Digital Commons Network^™

The Current Clinical Practice And Experiences In Buccal Midazolam Prescribing In Community For Status Epilepticus Termination In The United Kingdom: The Rescue Epilepsy Medication And Training (Remit) Study, Rohit Shankar

Peninsula Medical School

Background: Epilepsy is one of the commonest neurological conditions worldwide and confers a significant mortality risk, partly driven by status epilepticus (SE). Terminating SE is the goal of pharmaceutical rescue therapies. This survey evaluates UK-based healthcare professionals’ clinical practice and experience in community-based rescue therapy prescribing. Methods: A cross-sectional, 21 item questionnaire composed of Likert-style and free-text based questions was administered online. It was distributed through a non-discriminative snow-balling methodology to members of the Epilepsy Specialist Nurses’ Association (ESNA) and the British International League Against Epilepsy (ILAE). Quantitative analysis used Chi-squared, Fishers’ exact and Mann-Whitney tests. Qualitative data were analysed …

Serious Games For Constipation Management For People With Intellectual Disabilities: A Scoping Review And Narrative Synthesis, Serena Daniel, Ruth Bishop, Ellie Killner, Alison Whight, Sarah Lennard, Stephen Howard, Richard Laugharne, Rohit Shankar

Peninsula Medical School

Introduction: People with intellectual disability (PwID) are 2% of the UK population. Constipation and bowel movement (BM) problems (diarrhoea/faecal incontinence etc.) affects over a third of PwID and is a serious cause of morbidity and mortality. Pw ID rely heavily on outside support (family/professional carers/healthcare professionals), many of whom are ignorant to bowel related harms. There is significant stigma to discuss BM particularly constipation. Serious Games (SG) are increasingly used for education of health needs. This review examines if game-based technology can assist improving knowledge and reducing stigma of BM problems particularly constipation. Objective: To identify and gain evidence of …

Patient Experiences And Prerequisites Of Collaboration As Partners In Person-Centred Care: An Interview Study, Lena Rosenlund, Sofie Jakobsson, Helen Lloyd, Anna Diffner, Åsa Lundgren-Nilsson, Anna Dencker

School of Psychology

Aim: To explore what characterises communication and collaboration within a patient and professional partnership in outpatient care settings garnered from the experiences of persons living with long-term conditions. Design: A qualitative descriptive study design. Methods: Semi-structured individual interviews were conducted with 15 persons with long-term condition/s who experienced outpatient treatment or follow-up care. Data were explored through inductive thematic analysis. The COREQ checklist was followed. Results: The analysis revealed five themes: adapting and self-managing in daily life, handling and carrying information, building trust and continuity, acting in a flexible and transparent dialogue and sharing the way forward. The participants described …

“Without This Part, It’S Hard To Truly Recover”: Adults’ Experiences Of Body Compassion In Eating Disorder Recovery—A Reflexive Thematic Analysis, Vasiliki Anagnostopoulou

School of Psychology Theses

Background Eating disorder recovery can be complex, with high relapse rates despite the availability of various therapeutic approaches. Recent research suggests body compassion may play a protective role in recovery, but studies remain limited. This study aims to explore adults' experiences of body compassion in their eating disorder recovery journey.Methods Ten adults self-identified as recovered or ‘in recovery’ from anorexia nervosa, bulimia nervosa and/or binge eating disorder, and who had received therapeutic support, participated in online semi-structured interviews. Following ethical approval, data were analysed using reflexive thematic analysis.Analysis Participants described body compassion’s development as a dynamic process captured through five …

“The True Me”: Unravelling The Dual Narrative Of Borderline Personality Disorder And Autistic Spectrum Disorder, Robin Iliffe-Lewis

School of Psychology Theses

Purpose: There is growing recognition that some individuals who receive a diagnosis of Borderline Personality Disorder (BPD) are later diagnosed with autism. However, existing literature on this topic remains limited. This study aimed to explore the experiences of individuals diagnosed with BPD prior to autism, how they made sense of these diagnoses, navigated clinical systems, and learnt to manage the complex challenges associated with this diagnostic sequence.Methods: Thirteen (6 male, 6 female, 1 non-binary) adult participants took part in semi-structured interviews exploring their diagnostic journeys. Reflexive thematic analysis was used to develop a nuanced understanding of their experiences.Results: Three themes …

Masculinity, Muscles, And Minds. Investigating The Interplay Of Factors Affecting Gym-Attending Men For Psychological Formulation., Abigail Middlecote

School of Psychology Theses

Background: This study explores pursuits of a muscular ideal among gym-attending men, to aid understanding and exploration of Drive for Muscularity, considering potential for a Compassion Focused Therapy formulation.Methods: Using a mixed-methods approach, the research examines psycho-social dynamics surrounding ideals and experiences of men, particularly the role of masculinity within a western society. Quantitative data from 80 men analysed relationships among Gender Role Conflict, Traditional Masculine Ideology, body image, Drive for Muscularity, social rank, Attachment, Self-Compassion, Body-Compassion, and Help-Seeking. Qualitative interviews with eight participants focused on relevance of the CFT-formulation in considering these dynamics.Results: Quantitative findings demonstrated most variables significantly …

Exploring The Experience Of Co-Designing Mental Health Services In The National Health Service As An Expert By Experience, Annabelle Mccall

School of Psychology Theses

AbstractPurposeThe number of Experts by Experience (EbE) working in mental health services has grown in recent years. The National Health Service (NHS) five year plan states EbE should be employed across different levels, including service delivery, design and commissioning. While current research explores the role of EbE in service delivery, little is known about their experiences of co-designing services. This research explored EbE experiences of co-designing NHS mental health services. DesignThis research utilised qualitative semi-structured interviews with 10 participants who had worked on projects focused on co-designing NHS mental health services as an EbE. Data were analysed using reflexive thematic …

‘I Am Free, But I Am Not Free’: Nature-Based Interventions With Refugee And Asylum Seekers – An Ethnographic Action Informed Study, Louise Morgan

School of Psychology Theses

Refugees and asylum seekers (RAS) in the UK face significant barriers to well-being due to hostile immigration policies and limited mental health support. Nature-based interventions (NBIs) are emerging as culturally inclusive psychosocial support, yet RAS experiences remain underexplored. An Ethnographic Action Research (EAR) informed approach was used to examine a nature-based programme in Southwest England, developed with four lived experience co-researchers. Data was collected through five observation days, sixteen conversations, and one focus group, involving three staff facilitators and 30 RAS participants. Thematic Framework Analysis identified four themes: To Access, To Connect and Belong, To Survive, and To Be Me …

A Community-Based Participatory Action Research Project Exploring The Experiences Of Suicidal Distress For Autistic Adults: An Interpretive Phenomenological Study, Kyah Sisulu, Emily Hutswick, Philippa Wood, Bethany George, Lealah Hewitt-Johns

School of Psychology Theses

Background: Suicide is the leading cause of death for young people aged 15–29 (WHO, 2021). Autistic individuals experience elevated rates of mental health difficulties, often linked to stigma, discrimination, and a lack of appropriate support (Botha & Frost, 2020; Hedley et al., 2018). They are significantly more likely to experience suicidal thoughts and behaviours than the general population (Hirvikoski et al., 2016). Despite this, limited research has explored autistic adults’ lived experiences of suicidal distress. Calls from autistic advocates highlight the need for inclusive, co-produced research to avoid perpetuating harm (Pellicano et al., 2014; Kapp et al., 2013).Aims: This study …

Concordance Of Molecular Microbiology And Conventional Culture Techniques For Infected Diabetic Foot Ulcer Management, Angela Oates, Sarah T. Brown, Colin C. Everett, Fran Game, Jane E. Nixon, Tim Sloan, Michelle M. Lister, Michael Backhouse, Benjamin A. Lipsky, David Russell, Howard Collier, Joanna Dennett, Rachael Gilberts, E. Andrea Nelson, Jon Deeks, Sue Mallett, Roger Gasdby, Jane Lewis, Julie Brittenden, Andrew Bradbury, Joanne Paton, Zoe Hoare, Deborah Fitzsimmons, Mark Wilcox, Gerry Rayman, Brenda Riley, Christine Thomas, Ravikanth Gouni, Haroon Siddique, Gillian A. Lomax

School of Health Professions

Aim: The management of infected diabetic foot ulcers (DFUs) requires balancing the need for timely interventions against the desire for targeted antibiotic therapy, which relies on laboratory results. This study aimed to evaluate concordance between molecular and conventional culture and sensitivity (C&S) methods in identifying bacteria from infected DFUs. Methods: This study was conducted alongside CODIFI2, a Phase III randomised controlled trial comparing tissue sampling with wound swabbing. It assessed C&S and metagenomic 16S rRNA gene sequencing (M16S) in DFUs with suspected mild or moderate infections using both tissue and swab samples. Results: In 145 participants, C&S identified 248 microorganisms …

Sexual Communication Patterns Of Heterosexual-Identified Men Who Have Sex With Men, Travis R. Scheadler, Megan W. Rowe, Salem Rao, Oliver W.J. Beer, Tyrone J. Curtis, Sandra Kwan, Shih Ju Claire Lung, Adam Busch, Daniel Vandervoort, Paul A. Shuper, Andrew D. Eaton

School of Health Professions

The sexual communication patterns that comprise how heterosexual men with concordance between identity and behavior navigate their sexual encounters with women are well-established. Some heterosexual men experience discordance between their sexual identities and behaviors and may have unique practices of sexual communication, but this has not been studied. Knowledge of their sexual communication practices is an important step toward understanding and improving their sexual experiences. Therefore, semi-structured interviews were conducted with 11 heterosexual-identified men who have sex with men to learn more about their sexual communication strategies. Three themes were identified through interpretative phenomenological analysis: meeting sex partners, clear communication …

Interventions For Promoting Physical Activity In People With Newly Diagnosed Parkinson’S Disease: Scoping Review, Jonathan Gilby, Bridie Kent, Rachel Knight Lozano, Jonathan Marsden

School of Health Professions

Background: There is increasing evidence to suggest that physical activity can slow Parkinson’s progression. There is also increasing interest in non-pharmacological interventions to alleviate Parkinson’s symptoms. This scoping review aimed to map and describe the evidence for interventions that promote physical activity in people with newly diagnosed Parkinson’s. Methods: Studies conducted since 2011, on adults with Parkinson’s (≥ 18 years), investigating the effects of non-pharmacological interventions to promote physical activity and/or exercise were considered. Interventions needed to be conducted in healthcare or healthcare-related settings for people within 5 years of Parkinson’s diagnosis. Published or unpublished full-text articles since 2011 were …

Interactions Of Anthropogenic Microfibres With The Marine Macroalga, Ulva Lactuca, Adam Collins, Andrew Turner

School of Geography, Earth and Environmental Sciences

Little information exists on the interactions between microfibres (MFs) and marine macroalgae. In this study, the translucent green seaweed, Ulva lactuca, has been exposed to ∼2 mg L⁻¹ suspensions of MFs prepared from dryer lint under controlled conditions, with MFs on the alga surface and remaining in seawater subsequently counted and characterised. MFs were mainly <2 mm and cellulosic, and contained various additives and chemicals used in textile treatment. Interactions of MFs with U. lactuca were spatially heterogeneous but correcting for pre-existent MFs on the surface, mean trapping efficiencies on a dry mass and surface area basis were 252 mL g⁻¹ and 0.858 mL cm⁻², respectively. Despite this heterogeneity, there was evidence of differential trapping based on fibre colour and length. Interactions between the amphiphilic algal surface and MFs are likely both hydrophobic and electrostatic and are not fully reversible, with only …

Care‐Ful Encounters: A Case For Empathetic Youthful Encounters With Coastal Environments, Mark Holton

School of Geography, Earth and Environmental Sciences

This paper extends discourse of environmental stewardship and coastal management by examining the intersecting and overlapping relationships between notions of care and encounter in generating and maintaining forms of environmental empathy among young people at various socio-spatial scales. Exploring ‘care-ful encounters’ matters in terms of developing new ways of understanding how the choreographies of care and self-care shape, and are shaped by, encounters with human and non-human others, and prompts critical engagement and reflection with care as felt and experienced, that could otherwise be considered as distanced and ‘over there‘. Two key contributions emerge – first, that the combined role …

Anthropogenic Microfibres And Other Microplastics In The Sediments And Soils Of A Small, Moorland Reservoir (Burrator, Southwest England), Alexandra Sutton, Andrew Turner

School of Geography, Earth and Environmental Sciences

Little is known about the sources, transport and fate of anthropogenic microfibres (AMFs) and other microplastics (MPs) in dammed reservoirs. The aim of this study was to determine the concentrations, characteristics and pathways of anthropogenic particles in sediments and soils from a small, upland reservoir (Burrator, southwest England) and its influent and effluent river. Surface and subsurface (5 cm) sediments and soils were collected and characterised for organic matter and key geochemical (Ca, Fe and Rb) and anthropogenic (Pb and Zn) elements. AMFs and MPs were isolated from samples by flotation in ZnCl₂ and analysed microscopically; a selection was …

Exploring The Role Of Irf4 In The Sensitivity Of Mantle Cell Lymphoma Cells To Bruton's Tyrosine Kinase Inhibitors, Artjoms Portnojs

Peninsula Medical School Theses

Introduction and aim: Mantle cell lymphoma (MCL) is an aggressive subtype of B-cell lymphoma. Therapy using Bruton’s tyrosine kinase (BTK) inhibitors has improved clinical outcomes but primary and secondary resistance to BTK inhibitor (BTKi) therapy affects more than half of MCL patients. Resistance most often arises through gene mutations in cells protected from BTKi effects within the local tissue microenvironment. This thesis develops previous work by the group identifying IRF4 as a central mediator of resistance to BTK inhibitors in MCL; the thesis aims to understand how resistance develops and to identify mechanisms to prevent or overcome BTKi resistance in …

Acute, Low-Grade Inflammation Elevates White Matter Sensitivity To Ischaemia, Alex Mellor

Peninsula Medical School Theses

Ischaemic brain injuries, including ischaemic stroke, are highly prevalent neurological diseases. Acute, low-grade inflammation, often resulting from peripheral infection, has emerged as a risk factor. White matter axons, and their supporting glia, are susceptible to both ischaemic and neuroinflammatory injury. The mechanisms behind ischaemic injury in white matter are well established. However, the white matter response to acute, low-grade inflammation, and how this can interact with co-morbidities such as cerebral ischaemia, are yet to be examined. This thesis evaluated the response of white matter to acute, low-grade inflammation and the downstream effects this had on its sensitivity to ischaemia. Here, …

Targeting Mertk On Tumour Cells And Macrophages: A Potential Intervention For Sporadic And Nf2-Related Meningioma And Schwannoma Tumours, Kevin Herrera Keane

Peninsula Medical School Theses

Although schwannomas and meningiomas are generally benign and slow-growing, the mass effect of either tumour within the nervous system causes life-altering symptoms. Individuals with NF2-related schwannomatosis may develop schwannomas and meningiomas, increasing tumour burden. The primary treatment for large or symptomatic schwannomas and meningiomas is surgical resection, which may not be suitable in cases involving tumours located near sensitive neuroanatomy or clinically vulnerable individuals. Not all schwannomas and meningiomas respond to alternative targeted treatments such as stereotactic radiosurgery or the vascular endothelial growth factor inhibitor bevacizumab. The main objective of this thesis was to investigate targeting of the receptor tyrosine …

Increasing Serious Illness Conversations In Patients At High Risk Of One-Year Mortality Using Improvement Science: A Quality Improvement Study, Kanishk D. Sharma, Sandip A. Godambe, Prachi P. Chavan, Agatha Parks-Savage, Marissa Galicia-Castillo

Department of Family and Community Medicine Faculty Publications

Background: Serious illness conversation (SIC) in an important skillset for clinicians. A review of mortality meetings from an urban academic hospital highlighted the need for early engagement in SICs and advance care planning (ACP) to align medical treatments with patient-centered outcomes. The aim of this study was to increase SICs and their documentation in patients with low one-year survival probability identified by updated Charlson Comorbidity Index (CCI) scores. Methods: This was a quality improvement study with data collected pre- and post-intervention at a large urban level one trauma center in Virginia, which also serves as a primary teaching hospital to …

The Influence Of The Residency Interview Format On Future Interviewing Models And Use Of Preference Signals, John E. Snellings, Hanwen Miao, Daniel L. Meyer, Miranda A. Moore

Department of Family and Community Medicine Faculty Publications

Background and Objectives: The COVID-19 pandemic dramatically altered the format of residency recruitment, leading to the widespread adoption of virtual interviews, followed by the adoption of preference signaling. This study examines how the structure of the 2023-2024 interview season influenced family medicine residency program directors' intentions for future interview formats and their preferences regarding the number of preference signals.

Methods: A Council of Academic Family Medicine Educational Research Alliance survey, including demographic questions, was distributed to all family medicine residency program directors in the United States in spring 2024. Data analysis included descriptive statistics, cross-tabulations, χ² tests, and multivariable logistic …

Translating Cardiovascular Clinical Practice Guidelines On Nutrition Therapy: Validation Of The Portfolio Diet Toolkit For Healthcare Providers, Gabrielle Viscardi, Sahba Eskandari, Alyssa Chen, Nicholas Chiang, Meaghan E. Kavanagh, Songhee Back, Micheal Vallis, Mary J. Scourboutakos, Vasanti S. Malik, Cyril W.C. Kendall, David J.A. Jenkins, John L. Sievenpiper, Laura Chiavaroli

Department of Family and Community Medicine Faculty Publications

Background

Cardiovascular disease (CVD) remains a leading cause of death in Canada. Although the Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is supported by CVD clinical practice guidelines, its uptake in clinical practice remains limited. This study assessed the content and face validity of a healthcare provider (HCP)-facing toolkit (infographic and video), designed to support implementation of the Portfolio Diet.

Methods

HCPs were recruited for a 2-round evaluation. They assessed the toolkit using a questionnaire. Content validity of the infographic was assessed using a 4-point Likert scale (1 = irrelevant to 4 = extremely relevant) and face validity of …

Current Practices In Implementing The Occupational Therapy Doctoral Capstone Needs Assessment: A National Survey, Laurie D. Stelter, Kaitlyn Cremer, Lou Rutigliano, Leslye Morris, Lima Ghulmi, Ana Allegretti

Occupational Therapy Faculty Publications

Entry-level occupational therapy doctorate (OTD) programs navigate curricular decisions related to designing, implementing, and refining doctoral capstone processes. One of the complex requirements is the doctoral capstone needs assessment (DCNA) which each student completes prior to the implementation of the doctoral capstone project. The researchers aimed to contribute to the specificity of DCNA-related understanding, informing quality decision-making, via a national, cross-sectional survey of current DCNA practices. Purposive sampling resulted in a 24.3% (n=54) response rate of mostly Doctoral Capstone Coordinators (DCCs; 98.1%) representing programs across doctoral capstone experience levels. The timing of DCNA processes trended toward the latter half of …

Educator Equity And Pedagogy: Multilingual Learners In Rural Schools, Marsha R. Martin Kerr

Doctor of Education

This sequential explanatory mixed-method design study aims to understand and identify educator experiences and beliefs and how they affect equitable pedagogy with multilingual learners(MLLs) in rural K-12 public schools today. The research questions the significance of equitable pedagogy, systems, and resistances instructing MLLs to create dialogue supporting educator self-awareness, critical thinking, and collaboration while supporting diversity, equity, inclusion, and cultivating a positive school climate through multicultural education. The theoretical framework threads social learning theory through psychological mechanisms of observance and behavior from others, and social theory examines educational institutions through sociological perspectives and methodologies. These theories support teaching and learning …

Breastfeeding Education In Peripartum Women, Kristen Chassner

Doctor of Nursing Practice Projects

Breastfeeding is nature’s medicine. Though it is considered a natural experience between a mother and a child, it does not always come easy. Education is imperative for peripartum women to learn more about breastfeeding in general, its benefits to the mother and the child, identifying improper latching, and resources to seek help. The purpose of this project was to provide introductory breastfeeding education to peripartum women at a government-funded public health facility in Cleveland County, North Carolina, to increase breastfeeding knowledge, self-efficacy, and the intention to breastfeed for the baby’s first 6-months of life in 100% of the participants. Though …

Providing Community Education On Opioid Addiction And Emergency Intervention, Chasity Vargas

Doctor of Nursing Practice Projects

Introduction: The opioid crisis remains a significant public health concern, with opioid-related overdoses continuing to rise. Naloxone (Narcan) is a life-saving medication that can reverse opioid overdoses, yet many community members lack awareness and training on its use. This Doctor of Nursing Practice (DNP) project aimed to implement and evaluate a community-based Narcan education program to improve knowledge, accessibility, and confidence in administering Narcan.

Method: Using a quality improvement framework, the project targeted community members servicing the homeless population. Pre- and post-education surveys assessed changes in participants' knowledge and attitudes toward opioid overdose response.

Results: Findings demonstrated a significant increase …

Educating Caregivers And Parents On Infant Safe Sleep Guidelines In A Rural Community, Melody Hill

Doctor of Nursing Practice Projects

Sudden Infant Death Syndrome (SIDS) remains a leading cause of infant mortality, highlighting the need for effective, safe sleep education for caregivers and parents. Key safe sleep guidelines have been shown to reduce SIDS risk by placing infants on their backs to sleep, using firm mattresses, and avoiding soft bedding. However, misconceptions about safe sleep practices persist, making education for caregivers and parents essential. The desired outcome of this project was to significantly enhance the knowledge and behaviors related to infant sleep practices, ensuring that caregivers and parents understand and follow safe sleep guidelines. This project aimed to evaluate the …

On The Frontline: Stop The Bleed© Training For School Staff, Mary Michaela Hinson

Doctor of Nursing Practice Projects

The American College of Surgeons’ Stop the Bleed© course was introduced in 2015 following an outcry from the community surrounding the Sandy Hook Elementary School shooting. The Stop the Bleed© course was developed as a tool for training that any person could participate in, despite their medical background or knowledge. The course is comprised of a 30-minute didactic portion followed by a 30-minute hands-on portion where participants can practice applying tourniquets, packing a wound, and applying manual pressure. This DNP project aimed to educate school staff in a high school located in North Carolina on Stop the Bleed© in an …

The Path To Zero Clabsis: The Benefits Of Central Line Care Teams, Supplemental Checklist, Increased Education And Utilizing Clabsi Bundles, Lauren A. Bondurant

Doctor of Nursing Practice Projects

Central line-associated bloodstream infections (CLABSIs) result in a plethora of deaths each year and cost the U.S. healthcare system billions of dollars (Centers for Disease Control and Prevention, 2024). CLABSIs have been a type of bloodstream infection that has affected a plethora of individuals for years and one that does not discriminate patient type. Many articles were reviewed, but they all inferred that CLABSIs bundles,supplemental checklists, and central line care teams all showed the most significant data and resulted in the most decreased CLABSI rates. Upon assessment of the project unit, it was noted that the issue that most impacted …

The Use Of Music Therapy And Various Mechanisms Of Diversion To Aid Caregivers Of Those With Alzheimer’S Disease And Dementia, Sarah Elizabeth Kane

Doctor of Nursing Practice Projects

Background: Alzheimer’s Disease and Dementia inhabit an increasingly alarming number of individuals within the United States with the majority of their caregivers being loved ones with limited to no healthcare education. This DNP project was designed to specifically educate caregivers of those with Alzheimer’s Disease and Dementia. The goal of this project was to increase the knowledge of the disease while also increasing the ability and confidence to better care for their loved ones. In using the resources outlined in this project, such as music therapy and diversional tools, the caregiver would see a decrease in emotional outbursts and …

Providing Safe Care For Mental Health Patients Through Ongoing Education Of Non-Psychiatric Nurses And Staff, Amy Kilpatrick

Doctor of Nursing Practice Projects

Nurses care for many individuals with medical conditions, but also those who suffer from mental illness and are in an acute mental health crisis. Nonpsychiatric nurses often lack adequate knowledge and training while caring for individuals with mental health disorders and those in acute crisis, which can be a barrier to providing safe, effective care for this vulnerable population. When individuals are in crisis and present to the emergency departments, their first contact is with emergency room nurses who may lack the necessary skills to conduct a thorough assessment when evaluating for mental health disorders, including the presence of suicidal …