North Of England Research Articles

Female genital mutilation (FGM) trauma and mental health support during the UK lockdown: exploring women’s experiences

PurposeThe purpose of this study is to report findings from interviews with seven African-heritage women attending a female genital mutilation (FGM) Clinic in the north of England, during the COVID-19 lockdown. The Clinic, established several years before the pandemic, provides specialist therapeutic support to women and girls from minority ethnic communities who are affected by harmful “traditional” practices, including FGM. The services provided by the Clinic include early interventions, peer support, community engagement and empowerment around FGM.Design/methodology/approachData was collected during an online focus group discussion with seven women who had received counselling for FGM, to gain insight into their lived experiences of therapeutic support during the pandemic.FindingsUsing Braun and Clarke (2006) six-step thematic analysis, four superordinate themes derived from the data: consistency and continuity; safety in shared experience and creativity; feeling heard, feeling stronger; and altruism and desire for change.Research limitations/implicationsIt is important to recognise some limitations within this study. It is based on one focus group discussion that involved seven participants, who had experienced FGM, were living in a targeted area and whose mental health had been further compromised by the COVID-19 pandemic.Practical implicationsThe findings of this study indicate that it is essential to consider participants’ experiences of receiving therapeutic support during the COVID-19 pandemic. It was observed that emotional stressors linked with participants’ experiences of FGM may be exacerbated by those related to COVID-19.Social implicationsThere is a need to conduct similar research, perhaps on an individual basis, that would reach a wider sample of women from ethnic minority populations who are survivors of FGM, including those from FGM practicing communities who have been hospitalised through their deteriorating mental health. This would add to the small but growing body of evidence, to provide a better understanding of the experiences of their mental health needs during the COVID-19 pandemic and perhaps better identify effective therapeutic interventions.Originality/valueThese themes provide an insight into these women’s experiences of the trauma associated with FGM and receiving mental health support during the pandemic.

Autoethnography: a personal reflection on the work of the family bar in the North of England

ABSTRACT This study offers a personal reflection on 18 months at the Family Bar. It provides a unique perspective on a family justice system, which despite acute pressure has retained some of the most compassionate professionals who despite severe cuts to funding, and lack of resources, continue to work efficiently and effectively and with good humour, under stress. The authors are experienced practising lawyers who have published extensively in the area of family law relating to children and family justice. This experience, coupled with the methodological approach of autoethnography, provides a distinct perspective to which academics and practitioners may relate. The aim of this paper is to reflect upon the impact of recent changes in family justice on barristers working in both private and public law family cases.

Winter preparedness: a national framework for the delegation of insulin administration

British Journal of Community NursingVol. 28, No. 1 EditorialWinter preparedness: a national framework for the delegation of insulin administrationJulie Clennell, Lesley MillsJulie ClennellE-mail Address: [email protected]Regional Director of Nursing-Clinical Quality, NHS England North East and YorkshireSearch for more papers by this author, Lesley MillsCommunity Nurse Clinical Fellow / Consultant Nurse in DiabetesSearch for more papers by this authorJulie Clennell; Lesley MillsPublished Online:2 Jan 2023https://doi.org/10.12968/bjcn.2023.28.1.5AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Amazon Web Services. Delegation of insulin administration. 2020. https://tinyurl.com/3y7tets2 (accessed 5 December 2022) Google ScholarDiabetes UK. Delegation of Insulin Adminitration. 2023. https://www.diabetes.org.uk/Professionals/Resources/shared-practice/pharmacy-and-medicines/delegation-of-insulin-administration (accessed 5 December 2022) Google Scholar FiguresReferencesRelatedDetails 2 January 2023Volume 28Issue 1ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 2 January 2023 Published in print 2 January 2023 Information© MA Healthcare LimitedPDF download

Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study

ObjectivesThe Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19...

Constraints to travel outside the local area: Effect on social participation and self-rated health

BackgroundTravel outside the local area allows people to meet others and access a wide selection of services and opportunities. However, travel can be constrained by the lack of good transport or by personal factors. This paper investigates whether these constraints are associated with poor self-rated health, and the extent to which the association is mediated by reduced social participation. MethodRespondents in a survey in the North of England (n = 2747) stated levels of constraints to trip frequency, number of places visited, travel distance, and travel mode for trips more than 15 miles (24 km) away from home. Path analysis tested associations between these constraints, indicators of social participation (seeing family and friends frequently and being a member of clubs or societies), and self-rated health. ResultsConstraints to the number of places visited were associated with self-rated health via reduced social participation. Constraints to trip frequency had a negative association with self-rated health via pathways other than social participation. Constraints to travel distance were not significant and constraints to car use and public transport use were associated with self-rated health via other constraints. The results varied by age group and were robust to changes in variable specification and treatment of missing data. ConclusionsThe results confirm the importance of being able to travel outside the local area for social participation and health and emphasize the need for public policies that reduce constraints to travel, by providing better conditions for the use of both private and public transport and for the realization of more frequent trips to a wider set of places.

Precision medicine in laryngeal cancer: protocol of the laryngeal cancer cohort (LARCH)

IntroductionLaryngeal cancer disproportionately affects socioeconomically disadvantaged patients. Treatment can render a patient nil by mouth or in need of a permanent tracheostomy. In the past 30 years, survival has remained...

Language matters: The importance of person‐first language and an introduction to the People First Charter

Language matters: The importance of person‐first language and an introduction to the People First Charter

Pain, No Gain? A Joint-Autoethnography of Our Working Lives as Academics with Chronic Illnesses

This paper adopts a joint-autoethnographic approach to explore our lived experiences of working in academia whilst living with chronic illness, specifically Ankylosing Spondylitis, at two ‘new’ public universities in the North of England, UK. Use of the novel methodological approach of joint-autoethnography enables us to provide a snapshot into what it means to be ‘othered’ in contemporary neoliberal academia. We contribute to existing debates which seek to disrupt perceptions of academia as an elitist, ablest and privileged ivory tower. Through data captured in personal research diaries, we shed light on the emotional and embodied experiences of living with chronic illness whilst navigating academia, and how we perform our (un)spoiled academic identities. This is important because women with chronic illnesses and disabilities are significantly under-represented in senior roles within universities. This paper will interest an international readership because chronic illnesses are widespread in the workforce and these individuals offer a unique perspective within higher education, and have an awareness of the barriers faced by other academics and students with chronic illnesses.

Introduction to Fatal Years 30 Years Later: New Research On Child Mortality in the Past Special Issue

Abstract2021 marked the 30-year anniversary of the publication Fatal Years: Child Mortality in the late Nineteenth-Century United States, a pioneering work in historical demography by Samuel H. Preston and Michael R. Haines. This special issue showcases the current state of historical mortality studies through a collection of articles originally presented at two commemorative sessions at the 2021 meeting of the Social Science History Association. It provides new and more nuanced evidence on several of the major themes of Fatal Years in terms of the mortality experience and includes studies of a wide range of contexts, from North America, to Ireland, England and Wales, and continental Europe. They all bring new evidence and leverage the dramatic development that has taken place in availability of large-scale micro-level data in the 30 years since Fatal Years was published. This introduction first provides some background to the collection and then summarizes the main findings from the different articles included. Preston and Haines provide a coda to this collection with a short reflection article on researching and writing Fatal Years.

Writing the North of England in the Middle Ages: Regionalism and Nationalism in Medieval English Literature by Joseph Taylor (review)

Writing the North of England in the Middle Ages: Regionalism and Nationalism in Medieval English Literature by Joseph Taylor (review)

The intonation of declarative questions in Northern British English varieties in spontaneous speech

In this study, we analyse a sample of 76 utterances drawn from a corpus of spontaneous speech from the north of England. The selected statements present a declarative structure with different pragmatic functions (yes/no questions, echo questions, tag questions, and rhetorical questions). The objective of this study is to observe and describe the intonation of questions with a declarative structure in English from the north of England in spontaneous speech. Likewise, the pertinent bibliographic review is carried out for its subsequent discussion in view of the results obtained. The analysis is carried out in Praat, through the Melodic Analysis of Speech method (CANTERO, 2002) that allows the extraction of stylized, quantifiable and comparable melodic curves. As a result of this analysis, we obtain five different melodic that we can define as rising (21%), falling (50%), rising-falling (13%), final inflection with raised nucleus (4%), and declination and final rising inflection (12%).

Factors Associated with Subspecialty Choice of Cardiology Trainees in the North West of England: Forced by Vacancy or have a Clear Plan of Future?

Aim: Limited information exists on perceptions and professional development preferences on how trainees choose their sub-specialty. This study plan was set up to explore trainee cardiologists’ views of sub-specialty choice, with particular emphasis on career choices. Methods: This study was undertaken using questionnaires – “predetermined” through a web-based survey method. All cardiology trainees in the Health Education England North West (HEE NW) based in Merseyside and Manchester were asked to participate. This study had ethics approval from Edge Hill University and HEE research governance group. Results: The survey was sent to 49 trainees in the region and out of them 32 the completed survey. 25% were females, 66% were in their Specialty Training (ST) ST3-ST5 training, 78% had their under-graduate training in the UK, 94% were full time trainees and 69% were in the 30 to 35-year age group. The stimulating career, positive role model, family friendly and stable hours were found to be the key professional developmental factors in sub-specialty choice. Female friendly was less favored. Interference with family life, intellectually stimulating, and compensation and integration were key perception on sub-specialty choice. Adverse job conditions were not perceived as influential in sub-specialty choice. Prior clinical experience and easy access to training were the other factors influencing the trainee’s choice of sub- specialty. The adverse job conditions including exposure to radiation, unplanned on-calls and long operating time were associated with procedural related sub-specialties. The interference with family life, more financial benefit, positive role models, professional challenges and patient focus were associated with interventional Cardiology. Female friendly, family friendly, stable hours, compensation / integration were associated with imaging sub-specialty. Conclusion: Studying in depth into trainees’ perceptions and preferences may help in any efforts to make sub-specialty choice attractive and also help match work force to demand in the region.

Religious Influences on the Experience of Family Carers of People with Dementia in a British Pakistani Muslim Community.

This paper reports on a study that begins to address the paucity of research around the religious motivations of Muslim carers of family members with dementia. Seven carers were recruited for interviews from the British Pakistani Muslim community concentrated in the Midlands and North of England. Interview transcripts were analysed thematically using an iterative collaborative methodology. The findings suggested that the Muslim faith plays a pivotal role as a support mechanism for individual carers and their families, but the wider faith community and its leaders did not typically offer support and could impede access to external care. This was a result of cultural pressure and lack of awareness both among religious leaders and the community as a whole. The study concluded that the inequality in access to dementia services may be constructively addressed if service providers engage with these faith concerns in the community and religious leaders to meet the needs of Muslims of British Pakistani origin.

Upstreamist leaders: how risk factors for unscheduled return visits (URV) to the emergency department can inform integrated healthcare

PurposeThis paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of “upstreamist”, health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department.Design/methodology/approachPatients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of “upstreamist” system leadership to advance the integration of health care.FindingsOut of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with “upstreamist” system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED.Research limitations/implicationsAt a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services.Practical implicationsThis research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps.Originality/valueTo the best of the authors’ knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop “Esther” patient-centred approaches in the design of integrated health and care services.

‘Welcome to the North’: Public Art, Place-Marketing and the Northern Imaginary

Public art created in the cause of place-marketing has become a common component of urban regeneration. Focusing on the ‘Welcome to the North’ (WTTN) public art programme, this article examines public art’s contribution to place marketing at a pan-regional level. Funded under the UK government’s £100 million ‘Northern Way’ economic growth programme, between 2007 and 2010, WTTN commissioned six ‘iconic’ artworks across the north of England. Rather than comprising a cohesive visual imaginary, these artworks, and the process of their commissioning, are better understood as outcomes of a temporary alliance between divergent artistic and geopolitical ambitions – a Northern way of doing things perhaps?

A protracted outbreak of difficult-to-treat resistant Pseudomonas aeruginosa in a haematology unit: a matched case–control study demonstrating increased risk with use of fluoroquinolone

Between September 2016 and November 2020, 17 cases of difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) were reported in haematology patients at a tertiary referral hospital in the North of England. A retrospective case-control study was conducted to investigate the association between DTR-PA infection and clinical interventions, patient movement, antimicrobial use and co-morbidities. Cases were patients colonised or infected with the outbreak strain of DTR-PA who had been admitted to hospital prior to their positive specimen. A retrospective matched case-control study was performed. Exposures were extracted from medical records and cases were compared to controls using conditional logistic regression. Environmental and microbiological investigations were also conducted. 17 cases and 51 controls were included. The final model included age (>65,aOR 6.85,p=0.232), sex (aOR 0.60,p=0.688), admission under the transplant team (aOR 14.27,p=0.43) and ciprofloxacin use (aOR 102.13,p=0.030). Investigations did not indicate case-to-case transmission or a point source, although a common environmental source was highly likely. This study demonstrates fluoroquinolone use as an independent risk factor for DTR-PA in haematology patients. Antimicrobial stewardship and review of fluoroquinolone prophylaxis should be considered as part of PA outbreak investigations in addition to standard infection control interventions.

Choreographed Fan Displays: The Case of Israeli Sports

Choreographed Fan Displays: The Case of Israeli Sports

Cathedral of Power: Battersea Power Station in Dystopian Visual Culture

Cathedral of Power: Battersea Power Station in Dystopian Visual Culture

Sons of Kemet, Gorilla, Manchester, United Kingdom—February 19, 2022

Sons of Kemet, Gorilla, Manchester, United Kingdom—February 19, 2022

Designing person-centred technologies to support patients undergoing cancer surgery: a pharmacist-led, qualitative study

Abstract Introduction Lifestyle changes made during the pre-operative period can positively influence post-operative outcomes and the overall success of cancer surgeries.1 Digital technologies (including smartphone apps and fitness trackers) which support patients with physical activity and rehabilitation advice present an opportunity to support surgical patients remotely.2 However, little is known about the best way to design or provide these digital technologies in a person-centred manner. In order to develop effective digital strategies for this unique patient cohort, it is important to first understand in what way(s) do cardiothoracic cancer surgery patients want to be supported with technology.3 Aim To understand how digital technologies could be designed and delivered to better support patients undergoing cancer surgery, specifically: 1) what support do patients want from technologies, 2) how do they want to use them, and 3) when should they be implemented pre- and/or post-operatively? Methods The EQUATOR guidelines and COREQ checklist were followed. Pre- and post-operative patients attending cardiothoracic cancer surgery clinics within one large teaching hospital in the North of England were invited to take part. Purposive sampling was employed to recruit a representative sample of patients. Semi-structured interviews took place between September 2020-February 2021, during the coronavirus pandemic; interviews were conducted over the telephone or via video call-based software, and were audio-recorded and transcribed verbatim. Interviews included questions on participant surgical experience, behaviour change and perspectives on digital technologies. Reflexive thematic analysis enabled the development of themes from the data. QSR NVivo software (Version 12) facilitated data analysis. The Newcastle University Patient and Public Involvement and Engagement group had extensive input in the study design and conceptualisation. Ethical approval was obtained from the NHS Health Research Authority (HRA) and Care Research Wales (reference: 19/NE/0318). Results Sixteen participants were recruited; these included 9 females, with 6 interviews being ran via Zoom®, and an average age for all participants of 65-years (SD 8.29). Four themes were developed from the data that related to the design and delivery of person-centred technologies in order to best meet the needs of patients undergoing cardiothoracic cancer surgery; these centred on: (i) “getting the technology to tell me, guide me and encourage me”; (ii) “tracking me and supporting me to reach my goals”; (iii) “feeling comfort in knowing I’m not alone”; and (iv) “getting the timing right for me”. Discussion/Conclusion This study is one of the first in this patient cohort to involve pre- and post-operative participants. It provides key insights to address knowledge gaps relating to the design and optimisation of person-centred digital technologies for patients undergoing surgery for cardiothoracic cancer. We acknowledge some limitations with our work; whilst we did not sample participants by socioeconomic status, it is possible that different socioeconomic classes may have varied experiences with technologies. Our focus was solely cardiothoracic cancer surgery and thus findings may not be generalisable to other surgical procedures. These findings have the potential to shape and influence future work on the co-design and optimisation of person-centred digital health technologies in modern healthcare settings.