Examination of the literature suggests that relationships between psychiatric staff and the families of service-users are often characterized as unsatisfactory, and that psychiatric hospitals provide an unconducive environment for the implementation of family and network-orientated approaches. This research focused upon the development in an adult psychiatric admissions unit of family- staff network meetings, that occurred when a person entered hospital. These network meetings, or 'reception meetings', were strongly influenced by the Finnish social network approach (Seikkula, Alakare & Aaltonen 2001), which focuses upon the creation of open dialogue between the service-user, family members and professionals. An overall aim of the study was to generate a body of practice-based narrative accounts which might act as a catalyst to practice developments in this field. Drawing upon a postmodern methodological framework, a range of methods were employed to engage with the multiple voices of service-users, family members and staff in the research site. Data sources included semi-structured interviews, participant observation, secondary data, and material from a research diary that was maintained as a reflexive tool in relation to the practitioner research process. A 'voice-centred relational method' (Brown and Gilligan 1992) provided a heuristic device for guiding data interpretation which facilitated multiple readings from different perspectives. A subsequent stage of data-analysis entailed developing more general connecting themes from across the data-set. A number of themes are developed in the research, which principally relate to the tensions associated with the introduction of a relationally orientated, reflective approach to practice within an individually-based medico-psychiatric organizational context. Practice approaches are discussed which appeared to facilitate an ethos of 'safe uncertainty' (Mason 1993) within network meetings, which is a necessary condition for dialogue. Connections are also drawn between themes generated in this study and the broader contexts of government policy, professional and organizational development, and practice-based research.

Multiple Sclerosis (MS), the most common progressive neurological disease in young adults can take a relapsing remitting (RR) course especially in the early stages. There is a gap in knowledge in the application of self-management and self-efficacy with progressive long-term conditions. This research explored the experience of individuals with RRMS with particular focus on their attitudes to self-management and development of self-efficacy. The research addresses the question about engagement with self-management and self-efficacy influencing the journey of people with RRMS and their formal and informal carers. The research draws on the experiences, perspectives and understanding of the social processes and reality through interaction. Using grounded theory for generation of the themes captured from people with RRMS, their partners/carers and professionals involved in their care. The research design around a conceptual framework, used longitudinal studies capturing the experiences of people with RRMS and their partners/carers, through individual interviews and self-efficacy qualitative questionnaires over eight monthly meetings. The research sample of people with RRMS was three male and three female with an average age of 44.5 years, a mean duration with RRMS for 9.6 years. Professionals shared their perceptions and experiences through a focus group and individual interviews. Personal and reflective diaries kept by the researcher of events throughout the study enabled decision and audit trials to contribute to the rigour of the research. The data analysis has generated a number of themes that have been developed and presented throughout the thesis. The research process has generated new theory around the knowledge of and experiences of the three groups of research participants. Fluctuations of living with RRMS across roller coaster journeys, with transitional processes of daily changes and meanings brought threats and challenges. These highlight the importance of self-efficacy and self-control, of coping with uncertainty and unpredictability, through engaging with self-management behaviours. These enhanced perceptions of self- determination, positiveness, independence, quality of life and well-being. The transformation of uncertainty secured hope, opportunities and embracing RRMS through coping mechanisms and self-confidence. Formal and informal support was required where the People with RRMS deemed appropriate. The epistemological perspective has explored power as a multilayered and dynamic concept with different knowledge bases and issues that need addressing prior to successful partnership working. The research is original in terms of the groupings, the areas reviewed for this RRMS group and the potential for ongoing work, policy and practice changes both locally and nationally. Implications for practice, policy and further research were derived from the conclusions. In practice more empowerment, advice and information are required for people with RRMS to live independently. Policies for skills and knowledge training in these areas are required for shared decision-making and partnership working. Further research is required into utilisation of Integrated Care Management of ways of supporting independence, self-control and personalised plans for people with long- term conditions and their informal carers.

No description available.

Background: The recent advent of non-invasive functional magnetic resonance image (fMRI) has helped us understand how visual information is processed in the visual system, and the functional organising principles of high-order visual areas beyond striate cortex. In particular, evidence has been reported for a constellation of high-order visual areas that are highly specialised for the visual processing of different object domains such as faces, bodies, and tools. A number of accounts of the underlying principle of functional specialisation in high-order visual cortex propose that visual properties and object domain drive the category selectivity of these areas. However, recent evidence has challenged such accounts, showing that non-visual object properties and connectivity constraints between specialised brain networks can, in part, account for the visual system’s functional organisation. Methodology: Here I will use fMRI to examine how areas along the visual ventral stream and dorsal action stream process visually presented hands and tools. These categories are visually dissimilar but share similar functions. By using different statistical analyses, such as univariate group and single-subject region of interest (ROI) analyses, multivariate multivoxel pattern analyses, and functional connectivity analyses, I will investigate the topics of category-selectivity and the principles underlying the organisation of high-order visual areas in left occipitotemporal and left parietal cortex. Principle Findings: In the first part of this thesis I report novel evidence that, similar to socially relevant faces and bodies, the human high-order visual areas in left occipitotemporal and left parietal cortex houses areas that are selective for the visual processing of human hands. In the second part of this thesis, I show that the visual representation of hands and tools in these areas show large anatomical overlap and high similarity in the response patterns to these categories. As hands and tools differ in visual appearance and object domain yet share action-related properties, the results demonstrate that these category-selective responses in the visual system reflect responses to non-visual action-related object properties common to hands and tools rather than to purely visual properties or object domain. This proposition is further supported by evidence of selective functional connectivity patterns between hand/tool occipitotemporal and parietal areas. Conclusions/Significance: Overall these results indicate that high-order visual cortex is functionally organised to process both visual properties and non-visual object dimensions (e.g., action-related properties). I propose that this correspondence between hand and tool representations in ventral ‘visual’ and parietal ‘action’ areas is constrained by the necessity to connect visual object information to functionally-specific downstream networks (e.g., frontoparietal action network) to facilitate hand-tool action-related processing.

No description available.

The majority of deaths worldwide can now be attributed to so called, diseases of lifestyle, also known as non-communicable diseases (NCDs). These diseases are generally attributed to lifestyle behaviours, such as low fruit and vegetable consumption and lack of physical activity. Whilst historically NCDs have been known as diseases of the rich, current evidence shows that they are most prevalent in individuals with low socio-economic status. This thesis sets out to specifically address this issue by recruiting participants from a low SES population, in order to develop and test a web-based intervention addressing lifestyle behaviours. Initially the research identifies, and explores the barriers experienced by low SES individuals to leading healthy lifestyles, through interview data and further Q-sort analysis. The findings from these studies are used to tailor a health message, making it more pertinent to the target audience; the resulting message is incorporated into a website. The website is developed by understanding what constitutes a credible health related site in the eyes of the target audience. Initially the research identifies, and explores the barriers experienced by low SES individuals to leading healthy lifestyles, through interview data and further Q-sort analysis. The findings from these studies are used to tailor a health message, making it more pertinent to the target audience; the resulting message is incorporated into a website. The website is developed by understanding what constitutes a credible health related site in the eyes of the target audience. Self-affirmation theory (Steele, 1988) posits that reflecting on one’s positive attributes, reduces defensiveness to a potentially threatening health message. A recent study (Epton and Harris, 2008) suggests self-affirmation can lead to an actual change in the behaviour of individuals. This thesis replicates the work of Epton and Harris (2008) in an online environment, by demonstrating self-affirmed participants consumed more fruit and vegetable in the 7 days following exposure to the tailored website. These findings highlight the barriers experienced by low SES parents to adopting healthy lifestyles, and present a novel technique suitable for web-based interventions that has implications for a range of health related behaviours.

Background: There has been little research into the area of future disorientation in adults living with and beyond a cancer diagnosis. Research conducted in this area tends to focus on women who have been treated for gynaecological cancer and to be cross-sectional. Therefore, little is known about the impact of future disorientation on other groups of people living with and beyond cancer, including men, and little is known about how the experience may change over time. Aims: This thesis aims to develop a conceptual framework illustrating the experience of future disorientation. This was achieved by exploring what the consequence of future disorientation are, what factors cause participants to experience future disorientation and what factors prevent/reduce the impact of future disorientation. Methods: This study utilised an interpretative phenomenological analysis approach (IPA) which informed all aspects of the data collection and analysis process. Eight patients attending follow up clinics in the North East of England were recruited and were interviewed on two occasions six months apart. The interviews were semi-structured and analysed using an IPA approach. Results: The results of this study have shown that future disorientation can be experienced by men and women living with and beyond cancer, that it can persist over time, and have a number of consequences. A number of factors have been identified which may contribute to the experience of future disorientation such as cancer related fears, and anxiety. Furthermore a number of factors emerged which may protect patients from experiencing future disorientation, such as support networks and making lifestyle adjustments. This thesis constitutes an original contribution to knowledge as no work has previously sought to map out the conceptual framework of future disorientation or how it changes over time.

Background: Finding effective ways to care for people with palliative care needs is a national priority. A primary care locality has developed and implemented an Integrated Care Pathway (ICP) for those with life limiting illnesses. It focuses on identifying patients early, regardless of disease type, and uses proactive and patient centred interventions to plan for a good death. Although palliative care pathways present a promising practice framework, the literature does not allow for an assessment of how and when they work best. This thesis aimed to explain which parts of the ICP worked best, for whom and in what circumstances. Design: Realist evaluation was used to guide the analysis of multiple data strands: quantitative data from the GP practices; interviews with palliative care patients and bereaved relatives; bereaved relatives and matched health care professional questionnaires; focus groups with health care professionals; consultation recordings with palliative care patients and their GPs. Results: The results of this study are multifaceted, and focus on the conditions of successful implementation, such as the presence of a champion; palliative care registration decisions for all diagnoses and the importance of leadership and peer support; advance care planning, including the roles of mental capacity and time constraints; communication in consultations and the role of patient and GP traits; and using open multicomponent communication strategies to facilitate home deaths. Discussion: A realist approach has exposed how the ICP implementation has led to positive practice and patient level outcomes. The ICP can be construed as a translational tool, which enables the operationalisation of policy directives on shared decision making, proactivity and patient centeredness in primary care. In the context of palliative care, this study allows important reconceptualisations of shared decision making and advance care planning to be presented.

The overarching purpose of this research was to find out about life with Parkinson's disease and to use that knowledge to inform physiotherapy management. The project aimed to explore current and alternative ways in which professionals could seek to understand the experience of life with Parkinson's disease; to explore the implications of resultant new knowledge; and to investigate how physiotherapy relationships should take account of new ways of understanding and new knowledge. A spiral of research activity was undertaken comprising three successive cycles. The first two cycles were undertaken using case study methodology, focusing on the experience of life with Parkinson's disease from a group and an individual perspective. A wide range of qualitative and quantitative methods for both data collection (including interviews, disability and quality of life scales and activity monitoring) and data analysis were employed. The level and complexity of personal work undertaken by individuals to manage their condition was the principal theme to emerge from initial cycles. This insight led to the development of a tool — strategy mapping — to enable professionals to capture and use information about self- management in their interactions with individuals. The third cycle employed action research methodology to develop and evaluate the strategy mapping framework - centred on identifying strategies related to Self, Routines, Support and Involvement - in physiotherapy practice. A number of perspectives were developed in relation to the project's aims. The methodological perspective highlighted the need for commitment to listening to the experiential narrative and hearing the story of self-management. The ontological perspective offered the potential for practice and research to build on existing self- management solutions. The epistemological perspective pointed to addressing power differentials between knowledge bases to promote collaborative therapy relationships. The full potential of a paradigm shift which attempts to increase the degree of alignment between the everyday lives of individuals with Parkinson's disease and physiotherapy practice, education and research remains to be uncovered.

In total knee replacement (TKR) surgery, mobile bearing (MB) total knee prostheses were designed to more closely mimic the function of the normal knee than traditional fixed bearing (FB) designs by allowing axial mobility between the polyethylene insert and tibial tray. Despite the hypothetical benefits of the MB design, few studies have objectively analysed knee biomechanics during activities of daily living (ADLs) in the laboratory compared to FB designs. This thesis aimed to substantiate the theoretical advantages of MB implantation during ADLs in the laboratory as well as during free living conditions, in addition to investigating previous claims of instability in MB knees. Sixteen patients undergoing primary unilateral total knee replacement (TKR) surgery were randomised to receive either a FB (n=8) or MB (n=8) total knee prosthesis and were tested at pre-surgery, three months post-surgery, and nine months post-surgery using three dimensional motion analysis in the laboratory and electrogoniometry and accelerometry during free living conditions. No differences were found between FB and MB groups during walking at post-surgery that could not be explained by differences at pre-surgery. There were also no differences between FB and MB groups during the more biomechanically demanding activities of stair negotiation and sit to stand and stand to sit activities, as well as no differences during free living conditions away from the laboratory. There appears to be no evidence based rationale for the widespread use of MBs with regards to optimising knee function during ADLs. This thesis was the first to compare FB and MB designs using the same implant range, posterior cruciate ligament (PCL) scenario, posterior stabilising strategy, and patella strategy over a range of ADLs, as well as being the first to combine testing in the laboratory with testing during free living conditions away from the laboratory.