Tikki Immins

‘Baptism of Fire’: The First Year in the Life of a Newly Qualified Social Worker

This paper describes research commissioned by Skills for Care South West to identify and track the learning and development needs of newly qualified social workers through their first year of employment. The perceptions of 22 newly qualified social workers based in statutory settings are reported concerning the effectiveness of the social work degree (England), their induction and probationary periods and their progress towards post-qualifying social work education as part of their continuing professional development. The perspectives of line managers, people who use services and carers are also discussed. Findings from the research suggest that the social work degree has been well received by most newly qualified social workers and highlights the perceived importance of a statutory placement for social work degree students. Key social work practice skills that require further development are identified and a rationale is presented for greater investment in the induction and probationary periods of newly qualified social workers.

Evaluating the Impact of Post‐Qualifying Social Work Education

Post‐qualifying awards in social work are well established within the continuing professional development agenda for qualified social workers in the UK. The evaluation of education and training should be an integral part of this agenda because it is important to ensure that programmes continue to meet standards of delivery, are successful in meeting their aims and objectives and are making an impact on practice. However, there is a limited amount of published work on the evaluation of post‐qualifying social work education, with studies often focusing on programme delivery rather than on their impact on practice. This paper explores evaluative work within the current post‐qualifying social work framework and discusses the results of an evaluation of the Vulnerable Adults and Community Care Practice programme, a specialist post‐qualifying social work education programme run by a UK university, as an example of an evaluation of the impact on practice. The results indicate positive evidence of impact on practice and demonstrate examples of how the programme has had a direct effect on individuals, teams, organisations and on people who use services.

Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery.

This article examines the relevance of applying the Enhanced Recovery after Surgery (ERAS) approach to patients undergoing major spinal surgery. The history of ERAS, details of the components of the approach and the underlying rationale are explained. Evidence on outcomes achieved by using the ERAS approach in other orthopaedic and complex surgical procedures is then outlined. Data on major spinal surgery rates and current practice are reviewed; the rationale for using ERAS in major spinal surgery is discussed, and potential challenges to its adoption are acknowledged. A thorough literature search is then undertaken to examine the use of ERAS pathways in major spinal surgery, and the results are presented. The article then reviews the evidence to support the application of individual ERAS components such as patient education, multimodal pain management, surgical approach, blood loss, nutrition and physiotherapy in major spinal surgery, and discusses the need for further robust research to be undertaken. The article concludes that given the rising costs of surgery and levels of patient dissatisfaction, an ERAS pathway that focuses on optimising clinical procedures by adopting evidence-based practice and improving logistics should enable major spinal surgery patients to recover more quickly with lower rates of morbidity and improved longer-term outcomes.

Hip osteoarthritis: patients with complex comorbidities can make exceptional improvements following intensive exercise and education

A 71-year-old man presenting with hip osteoarthritis, with a complex range of comorbidities was referred by his general practitioner to CHAIN (Cycling against Hip PAIN), a 6 week programme developed to aid self-management of hip osteoarthritis through exercise, education and advice, as defined by the National Institute for Health and Care Excellence (NICE) guidelines. Significant improvements were seen in Oxford hip score, the Hip disability and Osteoarthritis Outcome Score (HOOS) – function score, sit-to-stand test, timed up and go test, pain scores and hip flexion. There was also a weight loss of 2.1 kg. The man reported ‘an amazing difference’ in his affected hip and leg, and improved fitness. Many clinicians would have questioned the mans suitability for the programme due to his coexisting medical conditions. This case study shows that patients may be much more able than we think to achieve significant improvement with exercise.

A review of wearable motion tracking systems used in rehabilitation following hip and knee replacement

Clinical teams are under increasing pressure to facilitate early hospital discharge for total hip replacement and total knee replacement patients following surgery. A wide variety of wearable devices are being marketed to assist with rehabilitation following surgery. A review of wearable devices was undertaken to assess the evidence supporting their efficacy in assisting rehabilitation following total hip replacement and total knee replacement. A search was conducted using the electronic databases including Medline, CINAHL, Cochrane, PsycARTICLES, and PubMed of studies from January 2000 to October 2017. Five studies met the eligibility criteria, and all used an accelerometer and a gyroscope for their technology. A review of the studies found very little evidence to support the efficacy of the technology, although they show that the use of the technology is feasible. Future work should establish which wearable technology is most valuable to patients, which ones improve patient outcomes, and the most economical model for deploying the technology.

A novel adaptive trial design: randomised evaluation of molecular guided therapy for diffuse large b-cell lymphoma with bortezomib (REMODL-B) with two interim analyses to explore safety and efficacy.

Methods The trial uses an adaptive design and aims to recruit 940 patients across 100 sites in the UK and Switzerland (currently recruited 398 patients). After being profiled within real time (during cycle 1), ABC, GCB and unclassifiable molecular phenotype patients are randomised to receive RB-CHOP or R-CHOP with equal allocation. Two interim analyses will be carried out to stop the good prognosis GCB group early if required using a Case Morgan [1] analysis: (i) The first will be a safety analysis performed after the first 55 GCB RB-CHOP patients have been followed for 6 months. If 6 month PFS<80%, the GCB group will close. (ii) The second will be for futility in the GCB group and performed after the first 73 GCB RB-CHOP patients have been followed for 1 year. If 1 year PFS<85%, the GCB group will close. If the GCB group closes the trial will then be modified to a randomised Phase II trial in ABC patients and sample size calculations will be revised.

Snapshot survey of physiotherapy practice for patients with hip osteoarthritis in the public sector

Abstract Purpose: Hip osteoarthritis (OA) is a chronic musculoskeletal condition affecting 2.5 million people in England. There is limited evidence on practice in the United Kingdom (UK) by physiotherapists in the public sector. A snapshot survey was conducted in a limited time period to inform standard care in a trial funding application. Methods: An online survey was circulated using Twitter. Thirteen Tweets linking to the survey were posted over 6 days to gain a snapshot view of physiotherapy practice within the public sector in the UK. Results: Sixty-two physiotherapists from 25 counties in the UK and Wales responded. The median waiting time from referral to physiotherapy treatment was 5 weeks and patients were seen a median of 3 times. The median total number of hours treated was 2 hours, and the median duration time for treatment was 8 weeks. All respondents used strengthening exercises, 73% stretches, 50% cardiovascular exercise, 73% balance exercises and 26% proprioceptive exercises. Thirty-nine percent of respondents use both strengthening and cardiovascular exercises, and provide an education leaflet, as contained within National Institute for Health and Clinical Excellence (NICE) guidance. Conclusions: This snapshot suggests that physiotherapeutic management varies widely across the UK.

What is the role of post-operative physiotherapy in general surgical Enhanced Recovery after Surgery pathways?

Abstract Purpose: Enhanced Recovery after Surgery (ERAS®) has improved outcomes following elective surgery. This narrative review aimed to assess current evidence for post-operative physiotherapy interventions in general surgical procedures which adopt ERAS® principles. Materials and methods: A systematic review of the literature between 2000 and 2017 was conducted. Randomised controlled trials (RCTs) that compared physiotherapy interventions for patients after the following elective ERAS® procedures were included: gynaecologic, gastrectomy, gastrointestinal, pancreatic, bariatric, head and neck, breast, cystectomy, colorectal, colonic and liver. Results: One study (two publications) was found to compare post-operative physiotherapy interventions in radical cystectomy patients on an ERAS® pathway. The addition of a progressive exercise-based intervention improved aspects of health-related quality of life (dyspnoea (p <.05), constipation (p <.02) and abdominal flatulence (p ≤ .05)). Enhanced mobilisation was achieved, but no differences were observed in length of stay or severity of complications. Conclusions: It is essential that the paucity of research to assess post-operative physiotherapy interventions within ERAS® cohorts is highlighted. The results of our literature search highlight that there is a role for post-operative physiotherapy in ERAS® pathways. However, without well-conducted RCTs to evaluate procedure-specific interventions, the optimal type, timing, and dose will not be found and the potential for improving patient functional recovery will be limited.

The effect of calf neuromuscular electrical stimulation and intermittent pneumatic compression on thigh microcirculation

OBJECTIVE This study compares the effectiveness of a neuromuscular electrical stimulation (NMES) device and an intermittent pneumatic compression (IPC) device on enhancing microcirculatory blood flow in the thigh of healthy individuals, when stimulation is carried out peripherally at the calf. MATERIALS AND METHODS Blood microcirculation of ten healthy individuals was recorded using laser speckle contrast imaging (LSCI) technique. A region of interest (ROI) was marked on each participant thigh. The mean flux within the ROI was calculated at four states: rest, NMES device with visible muscle actuation (VMA), NMES device with no visible muscle actuation (NVMA) and IPC device. RESULTS Both NMES and IPC devices increased blood flow in the thigh when stimulation was carried out peripherally at the calf. The NMES device increased mean blood perfusion from baseline by 399.8% at the VMA state and 150.6% at the NVMA state, IPC device increased the mean blood perfusion by 117.3% from baseline. CONCLUSION The NMES device at VMA state increased microcirculation by more than a factor of 3 in contrast to the IPC device. Even at the NVMA state, the NMES device increased blood flow by 23% more than the IPC device. Given the association between increased microcirculation and reduced oedema, NMES may be a more effective modality than IPC at reducing oedema, therefore further research is needed to explore this.

A Novel Approach to Overcome Movement Artifact When Using a Laser Speckle Contrast Imaging System for Alternating Speeds of Blood Microcirculation

The laser speckle contrast imager (LSCI) provides a powerful yet simple technique for measuring microcirculatory blood flow. Ideal for blood dynamic responses, the LSCI is used in the same way as a conventional Laser Doppler Imager (LDI). However, with a maximum skin depth of approximately 1 mm, the LSCI is designed to focus on mainly superficial blood flow. It is used to measure skin surface areas of up to 15 cm x 20 cm. The new technique introduced in this paper accounts for alternating speeds of microcirculations; i.e. both slow and fast flow flux measurement using the LSCI. The novel technique also overcomes LSCIs biggest shortcoming, which is high sensitivity to artifact movement. An adhesive opaque patch (AOP) is introduced for satisfactory recording of microcirculatory blood flow, by subtracting the LSCI signal from the AOP from the laser speckle skin signal. The optimal setting is also defined because the LSCI is most powerful when flux changes are measured relative to a reference baseline, with blood microcirculatory flux expressed as a percentage change from the baseline. These changes may be used for analyzing the status of the blood flow system.