Electronic swallowing intervention package to support swallowing function in patients with head and neck cancer: development and feasibility study

Background: Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemo-radiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work. Objective: To develop and conduct preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for head and neck cancer. Methods: The study involved health professionals and patients who were undergoing CRT for head and neck cancer. The scoping stage of e-SiP development involved investigated the potential usefulness of e-SiP, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as a means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SIP and informed the next stage of its development around requirements for tool. This was followed by further development and a testing stage of e-SiP involved the coding of a prototype which was then evaluated using a series of steering group meetings, semi-structured interviews with both patients and health care professionals, and analysis of e-SiP log data. Results: Feedback from focus groups and health professional interviews was very positive and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the ten patients offered e-SIP, only two opted to use it. For these patients, aspects of the e-SIP application were considered useful, in particular the ease of keeping a diary of exercises performed. Interviews with users and non-users suggested significant barriers to its use. Most significantly the lack of flexibility of platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions: Results suggest a need for further research to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care, and through patient training and staff engagement, can be seen as a beneficial tool to help support patients in conducting swallowing exercises

Framing the detection of elder financial abuse as bystander intervention: Decision cues, pathways to detection and barriers to action

This article is (c) Emerald Group Publishing and permission has been granted for this version to appear here (http://bura.brunel.ac.uk/handle/2438/8569). Emerald does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from Emerald Group Publishing Limited.This article has been made available through the Brunel Open Access Publishing Fund.Purpose – The purpose of this paper is to explore the detection and prevention of elder financial abuse through the lens of a “professional bystander intervention model”. The authors were interested in the decision cues that raise suspicions of financial abuse, how such abuse comes to the attention of professionals who do not have a statutory responsibility for safeguarding older adults, and the barriers to intervention. Design/methodology/approach – In-depth interviews were conducted using the critical incident technique. Thematic analysis was carried out on transcribed interviews. In total, 20 banking and 20 health professionals were recruited. Participants were asked to discuss real cases which they had dealt with personally. Findings – The cases described indicated that a variety of cues were used in coming to a decision that financial abuse was very likely taking place. Common to these cases was a discrepancy between what is normal and expected and what is abnormal or unexpected. There was a marked difference in the type of abuse noticed by banking and health professionals, drawing attention to the ways in which context influences the likelihood that financial abuse will be detected. The study revealed that even if professionals suspect abuse, there are barriers which prevent them acting. Originality/value – The originality of this study lies in its use of the bystander intervention model to study the decision-making processes of professionals who are not explicitly charged with adult safeguarding. The study was also unique because real cases were under consideration. Hence, what the professionals actually do, rather than what they might do, was under investigation.Economic and Social Research Counci

Health in medieval and early modern Norway: a comparative analysis of the impact of social, economic and environmental change on skeletal remains

The medieval and early modern periods in Norway and Europe were characterised by economic, social and environmental change. In particular, famines, epidemics, economic decline and climate change had effects on agriculture, population size, subsistence and health. The impact of environmental and social variables on human health has become increasingly prominent in the research literature. This research contributes to a broader understanding of the interactions between human health and our environment by studying a skeletal sample from 12th-17th century Norway and comparing it to a number of other skeletal samples from medieval and early modern Europe. Utilising a sample of human skeletal remains from the Library site in Trondheim (Norway), and data on pathological lesions from 38 European sites, this thesis quantifies the effects of these factors. The Library site sample was assessed for sex; age; stature; a number of pathological lesions and abnormalities, including dental caries, alveolar defects of pathological origin (ADP), ante-mortem tooth loss (AMTL), cribra orbitalia (CO), linear enamel hypoplasia (LEH), and non-specific signs of infection (NSI); and evidence for specific infectious diseases, such as syphilis and leprosy. The impacts of sex, phase and age on the frequencies of pathological lesions in the Library site sample were analysed and compared to those frequencies from the other European samples. Examinations revealed a complex picture of health and wellbeing during this period. Results indicated significant differences between the sexes in a number of instances, with higher frequencies of dental caries, LEH and NSI in males, and significantly higher frequencies of AMTL and CO in females. Prominent differences in frequencies of dental caries and LEH were also observed across the phases. It is likely that the majority of these differences were linked to social or biological factors, such as diet, which may be indirectly linked to environmental factors. Examinations also found evidence for endemic syphilis and probable leprosy in the Library site sample. Comparisons of the skeletons from the Library site to the others from Europe demonstrated that the health of the population from Trondheim was comparatively good, with the exception of high levels of NSI. Groupings of the skeletal samples in clusters by site were also apparent, probably influenced by common economic, social and dietary pressures. Finally, statistical modelling of the data from all the samples revealed significant relationships between pathological lesions and social and environmental variables. In particular, diet and settlement type were found to have a number of significant relationships with pathological lesions. Specific diets and settlement types were also associated with significantly higher frequencies of certain lesions. Modelling relative to latitude resulted in a single significant relationship with stature, whilst analysis of other environmental variables resulted in few significant relationships with pathological lesions. Further statistical modelling with a greater sample size, the inclusion of more variables and known data from historical documentation could produce a greater number of significant results when assessing these relationships. However, the complexities of these relationships are perhaps better served by a multi-disciplinary approach like the one taken here, rather than statistical modelling in isolation

Evaluation of modernisation of adult critical care services in England: time series and cost effectiveness analysis

Objective To evaluate the impact and cost effectiveness of a programme to transform adult critical care throughout England initiated in late 2000

Factors used in the detection of elder financial abuse: A judgement and decision-making study of social workers and their managers

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2011 Sage Publications Ltd.Factors social workers use in practice to detect elder financial abuse are currently unknown. A critical incident technique was applied within a judgement analysis approach to elicit cue use. Only three factors were key to decision-making: who raises concern, the elder’s mental capacity and the nature of the financial anomaly occurring.Economic and Social Research Counci

Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation

BACKGROUND & AIMS: We determined the optimal HCV treatment prioritization strategy for interferon-free (IFN-free) HCV direct-acting antivirals (DAAs) by disease stage and risk status incorporating treatment of people who inject drugs (PWID). METHODS: A dynamic HCV transmission and progression model compared the cost-effectiveness of treating patients early vs. delaying until cirrhosis for patients with mild or moderate fibrosis, where PWID chronic HCV prevalence was 20, 40 or 60%. Treatment duration was 12weeks at £3300/wk, to achieve a 95% sustained viral response and was varied by genotype/stage in alternative scenarios. We estimated long-term health costs (in £UK=€1.3=$1.5) and outcomes as quality adjusted life-years (QALYs) gained using a £20,000 willingness to pay per QALY threshold. We ranked strategies with net monetary benefit (NMB); negative NMB implies delay treatment. RESULTS: The most cost-effective group to treat were PWID with moderate fibrosis (mean NMB per early treatment £60,640/£23,968 at 20/40% chronic prevalence, respectively), followed by PWID with mild fibrosis (NMB £59,258 and £19,421, respectively) then ex-PWID/non-PWID with moderate fibrosis (NMB £9,404). Treatment of ex-PWID/non-PWID with mild fibrosis could be delayed (NMB -£3,650). In populations with 60% chronic HCV among PWID it was only cost-effective to prioritize DAAs to ex-PWID/non-PWID with moderate fibrosis. For every one PWID in the 20% chronic HCV setting, 2 new HCV infections were averted. One extra HCV-related death was averted per 13 people with moderate disease treated. Rankings were unchanged with reduced drug costs or varied sustained virological response/duration by genotype/fibrosis stage. CONCLUSIONS: Treating PWID with moderate or mild HCV with IFN-free DAAs is cost-effective compared to delay until cirrhosis, except when chronic HCV prevalence and reinfection risk is very high

The Design of Student Training Resources to Enhance the Student Voice in Academic Quality Assurance and Quality Enhancement Processes

Without appropriate training and recognition, students – in particular Class Representatives – often struggle to engage fully with a University’s quality assurance and quality enhancement processes. Through the “Our Student Voice” project in Technological University Dublin (TU Dublin), a suite of digital training resources were designed to provide training for students to help develop the requisite knowledge and skills for effective participation there processes, thus strengthening student engagement and enhancing the student voice. The resources are organised into thirteen accessible episodes that each commence with an animated scenario that sets out key messages. The remainder of the episode provides detailed guidance for students and learning activities to help students develop their skillset. Upon completion of the learning activities, and having satisfactorily undertaken one of three specific student role in the quality processes, students can apply for recognition through a digital badge. The training resources and digital badges have been co-designed by a project team comprised of staff and students from across the University guided by best practice internationally. This paper describes the co-design process and presents a set of lessons learned that may assist other higher education institutions in enabling impactful student engagement in their academic quality assurance and quality enhancement processes

Hospital Bioterrorism Planning and Burn Surge

On the morning of June 9, 2009, an explosion occurred at a manufacturing plant in Garner, North Carolina. By the end of the day, 68 injured patients had been evaluated at the 3 Level I trauma centers and 3 community hospitals in the Raleigh/Durham metro area (3 people who were buried in the structural collapse died at the scene). Approximately 300 employees were present at the time of the explosion, when natural gas being vented during the repair of a hot water heater ignited. The concussion from the explosion led to structural failure in multiple locations and breached additional natural gas, electrical, and ammonia lines that ran overhead in the 1-story concrete industrial plant. Intent is the major difference between this type of accident and a terrorist using an incendiary device to terrorize a targeted population. But while this disaster lacked intent, the response, rescue, and outcomes were improved as a result of bioterrorism preparedness. This article discusses how bioterrorism hospital preparedness planning, with an all-hazards approach, became the basis for coordinated burn surge disaster preparedness. This real-world disaster challenged a variety of systems, hospitals, and healthcare providers to work efficiently and effectively to manage multiple survivors. Burn-injured patients served as a focus for this work. We describe the response, rescue, and resuscitation provided by first responders and first receivers as well as efforts made to develop burn care capabilities and surge capacity