Healthcare professionals’ response to cachexia in advanced cancer

Background: Cancer cachexia is a complex metabolic syndrome characterised by severe and progressive weight loss which is predominantly muscle mass. It is a devastating complication of advanced cancer with profound bio-psycho-social implications for patients and their families. At present, there is no curative treatment for cachexia in advanced cancer therefore, the most important healthcare response entails the minimisation of the psycho-social distress associated with it. However, the literature suggests healthcare professionals’ are missing opportunities to respond to the multi-dimensional needs of this population.

Aim: The objective of this study was to explore healthcare professionals’ experience, understanding and perception of need of patients with advanced cancer who have cachexia and their families.

Methods: An interpretative qualitative approach based on symbolic interactionism was adopted. A purposive sample of doctors, nurses, specialist nurses, and dieticians were recruited from a cancer centre in a large teaching hospital in Northern Ireland. Data collection consisted of two phases: focus group interviews followed by individual semi-structured interviews.

Results: Findings from the focus group interviews were used as a framework for the semi structured interview schedule. Results centred on the influence of a variable combination of knowledge, culture, and resources on the management of cachexia in advanced cancer. Data revealed that variation in healthcare professionals’ perceptions of cachexia in advanced cancer, along with their professional ethos, influenced their response to it in clinical practice.

Conclusions: This study has revealed that cancer cachexia is a complex and challenging syndrome which needs to be addressed from a holistic model of care to reflect the multidimensional needs of patients and their families. Effective management will require a combination of knowledge, a supportive culture, and adequate resources.

It's a WRAP: Delivering Wellness for Women in the UK

Wellness Recovery Action Planning (WRAP) was first created by Mary Ellen Copeland in 1997 and reinforced the concept of people taking individual responsibility for their health status and wellbeing. To fuel personal responsibility for one's health status, Mary Ellen purported that it was necessary for the person to tap into their inner drive and resources with a view to owning their health. This concept has been widely accepted and disseminated within the field of mental health but has not yet been fully embraced by other professions, such as midwifery. In this piece, the authors highlight the recovery and wellness ethos inherent in the current zeitgeist of healthcare and discuss how WRAP could be utilised by midwives to facilitate the wellness of women during the antenatal period and beyond.

A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy

Aim: To evaluate and summarize the current evidence on the effectiveness of complementary and alternative medicine for the management of low back pain and/or pelvic pain in pregnancy.

Background: International research demonstrates that 25-30% of women use complementary and alternative medicine to manage low back and pelvic pain in pregnancy without robust evidence demonstrating its effectiveness.

Design: A systematic review of randomized controlled trials to determine the effectiveness of complementary and alternative medicine for low back and/or pelvic pain in pregnancy.

Data Sources: Cochrane library (1898-2013), PubMed (1996-2013), MEDLINE (1946-2013), AMED (1985-2013), Embase (1974-2013), Cinahl (1937-2013), Index to Thesis (1716-2013) and Ethos (1914-2013).

Review Methods: Selected studies were written in English, randomized controlled trials, a group 1 or 2 therapy and reported pain reduction as an outcome measure. Study quality was reviewed using Risk of Bias and evidence strength the Cochrane Grading of Recommendations and Development Evaluation Tool.

Results: Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However, osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low.

Conclusion: There is limited evidence supporting the use of general CAM for managing pregnancy-related low back and/or pelvic pain. However, the restricted availability of high-quality studies, combined with the very low evidence strength, makes it impossible to make evidence-based recommendations for practice.

Low Fidelity Simulation as a Mechanism to Enhance Midwifery Students’ Confidence in Relation to Emergency Obstetric Training

Simulation offers a safe opportunity for students to practice clinical procedures without exposure and risk of harm to real patients (Partin et al, 2011). Simulation is recognised to increase students’ confidence in their ability to make critical decisions (McCaughey and Traynor, 2010). Within Queen’s University Belfast, simulation for obstetric emergency training based on the ethos of ‘Practical Obstetric Multi-Professional Training[PROMPT]’ (Draycott et al, 2008) has been developed for midwifery students and is now uniquely embedded within the pre-registration curriculum. An important aspect of the PROMPT training is the use of low fidelity simulation as opposed to high tech support (Crofts et al, 2008). Studies have reflected that low fidelity simulation can be an effective tool for promoting student confidence (Tosterud, 2013; Hughes et al, 2013). Students are given the opportunity to experience obstetric emergencies within a safe environment and evaluation has indicated that students feel safe and have an increase in confidence and self-efficacy. The immediacy of the feedback offered by simulated situations encourages an exploration of beliefs and attitudes, particularly with peers, promoting a deeper sense of learning (Stoneham and Feltham, 2009).This paper will discuss why low fidelity simulation can effectively enhance the student experience and promote self-efficacy.

Promoting Harmonious Relations and Equitable Well-Being: Peace Psychology and “Intractable” Conflicts

The chapter explores Bar-Tal’s legacy in relation to key concepts, perspectives, and findings that comprise the growing field of peace psychology, specifically the promotion of sustainable peace through the indivisible constructs of harmonious relations and equitable wellbeing. Analyzed through a peace psychology lens, Bar-Tal’s work highlights both the barriers to and bridges for achieving sustainable peace. Central concepts from his work, such as fear, insecurity, and an ethos of conflict, demonstrate key obstacles to fostering harmonious intergroup relations based on social justice. Bar-Tal’s work also identifies processes that can overcome these barriers, which is consistent with peace psychology’s emphasis on the development of constructive responses to violence and conflict. For example, the chapter outlines how confidence-building mechanisms, mutually respectful identities, and reconciliation processes, may help foster an ethos of peace that can be embedded in the structure of societies through peace education. The chapter concludes with implications and suggestions for future research, with a focus on the role of young people in settings of prolonged intergroup division and generational approaches to peacebuilding, as conceptualized through a peace psychology lens.

Recruiting schools, adolescents and parents to a sexual-health trial: experiences, challenges and lessons learned from the Jack Trial

Background
Recruitment to school-based randomised trials is challenging; even more so when the focus of the study is a sensitive issue such as sexual health. The Jack Feasibility Trial aims to determine the facilitators and barriers to recruitment and retention to a school-based sexual health trial and identify optimal multi-level strategies for a full trial.
Method
The Jack Trial is an NIHR-funded feasibility study of a film-based sexual health intervention, recruiting over 800 adolescents from 8 post-primary schools in Northern Ireland. In order to examine the feasibility of piloted recruitment and retention methods and assess acceptability of participation across the range of schools and individuals approached, we analysed qualitative data from triangulated sources including a parents’ survey and semi-structured interviews with principals, vice-principals, teachers and parents recruited to the study.
Results
With reference to Social Learning Theory, we identified a number of individual, behavioural and environmental level factors which influenced recruitment and retention. Commonly identified facilitators included the perceived relevance and potential benefit of the intervention to adolescents, the credibility of the organisation running the study, support offered by trial staff, and financial incentives. Key barriers were prior commitment to other research, lack of time and resources, and perceptions that the intervention was incompatible with adolescent needs or school ethos.
Conclusion
This study highlights pertinent general and trial-specific facilitators and barriers to recruitment to a sexual health trial in a school setting, which will prove useful for successful conduct of future trials with schools, adolescents and parents.

Delivering a Research-Enabled Multistakeholder Partnership for Enhanced Patient Care at a Population Level: The Northern Ireland Comprehensive Cancer Program

The last 20 years have seen significant advances in cancer care in Northern Ireland, leading to measureable improvements in patient outcomes. Crucial to this transformation has been an ethos that recognizes the primacy role of research in effecting heath care change. The authors' model of a cross-sectoral partnership that unites patients, scientists, health care professionals, hospital trusts, bioindustry, and government agencies can be truly transformative, empowering tripartite clinical-academic-industry efforts that have already yielded significant benefit and will continue to inform strategy and its implementation going forward.

The Dark Side of Nudging: The Ethics, Political Economy, and Law of Libertarian Paternalism

Libertarian paternalism, as advanced by Cass Sunstein, is seriously flawed, but not primarily for the reasons that most commentators suggest. Libertarian paternalism and its attendant regulatory implications are too libertarian, not too paternalistic, and as a result are in considerable tension with ‘thick’ conceptions of human dignity. We make four arguments. The first is that there is no justification for a presumption in favor of nudging as a default regulatory strategy, as Sunstein asserts. It is ordinarily less effective than mandates; such mandates rarely offend personal autonomy; and the central reliance on cognitive failures in the nudging program is more likely to offend human dignity than the mandates it seeks to replace. Secondly, we argue that nudging as a regulatory strategy fits both overtly and covertly, often insidiously, into a more general libertarian program of political economy. Thirdly, while we are on the whole more concerned to reject the libertarian than the paternalistic elements of this philosophy, Sunstein’s work, both in Why Nudge?, and earlier, fails to appreciate how nudging may be manipulative if not designed with more care than he acknowledges. Lastly, because of these characteristics, nudging might even be subject to legal challenges that would give us the worst of all possible regulatory worlds: a weak regulatory intervention that is liable to be challenged in the courts by well-resourced interest groups. In such a scenario, and contrary to the ‘common sense’ ethos contended for in Why Nudge?, nudges might not even clear the excessively low bar of doing something rather than nothing. Those seeking to pursue progressive politics, under law, should reject nudging in favor of regulation that is more congruent with principles of legality, more transparent, more effective, more democratic, and allows us more fully to act as moral agents. Such a system may have a place for (some) nudging, but not one that departs significantly from how labeling, warnings and the like already function, and nothing that compares with Sunstein’s apparent ambitions for his new movement.

Re-Reading the Riots: Counter-Conduct in London 2011

The riots that took place in England in August 2011 have widely been described as destructive, senseless and without purpose. This article, taking inspiration from Michel Foucault’s later work on revolt as counter-conduct, argues for a new understanding of how to read political expression and thereby calls for the riots to be thought differently, as a form of counter-conduct. This demands a new appreciation for the possibilities of revolt where spontaneous, impulsive, mundane and non-spectacular events like riots can be construed as political rather than purely criminal. It also opens up possibilities for how we might understand the ethos of the ‘revolting subject’.

'This is a beautiful school.' 'This school is useless!' Explaining disengagement in a Greek vocational school through the examination of teacher ideologies

This multimethod case study of a Greek vocational school explored teachers’ culture (including beliefs about education, teachers’ role, and students’ nature) using the concept of Pupil Control Ideology to explain problems of disengagement and low morale among staff and students, as well as tensions in relationships. A prominent custodial culture was identified in the school using a functional/apolitical pedagogy to transmit ‘legitimate’ knowledge to students whose working-class background did not produce desired outcomes. This generated deficit views of students, teachers’ sympathy, and a seemingly caring school ethos which was, nevertheless, oppressive. Students’ failings were naturalised and vocational education misinterpreted as merely a streaming device in a system honouring academic achievement and middle-class ways. Teachers were blind to these cultural subtleties, believing they acted ‘rationally’ and altruistically. A humanistic subculture emphasising student empowerment and social transformation consisted of a minority of teachers and was rather marginalised. This disallowed meaningful dialogue and the identification of an alternative rationale for the sector, generating strong feelings of futility. Positive change in this school necessitated the deconstruction and (subsequent) reconstruction of custodial teachers’ worldview as embedded in their practice.

Destination Open Access: Getting Researchers On Board

This Open Access (OA) Poster - ‘Destination Open Access: Getting Researchers on Board’, was devised by the Queen’s University Belfast’s OA Team. It outlines the advocacy strategy undertaken to strengthen researchers’ uptake of OA at the University. Research funders, such as the Higher Education Funding Council of England (HEFCE), are increasingly mandating that researchers make their work publically available via an institutional repository. It is therefore imperative that researchers and departments fully engage with open access to ensure future funding.

The team’s advocacy strategy centres around collaboration with the Heads of Schools, Subject Librarians, the Research and Enterprise Office and, most importantly, the researchers themselves. The team regularly organises training sessions and events, on understanding OA, funder compliance and using the institutional repository. We also run outreach activities, such as practical drop-in sessions, promotional give-aways, OA updates to library staff and direct communications to schools. Finally, the team maintain a strong online presence via LibGuides, LibAnswers, the Library Blog and Twitter. We utilise these platforms to highlight topical OA issues, to advertise events, to provide support materials and to interact with researchers.

Statistics indicate that researchers are increasingly engaging with the OA training, communications and outreach events. Since August 2014 over 1200 researchers have attended advocacy sessions. Additionally, the numbers of papers uploaded to the repository each year has steadily increased and there are now over 3, 000 full-text OA research outputs in the Queen’s Research Portal.

This reflects positively on the team’s established approach of working with researchers to develop an OA culture within the University. Whilst it is clear that an open access strategy is essential, support for the open access ethos must come from individual researchers and Schools in order for the University to reach its desired destination of maximum uptake of open access.

Recruiting faith and non-faith based schools, adolescents and parents to a cluster randomised sexual-health trial: experiences, challenges and lessons from the mixed-methods Jack Feasibility Trial

Background: The move toward evidence-based education has led to increasing numbers of randomised trials in schools. However, the literature on recruitment to non-clinical trials is relatively underdeveloped, when compared to that of clinical trials. Recruitment to school-based randomised trials is, however, challenging; even more so when the focus of the study is a sensitive issue such as sexual health. This article reflects on the challenges of recruiting post-primary schools, adolescent pupils and parents to a cluster randomised feasibility trial of a sexual health intervention, and the strategies employed to address them.
Methods: The Jack Trial was funded by the UK National Institute for Health Research (NIHR). It comprised a feasibility study of an interactive film-based sexual health intervention entitled If I Were Jack, recruiting over 800 adolescents from eight socio-demographically diverse post-primary schools in Northern Ireland. It aimed to determine the facilitators and barriers to recruitment and retention to a school-based sexual health trial and identify optimal multi-level strategies for an effectiveness study. As part of an embedded process evaluation, we conducted semi-structured interviews and focus groups with principals, vice-principals, teachers, pupils and parents recruited to the study as well as classroom observations and a parents’ survey.
Results: With reference to Social Learning Theory, we identified a number of individual, behavioural and environmental level factors which influenced recruitment. Commonly identified facilitators included perceptions of the relevance and potential benefit of the intervention to adolescents, the credibility of the organisation and individuals running the study, support offered by trial staff, and financial incentives. Key barriers were prior commitment to other research, lack of time and resources, and perceptions that the intervention was incompatible with pupil or parent needs or the school ethos.
Conclusions: Reflecting on the methodological challenges of recruiting to a school-based sexual health feasibility trial, this study highlights pertinent general and trial-specific facilitators and barriers to recruitment, which will prove useful for future trials with schools, adolescent pupils and parents.

Collectively coping with contact: The role of intragroup support in dealing with the challenges of intergroup mixing in residential contexts

The social identity approach to stress has shown how intragroup support processes shape individuals' responses to stress across health care, workplace, and community settings. However, the issue of how these 'social cure' processes can help cope with the stress of intergroup contact has yet to be explored. This is particularly important given the pivotal role of intergroup threat and anxiety in the experience of contact as well as the effect of contact on extending the boundaries of group inclusion. This study applies this perspective to a real-life instance of residential contact in a divided society. Semi-structured interviews with 14 Catholic and 13 Protestant new residents of increasingly mixed areas of Belfast city, Northern Ireland, were thematically analysed. Results highlight that transitioning to mixed communities was fraught with intergroup anxiety, especially for those coming from 'single identity' areas. Help from existing residents, especially when offered by members of other religious denominations, signalled a 'mixed community ethos' to new residents, which facilitated adopting and sharing this identity. This shared identity then enabled them to deal with unexpected intergroup threats and provided resilience to future sectarian division. New residents who did not adopt this shared identity remained isolated, fearful, and prone to negative contact.

Outlier effects on robust joint modelling of longitudinal and survival data

Robust joint modelling is an emerging field of research. Through the advancements in electronic patient healthcare records, the popularly of joint modelling approaches has grown rapidly in recent years providing simultaneous analysis of longitudinal and survival data. This research advances previous work through the development of a novel robust joint modelling methodology for one of the most common types of standard joint models, that which links a linear mixed model with a Cox proportional hazards model. Through t-distributional assumptions, longitudinal outliers are accommodated with their detrimental impact being down weighed and thus providing more efficient and reliable estimates. The robust joint modelling technique and its major benefits are showcased through the analysis of Northern Irish end stage renal disease patients. With an ageing population and growing prevalence of chronic kidney disease within the United Kingdom, there is a pressing demand to investigate the detrimental relationship between the changing haemoglobin levels of haemodialysis patients and their survival. As outliers within the NI renal data were found to have significantly worse survival, identification of outlying individuals through robust joint modelling may aid nephrologists to improve patient's survival. A simulation study was also undertaken to explore the difference between robust and standard joint models in the presence of increasing proportions and extremity of longitudinal outliers. More efficient and reliable estimates were obtained by robust joint models with increasing contrast between the robust and standard joint models when a greater proportion of more extreme outliers are present. Through illustration of the gains in efficiency and reliability of parameters when outliers exist, the potential of robust joint modelling is evident. The research presented in this thesis highlights the benefits and stresses the need to utilise a more robust approach to joint modelling in the presence of longitudinal outliers.

We need to talk about managerialism: On the Importance of values dialogue and renewal within Catholic schools

Whilst reports of value tensions between new managerialism and Catholic education have emerged as a key theme in the academic literature there remains little empirical understanding of how teachers negotiate these complex terrains in Catholic schools. Drawing on qualitative data from teachers in two Catholic post-primary schools in Northern Ireland, this paper sought to explore how Catholic teachers developed a distinctively Catholic ethos against a culture of ‘creeping managerialism’. The paper has shown that despite the predominance of managerial practices, tensions between managerialist values and the ‘Catholic ethos’ did not emerge in either context: in one school managerialism permeated the school and the Catholic ethos was constructed within this context. In the other school a staff process of spiritual renewal had consolidated a commitment to the Catholic faith and social inclusion. It was argued that the dialogical engagement around Catholic values may help Catholic schools defend against the harsher manifestations of managerialism without compromising the pupils’ capacity to realise their academic potential