Now showing items 21-40 of 59

    • Development and feasibility of a Swallowing intervention Package (SiP) for patients receiving radiotherapy treatment for head and neck cancer—the SiP study protocol

      Wells, Mary; King, Emma; Toft, Kate; MacAulay, Fiona; Patterson, Joanne; Dougall, Nadine; Hulbert-Williams, Nicholas J.; Boa, Sally; Slaven, Eleanor; Cowie, Julie; et al. (BMC, 2016-08-04)
      Background Head and neck cancer (HNC) is the sixth most common cancer worldwide, and the functional, psychological and social consequences of HNC cancer and its treatment can be severe and chronic. Dysphagia (swallowing problems) affects up to two thirds of patients undergoing combined chemoradiotherapy. Recent reviews suggest that prophylactic swallowing exercises may improve a range of short- and long-term outcomes; however, the importance of psychological and behavioural factors on adherence to swallowing exercises has not been adequately studied. This study aims to develop and test the feasibility of a Swallowing intervention Package (SiP) designed in partnership with patients, speech and language therapists (SLTs) and other members of the head and neck multi-disciplinary team (MDT), for patients undergoing chemoradiotherapy (CRT) or radiotherapy (RT) for head and neck cancer. Methods/design This feasibility study uses quantitative and qualitative research methods, within a quasi-experimental design, to assess whether patients will tolerate and adhere to the SiP intervention, which aspects of the intervention can be implemented and which cannot, whether treatment fidelity can be achieved across different contexts, whether study processes and outcome measures will be feasible and acceptable and to what extent the intervention is likely to have an impact on swallowing dysfunction and quality of life. Patients are being recruited from five sites in Scotland and England (three interventions and two usual care). The SLT based in the relevant intervention centre teaches the exercise programme and provides supporting materials. A combination of patient-reported outcome measures (PROMs), adherence measures and clinical swallowing assessments are used prior to intervention (baseline), at the end of treatment, 3 and 6 months post-treatment. Discussion This collaborative study has taken a unique approach to the development of a patient-centred and evidence-based swallowing intervention. The introduction of an e-SiP app provides an exploration of the use of technology in delivering this intervention. The study provides an opportunity to examine the feasibility of delivering and participating in a supported swallowing intervention across several different NHS sites and will provide the evidence needed to refine intervention and study processes for a future trial. Trial registration NCRI portfolio, 18192 & 20259
    • A qualitative study exploring midlife women’s stages of change from domestic violence towards freedom

      Keeling, June J.; Smith, Debra; Fisher, Colleen; University of Chester; University of Central Lancashire; The University of Western Australia (BMC, 2016-03-08)
      Background Domestic Violence (DV) remains a significant global health problem for women in contemporary society. Existing literature on midlife women’s experiences of domestic violence is limited and focuses on health implications. Leaving a violent relationship is a dynamic process that often requires multiple attempts and separations prior to final termination. The aim of this study was to explore the process of leaving a violent relationship for midlife women. Methods This qualitative study involved fifteen women aged between 40–55 who had accessed residential and non-residential community support services for domestic violence within the UK. Community-based support agencies provided these women with access to letters of invitation and participant information sheet explaining the study. The women notified agency staff who contacted the research team to arrange a mutually convenient time to meet within a safe place for both the women and researchers. It was stressed to all potential participants that no identifiable information would be shared with the agency staff. Women were considered survivors of DV if they defined themselves as such. Data were gathered through semi structured interviews, transcribed verbatim and thematically analysed. Results Midlife women appear to differ from younger women by transitioning quickly though the stages of change, moving rapidly through the breaking free onto the maintenance stage. This rapid transition is the resultant effect of living with long-term violence causing a shift in the women’s perception towards the violent partner, with an associated reclamation of power from within the violent relationship. A realisation that rapid departure from the violence may be critical in terms of personal safety, and the realisation that there was something ‘wrong’ within the relationship, a ‘day of dawning’ that had not been apparent previously appears to positively affect the trajectory of leaving. Conclusions Midlife women appeared to navigate through the stages of change in a rapid linear process, forging ahead and exiting the relationship with certainty and without considering options. Whilst these findings appear to differ from younger women’s process of leaving, further research is needed to explore and understand the optimum time for intervention and support to maximise midlife women’s opportunities to escape an abusive partner, before being reflected appropriately in policy and practice.
    • Physical activity guidelines and cardiovascular risk in children: a cross sectional analysis to determine whether 60 minutes is enough

      Füssenich, Lotte M.; Boddy, Lynne M.; Green, Daniel J.; Graves, Lee E. F.; Foweather, Lawrence; Dagger, Rebecca M.; McWhannell, Nicola; Henaghan, Jayne; Ridgers, Nicola D.; Stratton, Gareth; et al. (BMC, 2016-01-22)
      Background: Physical activity reduces cardiovascular mortality and morbidity. The World Health Organisation (WHO) recommends children engage in 60 min daily moderate-to-vigorous physical activity (MVPA). The effect of compliance with this recommendation on childhood cardiovascular risk has not been empirically tested. To evaluate whether achieving recommendations results in reduced composite-cardiovascular risk score (CCVR) in children, and to examine if vigorous PA (VPA) has independent risk-reduction effects. Methods PA was measured using accelerometry in 182 children (9–11 years). Subjects were grouped according to achievement of 60 min daily MVPA (active) or not (inactive). CCVR was calculated (sum of z-scores: DXA body fat %, blood pressure, VO2peak, flow mediated dilation, left ventricular diastolic function; CVR score ≥1SD indicated ‘higher risk’). The cohort was further split into quintiles for VPA and odds ratios (OR) calculated for each quintile. Results Active children (92 (53 boys)) undertook more MVPA (38 ± 11 min, P < 0.001), had greater VO2peak (4.5 ± 0.8 ml/kg/min P < 0.001), and lower fat % (3.9 ± 1.1 %, P < 0.001) than inactive. No difference were observed between active and inactive for CCVR or OR (P > 0.05). CCVR in the lowest VPA quintile was significantly greater than the highest quintile (3.9 ± 0.6, P < 0.05), and the OR was 4.7 times higher. Conclusion Achievement of current guidelines has positive effects on body composition and cardiorespiratory fitness, but not CCVR. Vigorous physical activity appears to have beneficial effects on CVD risk, independent of moderate PA, implying a more prescriptive approach may be needed for future VPA guidelines.
    • Health inequalities as a foundation for embodying knowledge within public health teaching: a qualitative study

      Mabhala, Mzwandile A.; University of Chester (BMC, 2013-06-28)
      Introduction: Recent UK health policies identified nurses as key contributors to the social justice agenda of reducing health inequalities, on the assumption that all nurses understand and wish to contribute to public health. Following this policy shift, public health content within pre-registration nursing curricula increased. However, public health nurse educators (PHNEs) had various backgrounds, and some had limited formal public health training, or involvement in or understanding of policy required to contribute effectively to it. Their knowledge of this subject, their understanding and interpretation of how it could be taught, was not fully understood. Methodology This research aimed to understand how public health nurse educators’ professional knowledge could be conceptualised and to develop a substantive theory of their knowledge of teaching public health, using a qualitative data analysis approach. Qualitative in-depth semi-structured interviews (n=26) were conducted with eleven university-based PHNEs. Results Integrating public health into all aspects of life was seen as central to the knowing and teaching of public health; this was conceptualised as ‘embodying knowledge’. Participants identified the meaning of embodying knowledge for teaching public health as: (a) possessing a wider vision of health; (b) reflecting and learning from experience; and (c) engaging in appropriate pedagogical practices. Conclusion The concept of public health can mean different things to different people. The variations of meaning ascribed to public health reflect the various backgrounds from which the public health workforce is drawn. The analysis indicates that PHNEs are embodying knowledge for teaching through critical pedagogy, which involves them engaging in transformative, interpretive and integrative processes to refashion public health concepts; this requires PHNEs who possess a vision of what to teach, know how to teach, and are able to learn from experience. Their vision of public health is influenced by social justice principles in that health inequalities, socioeconomic determinants of health, epidemiology, and policy and politics are seen as essential areas of the public health curriculum. They believe in forms of teaching that achieve social transformation at individual, behavioural and societal levels, while also enabling learners to recognise their capacity to effect change.
    • Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer

      Eccles, Suzanne A.; Aboagye, Eric O.; Ali, Simak; Anderson, Annie S.; Armes, Jo; Berditchevski, Fedor; Blaydes, Jeremy P.; Brennan, Keith; Brown, Nicola J.; Bryant, Helen E.; et al. (BMC, 2013-10-01)
      Introduction: Breast cancer remains a significant scientific, clinical and societal challenge. This gap analysis has reviewed and critically assessed enduring issues and new challenges emerging from recent research, and proposes strategies for translating solutions into practice. Methods More than 100 internationally recognised specialist breast cancer scientists, clinicians and healthcare professionals collaborated to address nine thematic areas: genetics, epigenetics and epidemiology; molecular pathology and cell biology; hormonal influences and endocrine therapy; imaging, detection and screening; current/novel therapies and biomarkers; drug resistance; metastasis, angiogenesis, circulating tumour cells, cancer ‘stem’ cells; risk and prevention; living with and managing breast cancer and its treatment. The groups developed summary papers through an iterative process which, following further appraisal from experts and patients, were melded into this summary account. Results The 10 major gaps identified were: (1) understanding the functions and contextual interactions of genetic and epigenetic changes in normal breast development and during malignant transformation; (2) how to implement sustainable lifestyle changes (diet, exercise and weight) and chemopreventive strategies; (3) the need for tailored screening approaches including clinically actionable tests; (4) enhancing knowledge of molecular drivers behind breast cancer subtypes, progression and metastasis; (5) understanding the molecular mechanisms of tumour heterogeneity, dormancy, de novo or acquired resistance and how to target key nodes in these dynamic processes; (6) developing validated markers for chemosensitivity and radiosensitivity; (7) understanding the optimal duration, sequencing and rational combinations of treatment for improved personalised therapy; (8) validating multimodality imaging biomarkers for minimally invasive diagnosis and monitoring of responses in primary and metastatic disease; (9) developing interventions and support to improve the survivorship experience; (10) a continuing need for clinical material for translational research derived from normal breast, blood, primary, relapsed, metastatic and drug-resistant cancers with expert bioinformatics support to maximise its utility. The proposed infrastructural enablers include enhanced resources to support clinically relevant in vitro and in vivo tumour models; improved access to appropriate, fully annotated clinical samples; extended biomarker discovery, validation and standardisation; and facilitated cross-discipline working. Conclusions With resources to conduct further high-quality targeted research focusing on the gaps identified, increased knowledge translating into improved clinical care should be achievable within five years.
    • Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures

      Hughes, Stephen F.; Hendricks, Beverly D.; Edwards, David R.; Bastawrous, Salah S.; Middleton, Jim F.; University of Chester; Keele University; Glan Clwyd Hospital; Gwynedd Hospital; University of Bristol (BMC, 2013-11-09)
      Background: With an aging society and raised expectations, joint replacement surgery is likely to increase significantly in the future. The development of postoperative complications following joint replacement surgery (for example, infection, systemic inflammatory response syndrome and deep vein thrombosis) is also likely to increase. Despite considerable progress in orthopaedic surgery, comparing a range of biological markers with the ultimate aim of monitoring or predicting postoperative complications has not yet been extensively researched. The aim of this clinical pilot study was to test the hypothesis that lower limb orthopaedic surgery results in changes to coagulation, non-specific markers of inflammation (primary objective) and selective clinical outcome measures (secondary objective). Methods Test subjects were scheduled for elective total hip replacement (THR) or total knee replacement (TKR) orthopaedic surgery due to osteoarthritis (n = 10). Platelet counts and D-dimer concentrations were measured to assess any changes to coagulation function. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured as markers of non-specific inflammation. Patients were monitored regularly to assess for any signs of postoperative complications, including blood transfusions, oedema (knee swelling), wound infection, pain and fever. Results THR and TKR orthopaedic surgery resulted in similar changes of coagulation and non-specific inflammatory biomarkers, suggestive of increased coagulation and inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in an increase in platelet (P = 0.013, THR) and D-dimer (P = 0.009, TKR) concentrations. Evidence of increased inflammation was demonstrated by an increase in CRP and ESR (P ≤ 0.05, THR and TKR). Four patients received blood transfusions (two THR and two TKR patients), with maximal oedema, pain and aural temperatures peaking between days 1 and 3 postoperatively, for both THR and TKR surgery. None of the patients developed postoperative infections. Conclusions The most noticeable changes in biological markers occur during days 1 to 3 postoperatively for both THR and TKR surgery, and these may have an effect on such postoperative clinical outcomes as oedema, pyrexia and pain. This study may assist in understanding the postoperative course following lower limb orthopaedic surgery, and may help clinicians in planning postoperative management and patient care.
    • Eating for 1, Healthy and Active for 2; feasibility of delivering novel, compact training for midwives to build knowledge and confidence in giving nutrition, physical activity and weight management advice during pregnancy

      Basu, Andrea J.; Kennedy, Lynne; Tocque, Karen; Jones, Sharn; University of Chester; Wrexham Maelor Hospital (BMC, 2014-07-04)
      Background: Women in Wales are more likely to be obese in pregnancy than in any other United Kingdom (UK) country. Midwives are ideally placed to explore nutrition, physical activity and weight management concerns however qualitative studies indicate they lack confidence in raising the sensitive issue of weight. Acknowledging this and the reality of finite time and resources, this study aimed to deliver compact training on nutrition, physical activity and weight management during pregnancy to increase the knowledge and confidence of midwives in this subject. Methods A compact training package for midwives was developed comprising of evidence based nutrition, physical activity and weight management guidance for pregnancy. Training was promoted via midwifery leads and delivered within the Health Board. Questionnaires based on statements from national public health guidance were used to assess changes in self-reported knowledge and confidence pre and post training. Descriptive statistics were applied and 95% confidence intervals were calculated. Results 43 midwives registered for training, 32 (74%) attended and completed the questionnaires. Although, pre training knowledge and confidence varied between participants, statistically significant improvements in self-reported knowledge and confidence were observed post training. 97% indicated knowledge of pregnancy specific food and nutrition messages as ‘better’ (95% CI 85 to 100), as opposed to 3% stating ‘stayed the same’ – 60% stated ‘much better’. 83% indicated confidence to explain the risks of raised BMI in pregnancy was either ‘much’ or ‘somewhat better’ (95% CI 66 to 93), as opposed to 17% stating ‘stayed the same’. 89% indicated confidence to discuss eating habits and physical activity was ‘much’ or ‘somewhat better’ (95% CI 73 to 97) as opposed to 11% stating ‘stayed the same’. Emergent themes highlighted that training was positively received and relevant to midwifery practice. Conclusions This study provides early indications that a compact nutrition, physical activity and weight management training package improves midwives self-reported knowledge and confidence. Cascading training across the midwifery service in the Health Board and conducting further studies to elicit longer term impact on midwifery practice and patient outcomes are recommended.
    • Exploring the Development Needs of Postgraduate Taught Dissertation Supervisors

      Regan, Julie-Anne; Taylor, Kirsty; Simcock, Thomas; University of Chester (2014-10)
      The Graduate School, in collaboration with the Learning and Teaching Institute (LTI), undertook this project to explore the development needs of PGT dissertation supervisors. This information was vital to the effective planning of development opportunities, in order to enhance dissertation supervision on PGT programmes and ultimately improve the overall postgraduate student experience.
    • Welsh periodicals in the nineteenth century

      Peters, Lisa; University of Chester (2014-05-27)
      This presentation places the developing Welsh periodical press within the changing economic, political, and social nature of nineteenth century Wales.
    • Information literacy

      Fiander, Wendy; University of Chester (SAGE Publications, 2011)
      This book chapter discusses the importance of developing information literacy skills in healthcare students.
    • Monocytes/macrophages express CCR9 in rheumatoid arthritis and CCL25 stimulates their differentiation

      Schmutz, Caroline; Cartwright, Alison; Williams, Helen; Haworth, Oliver; Williams, John H. H.; Filer, Andrew; Salmon, Mike; Buckley, Christopher D.; Middleton, Jim F.; Keele University/University of Birmingham ; Keele University ; University of Chester ; University of Birmingham ; University of Chester ; University of Birmingham ; University of Birmingham ; University of Birmingham ; Keele University/University of Bristol (BMC, 2010-08-05)
      Abstract Introduction Monocytes/macrophages accumulate in the rheumatoid (RA) synovium where they play a central role in inflammation and joint destruction. Identification of molecules involved in their accumulation and differentiation is important to inform therapeutic strategies. This study investigated the expression and function of chemokine receptor CCR9 in the peripheral blood (PB) and synovium of RA, non-RA patients and healthy volunteers. Methods CCR9 expression on PB monocytes/macrophages was analysed by flow cytometry and in synovium by immunofluorescence. Chemokine receptor CCR9 mRNA expression was examined in RA and non-RA synovium, monocytes/macrophages from PB and synovial fluid (SF) of RA patients and PB of healthy donors using the reverse transcription polymerase chain reaction (RT-PCR). Monocyte differentiation and chemotaxis to chemokine ligand 25 (CCL25)/TECK were used to study CCR9 function. Results CCR9 was expressed by PB monocytes/macrophages in RA and healthy donors, and increased in RA. In RA and non-RA synovia, CCR9 co-localised with cluster of differentiation 14+ (CD14+) and cluster of differentiation 68+ (CD68+) macrophages, and was more abundant in RA synovium. CCR9 mRNA was detected in the synovia of all RA patients and in some non-RA controls, and monocytes/macrophages from PB and SF of RA and healthy controls. CCL25 was detected in RA and non-RA synovia where it co-localised with CD14+ and CD68+ cells. Tumour necrosis factor alpha (TNFα) increased CCR9 expression on human acute monocytic leukemia cell line THP-1 monocytic cells. CCL25 induced a stronger monocyte differentiation in RA compared to healthy donors. CCL25 induced significant chemotaxis of PB monocytes but not consistently among individuals. Conclusions CCR9 expression by monocytes is increased in RA. CCL25 may be involved in the differentiation of monocytes to macrophages particularly in RA.
    • Aspartame in conjunction with carbohydrate reduces insulin levels during endurance exercise

      Siegler, Jason; Howell, Keith; Vince, Rebecca; Bray, James W.; Towlson, Chris; Peart, Daniel; Mellor, Duane; Atkin, Stephen; University of Western Sydney ; University of York ; University of Hull ; University of Hull ; University of Hull ; University of Hull ; University of Chester ; University of York (01/08/2012)
      As most sport drinks contain some form of non-nutritive sweetener (e.g. aspartame), and with the variation in blood glucose regulation and insulin secretion reportedly associated with aspartame, a further understanding of the effects on insulin and blood glucose regulation during exercise is warranted. Therefore, the aim of this preliminary study was to profile the insulin and blood glucose responses in healthy individuals after aspartame and carbohydrate ingestion during rest and exercise. Each participant completed four trials under the same conditions (45 min rest + 60 min self-paced intense exercise) differing only in their fluid intake: 1) carbohydrate (2% maltodextrin and 5% sucrose (C)); 2) 0.04% aspartame with 2% maltodextrin and 5% sucrose (CA)); 3) water (W); and 4) aspartame (0.04% aspartame with 2% maltodextrin (A)). Insulin levels dropped significantly for CA versus C alone (43%) between pre-exercise and 30 min, while W and A insulin levels did not differ between these time points. Aspartame with carbohydrate significantly lowered insulin levels during exercise versus carbohydrate alone.
    • PDP in the curriculum - how far have we come?

      Done, Judith; Univesity of Chester (2007-06-01)
      This presentation discusses the extent to which the University of Chester's revised academic framework will raise the profile of personal development portfolios and career development learning. The potential impact on the student experience will also be explored.
    • Examining the workings of a late nineteenth century provincial press conglomerate: Frederick Edward Roe and his newspapers

      Peters, Lisa; University of Chester (2012-07-12)
      This presentation discuss four newspapers located in north Wales and the Marches owned by Frederick Edward Roe between 1880 and 1887. It analyses the relationship between the four titles and the extent to which they shared content, advertising, and staff.
    • Ethical issues in pedagogic research

      Regan, Julie-Anne; Baldwin, Moyra A.; Peters, Lisa; University of Chester (University of Bedfordshire, 2012-10)
      This paper explores the ethical issues identified by a research ethics committee (REC) over a three-year period. The REC is situated in a medium-sized univerity in the north west of England and deals exclusively with proposals for pedagogic research. The purpose of the research was to identify the nature and frequency of ethical concerns expressed by the REC, in order to improve guidance for future applicants. The most common concern was the lack, or inaccuracy, of the information provided to potential participants by which they were expected to make an informed decision about participation. Other concerns included the potential for bias, the lack of information provided to the REC, the provision for fair access by vulnerable groups and undue influence on voluntary particpation. The paper concludes that the potential risks of practitioners researching their own students are not given due consideration by many applicats. In particular the potential threats to valid informed consent are identified. Implications for improving the relationship between researchers and RECs are discussed, as is the guidance for applicants.
    • Kindle project at the University of Chester

      McLean, Fiona; Shepherd, Joanna; University of Chester (SCONUL, 2012)
      Towards the end of 2010, Learning and Information Services (LIS) at the University of Chester decided to undertake a pilot project which explored how useful e-readers are in a university setting and if they could help to resolve issues about resource availability.
    • Meeting the needs of distance learners: The creation of an interactive resource pack for library inductions

      Gleeson, Charlotte; University of Chester (2012-04-12)
      Within the UK, higher education is increasingly becoming more competitive, particularly with the arrival of increased fees from 2012. As a result, over the past few years the University of Chester has ran programmes in other countries including Dublin and Mumbai to raise its research profile and meet the needs of the market. Students on these distance learner programmes have the same rights with regards to online library resources as those studying at Chester. One of the main problems that has arisen from this has been how to induct the students and show them the wealth of online library resources available to them. The presentation will focus on an initiative at the University of Chester that looked at developing a new approach to inducting students at a distance. In September 2011, the Applied Sciences and Social Science library subject team at the University created a resource pack for students on distance learner programmes in other countries with an aim to improve the student experience during induction. The resources pack consisted of an interactive tutorial DVD and a resource CD containing information on how to access the library resources the students would need for their course. This pack replaced previous methods of induction such as printed hand-outs and workbooks. It was hoped it would be a more personable and accessible method of inducting the students into the library at a distance. The presentation will examine the rationale behind creating the resource pack and will look at the benefits and challenges involved in creating the content including compatibility issues with the format of the DVD. It will consider the feedback received from students regarding the resources pack and areas for potentially developing the project in the future.
    • Still Wrexham's longest running newspaper - the Wrexham Advertiser

      Peters, Lisa; University of Chester (Bridge Books, 2012-03)
      This article discuss the Wrexham Advertiser - a newspaper which ran from 1850 to 1957.
    • Ethical issues in pedagogic research

      Regan, Julie-Anne; Peters, Lisa; Baldwin, Moyra A.; University of Chester (2011-12-06)
      This presentation discusses the ethical issues identified by a research ethics committee (REC) over a three year period. The REC deals exclusively with proposals for pedagogic research. The purpose of the research was to identify the nature and frequency of ethical concerns expressed by the REC, in order to improve guidance for future applicants.
    • The student enrichment programme: An inter-professional collaboration

      Greenwood, Joanne; Thomas, Helen; Sinnott, Celia; Headon, Stephanie; Rogers, Lisa; University of Chester (2011-06-15)
      This presentation discusses how Learning Support Unit, Learning Information Services, Careers and Employability work together with academic lecturers to deliver skills sessions to nursing students.