Colman Hospital

BACKGROUND: Surgical and respirator masks are worn to reduce the risk of droplet and airborne transmission of viral respiratory disease. As a result of the novel coronavirus (COVID-19) pandemic, mask wearing has been designated mandatory for healthcare professionals working in UK hospitals for the foreseeable future. It is thus timely to consider the long-term implications of mask wearing on communication within healthcare settings, from both a patient and a clinician perspective. AIMS: The primary objective is to identify research evidence that corresponds to the mask-wearing experiences of healthcare professionals working on the ground. By drawing together a summary of the literature illustrating the potential challenges associated with mask wearing, it is possible to make an application to various clinical cohorts and to formulate a set of preliminary, evidence-based support strategies. The paper additionally explores the role for the Speech and Language Therapist (SLT) in supporting communication in the context of mask wearing. METHODS & PROCEDURES: Through a scoping review of the relevant literature, this paper reflects holistically on the prospective challenges associated with mask wearing across a variety of healthcare settings and patient populations. The subsequent conclusions have been used to inform the proposed clinical guidelines for safe and effective practice. OUTCOMES & RESULTS: There is a current research gap with regards to mask wearing in non-medical and non-clinical healthcare workers, and the impact this may have on both a professional and a personal basis. In the absence of preliminary data, the development of associated communication support strategies is hindered. This paper draws upon a variety of clinically conceivable issues faced by healthcare professionals, outlines important practical and ethical considerations, and proposes evidence-based solutions to some of the challenges identified. Future research is required to gather evidence with regards to actual clinical experiences of mask wearing to substantiate hypotheses. CONCLUSIONS & IMPLICATIONS: Although undoubtedly essential in protecting the health of staff and patients, there are numerous logistical, physiological, psychological, social and economic complications associated with the wearing of masks. The ability of healthcare staff to successfully communicate with patients and with colleagues is jeopardized, which may adversely affect the efficiency, effectiveness, equitability and, most notably, safety of therapeutic intervention. The SLT has a distinct role in facilitating communication in order to safeguard the provision, accessibility and efficacy of services. What this paper adds What is already known on the subject Existing research explores the impact of mask wearing on medical doctors, surgeons and dentists, and upon the corresponding patient cohorts. Little is known about how mask wearing may affect Allied Health Professionals and their ability to deliver therapeutic interventions safely and effectively. With mandatory face covering potentially a long-term requirement for UK healthcare staff, it is both timely and relevant to consider the consequences of mask wearing on communication across acute and community settings. What this paper adds to existing knowledge This paper identifies a range of prospective key issues associated with mask wearing across a variety of clinical and non-clinical populations, with application specifically to vulnerable patient cohorts. Through evidence synthesis, this paper provides a summary of fundamental issues supported by relevant literature, and draws upon these in order to propose a preliminary set of evidence-based clinical guidelines setting out potential solutions to the challenges faced. This review additionally assists in quantifying the role of the SLT within these extraordinary circumstances, with the aim of prompting unified practice, building upon professional guidance and increasing skill recognition. What are the potential or actual clinical implications of this work? In addition to their role in facilitating the development of individualised communication strategies for patients, SLTs should actively seek to provide widely accessible multidisciplinary education opportunities focusing on supporting communication; with specific reference to mask wearing and the associated communicative challenges. At a commissioning and managerial level, leaders within healthcare should acknowledge mask wearing as just one of the complexities associated with frontline working in the context of the COVID-19 pandemic, and aim to support their workforce by delivering resources and protocols which maximize and promote staff safety, efficiency, resilience and well-being in concurrence with positive patient outcomes.

PRIMARY OBJECTIVE: To investigate the use of a 'reminders' function on a mobile phone as a compensatory memory aid for five individuals with traumatic brain injury (TBI). RESEARCH DESIGN: A series of five single case ABAB reversal design. METHODS AND PROCEDURE: A mobile phone was given to each participant during two intervention phases. Target behaviours were recorded for the length of the study. EXPERIMENTAL INTERVENTION: The phone was programmed to prompt a number of identified target behaviours. MAIN OUTCOMES AND RESULTS: For two participants, there was an increase in the target behaviours achieved when the phone was used, with percentages rising from 51% to 95% for Participant 1 (P1) and 58% to 88% for Participant 5 (P5). The percentage of target behaviours achieved did not return to initial baseline levels when the phone was removed, indicating that the intervention may have facilitated P1 and, in particular, P5 in the learning of their routines. The participants who did not benefit from the mobile phone differed from P1 and P5 as they fell in the category of 'severe memory impairment' on the RBMT, were significantly impaired on an assessment of executive functioning (Tower Test) and required 24-hour care. CONCLUSIONS: The preliminary investigation with five participants suggests that this system may be of best use with individuals who do not require 24-hour care and do not experience severe memory and executive functioning difficulties. However, further research with a larger sample is highly recommended.

Because traumatic brain injury causes an almost limitless range of troubles, Mark Garrison and his contributors, all from North America, concentrate on disorders that are common and persistent. Their target readership includes physicians, allied therapists and case managers, and the book is divided accordingly. The medical section has ten chapters, of which the most fascinating (to me) is that on vestibular dysfunction—a frequent but often overlooked post-traumatic disorder. An easy-to-follow account of the anatomy, physiology and pathophysiology of the vestibular system is followed by technical descriptions of vestibular investigations that will provide a valuable resource to non-specialists. The chapter concludes with a plain breakdown of the various components integral to vestibular rehabilitation. The authors make clear that, especially in patients with other deficits, the best hope in vestibular rehabilitation will often be symptom control rather than symptom elimination. I also liked the brief chapter on heterotopic ossification, with its account of diagnostic methods and its flow chart to guide treatment. Less high marks go to the account of post-traumatic epilepsy. There is much information on the side-effect profiles of antiepileptic drugs (AEDs) and we are counselled on the importance of distinguishing seizures from behavioural spells (so as to avoid unnecessary AED prescription and resultant side-effects). The authors discuss when to start an AED and the controversy on this question but offer no clear guidance on the more difficult issue of whether and when to stop—a matter addressed in the UK national guideline, 'Rehabilitation following Acquired Head Injury', published in 2003. I did not enjoy the dense account of neurotransmitters and pharmacology, packed with basic science and of little practical use. The section on allied health themes includes an update on cognition and language that demands a good understanding of language theory. Much less jargon-laden is a contribution on therapeutic recreation, the origins of which can be traced to Socrates and Plato. Unfortunately, little research has been done on the benefits of exercise and activity specifically related to traumatic brain injury, so the authors have to lean heavily on results in other areas such as spinal cord injury and spina bifida. From these sources they extrapolate possible benefits including improved physical and mental health, higher cognitive functioning, enhanced social integration and better quality of life. The chapter ends by honestly acknowledging that the medical and insurance communities have yet to be convinced. A chapter entitled 'Children and Adolescents: Practical Strategies for School Participation and Transition' is full of valuable insights. It presents examples of cognitive difficulties and resultant classroom behaviours following traumatic brain injury together with specific strategies for dealing with them. To illustrate the principles the progress of 'John', who was injured as a child, is charted to the age of 19. In part three the best written chapter is an overview on external case management. The fact that it is geared to an American readership does not detract from its value to UK readers in summarizing the roles and responsibilities of a case manager—in particular, the importance of knowing the patient's family dynamics, premorbid personality and interests, the vocational rehabilitation services available, and the possible benefits and sources of funding. The emotional stresses faced by a case manager are not overlooked. The book is attractively produced and contains some excellent material. As I have indicated, the quality and pertinence vary.

Brainstem electric responses (BSER) were recorded simultaneously to give records which were ipsilateral and contralateral to the test ear. Eight normally hearing subjects were presented with a fixed stimulus level in one ear and various levels of masking in the other ear. Responses to binaural stimulation were also recorded. It appears from the analysis of results that, for normal subjects, contralateral masking has no statistically significant effect upon the BSER. For the responses obtained from the stimulated side the analyses of variance showed a significant subject effect but no significant masking level effect from 0 to 80 dB Sensation Level of masking. For the responses obtained from the masked side the same conclusions seem to apply. As contralateral masking has no adverse effect upon the BSER in normal subjects and has had considerable use on clinical patients, with no significant problem, the normal audiometric use of masking is recommended for BSER recording.

BACKGROUND: Functional Strength Training (FST) could enhance recovery late after stroke. The aim of this study was to evaluate the feasibility of a subsequent fully powered, randomized controlled trial. METHODS: The study was designed as a randomized, observer-blind trial. Both interventions were provided for up to one hour a day, four days a week, for six weeks. Evaluation points were before randomization (baseline), after six weeks intervention (outcome), and six weeks thereafter (follow-up). The study took place in participants' own homes. Participants (n = 52) were a mean of 24.4 months after stroke with a mean age of 68.3 years with 67.3% male. All had difficulty using their paretic upper (UL) and lower limb (LL). Participants were allocated to FST-UL or FST-LL by an independent randomization service. The outcome measures were recruitment rate, attrition rate, practicality of recruitment strategies, occurrence of adverse reactions, acceptability of FST, and estimation of sample size for a subsequent trial. Primary clinical efficacy outcomes were the Action Research Arm Test (ARAT) and the Functional Ambulation Categories (FAC). Analysis was conducted using descriptive statistics and thematic analysis of participants' views of FST. A power calculation used estimates of clinical efficacy variance to estimate sample size for a subsequent trial. RESULTS: The screening process identified 1,127 stroke survivors of whom 52 (4.6%) were recruited. The recruitment rate was higher for referral from community therapists than for systematic identification of people discharged from an acute stroke unit. The attrition rate was 15.5% at the outcome and follow-up time-points. None of the participants experienced an adverse reaction. The participants who remained in the study at outcome had received 68% of the total possible amount of therapy. Participants reported that their experience of FST provided a sense of purpose and involvement and increased their confidence in performing activities. The power calculation provides estimation that 150 participants in each group will be required for a subsequent clinical trial. CONCLUSIONS: This study found that a subsequent clinical trial was feasible with modifications to the recruitment strategy to be used. TRIAL REGISTRATION: Controlled-trials.com ISCTN71632550, 30 January 2009.

Research has shown that the supporters of relatives with dementia suffer high levels of stress and strain and it is the severity of stress which determines whether the dependent remains in the community or becomes institutionalized. This study evaluated the outcome of a 6-week, closed group, educational programme on reported levels of stress and strain on five supporters. Results showed an increase in the severity of problems presented by the carers whilst there was a decrease in their emotional distress. However, these results suggest that the carers in the present study were experiencing much higher levels of stress and strain than those of supporters in a larger investigation, where the eventual outcome was institutionalization of the dependents. The implications for the future of community care are discussed and a large scale survey of carers, including monitoring of eventual outcome for dependents, is recommended.

Wernicke-Korsakoff syndrome is a potentially debilitating and fatal condition that is caused by thiamine (vitamin B1) deficiency in the brain. It can be treated effectively or prevented completely; however, the condition is often undiagnosed and inadequately managed. Wernicke-Korsakoff syndrome is commonly considered to be specific to individuals who misuse alcohol; however, there are many other predisposing factors and causes associated with the condition. This article aims to raise awareness of Wernicke-Korsakoff syndrome, to enable nurses in all practice settings to recognise the signs, symptoms and risk factors associated with the condition and be informed about available treatments. Increased awareness aims to improve early diagnosis of the condition, enabling effective treatment and improving patients' symptoms, such as cognitive impairment.

BACKGROUND: There are 2.7 million people in the UK receiving incapacity benefits, costing approximately pound 18 billion pa. Government has adopted a policy of helping claimants back into work, through structured vocational rehabilitation schemes. There are no published results of vocational rehabilitation services in the UK. We present the results of the Papworth Trust vocational rehabilitation programme. Depending on the severity of their disability, the 'Early Rehab Programme' aims to get people on incapacity benefits: (a) into employment, (b) fit for and seeking work, (c) involved in voluntary work, (d) education, or (e) able to live independently. METHODS: Retrospective chart survey and telephone follow up. SETTING: Cambridgeshire. RESULTS: Since 1995, 274 people attended for a preliminary interview, of which 107 subsequently started a full rehab programme. Eighty-seven were male and 20 female. Half had been unemployed for more than two years. Ninety-four completed the programme, of whom 53 had gained employment, 33 were 'work ready' and four were doing voluntary work. At long-term follow-up, 52 were employed, 12 were in voluntary work, and 7 had retired on medical grounds. CONCLUSIONS: This programme demonstrates that long-term Incapacity Benefit recipients can return to sustained employment, as shown in those who participated in the Papworth Trust's vocational rehabilitation programme.

The purpose of this cross-sectional study was to evaluate the diet quality of a sample of individuals with type 2 diabetes, using the Healthy Eating Index 2005, and to determine differences in total and component scores among clinical and demographic characteristics. Participants were recruited from clinics at a large, urban medical center. Each participant (n = 99) completed three to four 24-hour recalls and a demographics questionnaire. Foods were converted to MyPyramid servings to create Healthy Eating Index 2005 scores (mean ± SD = 56.3 ± 10.2). The mean Healthy Eating Index 2005 score of the sample was 56.3 (n = 99). Older adults had significantly higher scores than adults 40 to 60 years of age, and individuals classified as food secure had significantly higher scores than those classified as the food insecure. Clinicians should place further emphasis on inclusion of dark green and orange vegetables and legumes, whole grains, and dairy and exclusion of items high in sodium, saturated fat, solid fat, alcohol, and added sugars. Individuals with low food security may require additional education to comply with nutrition guidelines.

This paper describes an on-going three-phase action research project undertaken by members of the Norwich Community Trust speech and language therapy adult services team. With the support of the Clinical Audit department the project was set up in order to: 1) investigate the characteristics, needs and aspirations of the population of dysphasic people in the community; 2) examine how dysphasic people and their families perceive the speech and language therapy service; 3) implement specific changes to the speech and language therapy service to dysphasic people and their families. These changes are based on proposals developed through a working partnership between the speech and language therapy department and dysphasic people and their families.

OBJECTIVE: To gain a better understanding of how registered nurses working in specialist palliative care assess and manage breakthrough cancer pain. METHODS: A mixed-methodology study was undertaken in two stages-this paper reports findings from stage two. Anonymous postal questionnaires, designed based on themes identified in interviews undertaken during stage one, were sent to trained nurses working in ten specialist palliative care services in England. RESULTS: A total of 104 questionnaires were returned. Respondents were experienced nurses mainly working in inpatient settings. Some 82% of the nurses wanted more training on the assessment of breakthrough cancer pain. Although there were inconsistencies around the use of terminology, pain management appeared to be good. CONCLUSION: The use of terminology in the field of breakthrough cancer pain remains variable. However, this does not appear to have a negative impact on patient management, which was broadly in line with recently published consensus recommendations. There is a desire for more education within this area of practice.

RATIONALE: Functional Strength Training may enhance motor function of people who are more than six months post stroke. AIMS: to evaluate the clinical efficacy of enhancing upper and lower limb motor function with FST to explore participants' views (expectations and experiences) of FST, and to determine what cost-effectiveness data to collect in a subsequent Phase III trial. DESIGN: Randomized, observer-blind trial with embedded qualitative investigation of participants' views of FST (n = 6, purposive sampling). STUDY: Participants (n = 58), six months to five years after stroke with difficulty using their paretic upper (UL) and lower limbs (LL) for everyday functional activity. All will be randomized to either FST-UL or FST-LL delivered in their own homes for four days each week for six weeks. FST involves repetitive progressive resisted exercise during goal directed functional activities. The therapist's main input is to provide verbal prompting and feedback. OUTCOMES: Measures will be undertaken before randomization (baseline), after the six-week intervention (outcome) and six weeks thereafter (follow-up). Primary outcomes for clinical efficacy will be the Functional Ambulation Categories (FAC) and the Action Research Arm Test (ARAT). Clinical efficacy analysis will use the proportional odds model for FAC and a Mann-Whitney test for ARAT. Participants' views of FST will be explored at baseline and outcome through audiotaped, semi-structured, narrative approach, interviews. The analytic process for interviews will sort transcribed data thematically and seek categories to inform conceptualization (theory-building). A purpose-designed cost questionnaire will identify what cost resource items are likely to be affected by FST.

Auditory brainstem responses (ABRs) were recorded in a group of nine normally-hearing subjects. Wide-band clicks were delivered at 70, 80 and 90 dB SL, both with and without 50 dB SL of contralateral masking. The amplitude of wave VI was significantly reduced in the presence of masking for the 90 dB SL stimulus but there was no effect at the lower stimulus levels. A possible explanation for this is that the observed response, to a 90 dB SL stimulus without masking, is a summation of the ipsilateral wave VI and a wave V elicited from the contralateral ear. Supporting evidence is provided and the implications of this result are discussed.

Everybody seems to be either talking about doing it, or trying to implement it; that is, evidence-based practice (EBP). EBP describes current developments towards clinical effectiveness across a wide section of health-related disciplines and practice groups, whose origins can be traced from evidence-based medicine (EBM). While it is by no means a new idea (its origins have been traced back to mid-19th century Paris (Sackett et al, 1996)), it has never been more popular or its use more widely advocated as now. However, to many patients and clinicians alike it may seem strange to suggest that it is needed at all. Surely, an organization like the NHS which spends £33 billion on delivering its service would base this on data which show that it is a wise investment? So, what is EBP, and will it help in any way? Is it just the current NHS buzzword which will fade with time?

The COVID-19 pandemic commenced in March 2020. In May 2019, a new Medical Examiner system was introduced to scrutinise deaths of patients dying within acute National Health Service Trusts. The Coronavirus Act 2020 which came into force in March 2020 modified certification of death requirements. Newly formed Medical Examiner Services were advised they could suspend scrutiny during the pandemic. The Norfolk & Norwich University Hospital Medical Examiner Service (NNUH MES) continued to scrutinise patient deaths throughout. This study summarises the workload of the NNUH MES from 1st June 2020 to 31st May 2021 over which period 2856 deaths were recorded and 2687 scrutinised by the Medical Examiners.

This article describes the development of a palliative care outreach service by two nurse practitioners into ten community hospitals. The service was designed to improve equity of service delivery in the area and to meet national initiatives aimed at developing palliative care services. It involved responding to direct referrals while developing an educational programme for staff members. The results of a survey, which identified achievements for patient care and staff development, are discussed.

INTRODUCTION: Most survivors of severe acquired brain injuries will have significant long-term disability. During inpatient rehabilitation, families often have expectations of recovery that do not match healthcare professional opinion. This impacts on patient care, service processes, professional-family relations, and wellbeing. This review aimed to understand how family expectations are managed in this setting, and to explore potential areas of improvement. METHOD: A scoping review was conducted by searching CINAHL, Medline, EMBASE and Web of Science. Krieger et al's 'Conceptual Building Blocks' provided a framework to analyze the data using a 'best fit' framework synthesis approach. RESULTS: Twenty-one papers were included in the review. Six sub-themes within three overarching themes were generated, which explored recommendations for effective expectation management. The sub-themes within the 'staff behaviors' theme were 'appropriate information provision,' 'open communication' and 'prioritize family.' Sub-themes within 'system behaviors' were 'cultural change' and 'increased resource.' 'Rehabilitation as a shared process' was the third theme. DISCUSSION: Misaligned expectations of recovery appear to reflect a range of unmet family needs related to their position within the healthcare hierarchy, professional-family communication, and their involvement in rehabilitation processes. Early identification of family and healthcare professional expectations alongside regular review may prevent misunderstanding and conflict.

This article presents an evaluation of a mindfulness group facilitated for trainee and qualified psychologists working in a university psychology clinic. The group was shown to have both personal and professional benefits for participants, but further evaluation is required.

This paper examines the perceptions and aspirations of secondary school pupils interested in a career in the performing arts. The pupils in this case study were participating in drama-based courses and this research offers findings relevant for those working in schools, FE and HE, as well as the creative arts industries. This research is located within a coastal area of deprivation, Waveside, situated within England, UK. We have used fictional names for the towns, school and participants in this research, to offer anonymity. England’s coastal areas are often linked to deprivation. Within this context, a focus group of GCSE, A level and BTEC Drama pupils from Seagreen Secondary Academy, a secondary school in Waveside, provides the data that informs this research, with additional contextual narrative from the pupils’ teacher. The findings show that to study a performing arts subject is perceived by some pupils as an act of transgression. These pupils resisted neoliberal curriculum priorities resulting in tensions between school, parents and friends. Those acting as gate-keepers to professional actor training and other career opportunities within the arts, may need to review practices for recruitment and development support within marginalised communities.

Previous research has demonstrated that social determinants of health are drivers of medical utilization, cost, and health outcomes. In this study, we compared the mean annual total cost to deliver health services per patient by health-related social need (HRSN) status and total HRSNs using linear regression and ANOVA, respectively. Patients with ≥1 HRSN (n = 8409) yielded $1772 higher annual costs compared to patients without HRSNs (n = 34 775) (P < .0001). Compared to patients without HRSNs, delivering care to patients with 1 HRSN (n = 4222) cost $1689 (P < .0001) more and to patients with ≥2 HRSN (n = 4187) cost $1856 (P < .0001) more per year.