• Keeping up with technology – The development of a tablet-based multimedia education programme for women with a history of gestational diabetes: a formative evaluation

      Jacobs, Helen (University of Chester, 2015-12)
      BACKGROUND A history of gestational diabetes significantly increases the risk of progression to type 2 diabetes (T2DM). Lifestyle intervention is an effective technique for delaying or preventing the onset of T2DM in this population and represents a unique opportunity for the primary prevention of type 2 diabetes. Following gestational diabetes, women face significant barriers to engaging in education and achieving health behaviour change. A multimedia patient education programme could overcome the barriers and be an effective method of reaching this population. OBJECTIVE The aim of the programme was to support women with a recent history of gestational diabetes to make lifestyle changes with the view to reduce the risk of type 2 diabetes in the future. This stage of the project aimed to evaluate the relevance, usability, content and appearance of the programme and also to identify any issues with the programme prior to proceeding to clinical trial. METHODS The multimedia education programme was developed using a five stage system development method: identification of user requirements, system design, system development, system evaluation and system application. Experts and patient representatives assessed the relevance, usability, content and appearance through a formative evaluation. RESULTS The multimedia education programme ‘Keeping Healthy after Gestational Diabetes’ contained seven modules: introduction, health, diet, lifestyle, baby health, living post GDM and warning signs. The formative evaluation by 22 experts and 20 patient representatives has provided valuable direction for the on-going development of the programme and suggest that the programme is relevant, easy to use, interesting and visually appealing. CONCLUSION Findings suggest that users found the programme relevant, easy to use, interesting and visually appealing; suggesting that this may be a feasible and acceptable mode of education.
    • Knowing and complying: Patient awareness of aspirin use for secondary prevention of stroke and transient ischaemic attack

      Hogard, Elaine; Little, Victoria (University of Liverpool (University College Chester)Arrow Park Hospital, 2005-11)
      The aim of this study was to gain understanding into compliance behaviour with aspirin as prescribed for secondary prevention of stroke. The study used a convenience sample of 20 patients who had been admitted to a NHS Trust following a subsequent stroke or transient ischaemic attack. Semi-structured interviews were used to explore the use of aspirin at the time of admission. Patient perception of personal risk and risk factors for stroke were explored. Where appropriate, responses were checked against health care records for comparison. The findings suggested that the majority of patients were compliant with aspirin, however deficiencies in current practice were identified. Patients lacked awareness of their risk factors and their risk of having a further stroke. They were also unaware why they were taking aspirin. Strategies that assisted compliance behaviour and reasons for non-compliance were identified.
    • Knowledge and attitudes of obesity in university students

      Fallows, Stephen; Morris, Mike; Giglia, Melissa (University of Chester, 2012-09)
      This paper reviews the literature which has measured individual’s knowledge on the health risks associated with obesity, and individual’s attitudes towards obese persons. This review primarily focuses on studies that recruited students, health care professionals, and the general population. The inclusion criteria was: students, health care professionals, general population, studies that used the Obesity Risk Knowledge (ORK-10) scale, studies that used the Attitudes Towards Obese Persons (ATOP) scale, and any other validated questionnaire which measured obesity risk knowledge (ORK), and attitudes towards obese persons. Results revealed high obesity risk knowledge among health care professionals, primarily dieticians and general practitioners, and low obesity risk knowledge amongst the general population. Negative attitudes towards obese persons were prevalent in most studies, and were evident in students, health care professionals and the general population. The variables gender and BMI yielded conflicting results among the selected studies. Education is needed to increase obesity risk knowledge among a number of health care professionals and the general population, this will aid preventative techniques towards overweight and obesity. In addition, educational tools to raise awareness and reduce weight related bias and stigma need to be implemented in employment and educational settings, amongst the general population and health care professionals.
    • The landscape, heritage and society of St Michael's churchyard, Shotwick

      Gaunt, Peter; Greatorex Roskilly, Vanessa J. (University of Liverpool (University of Chester), 2005-10)
      This dissertation examines the history and heritage of St Michael's Churchyard in the Wirral parish of Shotwick. It explores in particular the effect topographical features and historical events have had on the churchyard's development. Stylistic variations in memorials are analysed to identify chronological trends. The lifestyle of churchyard occupants is also discussed, with the spotlight focusing specifically on the Whaley, Roberts and Maddock families; parish curates; and RAF pilots killed in the final months of the Second World War. Information has chiefly been derived from memorials recorded during numerous visits to the churchyard itself, and from primary and secondary sources held by Cheshire and Chester Archives and Local Studies, in particular maps, parish registers and their transcripts, churchwarden's accounts, wills, reports of coroner's inquests, school log¬books, tithe apportionments, charters and church correspondence. Relevant information has been extracted from Cheshire County Council's Sites and Monuments Record, and material held by the War Graves Commission and the RAF Museum at Hendon has also contributed to the exposition. Data from all these sources has been collated and analysed to extrapolate parochial trends, and much supporting material discussed in the body of the dissertation is included in the Appendices as verification.
    • Language dependent business process outsourcing: A study of delivery methods

      Webb, Paul; Lynchelaun, Neil (University of Chester, 2009-08)
      Shared services operations are popular operating models delivering non-core activities to their parent companies following several common principles of consolidation, standardisation and leverage of resource, continuously improving best practice and advanced technology across client businesses on a competitive basis charging for services proportionate to their use. Business process outsource providers are held to the same expectations, whilst primarily driving cost competitiveness through wage arbitrage. The low cost locations are experiencing economic growth. Particularly for European language dependent transaction processing, the prospect for further wage arbitrage benefits from new locations is limited. This study investigates how BPO providers might sustain competitiveness, constrained by language dependent wage arbitrage, through new delivery models.
    • Linear fractional order differential equations and their solution

      Blank, L.; Simpson, A. Charles (University of Liverpool (Chester College of Higher Education)Chester College of Higher Education, 1996-03)
      Chapters 1, 2, 3, and 4 provide background material. Chapter 5 describes new results on the behaviour of solutions to (0.0.0).
    • Liverpool City Council's inclusion strategy for pupils with special educational needs

      Gleave, Karen (University of Chester, 2008-08)
      One of the key tenets of the present Government’s education policy for pupils with special educational needs (SEN) has been that of inclusion, i.e. that wherever possible and appropriate, pupils with SEN should attend local mainstream schools with appropriate support. Another important facet of Central Government policy over the last decade has been the increased emphasis on accountability in the public sector. One of the consequences of this trend has been the emergence of stakeholder theory as an important factor in determining the success of public sector organisations in meeting their objectives. This dissertation has reviewed the past and present literature relating both to stakeholder theory and to the debate around inclusion from the standpoint of three principal stakeholder groups: schools, children and young people, and parents and carers. The purpose of this was to give a context to Liverpool’s position vis a vis its stakeholders and to evaluate the likelihood of the success of Liverpool’s Inclusion strategy for pupils with SEN. The research examined the views of Liverpool’s key stakeholders towards inclusion in general and to Liverpool’s strategy in particular using a multi-method approach through the use of questionnaires, focus groups and case study. Results obtained from the data analysis indicate a wide range of views and standpoints on the part of stakeholders and reveal some positive aspects to Liverpool’s Inclusion strategy. They also point to a number of significant challenges which form the basis of some recommendations for the local authority to consider in order to ensure the success of its future strategy.
    • Liverpool City Council's performance management framework: An evaluation of its impact on customer-focused results

      Heath, Jan (University College Chester, 2004-08)
      Following the emergence of New Public Management, and the increased focus on performance management by the current UK government through initiatives such as the Local Government Modernisation Agenda, Best Value and Comprehensive Performance Assessment, local authorities have come under increasing pressure to improve their performance management systems. Within this context Liverpool City Council, with a history of poorly performing services and the highest Council Tax in the country, introduced its Comprehensive Performance Management Framework in 2000 to deliver performance improvement and embed a performance culture across the organisation. Since then, the Council has transformed services and overturned its image as a failing authority. This study evaluates the impact of the Council's Corporate Performance Management Framework on customer-focused results through analysis of quantitative and qualitative data and considers the potential negative consequences of performance management systems within the UK public sector with reference to other research. The research also identifies the role of control and accountability within public sector performance management regimes and considers whether it is possible to implement performance management systems based on private sector practices that are able to fulfil a dual role of both accountability and performance improvement.
    • Liverpool's approaches to tackling the educational attainment gap between mainstream pupils and looked after children (LAC)

      Stockton, Jim; Maher, Michael J. (University of ChesterLiverpool City Council, 2010-06)
      In October 2006 the Government Green Paper; 'Care Matters: Transforming the lives of Children and Young People in Care', outlined its proposals for the creation of Virtual Schools for Looked after Children (LAC) by setting out a radical package of proposals for transforming the lives of Children in Care (CiC). They noted the educational attainment gap between CiC and the wider school population was widening, leading to poorer life chances and much bleaker futures for children that had been looked after. The concept of the Virtual School (VS) has provoked much interest in England and Europe. The initial successes of the pilot LA(s) has meant that the programme is to be rolled out nationwide, albeit to claims that the Government's efforts are once again directed at symptoms rather than causes. However one thing is evident, and that is the political will to do the right thing. This dissertation examines the approaches to tackling the educational attainment gap between LAC and their mainstream peers. It investigates the deeper theoretical relationships required to tackle a holistic approach in developing a clearer strategy to assist the main driver as a concept of the VS. Liverpool's performance will be measured against its closest geographical, demographic and statistical neighbours. In conclusion recommendations will be offered to enhance the life chances for the future LAC of Liverpool.
    • Living with a very low fat diet

      Ellahi, Basma; Whitfield-Brown, Louisa M. (University of Chester, 2008-03)
      Aims: This study investigated compliance with the very low fat diet used by some clinics in the UK to treat severe hypertriglyceridemia and the patients’ experience of the diet. Methodology: Eight adults with severe hypertriglyceridemia attending the Lipid Clinic at Manchester Royal Infirmary, Manchester, UK took part in the study. Compliance with the therapeutic diet was assessed by analysis of telephone based diet histories and diet diaries using dietary assessment software. The patients’ experience of the diet was investigated using telephone based semi-structured qualitative interviews and analysed using thematic analysis. Main findings: The diet histories revealed the mean percentage energy contribution from fat was 22.5%. This is significantly higher than the target of 15% prescribed by the very low fat diet. The qualitative interviews revealed that patients considered complete compliance difficult. The patients understood the health benefits of the diet. Their level of adherence was affected by their perception of vulnerability to the health consequences of non-adherence. Barriers to adherence included lack of accessible nutritional information, increased patient burden, lack of appropriate food choices, other peoples’ ignorance with regard to the diet, lack of flavour and variety in the diet, a desire to broaden the palate, cost, social pressure to conform and negative experiences with dietitians. Enablers to compliance included nutritional awareness, desire to maintain good health, building on their nutritional knowledge base, behaviour and lifestyle modification, developing a routine, the support of family and friends and supportive eating environments. Conclusions: Compliance with the very low fat diet could be improved through extensive education on labelling, eating during special occasions such as Christmas, birthdays and eating out of home. Dietetic professionals need to work with food retailers and outlets to promote clear disclosure of the nutritional content of food to facilitate adherence to therapeutic diets.
    • Living with Multiple Sclerosis – exploring the effects of physical activity on quality of life

      Kennedy, Lynne; McGregor, Linda J. (University of Chester, 2017-08-31)
      Objective: To examine the effect of exercise on quality of life and investigate the perceived barriers to exercise participation. Methods: A qualitative study using semi-structured one-to-one interviews on 12 participants with multiple sclerosis. Results: Five qualitative themes were identified: environmental, personal, knowledge, quality of life, and taking control. Participants felt that discussing the benefits of physical activity engagement with a health professional and addressing problems such as transport would be helpful strategies for exercise engagement. All participants perceived that physical activity helped with quality of life. Conclusions: These findings indicate that exercise therapy is beneficial to quality of life and that physical activity should be promoted by the neurologist at diagnosis.
    • Longterm effects of preoperative carbohydrate loading for colorectal surgery

      Almiron-Roig, Eva; Commane, Daniel; Beadman, Claire (University of Chester, 2011-02)
      Recent changes in preoperative fasting guidelines have resulted in the development of preoperative carbohydrate drinks. Almost all research to date has examined the immediate/early postoperative metabolic and physiological effects, concluding beneficial clinical outcomes post surgery. The aim of this study was to test the hypothesis that preoperative carbohydrate loading results in longer term improvements in wellbeing, sustained return of postoperative physical function and better retention of muscle mass and nutritional status at a later (and potentially more clinically relevant) stage in the postoperative recovery period. This double-blinded placebo controlled randomised control trial took place at Salford Royal NHS Foundation Trust between 1st April 2008 and 31st January 2010. 10 males and 4 females, with a median age of 65.5 years, were included in the study and these were all listed for potentially curative colorectal cancer surgery. Each participant was assessed preoperatively, daily throughout their hospital admission and then at 30 days post surgery. Assessments included anthropometric measurements, analysis of dietary intake, physical activity and an evaluation of pain and well-being. The results showed that carbohydrate loading had no significant effects on anthropometric, dietary, physical or well-being parameters. However it was seen that pain scores in those patients who received carbohydrate loading were significantly lower (p=0.017) 30 days post surgery than those who received the placebo drinks. The trial was a pilot study and has shown that further research is needed to determine whether carbohydrate loading may have long-term clinical benefits.
    • Long‐term outcomes of cardiovascular rehabilitation: One year follow‐up concerning quality of life, physical activity and psychological state of health – a pilot study

      Buckley, John P.; Fallows, Stephen; Morris, Mike; Ilina, Viktoriia (University of Chester, 2014-10)
      Cardiovascular rehabilitation is known to be beneficial in short‐term and long‐term disease management and enhancing physical and psychological well‐being: the majority of recent evidence outlines that comprehensive cardiac rehabilitation has positive short term improvements in physical fitness, quality of life and psychological status, however, there is less data regarding similar long‐term outcomes of the programme. A recent systematic review highlighted the efficacy of exercise‐based cardiac rehabilitation towards reduction in mortality (medium to longer term studies) and in hospital admissions (short‐term studies). Further research should focus on evaluation of comprehensive programmes as far as quality of life, social and psychological status are less explored in research literature, compared to mortality and morbidity levels. Special considerations are advised to contribute into monitoring and management of anxiety and depression levels which may alter patients` quality of life and general health state. Lastly, the analysis of prolonged rehabilitation outcomes should be in a high priority, according to confirmation of continuous 12 months improvement in physical activity, depression and anxiety reduction after rehabilitation. Consequently, the future studies are recommended to investigate whether participants of cardiac rehabilitation services maintain the physical and psychological benefits, at one year, following programme and, consequently, to reveal effectiveness of these services.
    • “Looking from the outside in” – Emotional and cognitive reactions of sport, non-sport and ex-sport playing adults to initiation practices

      Lafferty, Moira E.; Gately, Joseph (University of Chester, 2017-09)
      Research examining hazing and the motives behind the events have received significant focus over recent years. While research has enhanced the understanding and provided interesting insight of hazing events, it has been done exclusively with those directly involved in the events. However, to date, research is yet to examine the perceptions from the wider general public and understand their opinions of hazing. The present study was an exploration in order to gain understanding of the general public’s emotional and cognitive response to modern day hazing events in the United Kingdom. Sixty-Seven participants of a mixed general public population completed quantitative and qualitative questions based on their experiences of watching hazing videos. Following each video, participants completed a self-report measure of arousal and I-PANAS-SF. In addition, participants were then required to answer 3 short qualitative questions on their perceptions of the videos viewed. Results of quantitative measures revealed that participant’s self-reported arousal and I-PANAS-SF scores were significantly effect by hazing videos. In addition, results of qualitative questioning revealed that participants provided a mixture of responses regarding hazing. In general, participants were accepting of events that involved no physical harm however, were also quick to highlight their disapproval of events where they perceived issues of hierarchy and power. While participants noted issues of hierarchy, participants generally, neglected any aspect of psychological harm that may occur following involvement in hazing events.
    • Lowering dietary carbohydrates to manage obesity and related disease: A systematic review and theoretical framework

      Fallows, Stephen; Verma, Radhika (University of Chester, 2012-09)
      This study aimed to evaluate the lowering of carbohydrates from conventionally recommended levels of ->55% of energy intake as a valid and safe treatment option for managing obesity and related disease. The study was a qualitative systematic review of fourteen randomized controlled studies, each with at least one study arm that lowered intake of carbohydrates to either ketogenic levels (->50g/) (Atkins type diet) or non-ketogenic levels including Zone type diets (>50g/d to 40-45% of energy intake). Low carbohydrate diets have generally implied increased protein intake to around 30% of energy intake. Outcomes evaluated included weight and fat loss; dyslipidemia; blood sugar control; hypertension; nutritional adequacy; hunger and satiety; adherence and safety. A synthesis of process, results and implications was used towards generating a theoretical weight maangement framework. In the short to medium term of up to six months both the ketogenic and non-ketogenic lowering of carbohydrates within the context of a calorie reduction of 300-750 kcal/day generated clinically meaningful weight loss results of 5-10% Lower-carbohydrates diet plans generated similar or better results for most of the main outcomes examined as comparted with conventional higher-carbohydrate/low-fat diet alternatives. Longer-term studies were few in number but weight loss results were in the range of 2-6% with no significant diet difference noted. Potential impact of ketogenic diets on dyslipidemia, renal and bone health needs further evaluation. When lowering carbohydrates or calories, nutritional adequacy may require maangement with the use of supplementation. Lowering carbohydrates may provide an important and useful strategy to achieve a regular daily caloriee deficit, generate clinically meaningful weight loss and improve related metabolic health markers. Recommended weight management protocols may be individualised based on a theoretical model that considers individual health risks and genetics, dietary preferences, carbohydrate sensitivity and is geared towards improved adherence.
    • MA: Critical and creative writing: Writing dissertation

      Chantler, Ashley; Winchcombe, Matthew (University of ChesterEnglish department, 2007-09)
      This dissertation contains an extract from a proposed novel set in Gdansk between 1935-1937.
    • MA: Critical and creative writing: writing dissertation

      Rees, Emma L E; Lamont, Joanna (University of ChesterUniversity of Chester, 2007-09)
      This dissertation contains an extract from a proposed novel for young adults called "Winter in Curio Crescent: The Hellhound and the Hypnotist" and a critical piece on "A reflection on the inherent didacticism in children's literature of the nineteenth century".
    • Male-only preserves: Homosocial environments in the nineteenth century

      Edwards, Carol (University of Chester, 2013)
      This dissertation explores those areas of nineteenth-century life from which women were excluded. Links are made throughout to literary texts as illustrations of how male-only groups were depicted in literature and how homosociality was represented. As well as describing the national picture, examples of male-only environments in Cheshire, which are still in existence in the twenty-first century, are used. The Introduction describes the background to the project and considers the development of male-only environments in the light of nineteenth-century attitudes to the respective roles of men and women. It reviews expectations with regard to men’s behaviour that were current at the beginning of the nineteenth century, and considers the changes in those attitudes that took place during Queen Victoria’s reign. The first chapter deals with public schools and the consequences for young boys of growing up in a female-free environment, paying particular regard to the aspirations of their parents, the pupils’ everyday lives and their relationships. Chapter 2 deals with adult male associations and societies: gentlemen’s clubs, Freemasonry, and examples of other local groups that survive today. It looks at their rules and rituals, specifically with regard to their attitude to the presence of women. The final chapter is concerned with intense male relationships and nineteenth-century public opinion about them; particular attention is given in this section to literary examples of close friendships between men and to the role of bachelors. Finally, the Conclusion reflects on the complexity of the subject matter and highlights the different perceptions, historical and contemporary, of the changes that took place during the nineteenth century; and considers how much, or little, has changed since then.
    • Malnutrition, enteral nutrition and the use of the percutaneous endoscopic gastrostomy

      Fallows, Stephen; Wolfendale, Christine; Eckersley, Deborah (University of Chester, 2014)
      The number of adult patients in the community receiving enteral feeding via a percutaneous endoscopic gastrostomy (PEG) is increasing. Identified problems in relation to PEG were highlighted by a community multidisciplinary team including delayed referrals and discharges. The study aimed to explore retrospectively outcomes in relation to PEG insertion following the implementation of a pilot community PEG placement care pathway. The number of adult patients in the community receiving enteral feeding via a percutaneous endoscopic gastrostomy (PEG) is increasing. Identified problems in relation to PEG were highlighted by a community multidisciplinary team including delayed referrals and discharges. The study aimed to explore retrospectively outcomes in relation to PEG insertion following the implementation of a pilot community PEG placement care pathway.The number of adult patients in the community receiving enteral feeding via a percutaneous endoscopic gastrostomy (PEG) is increasing. Identified problems in relation to PEG were highlighted by a community multidisciplinary team including delayed referrals and discharges. The study aimed to explore retrospectively outcomes in relation to PEG insertion following the implementation of a pilot community PEG placement care pathway. Data were analysed for a sample of participants over 18 years of age in three communities, served by a district general hospital in the North West of England. Group 1; ten participants managed on the community PEG placement care pathway and Group 2; ten participants who were not managed on community PEG placement care pathway with a similar primary diagnosis to Group 1. PEG insertion required to maintain nutritional status, hydration and/or medication administration for greater than fourteen days. Group 1 data for referral to treatment (RTT) waiting time was compared with the National Health Service (NHS) RTT waiting times for gastroenterology. Group 1 data for length of stay (LOS) following PEG insertion was compared to Group 2 data by conducting an Independent t‐test to analyse LOS between the two groups. A measure of central tendency obtained for LOS for Group 1 and Group 2 data was used in the calculation to estimate treatment cost. Group 1 data to estimate treatment cost was compared to Group 2 data by conducting an Independent t‐test to analyse treatment cost between the two groups. Data collection was obtained to establish if the hospital’s PEG information booklet was provided prior to PEG insertion. 6/10 participants in Group 1 had a RTT waiting time of 1 to 58 days. Median LOS for Group 1 was 4 days; Median LOS for Group 2 was 10 days. Group 1 had an estimated treatment cost of £1114.15 per patient; Group 2 had an estimated treatment cost of £2314.15 per patient. 7/10 Group 1 participants were provided with the hospital’s PEG information booklet at least one week prior to PEG insertion. A reduction in LOS, a RTT waiting time within 18 weeks and a lower estimated mean treatment cost were noted for Group 1 participants. Expansion of the exploratory study is required so the objectives generated can be challenged further.
    • Malnutrition; Can the Leeds screening tool identify haemodialysis patients at risk?

      Woodall, Alison; Morris, Mike; Bowra, Kim (University of ChesterLeeds Teaching Hospitals, 2014-11)
      There is global recognition of the need for early identification of those at risk of malnutrition. Nutritional screening has been advocated for systematically detecting and managing those at nutritional risk, triggering a dietetic referral where indicated. Dietetic assessment aims to minimise progression to overt malnutrition and ultimately, curtail the associated clinical and financial consequences. Patients receiving haemodialysis treatment are at increased risk of malnutrition. Generic nutritional screening tools are inherently limited in this population due to the observed variances in fluid status. There is currently no validated nutritional screening tool that is effective in this population. The present study aimed to test the effectiveness of the Leeds Nutritional Screening Tool (developed through pilot studies) in 140 representative haemodialysis patients. By means of a clinical audit, the clinical support worker tested the Leeds tool and the dietitian provided the criterion measure. A distinct feature was the inclusion of patients that were unable to fully complete answers, due to dementia, learning difficulties and a language barrier. Risk of malnutrition was evident in 49% of the Leeds sample. The Leeds tool showed good diagnostic accuracy (95%) with sensitivity and specificity comparable with other National Health Service tests. In turn, these results suggest that patients would be appropriately signposted for dietetic assessment, without wasting finite resources. Component analysis showed that the tool was well-balanced with a combination of objective and subjective measures and that it could be simplified by removal of a question on appetite, without affecting performance. Reliability testing was achieved by patient self-completion and by a nurse, both of whom produced consistent results with the clinical support worker. The tool was evaluated to have good practical acceptability amongst users. This research suggests that the Leeds tool can identify patients at risk of malnutrition, fulfilling the requirements needed to consider local implementation, alongside appropriate staff education. This research provide a sound framework for the development and testing of nutritional screening tools, in a field of variable study quality. It is hoped that the results will contribute to the wider audience, with further research needed to assess tool transferability amongst dialysis units.