Karen Kilner

Leadership styles used by senior medical leaders

– The purpose of this study was to determine the predominant leadership styles used by medical leaders and factors influencing leadership style use. Clinician leadership is important in healthcare delivery and service development. The use of different leadership styles in different contexts can influence individual and organisational effectiveness. , – A mixed methods approach was used, combining a questionnaire distributed electronically to 224 medical leaders in acute hospital trusts with in-depth “critical incident” interviews with six medical leaders. Questionnaire responses were analysed quantitatively to determine, first, the overall frequency of use of six predefined leadership styles and, second, individual leadership style based on a consultative/decision-making paradigm. Interviews were analysed thematically using both a confirmatory approach with predefined leadership styles as themes, and also an inductive grounded theory approach exploring influencing factors. , – Leaders used a range of styles, the predominant styles being democratic, affiliative and authoritative. Although leaders varied in their decision-making authority and consultative tendency, virtually all leaders showed evidence of active leadership. Organisational culture, context, individual propensity and “style history” emerged during the inductive analysis as important factors in determining use of leadership styles by medical leaders. , – The outcomes of this evaluation are useful for leadership development at the level of the individual, organisation and wider National Health Service (NHS). , – This study adds to the very limited evidence base on patterns of leadership style use in medical leadership and reports a novel conceptual framework of factors influencing leadership style use by medical leaders.

A comparison of the nutrient intake of a community-dwelling first-episode psychosis cohort, aged 19–64 years, with data from the UK population

Psychosis increases the risk of CVD, obesity and type 2 diabetes and reduces life expectancy. There are limited data comparing the dietary habits of community-dwelling first-episode psychosis sufferers – with autonomy over diet – and the general population. The data represent the retrospective evaluation of nutritional data collected between 2007 and 2013 from 143 individuals from the UK population receiving treatment for first-episode psychosis. Differences in mean nutrient intakes between the study cohort and the national sample were tested for statistical significance using independent t tests, incorporating Satterthwaites correction where required. Mean total energy intake was lower for males (P = 0·049) and higher for females (P = 0·016) in the cohort than in the corresponding subgroups of the national sample. Females in the study cohort consumed 12·9 (95 % CI 4·3, 21·5) g more total fat per d, whilst males consumed 7·7 (95 % CI 0·5, 14·9) g less protein per d than the national sample. Males in the study also showed significantly lower mean intakes than nationally of folate, Fe, Se, vitamin D and Zn, but not vitamin C. The proportion of individuals not meeting the lower reference nutrient intakes, particularly for Se (males 54·0 % and females 57·1 %) and for Fe amongst females (29·6 %), is cause for concern regarding potentially severe deficiencies. Further exploration of dietary habits within first-episode psychosis is warranted to assess whether individuals make beneficial dietary changes for their physical and mental health and wellbeing following dietary change intervention. It would also be pertinent to assess any correlation between diet and mental health symptomology.

Language difficulties and criminal justice: the need for earlier identification

BACKGROUND At least 60% of young people in the UK who are accessing youth justice services present with speech, language and communication difficulties which are largely unrecognized. The contributing reasons for this are discussed, suggesting that early language difficulty is a risk factor for other problems such as literacy difficulties and educational failure that may increasingly put the young person at risk of offending. Opportunities for identification and remediation of language difficulties before young people reach youth justice services are also outlined. AIMS To examine language skills in a sample of children in a secure childrens home aged 11-17 years. METHODS & PROCEDURES A sample of 118 males were routinely assessed on four Comprehensive Evaluation of Language Fundamentals (CELF) subtests and the British Picture Vocabulary Scale (BPVS). OUTCOMES & RESULTS Around 30% of the participants presented with language difficulties scoring 1.5 SD (standard deviation) below the mean on the assessments. Despite them entering the home because their vulnerability was recognized, only two participants had a previous record of language difficulties. A total of 20% of the participants had a diagnosis of mental illness, 50% had a history of drug abuse and 31% had looked-after status prior to entry to the home. CONCLUSIONS & IMPLICATIONS Children experiencing educational or emotional difficulties need to be routinely assessed for speech, language and communication difficulties. More population-based approaches to supporting the development of oral language skills in children and young people are also supported.

Information needs and decision making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer

To establish older womens (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify womens preferences for the mode of information presentation and decision‐making (DM) style.

Aerobic exercise interventions reduce blood pressure in patients after stroke or transient ischaemic attack: a systematic review and meta-analysis

Objective Secondary vascular risk reduction is critical to preventing recurrent stroke. We aimed to evaluate the effect of exercise interventions on vascular risk factors and recurrent ischaemic events after stroke or transient ischaemic attack (TIA). Design Intervention systematic review and meta-analysis. Data sources OVID MEDLINE, PubMed, The Cochrane Library, Web of Science, The National Institute for Health and Care Excellence, TRIP Database, CINAHL, PsycINFO, SCOPUS, UK Clinical Trials Gateway and the China National Knowledge Infrastructure were searched from 1966 to October 2017. Eligibility criteria Randomised controlled trials evaluating aerobic or resistance exercise interventions on vascular risk factors and recurrent ischaemic events among patients with stroke or TIA, compared with control. Results Twenty studies (n=1031) were included. Exercise interventions resulted in significant reductions in systolic blood pressure (SBP) −4.30 mm Hg (95% CI −6.77 to −1.83) and diastolic blood pressure −2.58 mm Hg (95% CI −4.7 to −0.46) compared with control. Reduction in SBP was most pronounced among studies initiating exercise within 6 months of stroke or TIA (−8.46 mm Hg, 95% CI −12.18 to −4.75 vs −2.33 mm Hg, 95% CI −3.94 to −0.72), and in those incorporating an educational component (−7.81 mm Hg, 95% CI −14.34 to −1.28 vs −2.78 mm Hg, 95% CI −4.33 to −1.23). Exercise was also associated with reductions in total cholesterol (−0.27 mmol/L, 95% CI −0.54 to 0.00), but not fasting glucose or body mass index. One trial reported reductions in secondary vascular events with exercise, but was insufficiently powered. Summary Exercise interventions can result in clinically meaningful blood pressure reductions, particularly if initiated early and alongside education.

Prevalence of laceration injuries in professional and amateur rugby union: a systematic review and meta-analysis

Background Studded footwear can cause severe lacerations in rugby union; the prevalence of these injuries is currently unknown. Objective To summarise the skin and laceration injury prevalence in published epidemiological studies and to investigate any differences in skin injury risk between amateur and professional players. Design Systematic literature review and meta-analysis of epidemiological studies. Data sources PubMed, Web of Science, Scopus and Ovid. Eligibility criteria for selecting studies Prospective, epidemiological studies published in English after 1995, measuring a minimum of 400 match or 900 training exposure hours. Participants should be adult rugby union players (amateur or professional). The study should report a separate skin or laceration injury category and provide sufficient detail to calculate injury prevalence within this category. Results Twelve studies were included. Mean skin injury prevalence during matches was 2.4 injuries per 1000 exposure hours; during training sessions, the prevalence was 0.06 injuries per 1000 exposure hours. Skin injuries accounted for 5.3% of match injuries and 1.7% of training injuries. Skin injury risk was similar for amateur compared with professional players during matches (OR: 0.63, p=0.46.), but higher during training sessions (OR: 9.24, p=0.02). Conclusions The skin injury prevalence of 2.4 injuries per 1000 exposure hours is equivalent to one time-loss injury sustained during matches per team, per season. Amateur players are more likely to sustain skin injuries during training sessions than professional players. There is a need for more studies observing injuries among amateur players. Trial registration number PROSPERO CRD42015024027.

1504 Self-determining medical leadership needs of occupational medicine physicians – a study that can reshape the medical leadership training

Introduction Physician leadership, irrespective of hierarchy, is an integral part of delivering complex modern-day healthcare which thrives on quality improvement and efficiency savings. Doctors’ participation in Medical Leadership however remains fragmented and patchy as has been their leadership training. Absence of empirical research in designing strategies to engage and motivate doctors and validated leadership qualities assessment instruments may have compounded the problem further. Methods This national study, facilitated by the Faculty of Occupational Medicine of the UK (FOM), explored factors that motivate the UK-based Occupational Medicine Physicians (OHPs) to engage in leadership roles alongside assessment of their leadership competency and training needs by framing an inquiry within Self-Determination Theory using the 7 domain National Health Service Leadership Academy self-assessment tools on a web-based platform. The data were analysed using descriptive statistics and simple inferential methods. Results 25% (250/1000) of the UK-based FOM (n=1000) members participated. OHPs were open about reporting their leadership strengths (mean score; 4.26/8 across 7 domains; highest in personal qualities; 5.77/8 and lowest in Creating the Vision; 2.73/8). Irrespective of personal level of competency, they universally recognised the need for life-long leadership training. Experience of management role (6 domains; p<0.05) was identified as the single most influencing factor behind a doctor’s confidence. In multivariate regression, management experience accounted for the usefulness of leadership training, suggesting that doctors learn best through applied ‘leadership learning’ as opposed to theory-driven programmes. Conclusions Drawing on Self-Determination Theory this study provides a theoretical framework for engaging doctors in Medical Leadership; assessing their leadership competency and learning needs and setting up reliable leadership training programmes. Doctors’ ability to reliably determine their learning needs and the invaluable role of hands-on leadership/management experience in boosting doctors’ leadership confidence, calls for more personalised and relevant learning plan that can build on their previous experience and expertise.

A comfort assessment of existing cervical orthoses

Abstract Purpose: Identify location and intensity of discomfort experienced by healthy participants wearing cervical orthoses. Method: Convenience sample of 34 healthy participants wore Stro II, Philadelphia, Headmaster, and AspenVista® cervical orthoses for four-hour periods. Participants reported discomfort level (scale 0–6) and location. Results: Participants reported mean discomfort for all orthoses over the four-hour test between ‘a little discomfort’ and ‘very uncomfortable’ (mean discomfort score = 1.64, SD = 1.50). Seven participants prematurely stopped tests due to pain and six reported maximum discomfort scores. Significant linear increase in discomfort with duration of wear was found for all orthoses. Significantly less discomfort was reported with Stro II than Headmaster and Philadelphia. Age correlated with greater perceived discomfort. Orthoses differed in the location discomfort was experienced. Conclusion: Existing cervical orthoses cause discomfort influenced by design and duration of wear with orthoses’ design the more significant factor. This work informed the design of a new orthosis and future orthoses developments. Practitioner Summary: The purpose of this study was to gain greater knowledge about the discomfort caused by wearing of existing neck orthoses in order to inform the design and development of a new neck orthosis. This study gathers empirical data from a surrogate population and concludes that orthosis design is more influential than the duration of wear.

Impact of dysphagia assessment and management on risk of stroke-associated pneumonia: A systematic review

Background: Patients with dysphagia are at an increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed during the acute phase. The aim of this review was to identify the methods of assessment and management in acute stroke that influence the risk of stroke-associated pneumonia. Studies of stroke patients that reported dysphagia screening, assessment or management and occurrence of pneumonia during acute phase stroke were screened for inclusion after electronic searches of multiple databases from inception to November 2016. The primary outcome was association with stroke-associated pneumonia. Summary: Twelve studies of 87,824 patients were included. The type of dysphagia screening protocol varied widely across and within studies. There was limited information on what comprised a specialist swallow assessment and alternative feeding was the only management strategy, which was reported for association with stroke-associated pneumonia. Use of a formal screening protocol and early dysphagia screening (EDS) and assessment by a speech and language pathologist (SLP) were associated with a reduced risk of stroke-associated pneumonia. There was marked heterogeneity between the included studies, which precluded meta-analysis. Key Messages: There is variation in the assessment and management of dysphagia in acute stroke. There is increasing evidence that EDS and specialist swallow assessment by an SLP may reduce the odds of stroke-associated pneumonia. There is the potential for other factors to influence the incidence of stroke-associated pneumonia during the acute phase.

Impact of adolescent age on maternal and neonatal outcomes in the Born in Bradford cohort

Objectives Explore associations between maternal and neonatal outcomes and maternal age, with particular reference to adolescent women. Design Population-based cohort study. Setting Maternity department of a large hospital in Northern England. Participants Primiparous women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 aged ≤19 years (n=640) or 20–34 years (n=3951). Subgroup analysis was performed using women aged ≤16 years (n=68). Women aged 20–34 years were used as the reference group. Primary outcome measures Maternal and neonatal outcomes. Results The odds of extremely low birth weight (<1000 g) were significantly higher in the adolescent group (≤19 years) compared with the reference group (adjusted OR (aOR) 4.13, 95% CI 1.41 to 12.11). The odds of very (<32 weeks) and extremely (<28 weeks) preterm delivery were also higher in the adolescent group (aOR 2.12, 95% CI 1.06 to 4.25 and aOR 5.06, 95% CI 1.23 to 20.78, respectively). Women in the adolescent group had lower odds of gestational diabetes (aOR 0.35, 95% CI 0.20 to 0.62), caesarean delivery (aOR 0.53, 95% CI 0.42 to 0.67 and instrumental delivery (aOR 0.53, 95% CI 0.41 to 0.67). Conclusions This study identifies important differences in maternal and neonatal outcomes between women by age group. These findings could help in identifying at-risk groups for additional support and tailored interventions to minimise the risk of adverse outcomes for these vulnerable groups. Further work is needed to identify the causal mechanisms linking age with outcomes in adolescent women where significant gaps in the literature exist.