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1. An evidence-based nipple care pathway for new breastfeeding mothers: a Delphi study.

Author

Olalere, Oladipupo and Harley, Clare

Subjects
*EDUCATION of mothers, *BREASTFEEDING, *RESEARCH funding, *CHILD health services, *DESCRIPTIVE statistics, *SYSTEMATIC reviews, *MEDLINE, *LITERATURE reviews, *RESEARCH methodology, *MEDICAL databases, *DELPHI method, *ONLINE information services, *QUALITY assurance, *NIPPLE (Anatomy), *PATIENT positioning
Abstract

Background/Aims: Only 1% of UK mothers maintain exclusive breastfeeding for the first 6 months, as per global recommendations. Early breastfeeding cessation often involves complex issues, with nipple-related injuries being a common cause. This study aimed to develop an evidence-based tool for early identification and management of breastfeeding-related nipple injuries through expert consensus. Methods: A mixed method approach was used, including a 5-stage scoping review and a modified Delphi consensus technique with 26 UK-based maternal health experts and experienced breastfeeding mothers. Results: Consensus (80% agreement) was reached on recommendations, including the provision of realistic information, early peer support engagement and Lanolin use. Some commonly recommended practices, such as letting the nipple air dry, did not reach consensus, highlighting a misalignment between expert consensus and published guidance. Conclusions: This study generated evidence-based, expert-validated self-management guidance, emphasising the need for improved stakeholder engagement in policy development. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Ageing and the control of posture during divided attention

Author

Harley, Clare

Subjects
155
Abstract

This thesis examined competition for attention resources between cognitive and posture tasks, amongst adult volunteers categorised into three age groups: young (aged between 18 and 32), 60-69 years, and 70 years and over. The,first experimental chapter examined the conflict between a verbal fluency task and continuous walking in a group of44 participants. Walking was shown to be . ''. attentionally demanding for all participants but there was evidence that walking was increasingly demanding with advanced age. The second experimental chapter used similar methods (N = 33) but altered the ph~sical demands of walking with a tray carrying task. The results ofthis study supported the findings ofthe previous experiment and demonstrated that the young and 60-69 year old groups were able to reallocate attention resources during certain task combinations, but the older 70+ group could not. The third and fourth experiments monitored foot positioning ~?uring real and virtual obstacle stepping tasks (N =46 in each experiment). Concurrently with stepping participants carried out either a verbal fluency or digit string reaction time tasks. The young adults stepped more conservatively during the verbal fluency task than any other task, yet the attention demands ofthis task were considered to be the greatest. The 70+ group showed riskier, 'cognitive first' stepping strategies during the verbal fluency task which could account for incidents oftrips in older age. I The final experimen{examined the integration of visual information for controlling postural sway, in visually stable, perturbed, and dark conditions. Participants (N = 30) carried out reaction time tasks in each condition. Different visual integration mechanisms were identified, suggesting that older adults relied less on visual information for postural stability compared to the young adults. Posture stability was also mediated by concurrent cognitive demands.

Published
2005

14. Individual differences in deductive reasoning

Author

Newstead, Stephen E., Handley, Simon J., Harley, Clare, Wright, Helen, and Farrelly, Daniel

Subjects
Psychology and mental health
Abstract

Three studies are reported, which examined individual differences in deductive reasoning as a function of intellectual ability and thinking style. Intellectual ability was a good predictor of logical performance on syllogisms, especially where there was a conflict between logic and believability. However, in the first two experiments there was no link between ability and performance on indicative selection tasks, in sharp contrast to previous research. This correlation did, however, return in the final study. Our data are consistent with the claim that the correlation with logical accuracy on abstract selection tasks is found primarily with participants of relatively high ability. At lower levels, pragmatically cued responses are given but those of slightly higher ability divorce the rule from the scenario and respond consistently (though incorrectly) across problems. Self-report questionnaires were generally poor predictors of performance, but a measure of the ability to generate alternative representations proved an excellent predictor. These results are consistent with a mental models approach to reasoning and also have implications for the debate about human rationality.

Published
2004

22. Systematic review and meta-analysis of pre-hospital diagnostic accuracy studies

Author

Wilson, Caitlin, Harley, Clare, Steels, Stephanie, Wilson, Caitlin, Harley, Clare, and Steels, Stephanie

Abstract

Introduction: Paramedics are involved in examining, treating and diagnosing patients. The accuracy of these diagnoses is evaluated using diagnostic accuracy studies. We undertook a systematic review of published literature to provide an overview of how accurately paramedics diagnose patients compared with hospital doctors. A bivariate meta-analysis was incorporated to examine the range of diagnostic sensitivity and specificity. Methods :We searched MEDLINE, CINAHL, Embase, AMED and the Cochrane Database from 1946 to 7 May 2016 for studies where patients had been given a diagnosis by paramedics and hospital doctors. Keywords focused on study type (‘diagnostic accuracy’), outcomes (sensitivity, specificity, likelihood ratio?, predictive value?) and setting (paramedic*, pre-hospital, ambulance, ‘emergency service?’, ‘emergency medical service?’, ‘emergency technician?’ Results: 2941 references were screened by title and/or abstract. Eleven studies encompassing 384 985 patients were included after full-text review. The types of diagnoses in one of the studies encompassed all possible diagnoses and in the other studies focused on sepsis, stroke and myocardial infarction. Sensitivity estimates ranged from 32% to 100% and specificity estimates from 14% to 100%. Eight of the studies were deemed to have a low risk of bias and were incorporated into a meta-analysis which showed a pooled sensitivity of 0.74 (0.62 to 0.82) and a pooled specificity of 0.94 (0.87 to 0.97. Discussion: Current published research suggests that diagnoses made by paramedics have high sensitivity and even higher specificity. However, the paucity and varying quality of studies indicates that further prehospital diagnostic accuracy studies are warranted especially in the field of non-life-threatening conditions.

Published
2018

25. 'If you can't see a dilemma in this situation you should probably regard it as a warning': a metasynthesis and theoretical modelling of general practitioners' opioid prescription experiences in primary care.

Author

Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, and Harley, Clare

Subjects
GENERAL practitioners, PRIMARY care, MEDICAL prescriptions, DILEMMA, U.S. states
Abstract

Introduction: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care. The majority of patients with chronic non-malignant pain (CNMP) are managed by their general practitioner (GP). Recent qualitative studies have examined the issue of opioid prescribing for CNMP from a GP viewpoint. The aim of this study is to identify and synthesise the qualitative literature describing the factors influencing the nature and extent of opioid prescribing by GPs for patients with CNMP in primary care. Methods: MEDLINE, Embase, PsycINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986 to February 2018. The full text of included articles was reviewed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researchers and themes organised using Thematic Network Analysis. Themes were constructed in a hierarchical manner, basic themes informed organising themes which informed global themes. A theoretical model was derived using global themes to explain the interplay between factors influencing opioid prescribing decisions. Results: From 7020 records, 21 full text papers were assessed, and 13 studies included in the synthesis; 9 were from the United States, 3 from the United Kingdom and 1 from Canada. Four global themes emerged: suspicion, risk, agreement and encompassing systems level factors. These global themes are inter-related and capture the complex decision-making processes underlying opioid prescribing whereby the physician both consciously and unconsciously quantifies the risk–benefit relationship associated with initiating or continuing an opioid prescription. Conclusion: Recognising the inherent complexity of opioid prescribing and the limitations of healthcare systems is crucial to developing opioid stewardship strategies to combat the rise in opioid prescription morbidity and mortality. [ABSTRACT FROM AUTHOR]

Published
2019
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27. Asking the right questions to get the right answers: using cognitive interviews to review the acceptability, comprehension and clinical meaningfulness of patient self-report adverse event items in oncology patients

Author

Holch, Patricia, primary, Warrington, Lorraine, additional, Potrata, Barbara, additional, Ziegler, Lucy, additional, Hector, Ceri, additional, Keding, Ada, additional, Harley, Clare, additional, Absolom, Kate, additional, Morris, Carolyn, additional, Bamforth, Leon, additional, and Velikova, Galina, additional

Published
2016
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39. “If you can’t see a dilemma in this situation you should probably regard it as a warning”: a metasynthesis and theoretical modeling of general practitioners' opioid prescription experiences in primary care

Author

Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, Harley, Clare, Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, and Harley, Clare

Abstract

Background: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care.1 The majority of patients with chronic non-malignant pain (CNMP) are managed by their GP.2 Recent qualitative studies have examined the issue of opioid prescribing for chronic non-malignant pain (CNMP) from a GP viewpoint. Several factors have been reported to influence the prescribing of opioids for CNMP including aetiology of pain condition, co-morbidities, access to specialised care, history of drug abuse and professional scrutiny. We require a better understanding of problems GP’s face when making opioid prescribing decisions, and interventions to provide better supports in the prescribing of opioids for CNMP.The aim of this study is to identify and synthesize the qualitative literature describing the factors influencing the nature and extent of opioid prescribing in CNMP in primary care. A theoretical model is then proposed which seeks to explain the relationship between factors influencing prescribing of opioids for CNMP by GPs. Methods: MEDLINE, Embase, PsychINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986-Feb 2018. Studies that documented GP’s experiences and behaviours relating to prescribing opioids for chronic non-alignant pain in a primary care setting were included. Studies were excluded if they were non-English language, theoretical or methodological articles, policy documents, conference abstracts or presentations, or where quotations were not clearly attributed to GPs participating in the study.The reviewers then independently assessed the full text of the articles using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researcher and these codes organised using Thematic Network Analysis. Basis themes were defined initia

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40. “If you can’t see a dilemma in this situation you should probably regard it as a warning”: a metasynthesis and theoretical modeling of general practitioners' opioid prescription experiences in primary care

Author

Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, Harley, Clare, Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, and Harley, Clare

Abstract

Background: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care.1 The majority of patients with chronic non-malignant pain (CNMP) are managed by their GP.2 Recent qualitative studies have examined the issue of opioid prescribing for chronic non-malignant pain (CNMP) from a GP viewpoint. Several factors have been reported to influence the prescribing of opioids for CNMP including aetiology of pain condition, co-morbidities, access to specialised care, history of drug abuse and professional scrutiny. We require a better understanding of problems GP’s face when making opioid prescribing decisions, and interventions to provide better supports in the prescribing of opioids for CNMP.The aim of this study is to identify and synthesize the qualitative literature describing the factors influencing the nature and extent of opioid prescribing in CNMP in primary care. A theoretical model is then proposed which seeks to explain the relationship between factors influencing prescribing of opioids for CNMP by GPs. Methods: MEDLINE, Embase, PsychINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986-Feb 2018. Studies that documented GP’s experiences and behaviours relating to prescribing opioids for chronic non-alignant pain in a primary care setting were included. Studies were excluded if they were non-English language, theoretical or methodological articles, policy documents, conference abstracts or presentations, or where quotations were not clearly attributed to GPs participating in the study.The reviewers then independently assessed the full text of the articles using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researcher and these codes organised using Thematic Network Analysis. Basis themes were defined initia

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41. “If you can’t see a dilemma in this situation you should probably regard it as a warning”: a metasynthesis and theoretical modeling of general practitioners' opioid prescription experiences in primary care

Author

Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, Harley, Clare, Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, and Harley, Clare

Abstract

Background: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care.1 The majority of patients with chronic non-malignant pain (CNMP) are managed by their GP.2 Recent qualitative studies have examined the issue of opioid prescribing for chronic non-malignant pain (CNMP) from a GP viewpoint. Several factors have been reported to influence the prescribing of opioids for CNMP including aetiology of pain condition, co-morbidities, access to specialised care, history of drug abuse and professional scrutiny. We require a better understanding of problems GP’s face when making opioid prescribing decisions, and interventions to provide better supports in the prescribing of opioids for CNMP.The aim of this study is to identify and synthesize the qualitative literature describing the factors influencing the nature and extent of opioid prescribing in CNMP in primary care. A theoretical model is then proposed which seeks to explain the relationship between factors influencing prescribing of opioids for CNMP by GPs. Methods: MEDLINE, Embase, PsychINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986-Feb 2018. Studies that documented GP’s experiences and behaviours relating to prescribing opioids for chronic non-alignant pain in a primary care setting were included. Studies were excluded if they were non-English language, theoretical or methodological articles, policy documents, conference abstracts or presentations, or where quotations were not clearly attributed to GPs participating in the study.The reviewers then independently assessed the full text of the articles using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researcher and these codes organised using Thematic Network Analysis. Basis themes were defined initia

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42. “If you can’t see a dilemma in this situation you should probably regard it as a warning”: a metasynthesis and theoretical modeling of general practitioners' opioid prescription experiences in primary care

Author

Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, Harley, Clare, Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, and Harley, Clare

Abstract

Background: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care.1 The majority of patients with chronic non-malignant pain (CNMP) are managed by their GP.2 Recent qualitative studies have examined the issue of opioid prescribing for chronic non-malignant pain (CNMP) from a GP viewpoint. Several factors have been reported to influence the prescribing of opioids for CNMP including aetiology of pain condition, co-morbidities, access to specialised care, history of drug abuse and professional scrutiny. We require a better understanding of problems GP’s face when making opioid prescribing decisions, and interventions to provide better supports in the prescribing of opioids for CNMP.The aim of this study is to identify and synthesize the qualitative literature describing the factors influencing the nature and extent of opioid prescribing in CNMP in primary care. A theoretical model is then proposed which seeks to explain the relationship between factors influencing prescribing of opioids for CNMP by GPs. Methods: MEDLINE, Embase, PsychINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986-Feb 2018. Studies that documented GP’s experiences and behaviours relating to prescribing opioids for chronic non-alignant pain in a primary care setting were included. Studies were excluded if they were non-English language, theoretical or methodological articles, policy documents, conference abstracts or presentations, or where quotations were not clearly attributed to GPs participating in the study.The reviewers then independently assessed the full text of the articles using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researcher and these codes organised using Thematic Network Analysis. Basis themes were defined initia

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43. “If you can’t see a dilemma in this situation you should probably regard it as a warning”: a metasynthesis and theoretical modeling of general practitioners' opioid prescription experiences in primary care

Author

Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, Harley, Clare, Kennedy, Mary-Claire, Pallotti, Phoebe, Dickinson, Rebecca, and Harley, Clare

Abstract

Background: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care.1 The majority of patients with chronic non-malignant pain (CNMP) are managed by their GP.2 Recent qualitative studies have examined the issue of opioid prescribing for chronic non-malignant pain (CNMP) from a GP viewpoint. Several factors have been reported to influence the prescribing of opioids for CNMP including aetiology of pain condition, co-morbidities, access to specialised care, history of drug abuse and professional scrutiny. We require a better understanding of problems GP’s face when making opioid prescribing decisions, and interventions to provide better supports in the prescribing of opioids for CNMP.The aim of this study is to identify and synthesize the qualitative literature describing the factors influencing the nature and extent of opioid prescribing in CNMP in primary care. A theoretical model is then proposed which seeks to explain the relationship between factors influencing prescribing of opioids for CNMP by GPs. Methods: MEDLINE, Embase, PsychINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986-Feb 2018. Studies that documented GP’s experiences and behaviours relating to prescribing opioids for chronic non-alignant pain in a primary care setting were included. Studies were excluded if they were non-English language, theoretical or methodological articles, policy documents, conference abstracts or presentations, or where quotations were not clearly attributed to GPs participating in the study.The reviewers then independently assessed the full text of the articles using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researcher and these codes organised using Thematic Network Analysis. Basis themes were defined initia

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44. Factors influencing the implementation of coercion reduction interventions for aggression management in inpatient mental health care

Author

Felemban, Sumayah Abdulaziz, Baker, John, Berzins, Kathryn, Clibbens, Nicola, and Harley, Clare

Abstract

Despite a general consensus against coercive practices in mental healthcare, the results and the sustainability of interventions designed to stop or reduce coercion are still variable. This thesis presents a study that aims to identify potential drivers and barriers to the implementation process of these interventions to better understand the dynamics of the observed variability. The study applies Extended Normalisation Process Theory (ENPT) across two phases. Firstly, a theory-informed integrative review of primary research on the implementation of coercion reduction interventions in adult inpatient mental health facilities. The data from the included studies were extracted qualitatively and analysed using (ENPT). The second study Semi-structured interviews informed by ENPT with experts involved in the implementation of coercion reduction intervention (experts by experience and academic and clinical implementation experts). Transcripts were analysed using qualitative content analysis. Analysis of the 28 implementation studies showed staff resistance, a lack of trust and resources to be barriers and a sense of ownership, and reflexive monitoring acted as drivers to the process. The analysis of the transcript data from 23 participants showed commitment as a driver and adverse problematic embedded cultures as a cause of resistance. Experts by experience played a central role in establishing reflexive practice, which was shown to facilitate positive shifts in culture, and through continuous reflexive monitoring, help achieve sustainability. The study demonstrates the dynamics of the implementation process and presents how specific factors impact that process. There is a need to consider the implementation process holistically; adequate attention must be given to all stages, in particular to understanding the existing context prior to implementation; and implementation must be supported at all organisational levels. The adverse context created by problematic cultures and the potential of reflective practice to address these problematic cultures is potentially of general relevance to implementing health care interventions.

Published
2022

46. Living with advanced cancer and using medicines at home : exploring experiences and support opportunities

Author

Chater, Kathryn Helen, Harley, Clare, Easthall, Claire, and Hughes, Nicholas

Abstract

Background: Living with advanced cancer can entail the use of multiple medicines. This research was undertaken to improve understanding about the experiences people living with advanced cancer have with medicines in the context of their everyday lives and healthcare and identify opportunities to support medicines optimisation. Method: A literature review was conducted to identify and synthesise existing evidence. Two studies were undertaken: the first used semi-structured interviews and photography to explore how people living with advanced cancer manage medicines use at home; the second used semi-structured interviews with photo-elicitation to explore healthcare professionals' perspectives about people's experiences with their medicines during advanced cancer. Finally, stakeholder engagement was carried out to disseminate research findings and obtain feedback to inform the direction of future work. Findings: The literature review highlighted a lack of evidence about medicines self-management during advanced cancer. The first empirical study summarised people's complex self-management of medicines in five themes: having cancer that is never going to go away, getting along with medicines, navigating the system, habituation in the home, and adapting and adjusting. The second study summarised three themes intrinsic to healthcare, which impact on people's experiences: Insight and Information; Oversight and Ownership; Expertise and Resources. Engagement found that stakeholders share rationale for improving medicine optimisation in this population, to make people's lives easier, empower them and improve outcomes. Proposed strategies for implementing medicines optimisation were summarised in three themes: communicating with people, communicating about them, and person-centred service redesign. Conclusions: This thesis has provided in-depth insight about self-management of medicines during advanced cancer. It shows that people embed an approach into their daily routine and circumstances. It highlights that the existing provision of healthcare is ill-equipped to support people and requires effort to join up services, improve contact with people and educate HCPs about medicines optimisation. More broadly, it has demonstrated an appetite amongst wider communities to improve experiences for people by developing and implementing interventions which put people living with cancer at their heart and foster approaches that are tailored to people's individual medicines use and everyday life.

Published
2021

48. Referrals from primary eye care : an investigation into their quality, levels of false positives and psychological effect on patients

Author

Davey, Christopher James, Elliott, David B., Harley, Clare, and Green, Clare

Subjects
617.7, Optometry, Ophthalmology, Referral, Anxiety, Referral quality, Rasch analysis, False positive, State-Trait Anxiety Inventory (STAI), Anxiety and Depression Scale (HADS)
Abstract

Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.

Published
2011

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