Category / Nursing & Midwifery

Research Ethics: Insights from the Centre for Midwifery, Maternal & Perinatal Health and the Centre for Social Work, Sociology & Social Policy

PG research, Publishing, Research Ethics, Research Integritiy

Ethics contributions

Collage of research ethics contributions

Academics based in HSC have experience in a wide-range of research.  In the process of reflecting on all aspects of the research process several members of HSC have published about ethical issues that they have had to address in their own research.    This BU Blog highlights some of these key HCS papers which may help fellow academics and students across the globe address similar ethical questions.  HSC has a history of publishing on research ethics, Professor Emerita Immy Holloway wrote about the researcher who may have a dual role, or even conflicting role, as researcher and health care professional (1).  More recently, several midwifery researchers in the Centre for Midwifery, Maternal & Perinatal Health wrote about the issues facing practitioners doing research in the field where they work, especially concerning the similarities and differences between professional ethics and research ethics (2-3).  Negotiating ethical paths cleaved by competing concerns between protecting research participants and over-managing the ethical process is tricky.

In her book Rainforest Asylum: The enduring legacy of colonial psychiatric care in Malaysia Dr. Ashencaen Crabtree in the Centre for Social Work, Sociology & Social Policy, addresses the problematic issue of gate-keepers in research together with the ethics of critical observation of abuse (potential or actual), as well as the ethics of advocating on behalf of research participants (4).

The fear that the ethical application process in the UK is becoming more and more cumbersome and bureaucratic has been widely recognised as highlighted by Prof. van Teijlingen and colleagues (5-6).

Research ethics review processes are also considered in terms of access to participants regarded as ‘vulnerable’ in a recently published paper by Dr. Ashencaen Crabtree (7) of ethnographers working in health settings who are seeking to understand the context of care and patient/service user experiences.  She concludes that paternalistic control of participation on the grounds of ethical protection of vulnerable people seriously disenfranchises potential participants in preventing them from being able to share their relevant, lived experiences as recipients of service provision.

Prof. van Teijlingen and BU Visiting Fellow Dr. Padam Simkhada highlighted that the social, cultural and economic contexts in which research is conducted often differ between developing and developed countries.  However they stress that researchers need to apply for research ethics approval to the relevant local authority, if national legislation requires one to do so (8).

A new and challenging area of research is the use of discussion boards as a source of research data.  In their paper Dr. Bond and BU colleagues discuss both practical and ethical dilemmas that arise in using such data (9). In earlier research, Prof. Parker of the Centre for Social Work, Sociology & Social Policy, highlighted some of the benefits and dangers of using email and the Internet for research as the potential for electronic media continues its rapid growth (10).

Obtaining informed consent is something that all researchers need to consider. However, in some research situations obtaining consent can be particularly challenging.  Prof. Hundley and colleagues discuss the ethical challenges involved in conducting a cluster randomised controlled trial, where consent needs to be considered at a number of levels (11).  In a second paper issues of consent during pregnancy, where there is the potential for harm to two participants, are considered (12).

In research into the implications of the Mental Capacity Act 2005 for social research, Prof. Parker explored the contested meanings and difficulties associated with informed consent in social research, highlighting some of the challenges raised by an almost unquestioned acceptance of biomedical research ethics in social research and questioning whether potential ‘harm’ is different in this context (13, 14). This research has led to further explorations of the potential for ethical covert research by Prof. Parker and Dr. Ashencaen Crabtree.

 

The way forward

There a plenty of challenges to research ethics in both the health and social care sectors.  Ethical considerations relate to technological developments such conducting research over the Internet or the analysis of tweets.  HSC staff will continue to publish on a range of moral dilemma as well as practical issues related to research ethics.  Moreover, academic from the two centres are planning a Masterclass on research ethics to be held in early 2014.

 

 

References

  1. Holloway, I., Wheeler, S. (1995) Ethical Issues in Qualitative Nursing Research, Nursing Ethics 2: 223-232.   Web address:  http://nej.sagepub.com/content/2/3/223.full.pdf+html
  2. Ryan, K., Brown, B., Wilkins, C., Taylor, A., Arnold, R., Angell, C., van Teijlingen, E. (2011) Which hat am I wearing today? Practicing midwives doing research, Evidence-Based Midwifery 9(1): 4-8.
  3. van Teijlingen, E.R., Cheyne, H.L. (2004) Ethics in midwifery research, RCM Midwives Journal 7 (5): 208-10.
  4. Ashencaen Crabtree, S. (2012) Rainforest Asylum: The enduring legacy of colonial psychiatric care in Malaysia, London: Whiting & Birch.
  5. van Teijlingen, E., Douglas, F., Torrance, N. (2008) Clinical governance and research ethics as barriers to UK low-risk population-based health research? BMC Public Health 8(396)                            Web address: www.biomedcentral.com/content/pdf/1471-2458-8-396.pdf
  6. van Teijlingen, E. (2006) Reply to Robert Dingwall’s Plenary ‘Confronting the Anti-Democrats: The unethical Nature of Ethical Regulation in Social Science, MSo (Medical Sociology online) 1: 59-60  Web address:  www.medicalsociologyonline.org/archives/issue1/pdf/reply_rob.pdf
  7. Ashencaen Crabtree, S. (2013) Research ethics approval processes and the moral enterprise of ethnography. Ethics & Social Welfare. Advance Access: DOI:10.1080/17496535.2012.703683
  8. van Teijlingen E.R., Simkhada, P.P. (2012) Ethical approval in developing countries is not optional, Journal of Medical Ethics 38 :428-430.
  9. Bond, C.S,  Ahmed, O.H., Hind, M, Thomas, B., Hewitt-Taylor, J. (2013) The Conceptual and Practical Ethical Dilemmas of Using Health Discussion Board Posts as Research Data, Journal of Medical Internet Research 15(6):e112)  Web address: http://www.jmir.org/2013/6/e112/
  10. Parker, J.  (2008) Email, ethics and data collection in social work research: some reflections from a research project, Evidence & Policy: A Journal of Research, Debate & Practice, 4 (1): 75-83.
  11. Hundley, V, Cheyne, HC, Bland, JM, Styles, M, Barnett, CA.. (2010) So you want to conduct a cluster randomised controlled trial? Lessons from a national cluster trial of early labour, Journal of Evaluation in Clinical Practice 16: 632-638
  12. Helmreich, R.J., Hundley, V., Norman, A., Ighedosa, J., Chow, E. (2007) Research in pregnant women: the challenges of informed consent, Nursing for Women’s Health 11(6):  576-585.
  13. Parker, J., Penhale, B., Stanley, D., 2010. Problem or safeguard? Research ethics review in social care research and the Mental Capacity Act 2005. Social Care & Neurodisability, 1 (2): 22-32.
  14. Parker, J., Penhale, B., Stanley, D. (2011) Research ethics review: social care and social science research and the Mental Capacity Act 2005, Ethics & Social Welfare, 5(4): 380-400.

 

Vanora Hundley, Sara Ashencaen Crabtree, Jonathan Parker & Edwin van Teijlingen

 

 

PechaKucha – presenting research in a fast and furious manner!

The Normal Labour and Birth Conference allowed me to experience a novel way of showcasing research and exchanging ideas – the PechaKucha. Pronounced “peh-chak-cha”, the PechaKucha session is made up of a series of short presentations. Presenters must use 20 slides, each of which must be displayed for exactly 20 seconds – no more, no less. The concept, conceived by two young architects (Astrid Klein and Mark Dytham) in Japan in 2003, is to enable individuals to exchange their ideas in a fast moving, concise and exciting format. Not one to ignore the call to try something new, I decided to undertake this challenge as a double act with my colleague Professor Helen Cheyne from the University of Stirling. We presented our team’s work on the media’s portrayal of labour and birth, which was also being displayed as a poster.

Poster
Research team includes Ann Luce, Marilyn Cash, Vanora Hundley, Helen Cheyne, Edwin van Teijlingen and Catherine Angell

The PechaKucha was quite an undertaking, as the slides move automatically and you cannot stop them moving on! However, it really focused the mind and helped us identify the key messages from our work. The session was very lively and the energy generated a lot of discussion that continued into the coffee break afterwards. As for the PechaKucha method, I’d say that it is definitely a useful tool for our community research meetings, and perhaps also for our doctoral students to use as they prepare for their vivas.

The conference was also an opportunity to catch up with colleagues from the International Early Labour Research Group. The group have been involved in producing a series of research papers featured in a special issue of Midwifery. We also discussed future research and opportunities for research collaboration.

Dizzy the dog attends midwives forum

Fusion

 

Left to Right: Mandy Williams - Community Midwife, Gay Rogers - Breakfast Host and Hospital Midwife and Luisa Cescutti-Butler, Senior Lecturer (Midwifery)

Every three months hospital and community midwives at Salisbury NHS Trust Hospital attend a forum dedicated to matters relating to Examination of the Newborn (EXON).  The aims of the forum are to support healthcare professional undertaking newborn examinations, sharing of experiences/case studies, interprofessional working, maintenance of competence, formulate and review internal  processes and peer support for professionals in training. Members consist of midwives, nurses, a consultant Paediatrician and Children’s physiotherapists. BU student midwives are welcome to attend when working with their community midwives and on this occasion two students were present. As unit leader for EXON at BU and one of the link lecturers at the hospital, I chair, coordinate and facilitate the forums, with venues alternating between hospital and community.  This month we met for breakfast at a colleague’s home, where midwives were greeted with the smells of freshly brewed coffee and a newly prepared home cooked frittata. Further offerings included fresh strawberries, raspberries, warm croissants, cocktail sausages and quails eggs.  

Minutes and agendas are sent out in advance. A standing item is a report from senior children’s physiotherapist Karen Robinson, whose department leads the service for Developmental Dysplasia of the Hips (DDH) in newborns.  A recent case was brought to our attention, where a baby had been examined by midwives and doctors and found to have an unstable right hip. The baby was appropriately referred for an ultrasound scan which subsequently found the right hip normal, but considered the left hip abnormal.  The Barlow’s and Ortolani manoeuvres used by both professions at the time of the examination had not detected any left hip abnormality. A robust discussion ensured as to the complexities of examining babies for DDH and the difficulties in detecting unstable hips when the manoeuvres used by all professionals were themselves unreliable. However Karen was able to reassure us by indicating that in the seven years of the Children’s Physiotherapy Department leading the DDH service, very few babies had been ‘missed’. Karen also emphasized the significance of caring for babies’ hips in general and the importance of educating parents around their baby’s ‘hip health’. The 3rd year midwifery students are currently taught theory around DDH with opportunities to practice manoeuvres on ‘Baby Hippy’. As facilitator for these sessions I realized that our midwifery curriculum had to include general baby hip health in the first year of the student’s programme. Rachael, a 3rd year student midwife, was in agreement: “the discussion around hip care for newborns was great to listen to. I agree that it would be really beneficial to have a lecture on hip care for students”. 

Left to Right: Rachael Callan - 3rd year student midwife, Carol Bremner - Community Midwife, Beccy Seaton-Harris - 1st year student midwife and Fiona White - Community Midwife

On other matters Karen highlighted a number of babies diagnosed with Erb’s Palsy following birth had recently been treated by the department. Various options were offered as to why these babies had sustained these birth injuries, resulting in the forum unanimously agreeing that education around Erb’s Palsy and Brachial Plexus Injuries would benefit all professionals involved with childbirth.  Terri Coates, an expert on Brachial Plexus Injuries and a midwife at Salisbury, agreed to arrange a study day with the national Erb’s Palsy Support Group, to be held at either Salisbury Hospital or BU for midwives and students.

There are many advantages in having a regular forum to discuss issues relating to newborn examination.  Case studies are presented and debated and education around various topics are provided at regular intervals. The forum also supports midwives from other trusts who are having difficulties with undertaking the examination in their areas. Beccy, the 1st year student midwife had the following to say: “It was very informative. It was good to see community and hospital midwives coming together as a team. I am also interested in learning more about Erb’s Palsy and attending a study day. Learning about general hip care would also be beneficial. The breakfast was lovely too”.

Dizzy

The last bark, I mean word, goes to Dizzy. He gets terribly excited when breakfast is served and runs from one midwife to another hoping for a dropped sausage or at least a titbit from a kind soul. After not having much luck, he eventually settles down and gently snores in the corner of the room. 

                                                                              

 

                                                                                        

 

 

 

Its Fika Time

Awarded & submitted bids, Fusion

 

Presentation – Birth in the UK to the 1st year Swedish Student Midwives at the Karolinska Institiute

Sue Mant (left), Helena Lindgren (Our Host representative), Sara Stride (right)

A colleague and I participated in an exchange visit to the Karolinska Institute (KI) in Sweden in May 2013 thanks to an Erasmus Mobility award. During the trip we visited several clinics and hospitals and had the opportunity to meet and talk with many Midwives, Student Midwives and Nurses working in different settings. When spending time at the KI with the Student Midwives we were able to provide an overview of Birth in the UK, where Waterbirth provision was of great interest and provoked much discussion.

During a visit to the Kista Barnmorskemottagning (a Midwife clinic) it was evident that as the Midwives are based in the clinics, they are able to provide good continuity of care. Midwives complete electronic records for every episode of care, there are no paper records or hand held notes for women to carry; in fact they are only issued with a printed copy of their blood group.

One of my objectives was to learn more regarding Group Antenatal Care provision in Sweden. A joint venture with a phd student from the KI enabled an exchange of information and a discussion of progress to date and to share ideas from a recent project regarding Group Antenatal Care in the UK.

During our many visits we were also introduced to the custom of “Fika”  –  or social time where work colleagues meet mid morning and mid afternoon for a drink and a chat. It is considered to be part of everyone’s daily routine, and is definitely a concept that might encourage staff in the UK to take regular breaks.

We also joined a social evening,  where First year Swedish Student Midwives were each presented with a Pinnard’s ready for practice.

Come to the Cabaret

Awarded & submitted bids, Fusion

 

1st Year swedish students with Sara Stride(centre) and myself, Sue Mant (right)

1st Year swedish students with Sara Stride(centre) and myself, Sue Mant (right)

Thanks to an Erasmus mobility award myself and a colleague were able to engage in a teaching exchange with the Karolinska Institute (KI) in Sweden. For the midwifery team, this is an annual reciprocal arrangement which fosters education/practice links and ensures the continuation of a programme of support for exchanges between Bournemouth University (BU)  midwifery students and KI midwifery students. A very comprehensive itinerary allowed us to visit midwife led units, clinics, birthing units, and hospitals. We were enabled to spend time with student midwives in the classroom and with clinical teachers in practice.

This was my first visit, and a personal objective was to explore practice education. Student midwives in Sweden study midwifery for 18 months prior to qualification and this contrasts with the three year course mainly offered at home. Notably, the direct entry route to midwifery is not yet available in Sweden and even though this is an approach that KI is considering for the future, current applicants to the course have to be qualified nurses. KI student midwives move around various placements and student support mechanisms there were very similar to BU. Where things begin to differ is that there is no formally recognised mentor system. At the Sodra BB birth unit I learned from the Chef Barnmorska (Lead Midwife), that clinical teachers have often been qualified for a minimum of 5 years and though very experienced, they receive no formal preparation for their clinical teaching role. This perhaps reflects the lack of any formal ongoing post-registration development programme.  At Danderyds birth centre we met a midwife who has recently taken on a role similar to that of Practice Educator. She has adopted a progressive programme of regular meetings between clinical teaching midwives and the Institute link allowing them an opportunity to discuss individual student’s needs and achievements. Attending one meeting, we were invited to contribute to the discussion and as a cohesive group we were able to discuss strategies and share ideas. Issues arising with learners seem to bear common threads internationally

Helena Lindgren (our host representative) with Sara Stride

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Finally, if you are wondering what ‘Come to the Cabaret’ has to do with this blog…. Our visit happily coincided with end of course celebrations, a chance for the cohort to dress as characters from that very musical. I learned….. Swedish midwives know how to party!

BU Research Blog Exclusive: Design & Look of eBU leaked

PG research, Publishing, Research themes

The first screenshot of the eBU interface has been exclusively leaked to the BU Research Blog, and is expected to go viral across the BU community over the next week.

eBU will provide both an internal and external forum for the development of research papers by undergraduate to Professor around the eight BU research themes:

–          Creative & Digital Economies

–          Culture & Society

–          Entrepreneurship & Economic Growth

–          Environmental Change & Biodiversity

–          Green Economy & Sustainability  

–          Health, Wellbeing & Ageing 

–          Leisure & Recreation

–          Technology & Design

Submissions will be open to immediate publication (in a safe internal environment) and open peer review by 2 appropriate BU academics. Authors will be encouraged to act upon these reviews by either reworking papers for submission to an external journal or by opting for publication on the external eBU site.

For BU academics this is a great opportunity to get critical appraisal on your research papers or ideas from colleagues. For academics it also an opportunity to encourage the submission of high quality student output, and possibly to facilitate the co-creation and co-production of publishable material to an external journal or to publish externally with eBU. For students, this is a fantastic opportunity to turn high quality essays or dissertations into scholarly outputs, which will be attractive to employers across many sectors and industries.

If you have any questions or would like to become involved in this exciting venture, please get in touch with me via email aharding@bournemouth.ac.uk or by telephone 01202 963025.

Celebrating diversity of women: a theme day provided for Level C student midwives

Undergraduate pre-registration first year midwifery students were enthralled at a recent theme day which formed part of their Intrapartum unit. The day is designed to celebrate diversity of women’s experiences during labour where students get to listen to stories of women and midwives. This year’s gathering was no exception.  First up was Rachel Arnold, a PhD student from BU. Her rich story, supported by beautiful photographs of Afghanistan, highlighted the plight of women in that country, where maternal mortality is amongst the highest in the world. Rachel in her role as a midwife has worked with Afghan people for many years and as she shared her experiences we began to see that Afghanistan is more than ‘suicide bombers and conflict’, it is about ordinary people who struggle to survive each and every day. Rachel’s talk inspired the whole audience and many students were interested to find out if they could go to Afghanistan for their elective which occurs in the 3rdyear of their training.

“It was wonderful to have a midwifery perspective from this country and the lecture was inspiring and passionate”

“Very interesting and thought provoking talk which has made me think about my own attitudes on diversity”

Jane Evans, an independent midwife, spoke about breech birth as a normal event during pregnancy.  She shared a number of photographs showing how a breech birth should be facilitated with the mantra “hands off”,  and students were able to see how the baby rotated , flexed and birthed itself with the help of his/her mother adopting a variety of positions. The mechanisms were reinforced through Jane using a doll and pelvis to further enhance student understanding. Many midwives are losing their skills within breech birth as women are often opting for caesarean section, but Jane was fortunate in that she was taught the craft of breech  (bottom down) birth by Mary Cronk, who specialised in independent midwifery practice with a keen interest in breech presentation. Mary is now retired but thankfully her many years of experience were passed onto Jane who shares her knowledge widely through study days and of course with the midwifery students at BU.  Many of the students’ views were changed following Jane’s presentation, as the following quotation demonstrates: “It was a privilege to hear this lecture. It offered a contrast to other breech perspectives and gave me more confidence as a student midwife to educate women that breech is merely another type of normal”

Sheetal Sharma, another BU PhD student provided the students with her insight into midwifery care in Nepal. She warned us that she was not a midwife, and was observing and recording midwifery practice as part of her doctoral studies. She provided a fascinating insight into how pregnancy and childbirth are perceived in Nepal where women have no rights within their own homes and are subject to the control, whims and superstitions of their ‘mother-in-laws’.  There were also parallels with Afghanistan in relation to maternal mortality, as around 4,500 Nepalese women die in childbirth due to a paucity of adequate healthcare or even skilled birth attendants.  Sheetal’s presentation included fabulous photographs of idyllic scenes in Nepal, but also of women and children where smiles were abundant and hope was evident. Nepal has made significant strides to reduce maternal mortality and is now on track to meet Millennium Development Goal (MDG)4.

Sheetal explaining her photograph where a woman is shown holding a scythe. Not only is this a tool used in the field to cut vegetation but also as an implement to cut the baby’s cord at birth.
 

The last presentation by Vanora Hundley, BU’s Professor of Midwifery, focused on the global picture of maternal and child health, where some of the key interventions that save mothers and babies lives were highlighted. Vanora reminded the audience that, for example, having a skilled attendant at birth may not always be thought of as ‘intervention’,  but evidence shows that countries where women have access to midwives or an attendant with midwifery skills have significant lower maternal mortality rates. Finally, a note of caution was provided by Vanora around the challenges faced in high income countries, as the over-use of interventions by health professionals are having a damaging impact on mothers and babies.

 
The students really enjoyed the day as the following quotes illustrate:

“I have thoroughly enjoyed the theme day, it has been very informative and insightful – more so than I had anticipated”.

“Fantastic to have a (nearly!) whole day of the wider context of midwifery. Inspirational – thanks”.

“Absolutely superb day. Reignites the fire in your belly!”

“Really insightful day. Demonstrated the importance of the midwife and our roles, not just at home but around the world. It’s nice to see the bigger picture”.

 

Does Guinness taste different in Dublin?

In August 2012 a call was put out through the midwifery networks by the Preterm Birth Clinical Study Group (CSG) who were seeking to recruit new members. The Preterm Birth CSG aims to identify important research questions around preterm birth and to work with the originators of supported studies around preterm birth, and to improve clinical outcomes following preterm birth by prevention or intervention.

This group, one of 11 CSGs, is a Royal College of Obstetrics and Gynaecology (RCOG) specialist group supported by British Maternal and Fetal Medicine Society (BMFMS), British Association of Perinatal Medicine (BAPM) and by Action Medical Research. Applications were welcomed from obstetricians, neonatologists and midwives who were interested in preventing preterm birth or in improving outcomes. I (Luisa Cescutti-Butler) was successful in my application and attended my first meeting on the 23rd April 2013 in Dublin.

Most of us were new to the group and following introductions we set to business. An urgent consideration was the representation of lay members. There were a number of suggestions put forward as to how lay members could be approached and groups such as MumsNet, Bliss and Bounty were to be approached for their views on research priorities within preterm birth. The group also felt that establishing a focus group of women who had experienced a preterm birth would be valuable and I offered to facilitate this.

A number of research projects were discussed and whilst many of these studies were focused on RCT’s and not within my comfort zone, I was able to provide input into some where a qualitative approach would work. Many of the professors around the table were comfortable with scientific methodologies, but were open to the possibilities of where proposed projects might benefit from a qualitative perspective, i.e. inviting women to speak about their experiences of possible interventions to prevent preterm birth.

Following the Preterm Birth Clinical Study Group meeting on the 23rd April 2013, I was fortunate to attend on the following two days a conference arranged by the British Maternal and Fetal Medicine Society (BMFMS) of which I am a member. The programme, which consisted of high quality clinical and basic science key lectures and presentations were fascinating for me as a midwife, although I did feel at various points throughout the two days that if it were left to ‘science’, women would never have an opportunity to have a normal pregnancy and birth. It appeared that every step of the childbirth continuum could be researched, with outcomes managed in some way because of ‘evidence,’ which for some women who experience life threatening conditions such as pre-eclampsia is of vital importance. In the event, I was able to gain information that would benefit BU undergraduate midwifery students. At the end of the conference I was in awe of all the high quality research being undertaken in the UK to prevent preterm birth and obstetric conditions such as pre-eclampsia, but also a little sad. Sad at the prospect that if midwives don’t continue to protect normality for women, it might fall forever within the realms of ‘medicine’ and who knows where pregnant women will end up? And finally in conclusion, I never did get to taste a Guinness in one of the many traditional Irish Pubs scattered around the city, so couldn’t say whether it tasted better in Dublin or not!

BU and University of Ljubljana working together to enhance midwifery practice

Slovenia, once part of communist Yugoslavia, is now an independent country which borders Italy, Croatia, Austria and Hungary. It is a modern and young economy with a strong infrastructure.  Midwifery has been practised in the region for hundreds of years; however a decision to suspend midwifery training in the 1980s resulted in a severe shortage of midwives.  In 1996 midwifery education was reinstated, but this time within higher education. In 2002 the first midwives were able to qualify with a degree from the University of Ljubljana, which offers the only undergraduate midwifery programme in Slovenia.

The role of the midwife in Slovenia is mainly concentrated within the area of intrapartum care; a consequence of the midwifery shortage that saw midwives drawn from other areas to cover labour and birth. Very little antenatal and postnatal care is offered by midwives. These aspects of care are typically provided by gynaecologists, obstetricians, paediatricians and community nurses. Thus there have been calls for midwives to increase their role within public health and to develop primary care services. One aspect of care that could develop midwifery practice is examination of the newborn.

A scoping visit funded by ERASMUS (British Council) and EUNF (Bournemouth University) was undertaken by Luisa Cescutti-Butler (Senior Lecturer) and Professor Vanora Hundley at the behest of the Head of Midwifery Dr. Ana Polona Misvek at the University of Ljubljana. The visit explored whether midwives, paediatricians, neonatologists and midwifery lecturers would be receptive to a course that would teach Slovenian midwives to examine normal healthy term babies. This examination is currently only undertaken by paediatricians.

A round table discussion was arranged with key professionals from the medical and midwifery community. The discussion was at times fairly animated; for example there was strong opposition from the neonatologist who believed that midwives were not ready to take on this role. In contrast, there was encouraging agreement from Professor Dr. Ciril Kržišnik (Senior Paediatrician and Head of the Paediatric Association) who was present, and Anita Prelec (Head of the Slovenian Nursing/Midwifery Association).

A positive outcome was the desire from all professionals to strengthen the midwife’s role within the initial examination of the newborn and it is this aspect of care and knowledge that offers further opportunities for future collaboration and training.

For further details about this study contact: Luisa Cescuttti Butler, Senior Lecturer, Lansdowne Campus.

How’s our Slovene?

BU’s Centre for Midwifery, Maternal & Perinatal Health was well represented at a recent conference run by the Midwifery Association of Slovenia in Čateẑ.  Professor Vanora Hundley and Luisa Cescutti Butler were invited by the President Anita Prelec to speak to midwives, nurses and students at their bi-annual conference: Skrb Za Dravje Žensk In Otrok.

I was asked to speak on the issue of intervention in early labour, something that is causing concern in many European countries, and whether midwives should be encouraging women to stay at home for longer. I started my session with a tentative “Dober dan” (Good morning) – my pronunciation must have been acceptable as I received a round of applause! However, the rest of my presentation was thankfully in English. The presentation was well received and clearly generated a lot of interest with discussion continuing over lunch.

Luisa, a senior lecturer in midwifery, spoke about the examination of the newborn baby and who should be involved – the midwife or the doctor. This was a question that we had discussed the previous day at a round table event with key stakeholders in Slovenia. Her presentation also gave us the opportunity to ask midwives what they thought. Participants were asked to complete a short questionnaire before the presentation and a second brief questionnaire afterwards. We are looking forward to seeing their responses – although we will rely heavily on colleagues from the University of Ljubljana to translate them!

Funding for our Slovenian trip was through networking grants – an EUNF award for Vanora to discuss research collaboration and an ERASMUS Preparatory Visit award for Luisa to explore the possibility of a staff mobility exchange. We both achieved these aims (more on that in our next blog), but this additional opportunity was too good to miss.

Open Access journals: Remember to check for changes!

PG research

BUI Research BlogThe BU Research blog has seen various pieces on Open Accessing Publishing, including http://blogs.bournemouth.ac.uk/research/bu-internal-funding-opportunities/open-access-publication-fund/  or http://blogs.bournemouth.ac.uk/research/files/2011/08/Open-Access-Fund-policy-180711.pdf).  Moreover, Bournemouth University professors are actively involved in Open Access journals.  For example  Prof. Vanora Hundley and I are both Associate Editors of a major Open Access journal (see:  http://blogs.bournemouth.ac.uk/research/2012/10/23/prof-hundley-associate-editor-bmc-pregnancy-childbirth/ .

This blog highlights that journals can change and that some become Open Access that were not before.  This happened to some of my methods papers in the scientific journal of the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists (RCOG).  Their journal the Journal of Family Planning & Reproductive Health Care used to be published in house as one of the RCOG journals.  The journal had a fairly closely defined readership and a very traditional way of paper-based publishing.  This meant very few academics, practitioners or students had access to my papers published over the years in the Journal of Family Planning & Reproductive Health Care. Then, a year or two ago, the journal became part of the BMJ Group (http://group.bmj.com/), which publishes over 40 journals in the health and health care field.

 

The deal between the Journal of Family Planning & Reproductive Health Care and the BMJ Group must include some arrangement to make previous issues available through Open Access.  All of a sudden seven of my research methods papers are freely available on the web through Open Access [1-7].   One of the key messages here is that it is worthwhile to see which journals offer Open Access, and to check regularly for changes in journals’ policies and publishers.

 

 

Prof. Edwin van Teijlingen, School of Health & Social Care, Bournemouth University

 

References:

  1. van Teijlingen, E.R., Forrest, K. (2004) The range of qualitative research methods in family planning and reproductive health care, Journal of Family Planning & Reproductive Health Care 30(3): 171-73.
  2. Forrest Keenan, K., van Teijlingen, E.R. (2004) The quality of qualitative research in family planning and reproductive health care, Journal of Family Planning & Reproductive Health Care 30 (4): 257-59.
  3. Forrest Keenan, K., van Teijlingen, E.R., Pitchforth, E. (2005) The analysis of qualitative research data in family planning and reproductive health care, Journal of Family Planning & Reproductive Health Care 31(1): 40-43.
  4. Pitchforth, E., Porter, M., van Teijlingen, E.R., Forrest Keenan, K. (2005) Writing up and presenting qualitative research in family planning and reproductive health care, Journal of Family Planning & Reproductive Health Care 31 (2): 132-135.
  5. van Teijlingen, E., Hundley, V. (2005) Pilot studies in family planning and reproductive health care, Journal of Family Planning & Reproductive Health Care 31 (3): 219-221.
  6. van Teijlingen, E.R., Pitchforth, E. (2006) Focus Group Research in Family Planning and Reproductive Health Care, Journal of Family Planning & Reproductive Health Care 32 (1): 30-32.
  7. van Teijlingen, E.R., Pitchforth, E., Bishop, C., Russell, E.M. (2006) Delphi method and nominal group techniques in family planning and reproductive health research, Journal of Family Planning & Reproductive Health Care 32 (4): 249-252.

Global Women’s (GLOW) Research Conference

The first Global Women’s (GLOW) Research Conference was held in Liverpool this week. The conference brought together 150 researchers and clinicians from across the globe to discuss women’s health in both low and high resource countries. Keynote speakers included France Donnay from the Bill & Melinda Gates Foundation, and Beverly Winikoff from Gynuity Health Projects.

BU was well represented with poster presentations from Vanora Hundley, Professor of Midwifery, and Emma Pitchforth, Visiting Fellow.

Vanora’s presentation examined the Use of oral misoprostol to prevent postpartum haemorrhage in home birth settings in low resource countries; a topic that has been the subject of considerable controversy in recent weeks. Emma’s presentation looked at Evidence response mechanisms in reproductive, maternal, newborn and child health in Asia and the Pacific.

One of the unique features of this conference was the mix of presentations. Presenters came from a variety of disciplines and alongside the well known international speakers were oral presentations from undergraduate students and early career researchers. This was a great opportunity to share experiences and build collaborations, and I would recommend that both staff and students look out for next year’s call for abstracts.

Prof. Hundley Associate Editor BMC Pregnancy & Childbirth

Publishing

Congratulations to BU Prof. Vanora Hundley who has been invited to become Associate Editor for BMC Pregnancy and Childbirth.  BMC Pregnancy & Childbirth is an international journal with Open Access and it has a good Impact Factor (currently 2.83) in its field.    More details of BMC Pregnancy & Childbirth can be found at http://www.biomedcentral.com/bmcpregnancychildbirth/

 

Prof. Hundley joins Prof. Edwin van Teijlingen as Associate Editor, giving Bournemouth University a very good representation on the editorial team.

More about Prof. Hundley: http://uk.linkedin.com/pub/vanora-hundley/16/b40/39b

Are we born to yawn?

Fusion, R & KE Operations, REF Subjects, Research assessment, Research Integritiy, Research themes

Yawning consistently poses a conundrum to neurologists and neuroscientists. Increasingly, evidence is found to link neurological disorders through the commonality of yawning episodes and contagious yawning. Despite discrete incidences (such as parakinesia brachialis oscitans) in brain stem ischaemic stroke patients, there is considerable debate over the reasons for yawning, with the mechanism of yawning still not fully understood. Cortisol is implicated in the stress response and fatigue; repetitive yawning may be the link between neurological disorders and with a strong correlation between yawning and a rise in cortisol levels. Evidence has now been found in support of the Thompson Cortisol Hypothesis that proposes cortisol levels are elevated during yawning [1]. Additional data is in press, and further research is planned with longitudinal consideration to neurological disorders such as multiple sclerosis and stroke. Funding for such initiatives is currently being sought.

[1] Thompson, S.B.N., & Bishop, P., 2012. Born to yawn? Understanding yawning as a warning of the rise in cortisol levels: randomized trial. Interactive Journal of Medical Research, 1(5), e4:1-9. Doi: i-www.jmr.org/2012/e4/

Dementia

News from the PVC

Most of us know someone touched by dementia – a friend, relative or loved one.  As the average age of our population grows ever older, the chances are some of us will be affected.

As such dementia is emerging as a new strategic priority for BU, with investment from our HEIF funds to create the Bournemouth University Dementia Institute, or BUDI as the team like to call it.  The team is growing rapidly working on a range of funded dementia projects with more in the pipeline. Working with the Director of BUDI Anthea Innes, Lee-Ann Fenge, Sue Barker, Vanessa Healsip, Michele Board have recently completed a review of Higher Education Dementia Curriculums on behalf of the Higher Education Dementia Network.  Work that reflects Anthea’s previous experience leading masters and undergraduate programmes in Dementia Studies and the dementia focus of social work and nursing colleagues within the School of Health and Social Care.  A number of research and knowledge exchange projects are underway including:

  • An ongoing programme of work funded by Bournemouth Borough Council involves the BUDI team delivering a range of activities via two different programmes; a ‘cupcake club’ and a technology group.  The evaluation report isn’t due until February 2013 so a lot is happening over the autumn months.
  • A BU Research Development Grant enabled an early collaboration between the Schools of Tourism and Health and Social Care.  This project led by Anthea Innes (HSC) and Stephen Page (Tourism) is currently being written up for publication and dissemination.  It is the first study to conceptualise ‘Dementia Friendly Tourism’ as an area worth investigation to try and improve the leisure opportunities for those with dementia and their families; but the project will also produce recommendations to  help advise tourism and leisure providers to enhance their provision to promote inclusion of those with dementia.
  • An international study GRIID (Gateway Rural International Initiatives in Dementia), involving partners from Australia, Canada, India, Sweden and the UK is also in the writing up stages following a policy synthesis and survey of Alzheimer Disease International (www.adi.co.uk) members.
  • European work is on-going too, focused on Malta where Anthea has long established links working on improving the quality of care offered in Maltese hospital wards
  • A multi-site NIHR project has just commenced exploring site loss and dementia for people who continue to live at home.  This is a collaboration between the Universities of York, BU, Cambridge, Worcester and consumer organisations; the Housing and Dementia Research Consortium (HDRC); Pocklington Trust supported by the Alzheimer Society and the Macular Disease Society

But this is just the start with money being committed by many of large funding agencies this is a societal theme of the moment.  BU is part of a large FP7 grant application currently first reserve for funding, and BU is coordinating a multimillion ESRC grant application with 12 other institution due for submission this autumn.  Working locally is also very much on the agenda.  Staff in BUDI are working for example in partnership with commissioners and clinicians across Dorset to secure funding via the NHS South of England Dementia Challenge fund with BU as the evaluator for a number of innovative local projects proposed by those delivering dementia care every day.

BUDI launched 16 May 2012 just three months ago and the progress is impressive, but there is also a long way to go to achieve its objectives of making a real contribution to improving the lives of those with dementia and those who provide support whether they be family or paid clinicians and carers.  This is not just an initiative launched from HSC but a cross BU one and I am delighted to announce the secondment of Samuel Nyman (Psychology, DEC) to BUDI to strengthen its work force and continue his existing collaboration with Anthea which includes a match funded BU PhD Studentship with Anthea Innes and Marilyn Cash which is looking at the role of gaming technology to support older men with dementia in rural areas.  BUDI is looking for staff who wish to engage from across BU and is truly multidisciplinary in its approach and reach.  There may be other who are interested in similar secondments and I would encourage them to get in touch with Anthea.  DEC and Tourism are already involved with BUDI contributing staff and time but there is huge scope for others to get involved for example in the Media School.  Why not drop Anthea a line and get in touch?

Also starting in September is Patricia McParland as BUDI Project Manager or Engagement Consultant, a post-doc appointment is pending, PhD student Ben Hicks will start soon and we will be advertising for an Associate Director for BUDI soon.  BUDI has the full support of UET and is receiving strategic investment to make things happen quickly; dementia is of the moment as illustrated by the Prime Minister Dementia Challenge launched earlier this year and it’s for BU to cease this moment.  BUDI offers the opportunity to have a real impact, to make a difference in our society, to develop practice and research and to do it quickly.  Please get involved and get in touch with Anthea or myself directly.

 

BUCRU – Seminar presenting Breaking News!

Post-award, Publishing

 

BREAKING  NEWS…

We would like to invite you to an afternoon seminar by one of our Visiting Faculty, Professor Mike Wee, presenting some exciting new research findings to come out of a recently completed Research for Patient Benefit funded study comparing two methods of pain relief during labour (abstract and biography below).  This paper was just voted best paper of the conference at the Obstetric Anaesthetists Association Annual Conference in Liverpool and was featured recently in the Bournemouth Echo http://www.bournemouthecho.co.uk/news/9770928.Pain_relief_in_labour__study_at_Poole_hospital_makes_important_discovery/

The seminar is scheduled for Thursday 19th July 2-3pm in BG10 Bournemouth House (after the HSC end of term lunch and next door for your convenience).

We hope you can make it and look forward to seeing you then.

BUCRU

Website: http://microsites.bournemouth.ac.uk/bucru/

Administrator: +44 (0)1202 961939 / wardl@bournemouth.ac.uk

Title: The IDvIP Trial: A two-centre double blind randomised controlled trial comparing i.m. diamorphine and i.m. pethidine for labour analgesia

Research team and affiliations: MYK Wee, JP Tuckey,* P Thomas,† S Burnard,* D Jackson.

Poole Hospital NHS Foundation Trust, Poole, UK, *Royal United Hospital, Bath, UK, †Bournemouth University Clinical Research Unit, Bournemouth, UK.

Abstract:

Background: Intramuscular pethidine, the commonest parenteral opioid analgesic used in obstetrics and more recently diamorphine usage has increased in the UK.  The maternal, fetal and neonatal side effects are well known for pethidine but there are no sufficiently powered large RCTs comparing pethidine with diamorphine. The aim of this trial is to address this.

Methods: After ethical approval, informed consent was obtained from 484 women randomised to receive either 7.5mg diamorphine i.m. or 150mg pethidine i.m. for labour analgesia. The sample size calculation derived from a small RCT giving 90% power (at the 5% significance level) is based upon the maternal primary outcome measure of pain relief at 60mins and the neonatal primary outcome measures of Apgar Score of <7 at 1min and neonatal resuscitation. Secondary outcome measures include verbal pain intensity at 60mins and over 3hrs post-analgesia, pain relief over first 3hrs, maternal oxygen saturation, sedation, nausea and vomiting and maternal satisfaction with analgesia. Fetal and neonatal secondary outcomes include CTG trace, meconium staining, UApH, UVpH, time of delivery to first breath, Apgar Score at 5mins, naloxone use, neonatal oxygen saturations, sedation and feeding behaviour for the first 2hrs after delivery.

Results: Reported using CONSORT guidelines. At 60mins post-administration and over a 3hr period, diamorphine is better at reducing pain scores than pethidine (p<0.001). There were no statistical differences between the two groups regarding Apgar Scores of <7 at 1min and the need for neonatal resuscitation.  The time between first dose administered and delivery is on average 82mins longer with the diamorphine group compared to pethidine (p<0.001). The vast majority of women experienced moderate to severe pain at all times. Women receiving diamorphine were more satisfied with their analgesia. There were no statistically significant differences in maternal sedation, nausea and vomiting or oxygen saturations over the 3hr period. There were no statistically significant differences in the fetal and neonatal outcomes including feeding behaviour between the two groups within 2hrs of birth but neonates in the pethidine group were more likely to be moderately or severely sedated at delivery.

Discussion: Intramuscular 7.5mg diamorphine gives significantly better analgesia than 150mg pethidine but prolongs delivery by approx. 82mins.  Women given diamorphine are more likely to be satisfied with their analgesia.  The mechanism for the prolongation of delivery time in the diamorphine group should be investigated further.

Acknowledgement: This research was funded by the NIHR Research for Patient Benefit Programme (PB-PG-0407-13170).

References

1. Tuckey JP, Prout RE, Wee MYK. Prescribing intramuscular opioids for labour analgesia in consultant-led maternity units: a survey of UK practice. International Journal of Obstetric Anesthesia 2008, 17(1):3-8.

2. Fairlie FM, Marshall L, Walker JJ et al. Intramuscular opioids for maternal pain relief for labour: a randomised controlled trial comparing pethidine with diamorphine. British  Journal of Obstetrics and Gynaecology 1999; 106(11): 1181 -1187.

Biography of speaker:

Michael Wee is a consultant anaesthetist from Poole Hospital and Royal Bournemouth Hospitals.  He has a special interest in obstetric anaesthesia and is the lead obstetric anaesthetist at Poole Hospital.  He is chair of the Research and Innovations Group at Poole Hospital and is a Board member of the Western Comprehensive Local Research Network.  He was awarded a visiting professorship at Bournemouth University in 2009.  He is a referee for several medical journals.  His research interests include patient information, safety in anaesthesia, maternal analgesia and simulation in epidural anaesthesia.  He is a co-supervisor of a PhD student at BU and chief investigator of the MObs study investigating early warning scores in obstetrics.

BUCRU – Supporting the development of grant applications

Awarded & submitted bids, Funding opportunities, Post-award, Publishing, Research assessment

In today’s post we give a case study of how Bournemouth University Clinical Research Unit (BUCRU) recently supported the development of a grant application.

Case study

We recently supported a Programme Development Grant (www.ccf.nihr.ac.uk/PGfAR/PDG/Pages/default.aspx) application to the National Health Service (NHS) National Institute for Health Research (NIHR). The Unit receives funding from the NIHR to be the Dorset Office of the NIHR Research Design Service (RDS), and thus can support local researchers in the University and the NHS to develop their funding applications. The topic of this grant application was early warning systems for use in an obstetric setting. Early warning systems are used by clinical staff in hospital to identify clinical problems before they get too serious, for example by regularly monitoring vital signs such as blood pressure. The purpose of Programme Development Grants is to fund preliminary work ahead of a larger Programme Grant for Applied Research (PGAR; www.ccf.nihr.ac.uk/PGfAR/Pages/Home.aspx). 

This support involved:

  • Providing methodological input in systematic reviews, surveys, qualitative designs, quantitative designs notably a sample size calculation, and trial design.
  • Patient and public involvement (PPI) – the team has a designated person supporting PPI.
  • Team development – a strong team needed to be developed with the appropriate skill mix to deliver the programme of research.  Four members of BUCRU became co-applicants on the proposal bringing methodological expertise in systematic reviews, qualitative research, quantitative research, and PPI support.  Via our link with the RDS we also have access to health economist support.   Collaborations were initiated with the Wessex Health Innovation and Education Cluster (HIEC; www.wessexhiecpartnership.org.uk/) to gain support in the educational/ training aspects of the research.  
  • Liaison – we liaised with a number of different organisations, such as Research and Knowledge Exchange Operations for costing the Bournemouth University (BU) costs, the NHS host organisation that will be responsible for the research, and the Market Research Group (MRG; https://mrg.bournemouth.ac.uk/) who were involved to support the administration and data entry for the survey component of the project.
  • Identification of appropriate funding schemes.
  • Obtained peer review from RDS colleagues across the region to provide feedback on the suitability of the funding scheme and the ‘readiness’ for submission. This service is usually provided through regular Scientific Committee meetings that act as ‘mock’ funding committees (www.rds-sw.nihr.ac.uk/scientific_committee.htm).

Quote from lead applicant: “Without the expertise and assistance of BUCRU staff it would not have been possible to even contemplate applying for a large and competitive grant such as the NIHR Programme Development Grant” .

Please contact us for support with health research:

Louise Ward (administrator):

Bournemouth University Clinical Research Unit

R505 Royal London House

Christchurch Road

Bournemouth BH1 3LT

BUCRU@bournemouth.ac.uk

Tel: 01202 961939

http://blogs.bournemouth.ac.uk/bucru/

People at Bournemouth University Clinical Research Unit (BUCRU)

Awarded & submitted bids, Post-award, Publishing, Research assessment

In yesterday’s posting we gave a brief introduction to BUCRU. Today we introduce you to the members of the team.

 

Louise Ward

Louise is one of the administrators for the unit and has been with the team since 2008.  She has worked in various NHS settings and has an interest in marketing.  Both her undergraduate and Masters degrees were studied here at Bournemouth University.

Professor Paul Thompson

Paul is Consultant Rheumatologist at Poole Hospitaland Visiting Professor at BU. He was appointed Director of the Centre of Postgraduate Medical Research and Education (CoPMRE) in 2007, where he has been leading developments between research and education active doctors in NHS Trusts and the academic community at the University. He is Co-director of BUCRU, Lead for the musculoskeletal local priority group for the Western Comprehensive Local Research Network (CLRN) and Fellow of the NHS Improvement Faculty. He is interested in clinical research and service development in the rheumatic diseases. He supervises PhD students and is an External Examiner at other Universities.

Dr Sarah Thomas

Sarah is Deputy Director (methodology). She has a background in psychology and since 2000 has worked in the NHS in Dorset.  As well as supporting other researchers in a Research Design Service capacity, she also conducts research. Her main research interests are in the field of multiple sclerosis (MS) and she is currently Chief Investigator for a pilot study funded by the UK MS Society exploring the use of the Nintendo Wii™ in people with MS.

Professor Peter Thomas

Peter is Co-Director and leads on research methodology. He has a background in epidemiology and statistics, and has been with Bournemouth University since 1996. He has a special research interest in psychosocial aspects of chronic disease and much of his recent work has focussed on multiple sclerosis.

Dr Zoe Sheppard

Zoe is a demographer with particular experience investigating socio-economic status.  She joined Bournemouth University in October 2009 as a Research Fellow in Research Methods.  She provides research methods support for people doing health research and support writing grant applications in her National Institute for Health Research (NIHR) Research Design Service (RDS) capacity.

Suzanne Sheppard

Suzanne is a Clinical Researcher recently recruited from the pharmaceutical industry to help manage the unit’s clinical trials.  She has experience in setting-up and monitoring clinical trials across phases 1 to 3 in a variety of therapeutic areas. 

Annabel Kenny

Annabel is a Clinical Research Administrator who joined Bournemouth University in October 2009.  She provides support to Dr. Tamas Hickish, Consultant Medical Oncologist, Royal Bournemouth Hospital/Poole Hospital and the rest of the research team on various ongoing research projects within the Bournemouth University Clinical Research Unit.

Liz Griffiths

Liz works for the Royal Bournemouth Hospital as a research facilitator.  She has been working in research within the NHS since 2003 in a variety of roles.  Currently focusing on supporting researchers to develop proposals and prepare submissions to regulatory authorities.

Louise Fazakarley

Louise is a Physiotherapy lecturer with experience in neurological rehabilitation, the management of chronic disability and rehabilitation research. She joined Bournemouth University in 2006 to establish and teach on the BSc (Hons) Physiotherapy course. Louise is currently working on the MS Society funded pilot study to look at the Nintendo Wii™ as a method of helping people with MS increase their physical activity.

Audrey Dixon

Audrey is the Centre of Postgraduate Medical Research and Education (CoPMRE) co-ordinator and co-administrator for BUCRU.  She has worked for the NHS since 1988.  She first joined Professor Paul Thompson in 2001 to assist him with his academic work, following his secondment to the university.  Audrey was seconded to BU in 2003.  She now looks after a growing Visiting Faculty of 41 members and the education arm of CoPMRE. She is very proud to see the little acorn grow into a Centre of Postgraduate Medical Research and Education and BUCRU.

Roger Baker

Roger is Professor of Clinical Psychology and runs the MSc course Foundations in Clinical Psychology at BU. He is also a Consultant Clinical Psychologist at Dorset Healthcare University NHS Foundation Trust.  He has expertise in the design of assessments and questionnaires, research design and clinical evaluation of services and has worked in a dual role as researcher and clinical psychologist at Leeds, Aberdeen & Bournemouth Universities and in NHS Trusts specialising in Mental Health.

Helen Allen

Helen is a health psychologist with a nursing and midwifery background.  She has a qualitative background with a particular interest in the mind:body interface and chronic disease, including patient empowerment.  She is the Unit lead on Public Patient Involvement.

Contact us: In the first instance please contact:

 Louise Ward (administrator):

Bournemouth University Clinical Research Unit

R505 Royal London House

Christchurch Road

Bournemouth BH1 3LT

BUCRU@bournemouth.ac.uk

Tel: 01202 961939

http://blogs.bournemouth.ac.uk/bucru/