS Study

This was presented at the Faculty of Medicine, Health and Social Care Lunchtime Research Seminar. The presentation discusses the current findings of Phase 1 and 2 of the TOPS study

Reviews

REview of WOMEN, WORK AND THE LABOUR MOVEMENT IN AUSTRALIA AND AOTEAROA/NEW ZEALAND and MULTINATIONAL BANKS AND THEIR SOCIAL AND LABOUR PRACTICE

Growing older in secure mental health care: the user experience

Background: The proportion of older adults using secure forensic psychiatric services is rising. Research is needed to examine the experience of older service users and evidence how adult services can adapt to meet their needs. Aim: To explore user experiences of being an older adult in secure forensic services. Methods: Thematic analysis of interviews and observations of weekly routines conducted with fifteen service users aged 50 and over residing in a low and medium secure NHS unit in England. Results: User experiences of ageing and age-related needs are reported using five themes: age-related identities; ward environments; participation in activities; management of physical health; and ageing futures. Older adults living with people their own age reported more social integration than those on wards dominated by younger adults. Most wished to self-manage their physical health needs with the support of primary care staff. Older adults were reluctant to identify as “old” or “vulnerable”. Some older adults downplayed their changing care needs. Conclusions: Placement of older people in adult secure services requires awareness of the age balance of the ward. A culture of inclusivity, sensitivity and respect for older persons’ agency is key to collaboratively meeting additional care needs and discharge planning

Illness representations, treatment beliefs and the relationship to self-care in heart failure

Purpose The purpose of this study was to explore the beliefs people with heart failure hold about their illness and its treatment and to determine any relationships between these beliefs and self-care using the Common Sense Model (CSM) of illness cognitions and behaviour as the theoretical framework (Leventhal et al, 1980). Methods Using a mixed methodology (Creswell and Plano Clark, 2007), findings from patient interviews were used to adapt the Revised Illness Perception Questionnaire (IPQ-R) (Moss-Morris et al, 2002) and the Beliefs about Medicines Questionnaire (BMQ) (Horne et al, 1999) in order to make them illness-specific. A questionnaire assessing self-care was developed based on the European Heart Failure Self-care Behaviour Scale (EHFScBS) (Jaarsma et al, 2003), the interview findings and a nominal group technique with specialist heart failure nurses. These questionnaires were used to determine beliefs and the relationship to behaviour in a cross-sectional survey of 169 patients with heart failure. Results A number of statistically significant correlations were found between beliefs and self-care. Most notably, perceived medication knowledge (r = 0.51, p ≤ 0.01), beliefs about the necessity of medication (r = 0.45, p ≤ 0.01) and illness coherence (r = 0.39, p ≤ 0.01). Multiple regression analysis revealed that 46% of the variance in self-care could be explained by illness representations and treatment beliefs (Adj. R2 = 0.46, F = 9.93, p = 0.00). Three factors were significant predictors of self-care - medication knowledge (β = 0.319, p = 0.003), a belief in the illness having serious consequences (β = 0.258, p = 0.008) and the impact of medication use on lifestyle (β = -0.231, p = 0.03). Discussion The exploration of illness representations revealed a realistic picture of heart failure with a cluster of beliefs around a chronic illness with serious consequences and a high number of symptoms. There was a strong belief in the necessity of medication but for some, medication use had a negative impact on daily life. Patients were confident in their knowledge of medication but this was reduced when family members took control of medication management. A number of beliefs were predictive of self-care, suggesting that interventions designed to maximise these beliefs and correct any misconceptions may enhance self-care and potentially improve clinical outcomes in this population.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Addition to the Flora of Canada? A Specimen from the Arctic Archipelago, Northwest Territories Links Two Allopatric Species of Alkali Grass, Puccinellia

A single herbarium specimen from Banks Island in the Canadian National Herbarium, Ottawa, is closest to Puccinellia wrightii (Puccinellia sect. Pseudocolpodium). This would represent a species new to Canada and an extension of over 1100 km from the previously known range in NW Alaska and NE Russia. The morphological characteristics of this specimen are compared with all taxa in P. section Pseudocolpodium and the North American P. arctica aggregate. Principal components analysis supports placement of this specimen in P. section Pseudocolpodium near P. wrightii, where it contributes to a morphological continuum between this species and P. vahliana. The new combination Puccinellia wrightii var. flava is made and a map of the current known distribution of the species in P. section Pseudocolpodium is presented