Easton P.,NHS Tayside |
Entwistle V.A.,University of Aberdeen |
Williams B.,University of Stirling
BMC Health Services Research | Year: 2013
Background: Low literacy is a significant problem across the developed world. A considerable body of research has reported associations between low literacy and less appropriate access to healthcare services, lower likelihood of self-managing health conditions well, and poorer health outcomes. There is a need to explore the previously neglected perspectives of people with low literacy to help explain how low literacy can lead to poor health, and to consider how to improve the ability of health services to meet their needs. Methods. Two stage qualitative study. In-depth individual interviews followed by focus groups to confirm analysis and develop suggestions for service improvements. A purposive sample of 29 adults with English as their first language who had sought help with literacy was recruited from an Adult Learning Centre in the UK. Results: Over and above the well-documented difficulties that people with low literacy can have with the written information and complex explanations and instructions they encounter as they use health services, the stigma of low literacy had significant negative implications for participants' spoken interactions with healthcare professionals.Participants described various difficulties in consultations, some of which had impacted negatively on their broader healthcare experiences and abilities to self-manage health conditions. Some communication difficulties were apparently perpetuated or exacerbated because participants limited their conversational engagement and used a variety of strategies to cover up their low literacy that could send misleading signals to health professionals.Participants' biographical narratives revealed that the ways in which they managed their low literacy in healthcare settings, as in other social contexts, stemmed from highly negative experiences with literacy-related stigma, usually from their schooldays onwards. They also suggest that literacy-related stigma can significantly undermine mental wellbeing by prompting self-exclusion from social participation and generating a persistent anxiety about revealing literacy difficulties. Conclusion: Low-literacy-related stigma can seriously impair people's spoken interactions with health professionals and their potential to benefit from health services. As policies increasingly emphasise the need for patients' participation, services need to simplify the literacy requirements of service use and health professionals need to offer non-judgemental (universal) literacy-sensitive support to promote positive healthcare experiences and outcomes. © 2013 Easton et al.; licensee BioMed Central Ltd.
Kiran M.,NHS Tayside |
Boscainos P.J.,University of Dundee
Journal of Arthroplasty | Year: 2015
We report a series of three patients who underwent uncemented total hip arthroplasty with a modular titanium-molybdenum-zirconium-iron stem and a cobalt-chrome-molybdenum head on an ultra-high molecular weight highly cross-linked polyethylene liner bearing. All three cases subsequently developed pain and adverse reaction to metal debris, leading to revision of the implants within thirty-six months. They were subsequently found to have hypersensitivity to cobalt or chromium. However where tested, blood metal ion levels were within MHRA guideline limits. Corrosion was noted at the taper-trunnion junction. It is possible, that the multi alloy head-neck combination may lead to corrosion. Hypersensitivity to metal ions may result to ARMD at lower metal ion levels. The use of ceramic heads may help avoid this risk. © 2014 Elsevier Inc.
Easton P.,NHS Tayside |
Entwistle V.A.,11 Health |
Williams B.,11 Health
BMC Public Health | Year: 2010
Background. Much of the evidence of an association between low functional or health literacy and poor health comes from studies that include people who have various cognitive difficulties or who do not speak the dominant language of their society. Low functional or health literacy among these people is likely to be evident in spoken conversation. However, many other people can talk readily about health and other issues but have problems using written information. Consequently, their difficulties may be far less evident to healthcare professionals, creating a 'hidden population' whose functional or health literacy problems have different implications because they are less likely to be recognised and addressed. We aimed to review published research to investigate relationships between low functional or health literacy and health in working age adults who can converse in the dominant language but have difficulty with written language. Methods. We searched reviews and electronic databases for studies that examined health-related outcomes among the population of interest. We systematically extracted data relating to relationships between low functional or health literacy and both health status and various possible mediators or moderators of the implications of literacy for health. We developed a narrative review. Results. Twenty-four studies met our inclusion criteria. Lower functional or health literacy in this population was found to be associated with worse health status. This may be mediated by difficulties accessing healthcare, and poorer self-management of health problems. It is currently unclear whether, how or to what extent these difficulties are mediated by poorer knowledge stemming from low functional or health literacy. The variation in functional or health literacy measures and comparisons make it difficult to compare study findings and to establish the implications of different literacy issues for health outcomes. Conclusions. There is evidence in the literature that low functional or health literacy is associated with poor health in the 'hidden population' of adults whose literacy difficulties may not be evident to health care providers. Further research is needed to help understand the particular disadvantages faced by this population and to establish appropriate responses. © 2010 Easton et al; licensee BioMed Central Ltd.
Lynch J.E.,NHS Tayside |
Henderson N.R.,NHS Tayside |
Ramage L.,NHS Tayside |
McMurdo M.E.T.,University of Dundee |
Witham M.D.,University of Dundee
Age and Ageing | Year: 2012
Background: statin drugs may induce skeletal myopathy, but might also have the potential to improve rehabilitation outcomes by improving sarcopenia or by preventing intercurrent illness. We examined the association between statin use and functional outcomes in the rehabilitation of older people.Methods: retrospective cohort study using routinely collected clinical data. Admissions to Royal Victoria Hospital, Dundee for inpatient rehabilitation over a 10-year period were identified. Data were available regarding demographics, statin therapy, antiplatelet therapy, admission and discharge Barthel scores, length of stay and comorbid disease. Multivariate analyses were performed to examine the difference between admission and discharge Barthel score in patients taking statins compared with those not taking statins.Results: a total of 3,422 patients were included. Mean age was 81.4 years; 40% were male. Baseline Barthel scores were similar in the statin/non-statin groups, respectively (10.4/20 versus 10.3/20, P = 0.57). Improvement in the Barthel score between admission and discharge was greater in the statin than non-statin group (3.59 versus 4.30 points, P < 0.001) after adjustment for age, sex, baseline Barthel score and comorbid disease.Conclusion: statin use was associated with improved Barthel scores on discharge from rehabilitation. This gain could contribute to improved outcomes as part of the rehabilitation package and requires further prospective investigation. © The Author 2011. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
Beveridge L.A.,Ninewells Hospital and Medical School |
Davey P.G.,University of Dundee |
Phillips G.,NHS Tayside |
McMurdo M.E.T.,Ninewells Hospital and Medical School
Clinical Interventions in Aging | Year: 2011
Urinary tract infections (UTI) occur frequently in older people. Unfortunately, UTI is commonly overdiagnosed and overtreated on the basis of nonspecific clinical signs and symptoms. The diagnosis of a UTI in the older patient requires the presence of new urinary symptoms, with or without systemic symptoms. Urinalysis is commonly used to diagnose infection in this population, however, the evidence for its use is limited. There is overwhelming evidence that asymptomatic bacteriuria should not be treated. Catheter associated urinary tract infection accounts for a significant amount of hospital-associated infection. Indwelling urinary catheters should be avoided where possible and alternatives sought. The use of narrow spectrum antimicrobial agents for urinary tract infection is advocated. Local guidelines are now widely used to reflect local resistance patterns and available agents. Guidelines need to be updated to reflect changes in antimicrobial prescribing and a move from broad to narrow spectrum antimicrobials. © 2011 Beveridge et al, publisher and licensee Dove Medical Press Ltd.
Symon A.G.,University of Dundee |
Whitford H.,University of Dundee |
Dalzell J.,NHS Tayside
Midwifery | Year: 2013
Background: breast-feeding initiation rates have improved in Scotland, but exclusive and partial breast-feeding rates fall rapidly for several reasons. We aimed to examine whether antenatal feeding intention was associated with satisfaction with infant feeding method; and to explore the similarities and differences in infant feeding experience of women with different antenatal feeding intention scores. Method(s): antenatal questionnaire assessment of infant feeding intentions, based on the theory of planned behaviour; two-weekly postnatal follow-up of infant feeding practice by text messaging; final telephone interview to determine reasons for and satisfaction with infant feeding practice. Results: 355 women in eastern Scotland were recruited antenatally; 292 completed postnatal follow up. Antenatal feeding intentions broadly predicted postnatal practice. The highest satisfaction scores were seen in mothers with no breast-feeding intention who formula fed from birth, and those with high breast-feeding intention who breastfed for more than 8 weeks. The lowest satisfaction scores were seen in those with high intention scores who only managed to breast feed for less than 3 weeks. This suggests that satisfaction with infant feeding is associated with achieving feeding goals, whether artificial milk or breast feeding. Reasons for stopping breast feeding were broadly similar over time (too demanding, pain, latching, perception of amount of milk, lack of professional support, sibling jealousy). Perseverance appeared to mark out those women who managed to breast feed for longer; this was seen across the socio-economic spectrum. Societal and professional pressure to breast feed was commonly experienced. Conclusions: satisfaction with actual infant feeding practice is associated with antenatal intention; levels are higher for those meeting their goals, whether formula feeding from birth or breast feeding for longer periods. Perceived pressure to breast feed raises questions about informed decision making. Identifying those who will benefit most from targeted infant feeding support is crucial. © 2012 Elsevier Ltd.
Walsh S.,NHS Tayside
Diagnostic Histopathology | Year: 2015
Lynch Syndrome (LS) is a relatively common cause of inherited colorectal carcinoma which have many typical gross and microscopic features. Histopathologists play a critical role in identifying such tumours but also in screening cases for LS using modern molecular techniques. Immunohistochemistry for mismatch repair proteins, microsatellite instability testing and mutation analysis of key genes such as BRAF are important tools in this regard. Pathologists must be aware of the advantages and limitations of all these tests. © 2015 Elsevier Ltd.
Nadir M.A.,University of Dundee |
Dow E.,NHS Tayside |
Davidson J.,Nuclear Medicine |
Kennedy N.,Nuclear Medicine |
And 2 more authors.
European Journal of Heart Failure | Year: 2014
Aims: Plasma BNP and high-sensitivity cardiac troponin-T (hs-TnT) are elevated by both ischaemia and LV systolic dysfunction (LVSD). As a result, it is unknown whether BNP and/or hs-TnT could be useful biomarkers to identify ischaemia in the presence of LVSD. Methods and results: Three separate patient populations were studied. Study A (n = 500) involved consecutive patients undergoing clinically indicated myocardial perfusion scintigraphy, study B (n = 100) included patients with vascular disease but no known cardiac disease, and study C (n = 300) recruited primary prevention patients with controlled risk factors. Levels of BNP and hs-TnT were measured prior to the stress testing to detect myocardial ischaemia. The prevalence of myocardial ischaemia was 28.2, 28, and 6.3% in study A, B, and C, respectively. For BNP, area under curve (AUC) values to identify ischaemia in the presence and absence of coincidental LVSD were: 0.73 vs. 0.63 (study A), 0.90 vs. 0.81 (study B), and 0.83 vs. 0.80 (study C). Equivalent figures for hs-TnT were: 0.64 vs. 0.60 (study A), 0.75 vs. 0.68 (study B), and 0.53 vs. 0.68 (study C). BNP and hs-cTnT, when combined together, performed better with an AUC of 0.75 vs. 0.65 (study A), 0.91 vs. 0.92 (study B), and 0.84 vs. 0.83 (study C). Conclusion: In three separate populations a consistent finding is that BNP is increased further by myocardial ischaemia even in the presence of LVSD. A disproportionately high BNP for the degree of LVSD might be due to (unsuspected) ischaemia, and a disproportionately low BNP could be useful as a 'rule out' test for ischaemia even in the presence of LVSD. © The Author 2013.
Agency: GTR | Branch: EPSRC | Program: | Phase: Research Grant | Award Amount: 149.99K | Year: 2011
Robert is a 50 year old man who was a professional footballer into his early 20s. A stroke at 22 resulted in loss of speech and mobility. He uses a wheelchair and needs daily living assistance. Robert often tries to tell others stories about his football career as it is in telling his story that he hopes people will view him as someone other than a man in a chair . However, because of his severe speech impairment, it takes him time and effort to express even short messages; most people lose patience. Robert worries that when his older sister dies, there will be no one left who knows his life story and his social identity will be lost.Danni, a 30 year old woman with cerebral palsy, has never been able to communicate intelligibly using natural speech. As a child Danni was unable to engage in storytelling and did not develop the skills needed to share stories. Danni has participated in research projects and has demonstrated the ability to learn storytelling skills but remains unable to participate equally in interactive communication. She uses her voice output communication aid to express needs and wants, but sharing stories is frustratingly slow. She wants to explore new possibilities and make new friends, but is severely limited by her existing device. Robert and Danni are two of 365,000 people in the United Kingdom who could benefit more from augmentative and alternative communication. Although they both use voice output communication aids (VOCAs), they find great difficulty in engaging in interactive conversation. Current VOCAs are well suited to supporting the expression of needs and wants (such as I am thirsty), but more complex interactions such as conversational narrative (e.g., Did I tell you about the time I went to Spain?) and social dialogue (e.g., pub chats about football) is not well supported.This project aims to work with adults with severe speech and physical impairment, their support staff, families and friends to harness existing research technology to support them in formulating, editing and telling their own narratives. In particular, we will be using natural language generation to create stories from basic information relating to time, place, people and activity. For example, the nonspeaking person may use a photograph as a prompt to when, where, who and what are in the photo. From this information, it is possible to generate the sentences: Last week I was in London. My sister was there. We went up the London Eye. By choosing to add a positive or negative comment, the system might generate It was great. or I didnt like it. Nonspeaking adults will be involved in providing requirements for the system and will actively participate in designing the system functionality and interface. The system will allow the user to embellish narratives during interactive conversation and to maintain access to narrative over the lifespan of individuals. The end product will be a high level prototype which will be evaluated with users in different environments.
Agency: GTR | Branch: EPSRC | Program: | Phase: Research Grant | Award Amount: 293.22K | Year: 2013
A major challenge facing the health and wellbeing of people with intellectual disabilities is the level of anxiety experienced by both the disabled patient and the dentist. When a patient with intellectual disabilities is anxious, they may become defensive and exhibit challenging behaviour when the dentist attempts to treat them. As a result of this, the procedure may have to either be abandoned or the patient sedated. The need for sedation is a common problem in dentistry as patients with intellectual disabilities often require a general anaesthetic for simple dental treatment. This carries increased risks, a longer recovery time and increases the cost of the procedure to the NHS. One reason for patients anxiety is the difficulty in communication between patient and dentist. In particular, it can be difficult for dentists to provide patients with intellectual disabilities with information about the treatment they require in a way that they can understand. An inability to understand what is about to happen or to express feelings makes a visit to the dentist frightening and stressful. In addition, it is considered good practice to obtain informed consent or assent from all patients. However, clinicians are often unsure if a patient with intellectual disabilities has understood explanations of procedures. It is difficult for people with intellectual disabilities to understand how abstract information relates to them with the result that, compared to the general population, patients with intellectual disabilities find it significantly more difficult to make healthcare decisions. This study aims to develop a computer based communication system to support people with intellectual disabilities to understand dental procedures with the aim of reducing anxiety for both patients and clinicians, and to enable patients to be more involved in the decision making process. The system will run on a tablet device, e.g. an iPad. The system will automatically generate a story about a dental procedure which is personalised to the patient. This will allow the dentist to explain the procedure to the patient using a graphical interface. The patient will be able to use the system to ask questions about the procedure and express their feelings. We know that improved communication reduces the anxiety in both the patient and the dentist. This research will investigate whether giving more information to patients with intellectual disabilities improves the outcomes for: (i) the patient; (ii) the practitioner; and (iii) the health service by reducing the time and the resources required to support patients with intellectual disabilities. While this has the potential to produce benefits across the health service, this study will focus on dental health.