• Autonomic dysfunction measured by baroreflex sensitivity in markedly abnormal in stable cirrhosis despite minimal haemodynamic changes.

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; University of Derby; Derby Hospitals NHS Foundation Trust (British Association for the Study of Liver (BASL), 2008)
      Introduction: Autonomic dysfunction occurs in 43-80% of cases of cirrhosis, but is usually asymptomatic. The baroreflex arc is an important component of the autonomic nervous system main- taining cardiovascular status both at rest and during physio- logical stress. Baroreceptor sensitivity (BRS) is impaired in cirrhosis and correlates with disease severity. It has been stud- ied extensively in advanced disease, especially pre-transplan- tation, where impairment of BRS correlates with the presence of ascites, encephalopathy, and the hyperdynamic circulation. Impaired BRS is associated with a five-fold increase in mortal- ity predominantly from sepsis and variceal bleeding, inde- pendent of the stage of liver disease. Manipulation by ACE inhibitors, aldosterone antagonists and liver transplantation all improve BRS. The aim of this study was to determine the preva- lence of BRS abnormalities in a stable population with well compensated disease. Methods: We studied 11 stable cirrhotic patients. Spontaneous BRS was assessed in the supine position on two different days using software studying the relationship between inter-beat variability and beat-to-beat changes in sys- tolic blood pressure. Systemic haemodynamics (heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), stroke vol- ume (SV), peripheral vascular resistance (PVR)) were assessed non-invasively using the Finometer®. Portal pressure was assessed by measurement of the hepatic venous pressure gra- dient (HVPG). Results: Median age 46 (30-67) years, 64% male, median Child-Pugh (CP) score 6 and MELD 11. Median haemodynamic data as follows: systolic BP 147 (115-169) mmHg, diastolic BP 82 (73-103) mmHg, MAP 103 (87-131) mmHg, HR 90 (63-110) bpm, SV 87 (38-141) ml, CO 8.0 (3.5-10.1) lpm, PVR 0.96 (0.64-2.14) MU, HVPG 18 (12-26)mmHg. 9/11 (82%) had abnormal BRS (normal 8- 10ms/mmHg) with median BRS 2.58 (1.14-9.46) ms/mmHg. Sequential BRS readings were not significantly different (2.58 vs 3.26 ms/mmHg, p=0.8). BRS did not correlate with disease severity (CP A 2.58 vs CP B 3.80 ms/mmHg, p=0.9), systemic haemodynamics, HVPG or serum sodium. Systemic haemody- namics were not significantly different in patients with impaired BRS compared to those with normal BRS. Conclusions: Auto- nomic function as assessed by BRS is markedly abnormal in sta- ble well compensated cirrhosis. Abnormalities are not specific to advanced disease as previously thought and in our group are not associated with marked hyperdynamic changes. Our data suggest that it is predominantly the vagal aspect that is impaired in well compensated disease. The long-term outcome of these patients needs to be assessed.
    • Autonomic dysfunction measured by baroreflex sensitivity in markedly abnormal in stable cirrhosis despite minimal haemodynamic changes.

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; University of Derby; Derby Hospitals NHS Foundation Trust (Wiley, 2008-09-24)
      Introduction: Autonomic dysfunction occurs in 43-80% of cases of cirrhosis, but is usually asymptomatic. The baroreflex arc is an important component of the autonomic nervous system main- taining cardiovascular status both at rest and during physio- logical stress. Baroreceptor sensitivity (BRS) is impaired in cirrhosis and correlates with disease severity. It has been stud- ied extensively in advanced disease, especially pre-transplan- tation, where impairment of BRS correlates with the presence of ascites, encephalopathy, and the hyperdynamic circulation. Impaired BRS is associated with a five-fold increase in mortal- ity predominantly from sepsis and variceal bleeding, inde- pendent of the stage of liver disease. Manipulation by ACE inhibitors, aldosterone antagonists and liver transplantation all improve BRS. The aim of this study was to determine the preva- lence of BRS abnormalities in a stable population with well compensated disease. Methods: We studied 11 stable cirrhotic patients. Spontaneous BRS was assessed in the supine position on two different days using software studying the relationship between inter-beat variability and beat-to-beat changes in sys- tolic blood pressure. Systemic haemodynamics (heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), stroke vol- ume (SV), peripheral vascular resistance (PVR)) were assessed non-invasively using the Finometer®. Portal pressure was assessed by measurement of the hepatic venous pressure gra- dient (HVPG). Results: Median age 46 (30-67) years, 64% male, median Child-Pugh (CP) score 6 and MELD 11. Median haemodynamic data as follows: systolic BP 147 (115-169) mmHg, diastolic BP 82 (73-103) mmHg, MAP 103 (87-131) mmHg, HR 90 (63-110) bpm, SV 87 (38-141) ml, CO 8.0 (3.5-10.1) lpm, PVR 0.96 (0.64-2.14) MU, HVPG 18 (12-26)mmHg. 9/11 (82%) had abnormal BRS (normal 8- 10ms/mmHg) with median BRS 2.58 (1.14-9.46) ms/mmHg. Sequential BRS readings were not significantly different (2.58 vs 3.26 ms/mmHg, p=0.8). BRS did not correlate with disease severity (CP A 2.58 vs CP B 3.80 ms/mmHg, p=0.9), systemic haemodynamics, HVPG or serum sodium. Systemic haemody- namics were not significantly different in patients with impaired BRS compared to those with normal BRS. Conclusions: Auto- nomic function as assessed by BRS is markedly abnormal in sta- ble well compensated cirrhosis. Abnormalities are not specific to advanced disease as previously thought and in our group are not associated with marked hyperdynamic changes. Our data suggest that it is predominantly the vagal aspect that is impaired in well compensated disease. The long-term outcome of these patients needs to be assessed.
    • Barriers to Family Caregivers’ Coping With Patients With Severe Mental Illness in Iran

      Ebrahimi, Hossein; Seyedfatemi, Naeimeh; Namdar Areshtanab, Hossein; Ranjbar, Fatemeh; Thornicroft, Graham; Rahmani, Farnaz; Whitehead, Bill; Tabriz University of Medical Sciences; Kings College London; University of Derby; et al. (2018-02-24)
      The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers’ experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers’ ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient’s isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.
    • Breast compression techniques in screening mammography – A Maltese evaluation project

      Naylor, Sarah; Cassar Agius, E; Sheffield Hallam University; National Breast Screening Programme, Lascaris Wharf, Valletta (Elsevier BV, 2018-04-05)
      In screening mammography, the radiographer should be responsible for providing mammograms of high diagnostic value, possibly without subjecting clients to a painful experience. This skill is demonstrated via the technique of breast compression and is explored in this study by analysing insights about methods and underlying principles in regards to this procedure. One-to-one semi-structured interviews were conducted with radiographers who perform screening mammography in Malta. For data analysis, a descriptive phenomenological approach following a simplified version of Hycner's (1985) method was adopted. Five general themes were extracted from the data; meeting the client, preparing the client, the mammography procedure, pain from compression and client turnout. It was determined that the participants alter their breast compression technique according to the client rather than following a rigid step-by-step process and that explanation and requesting client feedback are essential to obtain cooperation. Additionally, mammography positioning and compression application are tailored in a way that encourage compliance, however not at the expense of degrading image quality. Ultimately, it is also believed that a proper breast compression technique positively influences client turnout. The results of this study demonstrate that radiographers should be flexible in their approach in order to carry out a successful breast compression technique. However, it has also been shown that such effectiveness in practice is gained from experience rather than initial training. If exposed to this study's findings, new mammographers would be able to form a robust core of knowledge before embarking on the challenging specialisation of mammography.
    • Bronchiolitis: Treatment and management in an urgent out of hours care setting

      Mortimore, Gerri; Dexter, Justine; University of Derby (MAG, 2020-06-11)
      Bronchiolitis is an acute inflammation of the bronchioles that predominately affects children but is most common in the first 12 months of life. Viral bronchiolitis is the principal cause of admission in England and Wales, with numbers exceeding 30 000 annually. Occurrence is seasonal, in winter months incidence is typically at epidemic proportions for approximately six weeks. Bronchiolitis presents initially with coryza and a persistent cough; as the infection progresses, tachypnoea, chest recession, or both, may be present alongside wheeze or crackles. The assessment of an unwell child is challenging and as an advanced nurse practitioner, working in an out of hours service, the importance to prevent further deterioration should focus on spotting the sick child at an early stage. Therefore, an initial assessment should be undertaken, prior to taking a history and examination, to ensure patient safety. Bronchiolitis is usually a self-limiting illness, that requires supportive management only with treatment directed at fluid input. However, management approaches to bronchiolitis continue to be a subject of substantial debate with vast differences in practice exhibited in the UK, and beyond. with a lack of consensus regarding management. Therefore, the appropriate management of children presenting with bronchiolitis is challenging and can be overwhelming. Nurses must be aware of the pathophysiology, presentation, diagnosis, and management of children presenting to an out of hours service with bronchiolitis, to manage patients safely.
    • Care and compassion at the end of life

      Brown, Michelle; University of Derby (W.S Maney & Sons Ltd, 2012-07)
      Aim: To examine the provision of the ‘end of life care strategy’ and the perception of provision by patients and carers. Introduction: In determining what constitutes excellence in care at the end of life, one must firstly acknowledge ‘what care and compassion is’. Following this it should be established what one should expect as a minimum standard of care. The end of life care strategy was initiated by the Department of Health in 2008. This guidance was intended to drive forward end of life care provision where patients were seen as the priority and encouraged to engage in all decision making at each point in their journey. Standards suggested by NICE (2011) further support patient empowerment and inclusivity in care planning. Method: A literature search was conducted in order to determine whether there has been a change in provision and to identify whether patients and their carers perceive an excellence in the care that has been delivered. Results: The literature is limited but the underlying issues of pre-end of life care strategy (2008) remain apparent. Patients and their carers continue to lack the autonomy they deserve and decisions are made about them rather than by them. Owing to the lack of direction which should come from the patient, care may be fragmented with numerous members of a multidisciplinary team being involved. Conclusion: Patient involvement is paramount. Early discussions relating to choices at the end of life need to be achieved in a timely manner. This should ensure that the patient and carer experience a high standard of excellent care which has been planned with inclusivity in mind
    • Care at the end of life: how policy and the law support practice

      Brown, Michelle; Vaughan, Carol; University of Derby (Mark Allen Healthcare, 2013-08-16)
      The End of Life Care Strategy was introduced in an attempt to achieve a high standard of care for patients nearing the end of life and to improve carer experience. This high standard should not depend on socioeconomic status, geographical location or diagnosis. It was to ensure that individuals felt supported, informed and empowered, and that symptoms and issues were managed by experienced staff who employ evidenced-based practice. In addition, the service provision should involve a multidisciplinary team and have the patient at the centre of all decision-making. This would be facilitated by endorsing the use of end-of-life care pathways. These recommendations are further supported by frameworks and policies, for example the Preferred Priorities for Care Gold Standards Framework in Primary Care. Health professionals must also be cognisant of the legal frameworks that protect patients and facilitate their rights to exert their autonomy, for example the Mental Capacity Act and advanced directives. The issues surrounding care at the end of life with respect to legal frameworks alongside ethical and moral dilemmas will be further explored within this discussion paper.
    • Case study — primary sclerosing cholangitis

      Mortimore, Gerri; University of Derby (Mark Allen Healthcare, 2012-05)
    • Challenges and solutions during analysis in a longitudinal narrative case study

      Whiffin, Charlotte Jane; Bailey, Christopher; Ellis-Hill, Caroline; Jarrett, Nicola; University of Derby; University of Nottingham; Bournemouth University; University of Southampton (Royal College of Nursing, 2014-03-27)
      Aim To describe the challenges faced by those performing complex qualitative analysis during a narrative study and to offer solutions. Background Qualitative research requires rigorous analysis. However, novice researchers often struggle to identify appropriately robust analytical procedures that will move them from their transcripts to their final findings. The lack of clear and detailed accounts in the literature that consider narrative analysis and how to address some of the common challenges researchers face add to this problem. Data sources A longitudinal narrative case study exploring the personal and familial changes reported by uninjured family members during the first year of another family member’s traumatic brain injury. Review methods This is a methodological paper. Discussion The challenges of analysis included: conceptualising analysis; demonstrating the relationship between the different analytical layers and the final research findings; interpreting the data in a way that reflected the priorities of a narrative approach; and managing large quantities of data. The solutions explored were: the mapping of analytic intentions; aligning analysis and interpretation with the conceptual framework; and the use of matrices to store and manage quotes, codes and reflections. Conclusion Working with qualitative data can be daunting for novice researchers. Ensuring rigorous, transparent, and auditable data analysis procedures can further constrain the interpretive aspect of analysis. Implications for research/practice The solutions offered in this paper should help novice researchers to manage and work with their data, assisting them to develop the confidence to be more intuitive and creative in their research.
    • Changing attitudes with a MOOC on dementia

      Kotera, Yasuhiro; Robertshaw, David; University of Derby (Sciendo, 2019-07-12)
      Dementia is one of the most significant issues of our time and there are varying prevailing attitudes towards dementia, including negative stigma and perception. Massive open online courses (MOOCs) are a widely available online learning resource accessed for free which may present an opportunity to address prevailing attitudes. We conducted a questionnaire before and after a six-week MOOC where participants learned about dementia. We collected data using a survey instrument and analysed them with statistical testing. Although there was no statistically significant change between pre- and post-MOOC questionnaires, the change was observed in some questions and for particular groups. Our findings indicate this MOOC has a greater effect on changing the attitudes of non-healthcare workers, older people and those living in the United Kingdom. We recommend further analysis of MOOC as a change intervention and consideration of their application in other disciplines.
    • Christmas health warnings go down like a sack of coal.

      Mortimore, Gerri; University of Derby; Editorial Board (Mark Allen Group, 2017-12)
    • Cirrhosis in the over 16's: assessment and management

      Mortimore, Gerri; University of Derby (National Institute for Health and Care Excellence (NICE), 2016-07)
    • Collaborative development of an accelerated graduate entry nursing programme outside of traditional funding mechanisms

      Whiffin, Charlotte Jane; Clarke, Helen; Brundrett, Heather; Baker, Denise; Whitehead, Bill; University of Derby (Elsevier, 2017-09-21)
      Financial support for students entering nurse education programmes has typically been the responsibility of Governments who make a substantial contribution to tuition and/or living costs. However, where programmes are not funded by Government bodies, students must make alternative arrangements for financial support. This paper explores how a university worked with local employers to design, recruit and deliver an accelerated graduate entry nursing programme and how this philosophy of collaboration ultimately led to local health employers providing sponsorship for students. Therefore, we offer for debate the benefits of collaborative curriculum design and future considerations of attracting employer funding for graduate entry nursing programmes.
    • Confronting social risk factors for liver disease

      Mortimore, Gerri; University of Derby (2019-02-01)
      This presentation will explore the social risk factors for liver disease and how, as health professionals, we can confront these factors, to enable behavioural change. This session will also explore and reflect on our own social behaviours and how by understanding the complexity of changing our own behaviour, can assist in changing the behaviour of others.
    • Death cafés serve up a welcome taste of reality.

      Watson, Sharan; University of Derby (Final Choices Publishing Ltd., 2017)
      Death Cafés are helping to remove the taboo associated with talking about death. Sharan Watson considers how these local initiatives are providing opportunities for honest conversations and placing talking about dying, death and bereavement firmly on the national agenda
    • Delayed prescribing of antibiotics for self-limiting respiratory tract infections in an urgent care out of hours setting

      Mortimore, Gerri; Holroyd, Justine; University of Derby; Urgent Care South Derbyshire (MA Healthcare, 2020-03-02)
      Long-term overuse of antibiotics and inappropriate prescribing has led to widespread development of antimicrobial resistance. The Department of Health and Social Care recently published a five-year national action plan to reduce antimicrobial resistance, with the aim of reducing inappropriate antibiotic prescribing. This is mirrored in the NHS Long Term Plan, which aims to reduce unintentional exposure through a combination of antibiotic stewardship and leadership at all levels. An acute respiratory tract infection is one of the most common presentations in primary care, with 16.7% of all prescriptions issued attributed to it. Therefore, out-of-hours prescribers contribute significantly to general antibiotic consumption. This article analyses the practice of delayed prescribing of antibiotics for the treatment of self-limiting respiratory tract infections in an out-of-hours service. The advantages and disadvantages associated with delayed prescribing, to safely treat patients whilst facilitating the reduction of antimicrobial resistance, are discussed. In addition, recommendations for future practice are offered. This article also focuses on the development of an advanced nurse practitioner, reflecting on the four pillars of advanced practice, which underpin advanced clinical practice and associated competencies.
    • Delirium: a diagnostic dilemma. Part 1.

      Hardy, Kersten; Brown, Michelle; University of Derby (Mark Allen Group, 2015-09-10)
      Effective symptom management for a patient with a palliative diagnosis can be challenging. There are some symptoms that may be more difficult to control and understand than others. Delirium, as a symptom, may well prove to be a significant challenge for all involved, leaving family and health professionals perplexed and exhausted. Understanding the predisposing factors and the manifestations may aid the health professional in the assessment and identification of this distressing symptom, facilitating more effective management and care of those who are approaching the end of life. This article attempts to address some of the challenges and offer a number of suggestions that may aid in identifying delirium in patients at the end of life, but also examines some of the dilemmas when attempting to treat delirium.
    • Delirium: assessment and treatment of patients with cancer PART 2

      Brown, Michelle; Hardy, Kersten; University of Derby; Community Staff Nurse, Derbyshire (Mark Allen Group, 2016-02-25)
      Delirium at the end of life may present significant ethical dilemmas in clinical practice: whether to simply treat it in order to maximise symptom relief, with the resulting side effect being palliative sedation, or to attempt to reverse delirium and risk prolonging suffering. Determining whether the delirium can be reversed involves comprehensive assessment using established tools, which may or may not provide the answer to the question posed. This article examines the evidence surrounding several assessment tools that have been suggested as effective in identifying delirium, and the consequences of various approaches to the management of delirium in a patient with a cancer diagnosis. It also considers the impact delirium may have on the health professional and those close to the patient.
    • Dementia and stigma: a review of the literature on the reality of living with dementia.

      Kilduff, Alison; University of Derby (Unite, 2014-11)
      This paper provides a review of the literature on the reality of living with a diagnosis of dementia in terms of stigma and ageism, and their effects on care.
    • Designing a curriculum for the assistant practitioner of the future: Ensuring interprofessional care aspects and other stakeholder requirements are met.

      Baker, Denise; University of Derby (Elsevier, 2016-05)
      The role of the Assistant Practitioner in radiography has been established for over 10 years. Wakefield, Spilsbury, Atkin and McKenna13 (2009) describe how the role was originally introduced to overcome a shortage of registered staff at that time. Whilst there are clear overarching descriptions of what the role of the Assistant Practitioner is, Wakefield et al. concluded that there are many interpretations of the role and that there are inconsistencies between employers and subsequent uncertainty in workforce planners. Stewart-Lord, McLaren and Ballinger18 (2011) also found that there were a variety of roles and responsibilities undertaken by Assistant Practitioners in the field of radiography. This article outlines the curriculum design process for a foundation degree to develop Assistant Practitioners in diagnostic imaging and the associated challenges faced