Divided by a lack of common language? - a qualitative study exploring the use of language by health professionals treating back pain

Background: The importance of using a common language when communicating to others about back pain is acknowledged in the literature. There are broadly three areas where difficulties in communication about back pain arise. Firstly, patients seeking information from health care professionals can experience difficulties understanding them and the medical literature; secondly, misunderstandings among health professionals concerning terminology can arise. Thirdly, the lack of standardised definitions for back pain terms can make comparison of research studies problematic. This study aims to explore the meanings and issues surrounding the use of existing medical terms for back pain from the perspective of health care professionals, lay people who have consulted health care practitioners for back pain and lay people who have not seen a health care professional regarding back pain. \ud \ud Methods: A series of focus groups were used to explore participants' understanding. A purposive sampling approach was used to achieve a sample which included general practitioners, chiropractors, osteopaths, physiotherapists, and lay people. Focus groups were facilitated by an independent professional qualitative researcher. They were audio taped and full transcripts of each focus group underwent line by line analysis, identifying concepts and coded. Constant comparison was used to allow each item to be checked or compared against the rest of the data \ud \ud Results: Lay participants understood the majority of the terms explored in the group differently to the health professionals. The terms, as understood by the lay participants, can be split into three broad categories. Firstly, terms which were not understood or were misconstrued and which had inadvertent negative connotations or implications. Secondly, terms which were not understood or were misconstrued, but without this leading to negative emotional responses. Thirdly, terms which were understood by lay participants as the health professionals stated they intended them to be understood. \ud \ud Conclusion: Few of the existing medical terms were understood and accepted by lay participants in the way discussed and expected by health professionals. Misunderstandings, unintended meanings and negative emotional responses to terms were common within the study focus groups

Flooding and subsidence in the Thames Gateway : impact on insurance loss potential

In the UK, household buildings insurance generally covers loss and damage to the insured property from a range of natural and human perils, including windstorm, flood, subsidence, theft, accidental fire and winter freeze. Consequently, insurers require a reasoned view on the likely scale of losses that they may face to assist in strategic planning, reinsurance structuring, regulatory returns and general risk management. The UK summer 2007 flood events not only provided a clear indication of the scale of potential losses that the industry could face from an individual event, with £3 billion in claims, but also identified a need for insurers and reinsurers to better understand how events may correlate in time and space, and how to most effectively use the computational models of extreme events that are commonly applied to reflect these correlations. In addition to the potential for temporal clustering of events such as windstorms and floods, there is a possibility that seemingly uncorrelated natural perils, such as floods and subsidence, may impact an insurer’s portfolio. Where aggregations of large numbers of new properties are planned, such as in the Thames Gateway, consideration of the potential future risk of aggregate losses due to the combination of perils such as subsidence and flood is increasingly important within the insurance company’s strategic risk management process. Whilst perils such as subsidence and flooding are generally considered independent within risk modelling, the potential for one event to influence the magnitude and likelihood of the other should be taken into account when determining risk level. In addition, the impact of correlated, but distinctive, loss causing events on particular property types may be significant, particularly if a specific property is designed to protect against one peril but is potentially susceptible to another. We suggest that flood events can lead to increased subsidence risk due to the weight of additional water and sediment, or rehydration of sediment under flood water. The latter mechanism may be particularly critical on sites where Holocene sediments are currently protected from flooding and are no longer subsiding. Holocene deposits tend to compress, either under their own weight or under a superimposed load such as made ground, built structures or flood water. If protected dry sediments become flooded in the future, subsidence would be expected to resume. This research project aims to investigate the correlation between flood hazards and subsidence hazards and the effect that these two sources of risk will have on insurance losses in the Thames Gateway. In particular, the research will explore the potential hydrological and geophysical drivers and links between flood and subsidence events within the Thames Gateway, assessing the potential for significant event occurrence within the timescales relevant to insurers. In the first part of the project we have identified flood risk areas within the Thames Gateway development zone which have a high risk of flooding and may be affected by renewed or increased subsidence. This has been achieved through the use of national and local-scale 2D and 3D geo-environmental information such as the Geosure dataset (e.g. swell-shrink, collapsible and compressible deposits data layers), PSI data, thickness of superficial and artificial land deposits, and flood potential data etc. In the second stage of the project we will investigate the hydrological and geophysical links between flooding and subsidence events on developed sites; quantify the insurance loss potential in the Thames Gateway from correlated flooding and subsidence events; consider how climate change will affect risk to developments in the Thames Gateway in the context of subsidence and flooding; and develop new ways of communicating and visualise correlated flood and subsidence risk to a range of stakeholders, including the insurance industry, planners, policy makers and the general public

The effect of leg lengthening surgery on muscle function : implications for rehabilitation

Limb length discrepancy is a common orthopaedic problem, frequently requiring surgical intervention. This thesis is concerned with one method of limb equalisation, leg lengthening surgery. It investigates the effect of leg lengthening surgery on the muscle function and rehabilitation of patients. Qualitative research methodologies demonstrated that there is considerable uncertainty about the best physiotherapy management of patients treated by the Ilizarov method. There is little evidence-basedre search into the rehabilitation of patients treated by this method of surgery. A clinical cohort study was conducted which examined different aspects o f rehabilitation. These included the effects of leg lengthening surgery on joint range of motion, muscle strength and on the ability to perform functional activities. The study of the effect of surgery on joint range of motion highlighted the need for repeatable measurement techniques. It found that there was a significant loss of joint range of motion in the latent period prior to distraction of the bones starting. Factors that influenced loss of joint range in the subjects included in this study included the rate of lengthening, the age and the diagnosis of the patient. A mathematical model was developed to assist in predicting the loss of joint range, at the pre-operative examination. The ability to perform functional activities and the effect on muscle strength were investigated and found to recover for up to 2 years following surgery and the removal of the Ilizarov fixator. Muscle strength recovered to within 5% of the baseline value by 2 years. This emphasises the need for a prolonged period of rehabilitation for patients treated by this method of surgery. Finally a Delphi survey was conducted to produce Clinical Guidelines about the physiotherapy management of patients treated by the Ilizarov method

Employer expectations of public relations graduates’ transmedia storytelling proficiency

The rapid evolution of information and communication technologies presents challenges for public relations educators as they seek to develop pedagogical approaches that balance theoretical concepts with a practical or ‘working’ knowledge of new media platforms. The incipient practice of transmedia storytelling in public relations contexts offers a timely example of this pedagogical flashpoint. In this study, the authors explored the incorporation of transmedia storytelling within current public relations practice and employer expectations of the transmedia storytelling proficiency of recent public relations graduates.The study took a qualitative approach with findings based on 15 semi-structured interviews with senior public relations professionals from four Australian states and five industry sectors. Findings suggest transmedia storytelling campaigns of varying complexity are a common characteristic of contemporary public relations practice, and that digitally literate graduates who can provide evidence of a solid theoretical knowledge and practical skills in relation to transmedia storytelling are highly sought after by the practitioners who took part in the study

The influence of transmedia storytelling portfolio examples on employer perceptions of public relations graduate employability – a pilot study

Transmedia storytelling is the process of telling stories in an integrated fashion across multiple platforms, traditional and new (Jenkins, 2010). This paper suggests that public relations graduates who include transmedia storytelling examples in their portfolios are considered by hiring managers as displaying greater employability than graduates without them. This finding encourages public relations educators to assess current pedagogy to explore how it approaches the practice of transmedia storytelling. Additionally, educators are encouraged to ascertain whether current curriculum provides ample opportunities for students to develop transmedia storytelling examples as portfolio inclusions for perusal by prospective employers

Rehabilitation after resurfacing hip arthroplasty: cost-utility analysis alongside a randomized controlled trial.

OBJECTIVE: To assess the costs, effects, and cost-utility of an accelerated physiotherapy programme versus a standard physiotherapy programme following resurfacing hip arthroplasty. DESIGN: A cost-utility analysis alongside a randomized controlled trial. SETTING: A UK National Health Service hospital and patients' homes. SUBJECTS: A total of 80 male resurfacing hip arthroplasty patients randomized post procedure to one of the two programmes. INTERVENTIONS: The accelerated physiotherapy programme commenced in hospital with patients being fully weight bearing, without hip precautions, and following a range of exercises facilitating gait re-education, balance, and lower limb strength. Standard physiotherapy commenced in hospital, but hip precautions were used and exercises were only partially weight bearing. In both groups, patients continued with their exercises at home for an eight-week period. MAIN MEASURES: Data on healthcare contacts were collected from patients to 12 months and costed using unit costs from national sources. Information was also collected on patients' costs. Health-related quality of life was measured using the EuroQol EQ-5D questionnaire and used to estimate quality-adjusted life years (QALYs) to 12 months. Mean costs and QALYs for each trial arm were compared. RESULTS: On average, the accelerated physiotherapy programme was less expensive (mean cost difference -£200; 95% confidence interval: -£656 to £255) and more effective (mean QALY difference 0.13; 95% confidence interval: 0.05 to 0.21) than standard physiotherapy and had a high probability of being cost-effective. CONCLUSION: From the National Health Service perspective, an accelerated physiotherapy programme for male patients undergoing revision of total hip arthroplasty (RHA) is very likely to be cost-effective when compared to a standard physiotherapy programme

Meta-ethnography to understand healthcare professionals’ experience of treating adults with chronic non-malignant pain

Objectives We aimed to explore healthcare professionals’ experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care. Design Qualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals’ experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings. Results We screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high. Conclusions This is the first qualitative evidence synthesis of healthcare professionals’ experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations

Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy

Importance: Surgical site infection (SSI) is an important patient safety outcome. Although social risk factors have been linked to many adverse health outcomes, it is unknown whether such factors are associated with higher rates of SSI. Objectives: To determine whether social risk factors, including race/ethnicity, insurance status, and neighborhood income, are associated with higher rates of SSI after colectomy or abdominal hysterectomy, 2 surgical procedures for which SSI rates are publicly reported and included in pay-for-performance programs by Medicare and other groups. Design, Setting, and Participants: This cross-sectional study analyzed adults undergoing colectomy or abdominal hysterectomy, as captured in State Inpatient Databases for Arizona, Florida, Iowa, Massachusetts, Maryland, New York, and Vermont. Operations were performed in 2013 through 2014 at general acute care hospitals in the United States. Data analysis was conducted from October 2018 through June 2019. Exposures: Colectomy or hysterectomy. Main Outcomes and Measures: Postoperative complex SSI rates. Results: A total of 149 741 patients met the inclusion criteria, including 90 210 patients undergoing colectomies (mean [SD] age, 63.4 [15.6] years; 49 029 [54%] female; 74% white, 11% black, 9% Hispanic, and 5% other or unknown race/ethnicity) and 59 531 patients undergoing abdominal hysterectomies (mean [SD] age, 49.8 [11.8] years; 100% female; 52% white, 26% black, 14% Hispanic, and 8% other or unknown race/ethnicity). In the colectomy cohort, 34% had private insurance, 52% had Medicare, 9% had Medicaid, and 5% had other or unknown insurance or were uninsured; 24% were from the lowest quartile of median zip code income. In the hysterectomy cohort, 57% had private insurance, 16% had Medicare, 19% had Medicaid, and 3% had other or unknown insurance or were uninsured; 27% were from the lowest-income zip codes. Within 30 days of surgery, SSI rates were 2.55% for the colectomy cohort and 0.61% for the hysterectomy cohort. For colectomy, black race (adjusted odds ratio [AOR], 0.71; 95% CI, 0.61-0.82) was associated with lower odds of SSI, whereas Medicare (AOR, 1.25; 95% CI, 1.10-1.41), Medicaid (AOR, 1.23; 95% CI, 1.06-1.44), and low neighborhood income (AOR, 1.14; 95% CI, 1.01-1.29) were associated with higher odds of SSI. For hysterectomy, no social risk factors that were examined in this study had statistically significant associations with SSI after adjustment for clinical risk. Conclusions and Relevance: Inconsistent associations between social risk factors and SSIs were found. For colectomy, infection prevention programs targeting low-income groups may be important for reducing disparities in this postoperative outcome, and policy makers could consider taking social risk factors into account when evaluating hospital performance

‘It’s like she’s talking about me’ – exploring the value and potential impact of a YouTube film presenting a qualitative evidence synthesis about chronic pain : an analysis of online comments

Background: There is very limited research exploring the value and impact of qualitative research in chronic pain despite the large volume of research. Aims: To find out whether viewers comments in response to a YouTube film, portraying findings from a qualitative evidence synthesis about living with pain, revealed any potential value or impact to viewers. Methodological approach: A thematic analysis of online comments to evaluate the impact of an arts-based health research film on people living with chronic pain. Methods: We collected on-line data posted in response to the film ‘Struggling to be me’. We used themes from a large review of qualitative research as an a priori analytic framework. We used inductive thematic analysis to distil the essence of data that did not fit this framework. Results: We developed two inductive themes that explored the value and potential impact of watching the film online: (1) It has given voice to our suffering, and (2) it makes me feel that I am not alone. Two subthemes added insight to the a priori framework: First, I have had enough of me added insight to the theme, My life is impoverished and confined; Second, I am treated like a criminal because I take opioids, added insight to the theme, Lost personal credibility. Conclusions: Our findings indicate that watching the YouTube film has potential value and impact, giving voice to suffering and making people feel that they are not alone. There are specific ethical challenges relating to internet mediated research

Study Time Within Pre-Registration Nurse Education: A Critical Review Of The Literature

Background Pre-registration nursing students throughout the United Kingdom (UK) are required to complete a minimum number of theory hours within the course. Anecdotal evidence suggests that students are required to attend campus for approximately fifty percent of the theory hours. The remaining theory hours are often labelled as 'study time' in which students are not required to attend campus. There is a general assumption amongst many academics that all students are prepared and motivated to direct their learning and therefore use this time to study. However some students chose to work during this time and many have dependents. Considering the increasing cost of nurse education combined with the government cuts to student bursaries in England it is timely to review the literature to determine how study time is used within pre-registration nurse education. Objective To present a critical review of the literature pertaining to study time in pre-registration nurse education. Design An integrative review of the literature. Data Sources A search of electronic databases: Cumulative Index to Nursing and Allied Health (CINAHL); Cochrane; Medline; Science Direct; Blackwell Synergy; Electronic Journals Service (EJS); Scopus; Taylor & Francis, Eric and Routledge Wiley was undertaken. Review Methods The inclusion criteria consisted of peer reviewed primary research, discussion papers, unpublished doctoral theses' and editorial papers directly related to the key words and nurse education published in English. Results Twelve papers were included in the review. Analysis of the papers led to the development of two themes: orientation to self-directed learning (SDL) and preparation for SDL. Conclusions The literature demonstrates that pre-registration nursing students lack the necessary skills for SDL. There is a lack of research on how study time is used within pre-registration nurse education. This calls for empirical research to fully explore how nursing students and lecturers perceive study time within pre-registration nursing curricula