Background: Specialist 'therapeutic' footwear is recommended for patients with diseases such as rheumatoid arthritis (RA) as a beneficial intervention for reducing foot pain, improving foot health, and increasing general mobility. However, many patients choose not to wear this footwear. Recommendations from previous studies have been implemented but have had little impact in improving this situation. The aim of this study was to explore RA patients' experiences of this footwear to ascertain the factors which influence their choice to wear it or not. Method:Ten females and three males with RA and experience of wearing specialist footwear were recruited from four National Health Service orthotic services. Semi-structured interviews were carried out in the participants own homes. A hermeneutic phenomenological analysis of the transcripts was carried out to identify themes. Results:The analysis revealed two main themes from both the female and male groups. These were the participants' feelings about their footwear and their experiences of the practitioner/s involved in providing the footwear. In addition, further themes were revealed from the female participants. These were feelings about their feet, behaviour associated with the footwear, and their feelings about what would have improved their experience. Conclusion:Unlike any other intervention specialist therapeutic footwear replaces something that is normally worn and is part of an individual's body image. It has much more of a negative impact on the female patients' emotions and activities than previously acknowledged and this influences their behaviour with it. The patients' consultations with the referring and dispensing practitioners are pivotal moments within the patient/practitioner relationship that have the potential to influence whether patients choose to wear the footwear or not.

BackgroundTherapeutic footwear is recommended for those people with severe foot problems associated with rheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studies have recommended service and footwear design improvements, it is not known if services have improved or if this footwear meets the personal needs of people with RA. As an earlier study found that this footwear has more impact on women than males, this study explores women's experiences of the process of being provided with it and wearing it. No previous work has compared women's experiences of this footwear in different countries, therefore this study aimed to explore the potential differences between the UK, the Netherlands and Spain.MethodWomen with RA and experience of wearing therapeutic footwear were purposively recruited. Ten women with RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) was adopted during data collection and analysis. Conversational style interviews were used to collect the data.ResultsSix themes were identified: feet being visibly different because of RA; the referring practitioners' approach to the patient; the dispensing practitioners' approach to the patient; the footwear being visible as different to others; footwear influencing social participation; and the women's wishes for improved footwear services. Despite their nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and anger and that it is often the final and symbolic marker of the effects of RA on self perception and their changed lives. This results in severe restriction of important activities, particularly those involving social participation. However, where a patient focussed approach was used, particularly by the practitioners in Spain and the Netherlands, the acceptance of this footwear was much more evident and there was less wastage as a result of the footwear being prescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with the only choice being to reject it once it had been provided. All the women were vocal about what would improve their experiences and this centred on the consultation with both the referring practitioner and the practitioner that provides the footwear.ConclusionThis unique study, carried out in three countries has revealed emotive and personal accounts of what it is like to have an item of clothing replaced with an 'intervention'. The participant's experience of their consultations with practitioners has revealed the tension between the practitioners' requirements and the women's 'social' needs. Practitioners need greater understanding of the social and emotional consequences of using therapeutic footwear as an intervention.

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A s o ci al n o r m s a p p r o a c h t o c h a n gi n g s c h o ol c hil d r e n's p e r c e p tio n s of t o b a c c o u s a g e S h eik h, A, Vad e r a , S, R av ey, MI, Lov a t t, G a n d Kelly, G h t t p:// dx. doi.o r g/ 1 0. 1 1 0 8/ h e-0 1-2 0 1 7-0 0 0 6 Ti t l e A s o ci al n o r m s a p p r o a c h t o c h a n gi n g s c h o ol c hil d r e n's p e r c e p tio n s of t o b a c c o u s a g e A u t h o r s S h eik h, A, Vad e r a , S, R av ey, MI, Lov a t t, G a n d Kelly, G Typ e Articl e U RL This ve r sio n is a v ail a bl e a t : h t t p:// u sir.s alfo r d. a c. u k/id/ e p ri n t/ 4 3 1 1 9/ P u b l i s h e d D a t e 2 0 1 7 U SIR is a di git al c oll e c tio n of t h e r e s e a r c h o u t p u t of t h e U niv e r si ty of S alfo r d. W h e r e c o py ri g h t p e r mi t s, full t e x t m a t e ri al h el d in t h e r e p o si to ry is m a d e fr e ely a v ail a bl e o nli n e a n d c a n b e r e a d , d o w nlo a d e d a n d c o pi e d fo r n o nc o m m e r ci al p riv a t e s t u dy o r r e s e a r c h p u r p o s e s . Pl e a s e c h e c k t h e m a n u s c ri p t fo r a n y fu r t h e r c o py ri g h t r e s t ri c tio n s. Fo r m o r e info r m a tio n, in cl u di n g o u r p olicy a n d s u b mi s sio n p r o c e d u r e , pl e a s e c o n t a c t t h e R e p o si to ry Te a m a t: u si r@ s alfo r d. a c. u k . Abstract Purpose -Over 200,000 young people in the UK embark on a smoking career annually, thus continued effort is required to understand the types of interventions that are most effective in changing perceptions about smoking amongst teenagers. Several authors have proposed the use of Social Norms programmes, where correcting misconceptions of what is considered normal behaviour lead to improved behaviours. There are a limited number of studies showing the effectiveness of such programmes for changing teenagers' perception of smoking habits, and hence this paper reports on the results from one of the largest Social Norms programmes that used a variety of interventions aimed at improving teenagers' perceptions of smoking. Design/methodology/approach -A range of interventions was adopted for 57 programmes in Year 9 students, ranging from more passive interventions such as posters and banners to more active interventions such as student apps and enterprise days. Each programme consisted of a baseline survey followed by interventions and a repeat survey to calculate changes in perception. A clustering algorithm was also used to reveal the impact of combinations of interventions. Findings -The study reveals three main findings: (i) the use of social norms is an effective means of changing perceptions (ii) the level of interventions and change in perceptions are positively correlated and (iii) that the most effective combinations of interventions include the use of interactive feedback assemblies, enterprise days, parent and student apps and newsletters to parents.Originality/value -The paper presents results from one of the largest social norm programmes aimed at improving young people...

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patients, such as increased volume of distribution and increased clearance. For instance, subtherapeutic plasma concentrations are a concern. Aim and objectives The objective of this work was to determine if the current dosage of meropenem and piperacillin strategies in clinical practice are enough to achieve pharmacokinetic/pharmacodynamic targets (minimum 100% fT once above MIC, optimal 4-6 times above MIC). Material and methods A prospective study was conducted from February to June 2019 of serum levels of meropenem and piperacillin in an intensive care unit in the south of Spain. In all patients, the initial dose was chosen by the prescribing intensivist (extended infusions, high doses and adjustments for renal impairment were also included). A predose sample (100% fT >MIC) of the target antibiotics within the first 48 hours was included. As the majority of treatments were empirical, the CMI target was defined by EUCAST PK/PD break points (MIC >16 mg/mL for suspected Pseudomonas aeruginosa in the case of piperacillin and >2 mg/mL in the case of meropenem) Results Twenty-eight patients were included. Median age was 64 years (IQR 48-78 years), median APACHE II score was 15 (IQR 14-24) and 18/28 patients were men. Of the 28 patients treated, 10 did not reach 100% fT >MIC, mostly in the piperacillin group (6/9) and 4/9 in the meropenem group; 100% fT> 4-6×MIC was not achieved in 8/9 patients in the piperacillin group and in 12/19 in the meropenem group. Conclusion and relevance Over 5 months, thanks to the active surveillance of patients who were candidates for beta-lactam therapeutic drug monitoring and the request for determination of plasma levels by the hospital pharmacist, more than 30% of meropenem and piperacillin prescriptions were found to be subtherapeutic and 70% were optimisable.