Stoke-on-Trent, United Kingdom
Stoke-on-Trent, United Kingdom

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Mackey H.,Haywood Hospital | Mackey H.,Keele University
Australian Occupational Therapy Journal | Year: 2014

Background/aim: Reform of health organisations has brought significant changes to healthcare systems with attendant consequences for the definition and practice of professionalism. Occupational therapists must continually strive to provide excellent patient care, delivering positive patient outcomes whilst responding effectively to increasing fiscal constraint and changing organisational paradigms. This paper explores the experiences of occupational therapists as they reconstruct professionalism as a consequence of health care reform in England. Method: Fourteen occupational therapists were interviewed over 12 months across five National Health Service organisations in England. Each participant was interviewed three times and was asked to keep a monthly diary of critical incidents. A process of narrative analysis was developed to analyse these data. Results: Findings suggest that changes have occurred in the National Health Service which affects notions of professional values, expertise, status and accountability. However, far from seeing themselves as mere responders to stimuli, occupational therapists tell of mediating policies, of responding, experimenting and redefining choices whilst struggling to reconstruct professionalism. Conclusions: It is suggested that professionalism can be conceived as a reflexive ethical concept in that it is through the process of reflecting on the discursive and behavioural options and values available that occupational therapists come to understand, and define their professional selves. © 2013 Occupational Therapy Australia.


Vowles K.E.,University of New Mexico | Vowles K.E.,Haywood Hospital | Witkiewitz K.,University of New Mexico | Sowden G.,Haywood Hospital | And 3 more authors.
Journal of Pain | Year: 2014

There is an emerging body of evidence regarding interdisciplinary acceptance and commitment therapy in the rehabilitative treatment of chronic pain. This study evaluated the reliability and clinical significance of change following an open trial that was briefer than that examined in previous work. In addition, the possible mediating effect of psychological flexibility, which is theorized to underlie the acceptance and commitment therapy model, was examined. Participants included 117 completers of an interdisciplinary program of rehabilitation for chronic pain. Assessment took place at treatment onset and conclusion, and at a 3-month follow-up when 78 patients (66.7%) provided data. At the 3-month follow-up, 46.2% of patients achieved clinically significant change, and 58.9% achieved reliable change, in at least 1 key measure of functioning (depression, pain anxiety, and disability). Changes in measures of psychological flexibility significantly mediated changes in disability, depression, pain-related anxiety, number of medical visits, and the number of classes of prescribed analgesics. These results add to the growing body of evidence supporting interdisciplinary acceptance and commitment therapy for chronic pain, particularly with regard to the clinical significance of an abbreviated course of treatment. Further, improvements appear to be mediated by changes in the processes specified within the theoretical model. Perspective Outcomes of an abbreviated interdisciplinary treatment for chronic pain based on a particular theoretical model are presented. Analyses indicated that improvements at follow-up mediated change in the theorized treatment process. Clinically significant change was indicated in just under half of participants. These data may be helpful to clinicians and researchers interested in intervention approaches and mechanisms of change. © 2014 by the American Pain Society.


Chen Y.,Keele University | Chen Y.,Haywood Hospital | Nixon N.B.,Haywood Hospital | Dawes P.T.,Haywood Hospital | And 2 more authors.
Genes and Immunity | Year: 2012

Matrix metalloproteinases (MMPs) are involved in joint destruction in rheumatoid arthritis (RA), and are strongly associated with levels of inflammation. To understand the relationship between MMP-1 and-3 variants and MMP levels in RA, we investigated the genotypic and haplotypic relationships of the MMP-1 and-3 genes with circulating levels of these MMPs. The genotypes of single-nucleotide polymorphisms (SNPs) rs1799750 (1G/2G, MMP-1 promoter), rs495366 (G/A, intergene), rs679620 (A/G, MMP-3 coding region) and rs3025058 (5A/6A, MMP-3 promoter) were determined in 430 RA patients. Each polymorphism was associated with serum levels of MMP-1 (P trend <0.0001 for each SNP), with haplotype 1G-G-A-5A associated with the highest level. The intergenic and MMP-3 SNPs were associated with MMP-1 levels independent of the MMP-1 promoter SNP. The MMP-3 SNPs were associated with serum MMP-3 level (P trend <0.0001 for each SNP), and were each associated with mean time-averaged disease activity (DAS28) in patients followed up for 2 years (P=0.003). Our findings indicate that several closely linked polymorphisms in the MMP-1-MMP-3 loci have an important role in determining the circulating levels of these MMPs in RA, and that MMP-3 polymorphism is associated with the level of disease activity over time. © 2012 Macmillan Publishers Limited All rights reserved.


Vowles K.E.,Haywood Hospital | Vowles K.E.,Keele University | Thompson M.,Goldsmiths, University of London
Current Pain and Headache Reports | Year: 2012

The relationship between patient and provider has long been the subject of study within the psychotherapy literature, with the available data suggesting a modest, but reliable, association between the strength of this relationship and treatment outcome. Conversely, there has been little work focused on the patient-provider relationship in chronic pain settings despite the complexities and difficulties that are often involved in this area. This review provides a brief, broad overview of the literature on the patient-provider relationship and identifies key aspects that are specifically relevant to chronic pain settings. In addition to reviewing the literature in this area, a series of recommendations for future clinical and academic work are offered. © Springer Science+Business Media, LLC 2012.


Chen Y.,Haywood Hospital | Chen Y.,Keele University | Dawes P.T.,Haywood Hospital | Mattey D.L.,Haywood Hospital | Mattey D.L.,Keele University
Cytokine | Year: 2012

Objective: To assess the impact of common genetic variants in the vascular endothelial growth factor A (VEGFA) gene on circulating VEGF-A levels and disease activity in patients with rheumatoid arthritis (RA). Methods: A cohort (n=. 419) of consecutively recruited RA patients of Caucasian origin was studied. Disease activity (DAS28) was recorded on a regular basis (0, 12 and 24. months). Smoking history (never, past and current) was obtained. PCR-RFLP assays were used to determine the genotypes of VEGFA single-nucleotide polymorphisms (SNP) including VEGFA-2578 (rs699947), -460 (rs833061), +405 (rs2010963) and +936 (rs3025039). Circulating levels of VEGF-A were measured in serum samples using a fluorescent bead-based assay system (Luminex®). Associations were analyzed using univariate and multivariate statistics. Results: VEGFA-2578 AA genotype was associated with lower serum VEGF-A levels, as was the most frequent haplotype (A -2578-C -460-G +405, 48.1%) within the 5'-flanking region of the gene. The same genotype and haplotype were also associated with decreased disease activity in RA. This was seen only in patients who had never smoked. In multivariate multiple regression models, the VEGFA-2578 SNP was shown to be associated with disease activity at presentation (p=0.029) and over time (p=0.016) in patients who never smoked, independent of serum VEGF-A levels and other confounding factors. Conclusion: Genetic variation in the VEGFA gene is associated with serum VEGF-A levels in RA, and shows an association with disease activity in RA patients who have never smoked, independent of serum VEGF-A levels. © 2012 Elsevier Ltd.


Chen Y.,Haywood Hospital | Chen Y.,Keele University | Dawes P.T.,Haywood Hospital | Packham J.C.,Haywood Hospital | And 2 more authors.
Arthritis Research and Therapy | Year: 2012

Introduction: Transforming growth factor-beta1 (TGF-beta1) is a pleiotropic cytokine that plays important roles in immunity and inflammation. Some studies have suggested that polymorphism in the TGFB1 gene is associated with heart disease in the general population. The purpose of the present study was to determine whether common single-nucleotide polymorphisms (SNP) in the TGFB1 gene are associated with ischaemic heart disease (IHD) and/or myocardial infarction (MI) in patients with rheumatoid arthritis (RA), and to investigate the influence of smoking on any association.Methods: PCR-based assays were used to determine the genotypes of TGFB1 SNPs including TGFB1-509 C/T (rs1800469, in the promoter region), +868 T/C (rs1800470, in exon 1) and +913 G/C (rs1800471, in exon 1) in 414 subjects with established RA. Genotyping for the +868 SNP was also carried out on a second study population of RA patients (n = 259) with early disease. Serum levels of TGF-beta1 were measured using a commercial ELISA kit. Smoking history and IHD/MI status were obtained on each patient. Associations with IHD/MI were assessed using contingency tables and logistic regression analyses.Results: The heterozygous genotype of TGFB+868 was associated with an increased risk of IHD (OR 2.14, 95% CI 1.30 - 3.55) and MI (OR 2.42, 95% CI 1.30-4.50), compared to the homozygous genotypes combined. Smoking was an independent risk for IHD and MI, and evidence of interaction between smoking and TGFB+868 was found. Multivariate analyses indicated that the strongest associations with IHD and MI were due to the combined effect of the TGFB1+868 TC genotype and smoking (OR 2.75, 95% CI 1.59-4.75; and OR 2.58 95% CI 1.33-4.99, respectively), independent of other cardiovascular risk factors. The association of the +868 TC genotype and evidence of +868 TC-smoking interaction with IHD were replicated in a second population of RA patients with early disease. Serum TGF-beta1 levels were not associated with TGFB1 genetic variations, smoking or IHD/MI status.Conclusions: Interaction between smoking and polymorphism in the TGFB1 gene may influence the risk of IHD and MI in patients with RA. © 2012 Chen et al.; licensee BioMed Central Ltd.


Hassell A.,Keele University | Hassell A.,Haywood Hospital
Medical Teacher | Year: 2012

Patient instructors are patients trained to teach students in focussed history taking and/or examination in the context of the patient's specific illness. Their espousal has been quite extensively reported in rheumatology. The majority of studies show that patient instructors are effective in enhancing the knowledge and skills relevant to practice concerned with patients with the given conditions (in this case, typically rheumatoid arthritis and osteoarthritis). Most studies show patient instructors to be as effective as clinicians in this respect. They are especially effective at enhancing students' understanding of the impact of living with a chronic condition. With appropriate (quite extensive) training, they can also assess the examination skills of students, both undergraduate and postgraduate. Students value them, and the patient instructors themselves derive benefit from the activity. There are issues to be aware of regarding the adoption of patient instructors. The training required is significant. If employed as described in the literature, quite significant selection criteria come into play. In some cases, patient instructors feel under-rewarded financially; they should not be seen as medical education on the cheap. Nonetheless, patient instructors represent an excellent, relatively under-utilised, resource for the aiding of student learning in many areas of medicine. © 2012 Informa UK Ltd.


Chen Y.,Haywood Hospital | Chen Y.,Keele University | Mattey D.L.,Haywood Hospital | Mattey D.L.,Keele University
Clinical and Experimental Rheumatology | Year: 2012

Objective: The present paper aims to investigate whether polymorphisms in the vascular endothelial growth factor A (VEGFA) gene and the loci of matrix metalloproteinase (MMP) 1 and 3 genes are associated with age at onset of RA. Methods: A sample of 413 hospital-based RA patients of Caucasian origin was studied. Common single-nucleotide polymorphisms (SNP) with likely importance were typed, including rs699947, rs833061, rs2010963 and rs3025039 in VEGFA, and rs1799750 in the MMP1 gene, rs3025058, rs679620 in the MMP3 gene and rs495366 located within the region between the MMP1 and MMP3 genes. Age at onset of RA was obtained on each patient. Demographic variables, smoking information, and a core set of clinical characteristics measured at recruitment were recorded. Hazard ratios (HR) that measured the effect size of genetic risk on age at RA onset were computed using Cox regression models. Results: The T allele at rs3025039 was associated with an increased risk of early onset (HR=1.25 [95% CI 1.0-1.58] for the risk over time; HR=1.84 [95% CI 1.20-2.83] for the risk of onset <40 years old). The AA genotype at rs495366 was also associated with an increased risk (HR=1.92 [95% CI 1.27-2.89] over time; HR=2.54 [95% CI 1.30-4.95] for onset <40 years old). These associations were independent of other risk factors such as sex, smoking and anti-CCP status. Conclusion: Polymorphisms in the VEGFA gene and the MMP1-3 intergenic locus may influence age at onset of RA. © CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2012.


Ryan S.,Haywood Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2013

Fibromyalgia is a common condition characterised by widespread musculoskeletal pain, muscle stiffness, unrefreshed sleep and fatigue. The condition is associated with several physical and psychological manifestations, including irritable bowel syndrome and anxiety. The efficacy of drug therapy is limited, therefore the nurse has an important role in providing advice and guidance on symptom management to optimise functioning for patients.


Ward A.B.,Haywood Hospital
European Journal of Neurology | Year: 2014

Click here to view the accompanying paper in this issue. © 2014 EAN.

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