Jenny Hislop

Investigating couples' sleep: an evaluation of actigraphic analysis techniques.

‘Blip’ analysis, fast wavelet transformations (FWT) and correlation analysis have all been used to actigraphically assess the impact one person is having on anothers sleep, yet no review exists as to the differences between, and applicability of, these methods for investigating couples’ sleep. Using actigraphy data and audio sleep diaries collected from 18 couples, this paper provides such a review. This paper constructs and assesses two novel, analytical methods: Lotjonens sleep/wake algorithm, and the partner impact on sleep wake analysis (PISWA). Both ‘blip’ analysis and correlation suggest that the strongest relationship between bed partners occurs on an epoch‐to‐epoch basis. However, ‘blips’ deal strictly with onset of movement and fail to incorporate strength and duration of movement. Conversely, correlation analysis incorporates some elements of strength and duration of movement but makes identification of onset problematic. FWT offer useful ‘relativistic’ pattern recognition, identifying onset, strength and duration of movement, but are difficult to quantify. Although audio diary data support the potential of Lotjonens sleep/wake algorithm to identify sleep non‐movement, sleep movement, wake non‐movement (or quiet wakefulness) and wake movement, the problem remains that this method also relies on visualization. Of most promise, we argue, is the PISWA, which examines ‘impact’ of bed partners through incorporating elements of ‘blip’ analysis and the sleep/wake algorithm.

A Bed of Roses or a Bed of Thorns? Negotiating the Couple Relationship Through Sleep

The convention in Western societies of partners sharing a bed is symbolic of their status as a couple, their commitment to the relationship, and their desire for shared intimacy. Yet for many couples, incompatibility as sleeping partners may threaten to undermine romantic notions of the double bed. This paper draws on in-depth interview and audio diary data from research into sleep in couples aged 20-59 (N=40) to examine how couples negotiate the spatial, temporal and relational dimensions of the sleeping environment. The paper contends that the management of tensions inherent in the sleeping relationship plays a key role in framing the couple identity over time, as well as reinforcing the gendered roles, power relationships and inequalities which underpin everyday life.

Cardiovascular risk scores: qualitative study of how primary care practitioners understand and use them

BACKGROUND The National Institute for Health and Care Excellence guidelines and the Quality Outcomes Framework require practitioners to use cardiovascular risk scores in assessments for the primary prevention of cardiovascular disease. AIM To explore GPs understanding and use of cardiovascular risk scores. DESIGN AND SETTING Qualitative study with purposive maximum variation sampling of 20 GPs working in Oxfordshire, UK. Method Thematic analysis of transcriptions of face-to-face interviews with participants undertaken by two individuals (one clinical, one non-clinical). RESULTS GPs use cardiovascular risk scores primarily to guide treatment decisions by estimating the risk of a vascular event if the patient remains untreated. They expressed considerable uncertainty about how and whether to take account of existing drug treatment or other types of prior risk modification. They were also unclear about the choice between the older scores, based on the Framingham study, and newer scores, such as QRISK. There was substantial variation in opinion about whether scores could legitimately be used to illustrate to patients the change in risk as a result of treatment. The overall impression was of considerable confusion. CONCLUSION The drive to estimate risk more precisely by qualifying guidance and promoting new scores based on partially-treated populations appears to have created unnecessary confusion for little obvious benefit. National guidance needs to be simplified, and, to be fit for purpose, better reflect the ways in which cardiovascular risk scores are currently used in general practice. Patients may be better served by simple advice to use a Framingham score and exercise more clinical judgement, explaining to patients the necessary imprecision of any individual estimate of risk.

General practitioners’ views on quality markers for children in UK primary care: a qualitative study

BackgroundChildren make up about 20% of the UK population and caring for them is an important part of a general practitioner’s (GP’s) workload. However, the UK Quality Outcomes Framework (pay-for-performance system) largely ignores children – less than 3% of the quality markers relate to them. As no previous research has investigated whether GPs would support or oppose the introduction of child-specific quality markers, we sought their views on this important question.MethodsQualitative interview study with 20 GPs from four primary care trusts in Thames Valley, England. Semi-structured interviews explored GPs’ viewpoints on quality markers and childhood conditions that could be developed into markers in general practice. Interviews were audiotaped and transcribed verbatim. Analysis was thematic and used constant comparative method to look for anticipated and emergent themes as the analysis progressed.ResultsAll the GPs interviewed supported the development of ‘benchmarks’ or ‘standards’ to measure and improve quality of care for children. However no consensus was expressed about the clinical conditions for which quality markers should be developed. Many participants reflected on their concerns about unmet health care needs and felt there may be opportunities to improve proactive care in ‘at risk’ groups. Some expressed feelings of powerlessness that important child-relevant outcomes such as emergency department visits and emergency admissions were out of their control and more directly related to public health, school and parents/carers. The importance of access was a recurrent theme; access to urgent general practice appointments for children and GP access to specialists when needed.ConclusionThe GPs expressed support for the development of quality markers for the care of children in UK general practice. However, they flagged up a number of important challenges which need to be addressed if markers are to be developed that are measureable, targeted and within the direct control of primary care. Easy access to primary and secondary care appointments may be an important benchmark for commissioners of care.

A gendered lifecourse examination of sleep difficulties among older women

ABSTRACT Recent research has suggested that understanding and addressing the high prevalence of sleep difficulties in older women requires going beyond a purely physiological focus to address the role of social contextual pressures and demands. We take a gendered lifecourse approach to explore how sleep difficulties have evolved and how their management might reflect the position of older women in society more broadly. We conducted in-depth interviews with 12 oldest-old (average age 86) community-dwelling women who currently experienced sleep difficulties. Five themes emerged from the analysis: significant life stages; contingent lives; daily concerns in relation to ageing; attitudes and responses of women and general practitioners; and stigma and sleeping pills, which provided a conceptual framework through which to explain the reality of sleep difficulties for these women. For all women, sleep difficulties were not related to physical aspects such as pain or discomfort, but were largely shaped by demands associated with family relationships at different times in the lifecourse. Furthermore, our findings suggest that responses by women themselves, and health professionals, reflect a sense of stigma around sleep difficulties and use of sleeping pills. More emphasis on the social contextual explanations underpinning sleep difficulties might lead to better prevention and treatment of such problems, and increase quality of life.

Automated Software System to Promote Anticoagulation and Reduce Stroke Risk: Cluster-Randomized Controlled Trial.

Background and Purpose— Oral anticoagulants (OAC) substantially reduce risk of stroke in atrial fibrillation, but uptake is suboptimal. Electronic health records enable automated identification of people at risk but not receiving treatment. We investigated the effectiveness of a software tool (AURAS-AF [Automated Risk Assessment for Stroke in Atrial Fibrillation]) designed to identify such individuals during routine care through a cluster-randomized trial. Methods— Screen reminders appeared each time the electronic health records of an eligible patient was accessed until a decision had been taken over OAC treatment. Where OAC was not started, clinicians were prompted to indicate a reason. Control practices continued usual care. The primary outcome was the proportion of eligible individuals receiving OAC at 6 months. Secondary outcomes included rates of cardiovascular events and reports of adverse effects of the software on clinical decision-making. Results— Forty-seven practices were randomized. The mean proportion–prescribed OAC at 6 months was 66.3% (SD=9.3) in the intervention arm and 63.9% (9.5) in the control arm (adjusted difference 1.21% [95% confidence interval −0.72 to 3.13]). Incidence of recorded transient ischemic attack was higher in the intervention practices (median 10.0 versus 2.3 per 1000 patients with atrial fibrillation; P=0.027), but at 12 months, we found a lower incidence of both all cause stroke (P=0.06) and hemorrhage (P=0.054). No adverse effects of the software were reported. Conclusions— No significant change in OAC prescribing occurred. A greater rate of diagnosis of transient ischemic attack (possibly because of improved detection or overdiagnosis) was associated with a reduction (of borderline significance) in stroke and hemorrhage over 12 months. Clinical Trial Registration— URL: http://www.isrctn.com. Unique Identifier: ISRCTN55722437.

Do we all agree what “good health care” looks like? Views from those who are “seldom heard” in health research, policy and service improvement

The aim of this study was to ask whether there are shared ideas about what good health care looks like that apply across different populations and conditions. Do priorities among “seldom heard” groups differ from mainstream views and, if so, how might we understand these differences?