The Centre is funded by Barts Charity and based within Queen Mary University of London at the Whitechapel campus.
The centre team (pictured above) will focus on improving the health of mothers and babies in East London, addressing healthcare challenges such as diabetes, obesity and heavy blood loss during childbirth.
The first BARC study is set to start in January 2018 – “EMmY: Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes: a pilot placebo controlled double blind randomised trial”.
EmMY will aim to randomise 200 women who are at risk of developing gestational diabetes, across three sites (Barts Health, Guy’s and St Thomas’, and Central Manchester University NHS Trusts).
Participants will be randomised to receive either 4g of Myo-inositol – a naturally occurring substance produced in the human body that belongs to the vitamin B complex group – or placebo study supplement daily, from the end of the first trimester until delivery.
The pilot will examine rates of recruitment and randomisation to the trial, and rates of adherence to the intervention. Researchers will analyse reasons for participation, non-participation, and non-adherence to the trial protocol. Any preliminary estimates and insight into trial procedures from the EMmY study will then inform a future large-scale trial.
The CLAHRC is supporting the study by providing health economic analysis for the pilot and full trial and assisting with patient and public involvement..
New CLAHRC research looks at how comorbidities – multiple conditions experienced by patients – influence referrals to, and outcomes of hip and knee replacement surgery.
Taking a 360-degree view of the referral and treatment process our researchers, led by Bélène Podmore, investigated current evidence in this area for patients with multiple conditions undergoing surgery. We examined;
the short-term outcomes relating to the safety of the hip or knee replacement surgery
long-term outcomes relating to the benefits of undergoing hip and knee replacement surgery.
We found comorbidities predominantly impact the safety of hip and knee replacement surgery but have little impact on its effectiveness.
Bélène also interviewed a variety of health professionals and therapists for their take on referring and selecting patients with comorbidities for joint replacement surgery. We found some disagreement among professionals – ranging from GPs to surgeons – on roles and responsibilities in the management of these patients.
The two pieces of research are presented in handy new “BITE-sized” summaries with links to full papers and further reading –
CLAHRC research investigating the impact of low emission zones on children’s physical activity and health has been featured on the BBC News
CLAHRC North Thames, in collaboration with three other CLAHRCs and a number of other research bodies, is evaluating the effects of London’s new Ultra Low Emission Zone (ULEZ) on children’s physical health and activity.
Our work is an offshoot of the CHILL (Children’s Health in London and Luton) study investigating the impact of pollution on children’s lungs. We are using the data created by CHILL to focus specifically on the impacts on children’s physical activity and health. CHILL featured on BBC News on January 16th.
Watch a clip below to see how school children are recording the effects of pollution on their lungs.
Professor Chris Griffiths, Chief Investigator for our work and part of the CHILL study is interviewed in the clip
The NHS Long-term plan published on Monday, January 7th includes extensive commitments to research.
The Plan sets out how the £20.5bn annual budget increase promised by prime minister Theresa May will be spent, and sets out priorities and targets for the service for the next ten years. A big focus will be on prevention and early detection of illness and disease with a view to taking pressure off hospital services.
Other big priorities for the Service include mental health and obesity, with GPs, mental health and community care receiving investment that will grow faster than the rest of the overall NHS budget.
The NHS Long Term Plan will also:
Open a digital ‘front door’ to the health service, allowing patients to be able to access health care at the touch of a button
Provide genetic testing for a quarter of people with dangerously high inherited cholesterol, reaching around 30,000 people
Give mental health help to 345,000 more children and young people through the expansion of community based services, including in schools
Use cutting edge scans and technology, including the potential use of artificial intelligence, to help provide the best stroke care in Europe with over 100,000 more people each year accessing new, better services
Invest in earlier detection and better treatment of respiratory conditions to prevent 80,000 hospital admissions and smart inhalers will be piloted so patients can easily monitor their condition, regardless of where they are
Ensure every hospital with a major A&E department has ‘same day emergency care’ in place so that patients can be treated and discharged with the right package of support, without needing an overnight stay.
It includes a section highlighting the role of research and innovation in enabling breakthroughs, prevention of illness, earlier diagnosis, more effective treatments, better outcomes and faster recovery. Some measures relating to research in the plan include:
NHS endorsement of recently announced Life Sciences Sector deal and recognition that research and innovation are important for patients and the UK economy
Increasing the number of people registering to participate in health research to one million by 2023/24
A commitment to innovation and ensuring it reaches patients faster with a simpler, clearer system for drugs, medtech and digital uptake
In an effort to strengthen the ability of patients, professionals and the public to contribute to improving the Service an NHS Assembly will be established in early 2019. The Assembly, consisting of national clinical, patient and staff organisations; the Voluntary, Community and Social Enterprise (VCSE) sector; the NHS Arm’s length bodies (ALBs); and frontline leaders from ICSs, STPs, trusts, CCGs and local authorities will advise the boards of NHS England and NHS Improvement as part of the ‘guiding coalition’ to implement this Long Term Plan.
Read reactions to, and summaries of the plan from vaious organisations
A new BMJ Quality and Safety editorial by Dr Roman Kislov, Senior Research Fellow at the Alliance Manchester Business School, has highlighted CLAHRC work as an example of successful engagement with management theory by researchers.
Dr Kislov’s research focus is the processes and practices of knowledge mobilisation, and his editorial highlights our recent paper on how different NHS Boards implement a quality improvement intervention – the QUASER guide.
He cites the paper as “an example of successfully deployed theoretically informative approach, highlighting some practical tips for researchers who aspire to move from merely applying theory towards entering into dialogue with it and, through doing so, refining its assumptions.”
Repeated calls have been made for the increased use of theory in designing and evaluating improvement and implementation interventions.1-4 The benefits are argued to include identifying contextual influences on quality improvement (QI), supporting the generalisability of findings and anticipating how future phenomena might unfold.2 5 Most importantly, the ability of
Background Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.
The work of CLAHRC researcher Dr Bélène Podmore has been highlighted as “high quality” by the National Institute for Health Research. Bélène’s work, recently published in BMJ Open investigated how having a long-term condition impacts access to and benefit from hip and knee surgery. The research was promoted by NIHR via their “Signals” service. NIHR Signals summarise the latest important research on health care, public health and social care, along with implications for practice.
Why was this study needed? In the UK, over 210,000 hip and knee replacements were performed in 2017 at an average age of 68 for hips and 69 for knees. One in six of these people had an illness affecting their day to day life.
CLAHRC researchers highlight potential to use patient-reported outcomes for emergency admissions.
Patient-reported outcome measures or PROMs are a well-established method of capturing the views of NHS patients, allowing the service to assess the quality of care delivered, from the patient perspective.
PROMs use pre- and post-operative surveys completed by patients to calculate their health gains after surgical treatment.
While there is an extensive PROM programme across the English NHS, they have yet to be used in emergency admissions. These account for nearly 40% of all hospital admissions and are an area of increasing demand. However, this is also an area where the NHS knows least about;
the quality of patient outcomes,
whether resources are being used effectively,
and whether there are unexpected variation between different providers
CLAHRC researcher and PhD Dr Esther Kwong investigated how to use PROMs to evaluate the quality of acute and emergency hospital care in the NHS. Esther developed and tested PROMS with patients who underwent emergency admissions, establishing that it is feasible to use PROMS in this clinical area.
They are presented in four new CLAHRC BITEs – postcard summaries of Esther’s published academic papers.
Do you need to demonstrate the impact of projects in your organisation?
Do you want to improve the design and implementation of your programme?
Are you tasked with carrying out an evaluation, but don’t know where to start?
This one day, hands-on workshop, run by the NIHR CLAHRC NorthThames Academy, addresses these challenges. It is aimed at staff from NHS Trusts, CCGs and Local Authorities, who have limited experience of conducting service evaluations.
After attending this workshop, you will have the skills and knowledge to undertake your own evaluation of a local programme or service.
The course covers:
Different types of evaluation, including their pros and cons
How to select suitable methods and approaches for evaluating a local programme or service
Practical skills and tips in using evaluation methods and approaches
Ways of sharing your evaluation findings to make an impact
This workshop is suitable for staff from NHS Trusts, Local Authorities and CCGs. It is not aimed at academics and/or researchers. Participants should attend the course with an evaluation in mind that they may need to carry out. No previous experience of study design, statistics or evaluation is needed.
All participants will receive a certificate of attendance.
Cost – This course is free for staff working in NIHR CLAHRC North Thames partner organisations (please click here to see a list of our partners). There is adelegate fee of £250 for other attendees.
Women who experience domestic violence and abuse (DVA) are more than twice as likely to seek emergency contraception as other women, according to a study by National Institute for Health Research (NIHR)-funded researchers at the University of Bristol and Queen Mary University of London, suggesting that requests for emergency contraception could be an important sign of abuse.
In the study, published in the British Journal of General Practice today, the researchers analysed medical records of over 200,000 women of reproductive age registered with a GP and found that those who had a record of DVA were 2.06 times more likely to have a consultation for emergency contraception compared to other women, rising to 2.8 times for women aged 25-39.
The researchers also found some evidence that abused women are more likely to seek emergency contraception repeatedly.
DVA is a major public health problem, with devastating consequences for the women who experience it and great financial cost to the NHS. It is known to have a significant impact on women’s reproductive health, including an increased risk of unintended pregnancy and abortion, as abusive and controlling partners coerce women to have unprotected sex or rape them.
Although emergency hormonal contraceptive, also known as the morning-after pill, is available from pharmacies, women can also get it from their GP. Up to a third of all emergency contraceptives are prescribed by GPs.
The researchers are calling for this new evidence to be included in existing DVA training programmes for GPs and sexual health practitioners, and for the training to be extended to community pharmacists, to help them identify and refer women who have experienced DVA on to specialist support services. Such programmes are recommended by the National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) as part of a multi-sector response to DVA.
Joni Jackson, Research Associate from the NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) West and co-lead author of the study, said:
“We found a strong positive association between exposure to domestic violence and abuse and requests for emergency contraception. Our findings are in line with evidence from studies in other countries suggesting that women experiencing DVA use more emergency contraception than other women. GPs, pharmacists and sexual health practitioners are at the frontline responding to these requests, with community pharmacists dispensing 50% of all emergency contraceptive pills. This presents an important opportunity to identify women experiencing DVA, signpost them to appropriate support services, and potentially save lives.”
Dr Natalia Lewis, from the Centre for Academic Primary Care at the University of Bristol and co-lead author, said:
“The negative impact of domestic violence and abuse on health results in higher use of healthcare services by abused women compared to the general population. This means that healthcare services are an important point of contact for DVA victims and survivors. We have already seen improvements in GPs’ ability to identify and refer women experiencing DVA through the success of the IRIS (Identification and Referral to Improve Safety) programme. IRIS has recently been adapted for sexual and reproductive health services. Our findings support the case for adapting the IRIS intervention to the community pharmacy setting, although more research is needed to explore if and how this could be done.”
The research was supported by NIHR CLAHRC West and CLAHRC North Thames.
Dr Werner Leber, an East London GP with a passion for driving earlier identification and diagnosis of HIV, has seen his work recognised by the European agency responsible for the continent’s defences against infectious disease – the European Centre for Disease Prevention and Control (ECDC).
Werner’s research among East London’s GP practices will now have a Europe-wide impact after being highlighted as good practice by the ECDC in its first integrated European hepatitis B virus (HBV) hepatitis C virus (HCV) and HIV testing guidance. The trial is summarised on page 71 of the guidance.
“The results support the hypothesis that an education programme promoting rapid HIV testing in general practice leads to increased and earlier HIV diagnosis.”
Public health guidance on HIV, hepatitis B and C testing in the EU/EEA; An integrated approach European Centre for Disease Prevention and Control, 2018
In this trial in Hackney, general practices were randomly assigned to offer either opt-out rapid HIV testing to newly registering adults or continuing usual care. The study found that promotion of opt-out rapid testing in general practice led to an increased rate of diagnosis, and might increase early detection, of HIV.
In developing the guidance the ECDC looked for excellent examples of HBV, HCV and HIV testing services across EU/EEA Member States, reviewing the latest evidence and putting out two published calls for submissions of good practice.