• A randomised controlled trial to compare the effectiveness of ice-packs and Epifoam with cooling maternity gel pads at alleviating postnatal perineal trauma

      Steen, Mary; Cooper, Keith; Marchant, Paul; Griffiths-Jones, Martin; Walker, James; Community Midwifery Office, St James University Hospital, Leeds (Churchill Livingstone, 2000-03)
      OBJECTIVE: To evaluate the effectiveness of standard regimes (ice packs and Epifoam) at relieving perineal trauma and compare these with a new cooling device (maternity gel pad). DESIGN: A randomised controlled trial involving three treatment groups. The women were free to choose the time of initial application (within four hours after delivery) in all treatment groups and the number of subsequent treatments up to 48 hours after suturing. SETTING: A midwifery unit in the north of England and then continued in the women's own homes. PARTICIPANTS: 120 women who had undergone an instrumental delivery and had a 48 hours post-delivery stay in a postnatal ward. MEASUREMENTS AND FINDINGS: The ordinal scale of none, mild, moderate and severe was used to determine the levels of perineal oedema and bruising at initial assessment (less than 4 hours), 24 hours and at 48 hours, by use of a newly developed visual evaluating tool. Self-assessed pain was recorded using a 10-point visual analogue scale within four hours, at 24 hours, 48 hours, and finally at five days after suturing. Women's opinions as to the effectiveness of their treatment was rated by use of a 5-point scale describing the categories; poor, fair, good, very good and excellent. A high proportion of women had some perineal oedema at initial assessment. A statistically significant difference in the proportion of women with oedema was found between treatment groups at 48 hours (p = 0.01), which was in favour of the maternity gel pad group. This was particularly noticeable for women with initial levels of mild oedema (p = 0.017). Localised treatment with the gel pad caused a significant decrease in reported pain at 48 hours in women who initially demonstrated moderate or severe pain (p = 0.048). A significant increase in the proportion of women with some bruising was seen across all treatment groups from initial assessment, through 24 hours to 48 hours (p < 0.0005). The bruising was significantly less in the gel-pad group in women who initially had no bruising (p = 0.021). There was no statistically significant effect of treatment at other initial levels of severity for oedema, bruising or pain at 24 hours, 48 hours and five days (for pain). Women in the gel-pad group rated the effectiveness of their localised treatment to be significantly higher than women in the other two treatment groups (p < 0.0005). KEY CONCLUSIONS: This trial demonstrated that a high proportion of women experience perineal oedema, bruising and pain following an instrumental delivery, which continues for at least five days for perineal pain, despite oral analgesia. Maternity gel pads, which were specially designed to cool the perineal region, were more effective in alleviating perineal trauma when compared with hospital standard regimens and were more highly rated by women.
    • A randomised controlled trial to evaluate the effectiveness of localised cooling treatments in alleviating perineal trauma: The APT study

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (MIDIRS, 2002-09)
      This article reports a randomised controlled trial conducted at St James's University Hospital in Leeds comparing the effectiveness of cooling gel pads with ice packs and no localised treatment for relieving pain following perineal injury during childbirth.
    • Reablement and support workers

      Dibsdall, L; Clampin, A.; Chapman, Hazel M.; Ebrahimi, V.A.; University of Chester (Macmillan, 2018-03-30)
      Chapter outline Support workers are key to the delivery of reablement services as they are the people who work on a day-to-day basis with service users. Support workers may join reablement teams without any experience in working in health and social care. More commonly, support workers move into reablement teams from therapy assistant roles or from working in a home care service. These support workers bring a wealth of experience to the role, but differences in both the process and the outcome of reablement and home care can offset the benefits of this experience. Reablement is a change in approach to care from being ‘task-led’ to a ‘doing with’, person-centred and outcomes-based approach. This holistic view of working with people who use these services has been largely welcomed by support workers who enjoy supporting them to do more for themselves. This chapter will consider some key skills and techniques used by support workers in reablement services, such as use of equipment, activity analysis and energy conservation. Support workers need appropriate training and education in reablement so that practice is meaningful, and the concept of reablement is clearly understood and articulated. This is fundamental to an inclusive approach to interacting with the service user, enabling them to grow in confidence and autonomy, and engage in the process of reablement. Suggested topics for inclusion in reablement training are included in this chapter and it is argued that occupational therapists (OT) are suitably experienced, and well placed, to provide this training. Before reading any further, you may want to recap on the concept discussed in Chapter 1 in the section ‘Defining occupation, activity and task (OAT) for reablement interventions’. Chapter objectives By the end of this chapter you should be able to: ➢➢ Outline the development of the reablement support worker role ➢➢ Compare and contrast ‘doing to’ and ‘doing with’ support worker approaches ➢➢ Explain the role of the support worker ➢➢ Evaluate equipment and reablement techniques support workers may use ➢➢ Describe the training requirements for being a support worker ➢➢ Consider the opportunities and challenges of being a support worker
    • Reablement services in health and social care

      Ebrahimi, V.A.; Chapman, Hazel M.; University of Chester (Macmillan, 2018-03-30)
      Edited book with concluding remarks written by the editors.
    • Reactions of patients and carers

      Phillips, Sue; University of Chester (SAGE, 2010-10-15)
      This book chapter discusses the ways in which people react to news of terminal illness.
    • Real-world comparative analysis of bleeding complications and health-related quality of life in patients with haemophilia A and haemophilia B.

      Booth, Jason; Oladapo, Abiola; Walsh, Shaun; O'Hara, Jamie; Carroll, Liz; Garcia Diego, Daniel-Anibal; O'Mahony, Brian (2018-08-09)
      Clinical severity and impact of haemophilia on quality of life have been generally considered to be lower for haemophilia B (HB) compared with haemophilia A (HA) patients. To compare annual bleeding rate (ABR), target joint development and health-related quality of life (HRQoL) between adult (≥18 years) severe HA and HB patients using recent data from the Cost of Haemophilia in Europe: a Socioeconomic Survey (CHESS) study. Multivariate generalized linear models (GLM) were constructed to assess the relationship between haemophilia type, ABR, HRQoL (derived from EQ-5D index scores) and the presence of target joints while controlling for covariates. Of the 1225 patients included, 77% (n = 949) had HA and 23% (n = 278) had HB. Of the 514 patients who completed the EQ-5D, 78% (n = 405) had HA, and 22% (n = 110) had HB. Unadjusted mean ABR was 3.79 in HA and 4.60 in HB. The presence of ≥1 target joint was reported in 59% and 54% of patients with HA and HB, respectively. Unadjusted mean EQ-5D index score was 0.78 in HA and 0.76 in HB. Haemophilia type was not a significant predictor of ABR, target joints or HRQoL when adjusted for confounding factors such as BMI, age and replacement therapy regimen. Data suggest comparable ABR, incidence of target joints and HRQoL between patients with HB and HA indicating comparable clinical severity and disease impact on patient quality of life. [Abstract copyright: © 2018 John Wiley & Sons Ltd.]
    • Real-world evidence on Kovaltry (81-8973) in children with moderate or severe hemophilia A in Europe: a nested cohort analysis

      O’Hara, Jamie; Hirst, Ceri; orcid: 0000-0001-9094-2437; email: ceri.hirst@bayer.com; Cabre Marquez, Jose Francisco; Burke, Tom (BioMed Central, 2021-01-15)
      Abstract: Background: Untreated hemophilia A patients may experience recurrent bleeding events leading to debilitating joint damages. While RCT and pharmacokinetic data support the value of Kovaltry [an unmodified full-length recombinant factor VIII (FVIII) product], real world evidence in children is lacking. This report describes a descriptive and multivariate analysis of the effectiveness of Kovaltry in children with hemophilia A in the real-world setting, using data from medical chart abstraction and cross-sectional surveys of physicians, patients, and caregivers. Results: Male patients aged < 18 years with moderate or severe hemophilia A, residing in five European countries and treated with FVIII were studied. The co-primary endpoints were the annualized bleeding rate (ABR) and the annual FVIII utilization rate. Twenty nine patients treated with Kovaltry were included, of whom 93% had severe disease and 75% were on continuous prophylactic treatment. The mean ABR was 2.66 ± 2.06, with rates decreasing with age. The children received on average 2.45 infusions per week, consistent across age groups (median 3; range 1–3). There were no reports of inhibitor development or adverse events in the study (AEs), and all patients were satisfied or very satisfied with the treatment. An exploratory multivariate analysis suggests no significant difference in ABR or units utilized between Kovaltry and some extended half life products in children with severe hemophilia A, though characteristics of these patient cohorts were markedly different. Conclusion: This analysis demonstrates the effectiveness and safety of Kovaltry in a pan-European pediatric population with severe hemophilia A.
    • Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 2016–20

      Barlow, Pepita; Sanap, Rujuta; Garde, Amandine; Winters, L. Alan; Mabhala, Mwandile A.; Thow, Anne-Marie; London School of Economics and Political Science; Univeristy of Liverpool; University of Sussex Business School; University of Chester; University of Sydney
      To ensure a high level of health protection, governments must ensure that health and trade policy objectives are aligned. We conducted a systematic review of the health impacts of trade policies, including trade and investment agreements (TIAs), to provide a timely overview of this field. We systematically reviewed studies evaluating the health impacts of trade policies published between Jan 19, 2016, and July 10, 2020. Included studies were quantitative studies evaluating the impact of TIAs and trade policies on health determinants or outcomes. We evaluated methodological quality and performed a narrative synthesis. 21 of 28 067 articles identified via searches met our criteria. Methodologically strong studies found reduced child mortality, deteriorating worker health, rising supplies of sugar, ultra-processed food, tobacco, and alcohol supplies, and increased drug overdoses following trade reforms, compared with the time periods before trade reform. However, associations varied substantially across contexts and socioeconomic characteristics. Our findings show that trade policies, including TIAs, have diverse effects on health and health determinants. These effects vary substantially across contexts and socioeconomic groups. Governments seeking to adopt healthy trade policies should consider these updated findings to ensure that opportunities for health improvement are leveraged and widely shared, while harms are avoided, especially among vulnerable groups.
    • Recovery budget in a mental health service: Evaluating recovery budgets for people accessing an early intervention service and the impact of working with self directed services on the team members within a north west of England NHS trust

      Coyle, David L.; University of Chester (University of Chester, 2009-07)
      This report follows a 12 month pilot of implementing Individual Recovery Budgets within an early intervention service across Mersey Care NHS Trust.
    • Recruitment to the “Breast—Activity and Healthy Eating After Diagnosis”(B-AHEAD) Randomized Controlled Trial

      Pegington, Mary; Adams, JE; Campbell, AM; Bundred, Nigel J.; Howell, Anthony; Howell, Sacha J.; Speed, Shaun; Wolstenholme, J; Harvie, Michelle N.; University Hospital of South Manchester; University of Manchester; Central Manchester University Hospitals NHS Foundation Trust; Edinburgh Napier University; The Christie NHS Foundation Trust; University of Oxford; University of Chester
      Excess weight at breast cancer diagnosis and weight gain during treatment are linked to increased breast cancer specific and all-cause mortality. The Breast—Activity and Healthy Eating After Diagnosis (B-AHEAD) trial tested 2 weight loss diet and exercise programmes versus a control receiving standard written advice during adjuvant treatment. This article identifies differences in characteristics between patients recruited from the main trial site to those of the whole population from that site during the recruitment period and identifies barriers to recruitment. A total of 409 patients with operable breast cancer were recruited within 12 weeks of surgery. We compared demographic and treatment factors between women recruited from the main trial coordinating site (n = 300) to the whole breast cancer population in the center (n = 532). Uptake at the coordinating site was 42%, comparable to treatment trials in the unit (47%). Women recruited were younger (55.9 vs 61.2 years, P < .001), more likely to live in least deprived postcode areas (41.7% vs 31.6%, P = .004), and more likely to have screen-detected cancers (55.3% vs 48.7%, P = .026) than the whole breast cancer population. The good uptake highlights the interest in lifestyle change around the time of diagnosis, a challenging time in the patient pathway, and shows that recruitment at this time is feasible. Barriers to uptake among older women and women with a lower socioeconomic status should be understood and overcome in order to improve recruitment to future lifestyle intervention programs.
    • Reflecting on the characteristics and values of military nurses: war zone qualitative research

      Finnegan, Alan; University of Chester
      Background. Between 2001 and 2014, British military nurses served in Afghanistan caring for both Service personnel and local nationals of all ages. However, there have been few research studies assessing the effectiveness of the military nurses’ operational role and no papers naming the core values and characteristics. This paper is the only qualitative nursing study completed in this period where data was collected in the War Zone. Objective. To explore the characteristics and values that are intrinsic to military nurses in undertaking their operational role. Design. A Constructivist Grounded Theory was utilised. The first author designed the interview schedule, then conducted and transcribed the discussions. Informed consent and UK Ministry of Defence Research Ethical Committee approval was obtained. Setting. Camp Bastion Hospital, Afghanistan, in 2013. Method. Semi-structured interviews were conducted with 18 British Armed Forces nurses. Results. A theoretical model was developed that identifies the intrinsic characteristics and values required to be a military nurse. Nursing care delivered within the operational environment was perceived as outstanding. Nurses consciously detached themselves from any legal processes and treated each casualty as a vulnerable patient, resulting in care, compassion and dignity being provided for all patients, irrespective of their background, beliefs or affiliations. Conclusion. The study findings provides military nurses with a framework for a realistic personal development plan that will allow them to build upon their strengths as well as to identify and ameliorate potential areas of weakness. Placing nurses first, with a model that focusses on the requirements of a good nurse has the potential to lead to better patient care, and improve the quality of the tour for defence nurses. These findings have international implications and have the potential for transferability to any level of military or civilian nursing practice.
    • Reflection

      Gidman, Janice; Mannix, Jean; University of Chester (SAGE, 2008-03-17)
      This book chapter discusses reflection as a learning, teaching, and assessment strategy and its benefits.
    • 'Reflections on a birthday': An auto-ethnographic account of caring for a child with a learning disability

      Gant, Valerie; University of Chester (Sage, 2016-09-10)
      This commentary offers some of the author’s experiences of parenting a child with a severe learning disability and complex and challenging behaviours. Drawing on principles of auto-ethnography and critical reflection, the author considers issues of transition from children’s to adult social care services and the potential for support from a new piece of UK Legislation, the Care Act, 2014.
    • Regulation of corticosteroid receptors in the rat brain: The role of serotonin and stress

      Robertson, Deborah A. F.; Beattie, J. E.; Reid, I. C.; Balfour, David J. K.; University of Chester (Roberston) (Blackwell, 2005-04-12)
    • Relationship based practice past and present and its knowledge foundations in the contemporary curriculum

      Harlow, Elizabeth; University of Chester (2012-07-02)
      Published in 1957, Biestek’s text The Casework Relationship might be described as a social work classic. According to Biesteck, social science formed the foundations for practice. Whilst sociology was valued, it was psychoanalytic and humanist psychology that appeared to be of greatest significance. Biestek drew on psychological knowledge as a means of understanding others, but personal reflection was also considered to be crucial: put another way, in order to understand others, a practitioner had to understand him or herself. It was scientific knowledge, as well as a deep understanding of the self, that enabled practitioners to build purposeful relationships with clients or service users. Biestek emphasised relationship as essential to humanity: relationships were seen as the most crucial component of our existence and the main source of our happiness. In terms of social work, it was by means of the practitioner – client relationship that problems were resolved. With the cultural change of the 1960s, Biestek’s work became an edifice of another era. Whilst Howe (2008) suggests that enclaves of relationship based casework have continued over the years, of late there has been a more evident promotion of this approach (see Hennessey 2011; Munro 2011 and Ruch et al. 2010). Concerned as this conference is with the question of whether developments in social work are evolving or revolving, this theory based paper draws on evidence from the literature, and compares relationship based practice of the past with relationship based practice of the present. In acknowledging the particular contribution of psychology to this approach, the paper will include a brief reflection on the place of this discipline in the newly emerging curriculum.
    • The relationship between target joints and direct resource use in severe haemophilia

      O’Hara, Jamie; Walsh, Shaun; Camp, Charlotte; Mazza, Giuseppe; Carroll, Liz; Hoxer, Christina; Wilkinson, Lars; University of Chester; HCD Economics, The Innovation Centre, Daresbury; University College London; The Haemophilia Society; Novo Nordisk A/S (SpringerOpen, 2018-01-16)
      Objectives Target joints are a common complication of severe haemophilia. While factor replacement therapy constitutes the majority of costs in haemophilia, the relationship between target joints and non drug-related direct costs (NDDCs) has not been studied. Methods Data on haemophilia patients without inhibitors was drawn from the ‘Cost of Haemophilia across Europe – a Socioeconomic Survey’ (CHESS) study, a cost assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the United Kingdom) in which 139 haemophilia specialists provided demographic and clinical information for 1285 adult patients. NDDCs were calculated using publicly available cost data, including 12-month ambulatory and secondary care activity: haematologist and other specialist consultant consultations, medical tests and examinations, bleed-related hospital admissions, and payments to professional care providers. A generalized linear model was developed to investigate the relationship between NDDCs and target joints (areas of chronic synovitis), adjusted for patient covariates. Results Five hundred and thirteen patients (42% of the sample) had no diagnosed target joints; a total of 1376 target joints (range 1–10) were recorded in the remaining 714 patients. Mean adjusted NDDCs for persons with no target joints were EUR 3134 (standard error (SE) EUR 158); for persons with one or more target joints, mean adjusted NDDCs were EUR 3913 (SE EUR 157; average mean effect EUR 779; p < 0.001). Conclusions Our analysis suggests that the presence of one or more target joints has a significant impact on NDDCs for patients with severe haemophilia, ceteris paribus. Prevention and management of target joints should be an important consideration of managing haemophilia patients.
    • Relationship between the individual and society

      Lovell, Andy; University of Chester (SAGE, 2008-03-17)
      This book chapter discusses social order, social change, and socialisation.
    • Relationship to practice

      Watkins, Caroline; Carlisle, Caroline; Whitehead, Elizabeth; Mason, Tom; Manchester University ; University of Liverpool ; Chester College of Higher Education ; Clinic/University of Glamorgan (Routledge, 2001-07-12)
      This book chapter discusses the macro and micro levels of practical impact that theories relating to stigma can have on individuals and groups.