The impact of comorbidities on referral to and outcomes of hip and knee replacement surgery

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 –

How do comorbidities impact on the referral pathway to access joint replacement surgery in the NHS? An interview study with healthcare professionals in the NHS

What is the impact of comorbidities on outcomes of hip and knee replacement surgery? A review of the evidence

Evaluation of heath impact of Low Emisison Zones makes the news

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

 

Big role for research and innovation in the NHS Long-term plan

#NHSLongTermPlan 

https://www.longtermplan.nhs.uk/

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

Healthy London Partnership; 
https://www.healthylondon.org/resource/the-nhs-long-term-plan-summary/

Association of Medical Research Charities
https://www.amrc.org.uk/research-and-innovation-in-nhs-englands-long-term-plan
KIng’s Fund
https://www.kingsfund.org.uk/press/press-releases/kings-fund-response-nhs-long-term-plan
Nuffield Trust:
https://www.nuffieldtrust.org.uk/event/learning-from-history

Professor Rosalind Raine

In the last 5 years Rosalind Raine has been awarded £16M (as PI and co-applicant) in AHR grants from NIHR, MRC, Wellcome Trust and other funders. Her research is of value to policy makers due to its diversity (spans acute & chronic conditions and all NHS settings), representativeness (national datasets,long time periods) and applied nature, allowing direct policy translation.

Her analyses have influenced national inequalities policies, EU policy makers, the Cabinet Office, the GLA, LAs and PCTs. She has held national leadership positions including the National Chair of the Heads of Academic Departments of Public Health (2010-2014). Her commitment to internationally competitive research which makes a major contribution to NHS, patients and the public is demonstrated by her membership of the: REF2014 Sub Panel for Public Health, Health Services Research and Primary Care; MRC Career Development Panels (2005-12); NIHR Programme Grant Experts Panel (2007-12) and the MRC Health Services & Public Health Research Board (2005-8). As National and Regional Chair of the UK Clinical Research Network (CRN) NIHR Health Services Research (HSR) Speciality Group (2009-11), she established networks of applied researchers across London Universities to promote research collaborations.

Nationally she worked with the CRN to achieve more appropriate inclusion of HSR in the CRN. Raine’s effective leadership and commitment to capacity building, led her to being asked to establish and lead the UCL Department of Applied Health Research (2012-). Current grants in the Department total £59.3M (as lead and co-applicants).