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Shared decisions, shared goals: Trauma amputees’ clinical experiences and communication with their prosthetists

During the Iraq and Afghanistan conflicts there was a rise in the number of trauma related military amputees with complex prosthetic needs.  The level of prosthetic provision from the Ministry of Defence at that time was anecdotally high and the expectation was that the responsibility for this level of provision would be passed to the NHS when military amputees were discharged from the Armed Services. This brought about fears from NHS prosthetic providers and veteran charities around how this transition of care would be funded in the best interest of veteran amputees.

As a trained prosthetist I was also curious about how the switch of care from the Ministry of Defence to the NHS would be managed in a practical sense as well as how the NHS would manage the provision of high end prosthetic limbs within restricted prosthetic budgets.  It was this interest that led me to undertake my PhD at the University of Stirling.

My project aimed to explore the decision making of prosthetists working within the NHS in Scotland with experience of treating amputee veterans. I also wanted to explore military and civilian trauma amputees’ experiences of involvement in their prosthetic care.  This was achieved through analysis of a series of interviews with members of four clinical and managerial groups involved in the delivery of prosthetic care in the NHS and interviews with civilian and trauma amputees. Due to the exploratory nature of this project qualitative semi structured interviews were used to collect data which was then analysed using thematic analysis.  Staff and amputee data was analysed separately.

The stories of the amputees included in my thesis show that the circumstances which led to their amputation can have a lasting effect on their rehabilitation journey.  Those who have lost a limb through trauma, whether in a civilian or military setting, have experienced a unique set of experiences.  This can greatly impact the way they view their amputation as well as the way they interact the clinicians who are involved in their prosthetic rehabilitation.  The effect of this suggests that prosthetists and other clinicians involved in the care of trauma amputees should be conscious of the circumstances which led to their amputation and take that into account in the rehabilitation process.

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Dr Karen Semple (centre) pictured with her supervisors Prof Margaret Maxwell (L) and Prof Helen Cheyne (R)

My thesis Exploring decision making and patient involvement in prosthetic prescription highlighted the importance of the evolving relationship between trauma amputees and their prosthetists and the benefits that were seen by both groups from developing a good relationship and the impact that this could have on the prosthetic prescription process.  Through these developing relationships combined with communication between prosthetists and patients, these groups can work together to create optimal prosthetic prescriptions. Clinical experience and communication are key in enabling prosthetists to prescribe limbs which allow patients to achieve their goals and aspirations in their post amputation lives.

Dr Karen Semple,
Researcher, Faculty of Health Sciences and Sport, University of Stirling
11 July 2016

Prosthetic photo copyright Belahoche on 123RF
Graduation photo copyright University of Stirling

What inspires us to nurse?

Nursing_123RF_31309931_lTo mark International Nurses Day 2016 we asked our nursing students and staff what inspired them to nurse; this is what they said:

“For me, a role that matters and allows me to contribute to the society I live in.”
Ric, second year student nurse

“Circumstances saw me having to support myself through education from the age of 16, I always persevered, knowing my aim was to become a nurse one day. Life and motherhood saw ten years pass. I knew then that if I want to truly encourage my daughters to become whatever they want to be, it was through doing it myself. An HNC, years of work experience and a year of night college later I am exactly where I know I should be! My daughters are proud of me, and I am proud of myself. Nursing is where my heart is.”
Sandra, third year student nurse

“What motivates me is the opportunity I have to make a difference and to improve the quality of life for others, which for me is more of a calling than a career.”
John, second year student nurse

“I wanted to make a difference, sounds corny but it’s true! I never wanted to do anything else, it may have taken me a few years longer than most, I’m now 37 but now I’m finally making that dream become a reality.”
Hazel, first year student nurse

“I was inspired to go into nursing while working in a high school, I witnessed so many young people struggling with their thoughts, feelings and emotions, not knowing how to manage these.   I want to be able to help them make a difference in their lives so they can mature and grow into confident individuals who are ready for adulthood.”
Pamela, second year student nurse

“I worked with a lovely probationary teacher last year who went into teacher training later. She inspired me, it’s never too late to achieve your dreams.”
Liz, first year student nurse

“I worked in a dementia unit for nearly 4 years, to begin with it was ‘just a job’ (I was 19 at the time and didn’t know what i wanted to do career-wise!) but as the months progressed and I received additional  training and  learning regarding the job. I realized how much I deeply cared for the well-being of all the clients and their families and loved how the feeling of providing care, support, comfort and compassion to each client was like receiving a personal reward on a daily basis. My experience of working as a Care Assistant prompted me to start my training, broaden my skills, expand my knowledge and continue onto a career of more person-centred care.”
Kirsty, first year student nurse

“Helping someone when they cannot help themselves even by just making them smile, nursing is such a rewarding career”
Lindsay, first year student nurse

“When I was 17 other people kept telling me that I should go into nursing. They said I had a strong value base, caring and compassionate nature and an ability to influence people. I always wanted to be a teacher, but didn’t apply as I could not spell! Who would have thought I would end up being a nurse teacher!”
Janet Smith, Teaching Fellow

“I’ve always been interested in the science behind the human body, but witnessing the care and compassion shown by nurses when my Granda was dying made me realise that nursing was the dream career for me –  I wanted to make an impact on someone’s life like those nurses did for me and my family.”
Holly, second year student nurse

“What motivated me to choose nursing was the never ending possibilities nursing offers, as well as being able to make a difference in someone’s life. I also wanted a career, and not just a ‘job’.”
Michelle, third year student nurse

“When I was young (3/4), I spent a lot of time with my granny around nursing homes and would often help the nurses with tea, biscuits and bingo so I was around the environment from a young age. When I was 16, unfortunately I got ill. Although this allowed me to see all the different departments of the hospital I was in. I always had an interest for some science-based jobs, but personally experiencing the kindness of the nurses on the ward made me decide that it was what I wanted to do. I really wanted to give something back, to make other people experience the high level of care and compassion, like the care I had received. And well, here I am!”
Ryan, second year student nurse

“Seeing several family members working in mental health services, and the public’s perception of mental health issues, inspired me to train as a Mental Health Nurse.”
Sophie, first year student nurse

“I wanted to be a nurse because I care about other people’s health and well-being. Whether that be children or adults. I am a mature student and sadly have lost my own parents and my children are more independent. I suppose there in a need in me to nurture and care for other people and I want to make a difference, however small.”
Liz, first year student nurse

“The film Patch Adams.”
Sandra, third year student nurse

What motivated me to become involved with research was the awareness that when someone is in the same position for too long they can stop questioning, they become too set in their ways and are resistant to change.  I didn’t want to become complacent.  I was questioning everything and I needed to be involved with finding answers.”
Gaylor Hoskins, Clinical Academic Research Fellow

“I have always enjoyed helping people, in every aspect of life, therefore nursing is something I have always considered. However it wasn’t till after my travels to South Africa – witnessing poverty and severe illness – that it was made clear to me that I wanted to strive and work to the best of my ability to become a successful, compassionate nurse.”
Caitlin, first year student nurse

“I saw nursing as a challenge, a changing challenge and I’ve never looked back. Can’t wait to qualify!”
Kim, second year student nurse

“The reason I went into nursing is because my aunts are Mental Health Nurses. Initially it never really appealed to me. I was always complaining of how bored I was getting in my job. My aunts said they knew I would make a great nurse and to give a shot. I applied to work as a Rehab Assistant to see if I liked it. I did! I then put my application in to Stirling. The thing I like about it is that you’re always busy, no two days are the same, it is very rewarding and there is job satisfaction. I wish I did it earlier. I have never looked back since!”
Blair, first year student nurse

“I have always had a great amount of empathy for others, I chose mental health nursing to utilise this and have a career in which I care for people every day.”
Ela, first year student nurse

“What motivated me to get into nursing research was the opportunity to use my skills in technology, decision making and interventions to support care delivery, and make a meaningful difference to patients and those who care for them.”
Dr Julie Cowie, Lecturer

“I chose to nurse for the opportunity to make a positive impact on people’s lives, no matter how big or small.”
Kourteney, first year student nurse

“I am constantly inspired by patients and I love the feeling I get when I help others, it is so rewarding, the difference you can make to a person’s/family’s life is incredible and to be in a privileged position to do this is so humbling.”
Nicola, first year student nurse

“The idea of nursing being a rewarding career with so many areas that one can work in and the fact that I love working with people inspired me to get into nursing.”
Davinia, first year student nurse

“My mum and older brother work as nursing assistants in our local mental health wards and always talked about how rewarding it is as a career. They have inspired me to become a nurse from their experience and my want to help others.”
Fionnuala, second year student nurse

“I chose nursing because I liked interacting with people and thought it would be an interesting job – I was so right.”
Dr Susanne Cruickshank, Reader in Cancer Nursing

“I always wanted to study at University and, eventually, at the grand age of 46 I started my nursing degree. Now 2 years into my studies I am loving every aspect of it and looking forward to joining the nursing profession. It was definitely worth the wait!!”
Jane, second year student

“As I was born with a heart defect and went through a heart transplant at the age of 8, I have spent a lot of time in the hospital. The people that supported me the most, held my hand through different procedures and was always there for me when I was scared and vulnerable, was the nurses. They inspired me every day through their hard work and always with a smile around their faces which made me look at life in a more positive way even though that wasn’t always the case. That’s why I want to be a nurse, I want to give something back and help other people as they helped me and my family through the hardest times of my life”. Emilie, second year student

And the last word from Hazel:

“Complications after my surrogate baby was born meant an emergency trip to theatre. I will never forget how I felt a nurse suddenly hold my hand, I never saw her face but that hand ‘spoke’ a thousand words.”
Hazel, first year student nurse

How women can go the full nine months without knowing they’re pregnant

Helen CheyneIt is a “notorious fact”, one so commonly accepted and obvious it requires no evidence to support it in a court of law, that every woman knows when she is pregnant.

In a society that has a low tolerance for uncertainty, cases that challenge our collective notion of the possible fascinate and confuse us.  …………

Read Prof Helen Cheyne’s full article in The Conversation.

10 things a new PhD student should know at the beginning of their study – postgraduate blog

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Postgraduate Student Andrea Mohan

Starting a PhD can be very exciting, but it can also be very scary to some students. Now that I’m in my final year, I realise that there are things that I had wish known when I first started. I’ve pulled together a list of 10 things (with the help of my peers) that you should know as a new PhD student.

  1. When you first start, you will feel like you don’t know what you’re doing and that’s OK. In fact, that’s NORMAL. Chances are, you will still feel like this a year into your studies. How do you deal with this? Communicate with your supervisors on a regular basis, and speak to your peers as often as you need to. You’ll be amazed to find out how any people feel the same as you!
  2. In your first month, you’ll feel like you’re not doing anything. Relax. In this month, spend your time getting to know your way around your department and the university campus. Trust me. This can save you a lot of time in the future. Find out about specifics like printing, using the library and where the nearest kettle and microwave are located. Take wee walks around the campus and get to know the place better. Also, take the time to get acquainted with your fellow PhDs as well.
  3. Ask your postgraduate tutor or postgraduate representative (staff or student). Chances are, they will have the answer to your questions, or if not, they will direct you to someone who will know.
  4. If you’re new to research, and feel a bit nervous/daunted by the thought of doing a research degree, then find a good book that addresses this. One of my peers recommends Norman Blaikie’s book ‘Designing Social Research’ (Blaikie, N. (2010) Designing Social Research. (2nd edn) Cambridge: Polity Press).
  5. You may be shocked to find out that you are not a proper PhD ‘student’ when you first start. Don’t worry…for all intents and purposes, you are, but in most universities, you only become officially registered after some sort of review process. This usually occurs nine to twelve months after you first start, and the review process differs across institutions. Try to find out from the beginning what this process entails, and make sure that you prepare sufficiently for it.
  6. Try to establish a good working relationship with your supervisors, or at least your main supervisor from the beginning. It’s important that you are able to communicate properly with them. Don’t be afraid to let them know if you are worried about something relating to your study. If you finding it difficult to communicate with your supervisor, then speak to your postgraduate tutor or representative.
  7. Find a sport or a hobby. A lot of people will remind you that your PhD is not the only thing going on it your life, and this is true. Find something that you like to do, that can help you to de-stress. Just make sure that it doesn’t overtake your life and prevent you from doing your work. It’s all about balance.
  8. Take coffee/tea or lunch breaks with your peers. When pursuing a research degree it’s easy to feel isolated. If you’re in one day, and a peer or some peers are around, then ask them if they’d like to go get some coffee or lunch with you – even if it’s once a month. Don’t take it personal if some refuse (they may be genuinely busy).
  9. Try to find out what special events are on for postgraduate students throughout the year in your department and the university. There may also be seminars, writing days and lunches as well. If you can make time to attend some of these events, this will be useful in terms of helping you to meet and network with other peers (or members of staff).
  10. This tip is for international PhDs. I’ve spoken about isolation already, but this can affect international students even more than local students. The best way to deal with being homesick or being lonely is to make friends: befriend your PhD peers, find out if there is a group of students at the university that are from your country, or find a group of students who have similar interests as yourself. If you find yourself feeling really sad, speak to your supervisor or a counsellor.

Always remember that you are not in this alone!

Andrea Mohan
PhD Student, Health Sciences, University of Stirling

Can talcum powder really cause ovarian cancer?

Photo of Professor Andrew Watterson

Professor Andrew Watterson

Professor Andrew Watterson writes in The Conversation:

The debate about whether or not talcum powder causes ovarian cancer has rumbled on for decades. However, it recently reached fever pitch after a US court awarded damages to the family of a woman who died of ovarian cancer, allegedly as a result of having used talc as a feminine hygiene product for many years. Does that mean women should avoid using talcum powder? What does the science say?

Read the full article here.

Ten deadly carcinogens (you’ve probably never heard of)

Photo of Professor Andrew Watterson

Professor Andrew Watterson

Professor Andrew Watterson writes in The Conversation

“Bad news for bacon butty lovers and barbecue afficionados. The World Health Organisation now deems bacon, sausage – and other processed meats – a serious cancer risk.

“With more than 14m new cancer cases occurring around the world each year and more than 8m cancer deaths a year, carcinogens certainly merit serious attention. Asbestos, diesel exhaust fumes, radiation in various forms, nightshift work, tobacco and alcohol are all well-known causes of cancer, but there are lots more besides, including several you may never have heard of.”

Read the full article here.

High quality reporting is required in research studies – a recent review highlights why

Photo of Nadine Dougall

Nadine Dougall, University of Stirling

One in one hundred people will experience schizophrenia in their lifetime. Schizophrenia can be managed well with a person-centred combination of therapy and medication and an emphasis on recovery. Many of us are likely to know people who are affected by the symptoms of schizophrenia but are still managing to lead fairly ordinary lives.

However, for others living with more severe symptoms, schizophrenia can be a distressing and highly debilitating experience. Symptoms experienced such as hearing voices or seeing things (hallucinations) often fail to respond to medication. Even when antipsychotic medication is effective, the side effects of weight gain, apathy, shaking or lack of drive are also debilitating. More effective drugs are urgently needed, however despite promising leads there has not been ground-breaking progress in drug development for schizophrenia for many decades.

One emerging non-drug therapy proposed for the treatment of schizophrenia and the symptom of hearing voices is transcranial magnetic stimulation (TMS). TMS is a device which involves the skilful application of a strong magnetic field close to the scalp surface. TMS is a relatively painless and non-invasive technique which stimulates parts of the brain. Researchers over the last decade have set about assessing whether this promising new therapy TMS could be an alternative treatment for people who do not respond, or do not cope well with medication.

Researchers have typically used ‘randomised controlled studies’ to assess the effectiveness of TMS. This has usually meant randomising people with schizophrenia – with their full consent – into an experiment of either having TMS or having ‘sham’ TMS (i.e. identical process without the magnet switched on). Therefore, randomised controlled studies are a way of comparing two groups of people with schizophrenia who are as identical as possible in every way except for the active ingredient of the TMS itself.

Although many of these study results have now been reported by researchers across the world, the results differed widely and there was no consensus on whether TMS should be routinely used in practice. Therefore we set out to achieve this consensus by reviewing all the reported TMS studies of schizophrenia using Cochrane methodology (the internationally recognised highest standard of review). The purpose of our Cochrane review was to assess the quality of all reported studies, and then combine the results into one analysis (a ‘meta-analysis’) to give summary estimates of whether TMS is effective, or not.

We found that from 41 reported studies (1473 people) there was some evidence to suggest TMS may improve certain symptoms such as hearing voices when compared with ‘sham’ TMS. However, because we also graded many of the studies as ‘low’ or ‘very low’ quality evidence, this meant we were uncertain that TMS was effective, and could not make firm conclusions about using TMS as routine treatment for schizophrenia.

To be clear, this is not the same as researchers doing low quality studies, but rather that frequently the way the study was conducted was not reported to a sufficient standard to rule out risks of bias. This is frustrating, and authors who are reporting on study results are urged to adopt clear reporting practices to remove ambiguity by using standards such as the CONSORT criteria. Journal editors should consider routinely recommending the use of CONSORT criteria and lift restrictions on word limits which inhibit full reporting.

In future, high quality research studies AND high quality reporting of these studies is very likely to have an important impact on whether we can confirm TMS alleviates some symptoms of schizophrenia, but for now we remain quite uncertain. It is important that the research community pursues this aim so that we can improve the quality of treatment provided to people who are living with the debilitating symptoms of schizophrenia.

N Dougall
1 October 2015 

Reference:
Dougall N, Maayan N, Soares-Weiser K, McDermott LM, McIntosh A. Transcranial magnetic stimulation (TMS) for schizophrenia. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.:CD006081.
http://onlinelibrary.wiley.com/enhanced/doi/10.1002/14651858.CD006081.pub2