Clare Harley | University of Leeds (original) (raw)

Papers by Clare Harley

Physiotherapy, May 1, 2020

Red" and four were "Green". An additional three had contraindications to mobility. So for Decembe... more Red" and four were "Green". An additional three had contraindications to mobility. So for December 80% of patients achieved their maximum level of rehabilitation as per the guideline. Finally in January two were "Red", two were "Yellow" and seven were "Green". Only two in January had contraindications to mobility. So for January 64% of patients achieved their maximum level of rehabilitation as per the guideline. Conclusion(s): As the mobility guideline was implemented, taking into account the patients RASS/GCS, there was an improvement in the proportion of patients mobilised by physiotherapy to the maximum level indicated. Thus causing the proportion of patients who did not receive appropriate mobility to reduce. This enhanced mobility occurred despite the patients having a higher degree of sedation with a RASS around the-3 mark for December and January. Implications: Implementing a mobility guideline seems to improve the maximum achievable level of rehabilitation. Sedation level, as measured by the RASS, or degree of consciousness, as measured by GCS, can limit the type of mobility possible but this does not need to be a barrier to mobility or the patient's rehabilitation. Funding acknowledgements: No funding was received for this project.

Journal of Medical Microbiology

Introduction. Urine samples submitted for investigation of urinary tract infection (UTI) may iden... more Introduction. Urine samples submitted for investigation of urinary tract infection (UTI) may identify more than one bacterial isolate. These samples may be reported as ‘mixed growth urine culture’ (MGUC). The clinical significance of MGUC remains controversial. Hypothesis/Gap Statement. The impact of MGUC on patient management is not known and should be assessed. To describe MGUC and assess its impact on patient management. Methodology. Microbiology laboratory reports (Leeds, UK) were retrospectively analysed and urine cultures reported as MGUC from a 1 week period underwent detailed laboratory analysis. Semi-structured interviews of NHS clinicians’ response to MGUC reports were explored for emergent themes. Results. In 2018, 12.4 % (14,323/115,664) of urine specimens processed to detect bacterial pathogens were reported as MGUC. Among a total of 200 MGUC samples identified within 1 week in 2019, detailed laboratory analysis identified 459 bacterial isolates. Enterococcus species (3...

BMJ Supportive & Palliative Care, 2021

BackgroundAs treatments continue to progress, patients with advanced cancer are living longer. Ho... more BackgroundAs treatments continue to progress, patients with advanced cancer are living longer. However, ongoing physical side-effects and psychosocial concerns can compromise quality of life (QoL). Patients and physicians increasingly look to the internet and other technologies to address diverse supportive needs encountered across this evolving cancer trajectory.Objectives1. To examine the features and delivery of web and technological interventions supporting patients with advanced cancer. 2. To explore their efficacy relating to QoL and psychosocial well-being.MethodsRelevant studies were identified through electronic database searches (MEDLINE, PsychINFO, Embase, CINAHL, CENTRAL, Web of Science and ProQuest) and handsearching. Findings were collated and explored through narrative synthesis.ResultsOf 5274 identified records, 37 articles were included. Interventions were evaluated within studies targeting advanced cancer (13) or encompassing all stages (24). Five subtypes emerged:...

BMJ Supportive & Palliative Care, 2019

ObjectivesPatients are living longer with active, advanced or metastatic disease that cannot be c... more ObjectivesPatients are living longer with active, advanced or metastatic disease that cannot be cured, but may be managed (ie, ‘chronic cancer’). The experiences and needs within this growing group are likely to be different from those shortly after diagnosis, on active curative treatment, or in the palliative or end-of-life phase, yet are poorly defined. We described chronic cancer patient experiences and support needs in a quantitative, multicentre cross-sectional study.MethodsPatients from five district general hospitals in England completed the 75-item Chronic Cancer Experiences Questionnaire (CCEQ). Responses were described and linear regression analysis was performed to explore the associations between poorer patient experiences and clinical/sociodemographic variables.ResultsIn total, 416 patients with prostate cancer (28%), breast cancer (24%), gynaecological cancer (19%), colorectal/gastrointestinal cancer (17%) and renal cancer (12%) completed the CCEQ (response rate 90%). ...

Emergency Medicine Journal, 2019

BackgroundPre-hospital clinicians are involved in examining, treating and diagnosing patients. Th... more BackgroundPre-hospital clinicians are involved in examining, treating and diagnosing patients. The accuracy of pre-hospital diagnoses is evaluated using diagnostic accuracy studies. We undertook a systematic review of published literature to provide an overview of how accurately pre-hospital clinicians diagnose patients compared to hospital doctors. A bivariate meta-analysis was incorporated to examine the range of diagnostic sensitivity and specificity.MethodsWe searched MEDLINE, CINAHL, Embase, AMED and the Cochrane Database of Systematic Reviews from 1946 to 7th May 2016 for studies where patients had been given a diagnosis by pre-hospital clinicians and hospital doctors. Key words focused on study type (‘diagnostic accuracy’), outcomes (sensitivity, specificity, likelihood ratio?, predictive value?) and setting (paramedic*, pre-hospital, ambulance, ‘emergency service?’, ‘emergency medical service?’, ‘emergency technician?’). The sole researcher screened titles and abstracts to e...

Psycho-Oncology, 2020

Background: Androgen Deprivation Therapy (ADT) is a wellestablished treatment for prostate cancer... more Background: Androgen Deprivation Therapy (ADT) is a wellestablished treatment for prostate cancer (PCa). Side effects, which can affect appearance and masculinity, might be counterbalanced by exercise. Despite its physical and psychological benefits, exercise rates among PCa patients are low. Aims: This study investigated the association between body image issues and exercise in patients on ADT. We hypothesized that: 1. Patients on ADT will present higher body image concerns, fear of negative appearance (FNAE) and physical performance evaluation (FNPPE), masculinity issues, and lower functionality appreciation when compared to ADT-naïve patients and controls. 2. Considering only patients on ADT, FNAE and FNPPE will predict higher masculinity issues, body image concerns, and lower functionality appreciation. These relationships will be mediated by low exercise frequency. Methods: 60 PCa patients undergoing ADT, 60 ADT-naïve patients, and 60 age-matching cancer-free men completed a questionnaires package online. H1 was tested with a MANOVA and H2 with linear regressions. Results: We found no significant difference between groups on any of the outcomes (p = 0.28). In the ADT group, FNAE and FNPPE significantly predicted body image concerns (p < .001) and masculinity issues (p < .001), but were not associated with functionality appreciation (p = .66, p = .34). None of these relationships were mediated by exercise. Conclusions: The results suggest that ADT is not associated with ++ negative body image. Future research should investigate the protective factors preventing body image issues in PCa. FNAE and FNPPE predicted poorer body image outcomes but exercise frequency did not contribute to this relationship. Future research should further explore exercise barriers in PCa.

Emergency Medicine Journal, 2017

Annals of Oncology, 2017

This is a repository copy of Development of an integrated electronic platform for patient self-re... more This is a repository copy of Development of an integrated electronic platform for patient self-report and management of adverse events during cancer treatment.

Three studies are reported, which examined individual differences in deductive reasoning as a fun... more Three studies are reported, which examined individual differences in deductive reasoning as a function of intellectual ability and thinking style. Intellectual ability was a good predictor of logical performance on syllogisms, especially where there was a conflict between logic and believability. However, in the first two experiments there was no link between ability and performance on indicative selection tasks, in sharp contrast to previous research. This correlation did, however, return in the final study. Our data are consistent with the claim that the correlation with logical accuracy on abstract selection tasks is found primarily with participants of relatively high ability. At lower levels, pragmatically cued responses are given but those of slightly higher ability divorce the rule from the scenario and respond consistently (though incorrectly) across problems. Selfreport questionnaires were generally poor predictors of performance, but a measure of the ability to generate al...

eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Items deposited in White Rose Rese... more eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item.

Journal of Women's Health Physical Therapy, 2021

Background: Traditional treatments for pelvic organ prolapse (POP) assume weak pelvic tissue as t... more Background: Traditional treatments for pelvic organ prolapse (POP) assume weak pelvic tissue as the cause. Pelvic floor muscle training has been shown to improve POP symptoms but not prolapse stage and does not reduce rates of referral for future treatment (eg, pessary or surgery). An alternative hypothesis is proposed that excessive tissue stiffness causes tension and pulling, which disrupts pelvic organ arrangement. Objectives: Treating pelvic tissue stiffness through Biotensegrity Focused Therapy is anticipated to improve organ position and prolapse symptoms. Study Design: Nonrandomized prospective clinical case series. Methods: Women presenting to a private physiotherapy practice in the United Kingdom with POP received Biotensegrity Focused Therapy. Treatment included a series of 1-hour physiotherapy sessions focusing on identifying areas of stiff pelvic tissue and using a direct myofascial release technique to normalize elasticity to restore dynamic equilibrium within the pelvis. Prolapse grade (mild, moderate, severe), pelvic floor strength (Modified Oxford Grading Scale), and self-reported symptoms (Pelvic Floor Distress Inventory, PFDI-20) were assessed at baseline and after final treatment. Results: Thirty-three women received treatment. At baseline, 23 of 33 (70%) women presented with moderate to severe prolapse. After final treatment, 3 of 33 (9%) women had moderate prolapse and 0 of 33 (0%) women had severe prolapse. A total of 12 of 33 (36%) women achieved complete recovery of organ position and shape. A total of 27 of 33 (81.82%) women improved by at least 1 prolapse stage. Pelvic floor strength improved from mean: 1.28 (SD: 0.85) at baseline to 3.33 (SD: 0.78) after final treatment. Self-reported PFDI-20 scores corroborated clinical observations, reducing from mean: 98.77 (SD: 42.43) at baseline to 49.87 (SD: 27.28) after final treatment, suggesting a clinically meaningful improvement. Mean treatment received was 6.06 (SD: 2.28) sessions over a duration of 4.39 (SD: 2.46) months. Discussion: Biotensegrity Focused Therapy was shown to have a beneficial impact on organ position and prolapse symptoms and may be an appropriate treatment for women with POP.

Journal of Paramedic Practice, 2020

Background: The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and ... more Background: The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and treated prehospitally. Aim: To determine diagnostic accuracy of HVS by paramedics and emergency medical technicians using hospital doctors' diagnosis as the reference standard. Methods: A retrospective audit was carried out of routine data using linked prehospital and in-hospital patient records of adult patients (≥18 years) transported via emergency ambulance to two emergency departments in the UK from 1 January 2012–31 December 2013. Accuracy was measured using sensitivity, specificity, positive and negative predictive values (NPV/PPVs) and likelihood ratios (LRs) with 95% confidence intervals. Results: A total of 19 386 records were included in the analysis. Prehospital clinicians had a sensitivity of 88% (95% CI [82–92%]) and a specificity of 99% (95% CI [99–99%]) for diagnosing HVS, with PPV 0.42 (0.37, 0.47), NPV 1.00 (1.00, 1.00), LR+ 75.2 (65.3, 86.5) and LR− 0.12 (0.08, 0.18...

Emergency Medicine Journal, 2018

IntroductionParamedics are involved in examining, treating and diagnosing patients. The accuracy ... more IntroductionParamedics are involved in examining, treating and diagnosing patients. The accuracy of these diagnoses is evaluated using diagnostic accuracy studies. We undertook a systematic review of published literature to provide an overview of how accurately paramedics diagnose patients compared with hospital doctors. A bivariate meta-analysis was incorporated to examine the range of diagnostic sensitivity and specificity.MethodsWe searched MEDLINE, CINAHL, Embase, AMED and the Cochrane Database from 1946 to 7 May 2016 for studies where patients had been given a diagnosis by paramedics and hospital doctors. Keywords focused on study type (‘diagnostic accuracy’), outcomes (sensitivity, specificity, likelihood ratio?, predictive value?) and setting (paramedic*, pre-hospital, ambulance, ‘emergency service?’, ‘emergency medical service?’, ‘emergency technician?’).Results2941 references were screened by title and/or abstract. Eleven studies encompassing 384 985 patients were included ...

Access Microbiology, 2020

Background: Leeds Teaching Hospitals NHS Trust (LTHT) Microbiology department report urine cultur... more Background: Leeds Teaching Hospitals NHS Trust (LTHT) Microbiology department report urine cultures with >1 isolate as ‘mixed growth’ (MG). The clinical significance of this remains controversial. We aimed to describe MG and explore how clinicians interpret MG reports. Methods: Urine culture data (2018) were retrospectively collected from the LTHT laboratory information system. Urine cultures reported as MG from a one-week period in 2019 underwent further laboratory analysis. Semi-structured interviews of eight NHS clinicians were explored for emergent themes around MG using framework analysis. Clinicians were also provided with data in existing MG report formats and alternative reports including organism identities and sensitivities; and clinician propensity to diagnose/treat urinary tract infection (UTI) was noted. Results: Of 115664 cultured specimens, 12% were MG with rates highest in patients >65yrs (19.3%, n=41760) and <1yr old (18.7%, n=2727). Of 459 isolates from 200 MG cultures, Enterococcus species (30.1%) and E. coli (27.5%) were most frequently isolated and the most frequent organism combination (24%). 65.5% of cultures contained 2 organisms, with 82.5% having at least one Enterobacteriales. Many clinicians believed MG statements represented detection of many commensal bacteria which did not represent infection. When given alternative reports including organism identities/sensitivities, (cf. report of MG only), more were likely to diagnose and treat a UTI Conclusions: MG in urines is common. Most MGs include Enterobacteriales, an important cause of UTI. Reporting two species as MG only can be misleading, resulting in failure to treat clinically apparent infections.

British Journal of Pain, 2018

Introduction: The prescribing of opioids has increased internationally in developed countries in ... more Introduction: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care. The majority of patients with chronic non-malignant pain (CNMP) are managed by their general practitioner (GP). Recent qualitative studies have examined the issue of opioid prescribing for CNMP from a GP viewpoint. The aim of this study is to identify and synthesise the qualitative literature describing the factors influencing the nature and extent of opioid prescribing by GPs for patients with CNMP in primary care. Methods: MEDLINE, Embase, PsycINFO, Cochrane Database, International Pharmaceutical s, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986 to February 2018. The full text of included articles was reviewed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researchers and themes organised using Themati...

British journal of community nursing, 2016

The intermediate care team supports patients in their own homes to manage complex needs. They are... more The intermediate care team supports patients in their own homes to manage complex needs. They are ideally placed in the community to identify older adults at risk of loneliness. However, little is known about how intermediate care team professionals perceive, detect or respond to loneliness in their clients. This study explores intermediate care team professionals' attitudes to loneliness in the context of perceived service priorities and their experiences of managing loneliness in their clients. Eight professionals (n=2 physiotherapists, n=3 occupational therapists, n=3 nurses) took part in semi-structured interviews. Data were analysed thematically using framework analysis, applying the theory of planned behaviour as an interpretive framework. Intermediate care team professionals see loneliness as a significant issue for many of their older clients but a low priority for intermediate care team services. They believe that loneliness often goes undetected because it is difficult...

The breast journal, Jan 18, 2016