Optimising diagnostics through imaging informatics: Costs and opportunities

YesIncreasing diagnostic capacity is a national priority to expedite the timeliness and appropriateness of patient treatment interventions. Imaging—encompassing a range of technologies including X-ray, CT, MRI, nuclear medicine and ultrasound—is a key diagnostic service and central to decision-making in most, if not all, disease pathways. However, imaging is an expensive discipline accounting for an estimated 3–5% of the annual NHS budget. As a result, it is imperative that we maximise service efficiency while optimising patient outcomes.The manuscript version differs from the published version

Liaison Psychiatry for every acute hospital: Integrated mental and physical healthcare. College Report 183

Liaison psychiatry is a critical service that should be integral to all acute hospitals. Effective liaison psychiatry can reduce avoidable costs and ineffective or inappropriately located management of mental health problems by reduced length of stay, readmissions and investigations, and improved care of medically unexplained symptoms, dementia and long-term conditions. This report summarises the evidence, provides case examples and outlines key considerations required to set local standards

Reconsidering memorisation in the context of non-tonal piano music

Performers, pedagogues and researchers have shared interest in the topic of musical memorisation for centuries. A large and diverse body of studies on this subject has contributed to the current understanding of musicians’ views of performing from memory, as well as the mechanisms governing encoding and retrieval of musical information. Nevertheless, with a few exceptions, existing research is still highly based on tonal music and lacks further examination in the musical world of non-tonality. The convention of performing from memory is a well-established practice for particular instruments and musical genres, but an exception is often made for recent styles of repertoire moving away from tonality. No study to date has systematically investigated the reasons for such exception and musicians’ views on this matter. Moreover, the existing principles of memorisation that are thought to apply to musicians in the highest levels of skill are strongly based on the use of conceptual knowledge of tonal musical vernacular. Such knowledge is often obscured or absent in non-tonal repertoire. This thesis aims to extend the findings of previous research into musical memorisation in the context of non-tonal piano repertoire by documenting pianists’ views and practices in committing this music to memory. An interview study with pianists expert in contemporary music (Chapter 3) establishes the background for the thesis. A variety of views on performing contemporary music from memory were reported, with several pianists advocating benefits from performing this repertoire by heart and others from using the score. Memorisation accounts revealed idiosyncrasy and variety, but emphasised the importance of specific strategies, such as the use of mental rehearsal, principles of chunking applicable to this repertoire and the importance of different types of memory and their combination. The second study (Chapter 4) explores the topic in further depth, by thoroughly examining the author’s entire process of learning and memorising a newly commissioned non-tonal piece for prepared piano. This study extends findings from performance cue (PC) theory. This widely recognised account of expert memory in music suggests that musicians develop retrieval schemes hierarchically organised around their understanding of musical structure, using different types of PCs. The use of retrieval schemes in this context is confirmed by this study. The author organised the scheme around her own understanding of musical structure, which was gradually developed while working through the piece, since the music had no aural model available or ready-made structural framework to hold on to early in the process. Extending previous research, new types of PCs were documented and, for the first time, negative serial position effects were found for basic PCs (e.g., fingering, notes, patterns) in long-term recall. Finally, the study provided behavioural evidence for the use of chunking in non-tonal piano music. The third study (Chapters 5 and 6) extends these findings to a serial piece memorised by six pianists. Following a multiple-case study approach, this study observed in great depth memorisation approaches carried out by two of those pianists, who performed the music very accurately from memory, and by one pianist who performed less accurately. The first two pianists developed retrieval schemes based on their understanding of musical structure and different types of PCs, mainly basic and structural. Comparisons between the pianists revealed very different views of musical structure in the piece. Even so, both musicians used such understanding to organise encoding and retrieval. The pianist with the least accurate performance adopted an unsystematic approach, mainly relying on incidental memorisation. The absence of a conceptual retrieval scheme resulted in an inability to fully recover from a major memory lapse in performance. The findings of this research provide novel insights into pianists’ views towards performing non-tonal music from memory and into the cognitive mechanisms governing the encoding and retrieval of this music, which have practical applications for musicians wishing to memorise non-tonal piano music

Older and wiser? Men’s and women’s accounts of drinking in early mid-life

Most qualitative research on alcohol focuses on younger rather than older adults. To explore older people’s relationship with alcohol, we conducted eight focus groups with 36 men and women aged 35 to 50 years in Scotland, UK. Initially, respondents suggested that older drinkers consume less alcohol, no longer drink to become drunk and are sociable drinkers more interested in the taste than the effects of alcohol. However, as discussions progressed, respondents collectively recounted recent drunken escapades, challenged accounts of moderate drinking, and suggested there was still peer pressure to drink. Some described how their drinking had increased in mid-life but worked hard discursively to emphasise that it was age and stage appropriate (i.e. they still met their responsibilities as workers and parents). Women presented themselves as staying in control of their drinking while men described going out with the intention of getting drunk (although still claiming to meet their responsibilities). While women experienced peer pressure to drink, they seemed to have more options for socialising without alcohol than did men. Choosing not to drink alcohol is a behaviour that still requires explanation in early mid-life. Harm reduction strategies should pay more attention to drinking in this age group

Clinicians in the classroom: The consultant midwife

This is the third in a series of articles exploring expert clinicians’ participation in teaching pre-registration midwifery students in the classroom setting. This article will consider sessions facilitated by Carolyn Rooth, Consultant Midwife at Milton Keynes University Hospital NHS Foundation Trust. The role of Consultant Midwife was first introduced in the United Kingdom in 2000 (Byrom et al., 2009) with post holders attaining key senior positions within maternity services to provide professional leadership and a senior level of clinical midwifery expertise (Coster, 2006). A key element of the role of the Consultant Midwife is education, training and development (NHS Executive, 1999). Redfern et al. have suggested that whilst these advanced practitioners are practice based, they should have a key role in creating and maintaining ‘partnerships between the NHS and local universities […] to enhance education and research functions’ (2003:154)

Exploring the experiences of young people nursed on adult wards

This paper reports on a study of experiences of young people aged 14 to 18 years who were nursed on acute adult hospital wards in NHS hospitals in England. In spite of British government guidelines, young people from 14 years of age continue to be admitted to adult wards in the UK. Although much has been written about the transition of the young person to adult services there is little research about the experiences of young people who are nursed on adult wards.Hermeneutic phenomenology was used to explore the lived experiences of eight young people who had been nursed on adult wards between 2004 and 2010. Data were collected in 2010. In-depth interviews were recorded, transcribed and analysed using Colaizzi’s framework (Colaizzi, 1978). Themes explored included expectations of what the experience may be like, young people’s first impressions of the ward environment, the feelings of the young person while in hospital, the attitudes of people towards them including—both staff and other patients, and finally, future admissions and how they would cope with readmissions. Better provision needs to be made for young people including appropriately trained staff, adolescent friendly environments and areas in adult wards that are dedicated to adolescents

Modifiable factors influencing parental decision making and organ donation: A scoping review

A global shortage of organs from children and adults available for transplantation is compounded by the failure of next of the kin to consent for organs to be donated after death. There are both non-modifiable and modifiable factors which influence decision-making. Modifiable factors can though be influenced and are therefore of interest when examining families’ decision making surrounding the donation of organs from their deceased child. A scoping review was undertaken to determine how modifiable factors influence parental decision-making in cadaver organ donation. Following thematic analysis two themes were identified, these were ‘interaction with healthcare professionals’ and ‘pre-disposition to organ donation’. Satisfaction with experiences of hospital care, the information provided and the way it was communicated as well as interactions pertaining to emotional support were all found to be modifiable factors that influenced decision-making. Likewise, a predisposition to organ donation and knowing the wishes of the deceased, are highly associated with the consent decision. Nurses working in critical care environments need to be able to support parents during this difficult time. This paper therefore aims to raise awareness of modifiable factors that influence decision-making, highlighting their relevance for children’s nursing practic