NIHR CLAHRC North Thames funded PhD studentships launched

NIHR CLAHRC North Thames is now recruiting to its 2019 PhD studentships. NIHR CLAHRC North Thames is funded to conduct high quality applied health research, focused on the needs of patients and the public to produce a direct impact on health and the way health care and public health is organised and delivered.

Led by Professor Rosalind Raine (UCL), we are a collaboration of 50+ partners, including leading universities, NHS trusts, local authorities, clinical commissioning groups, UCLPartners, industry and organisations representing patients and the public.

We invite applications for these 3-year PhD studentships starting October 2019 (exact date dependent on the individual university). Studentships will be based at one of the following Universities: London School of Hygiene and Tropical Medicine, Queen Mary University of London, University College London. Details of the individual projects and supervisors are given below. The studentships include a stipend and full UK/EU fees.

Read more about how to apply on this page;

http://clahrc-norththames.nihr.ac.uk/nihr-clahrc_north-thames-academy/phds/ 

The PHDs on offer are below:

Cancer and comorbidity: impact of comorbid conditions on equity of access and safety and outcomes of cancer treatments

CLAHRC Research area: Health Economics and Data

Developing and evaluating an online community of practice for public health decision-makers

CLAHRC Research area: Health Economics and Data

Addressing the polypharmacy challenge in working-age adults

CLAHRC Research Area: Multimorbidity

Optimising resources from the internet in primary care consultations

CLAHRC Research area: Innovation and Implementation Science

Somatic and psychotropic polypharmacy: Understanding sociodemographic factors and the effects of polypharmacy in people with mental health problems

CLAHRC Research Area: Multimorbidity

Mapping Complex CAre Pathways for Personality Disorder (MACCA-PD)

CLAHRC Research area: Mental health

Understanding and facilitating self-management in child and youth mental health for socially excluded populations

CLAHRC Research area: Mental health

Evaluating services for older adults with multimorbidity across health and social care

CLAHRC Research area: Multimorbidity

Patient experiences on inpatient psychiatric wards: does this information get used to improve outcomes?

CLAHRC Research area: Mental health

Equity in service provision for people newly diagnosed with dementia and their family

CLAHRC Research area: Mental health

Implications of digital health innovations on the demand, use, cost and experiences of health and social care services

CLAHRC Research area: Innovation and Implementation Science

 

Mechanical thrombectomy is cost-effective up to 24 hours from stroke

CLAHRC researchers demonstrate the value of intervention beyond the current recommended 6 hours

Ischaemic stroke is the most common type of stroke, occurring when a blood clot blocks an artery cutting blood flow to part of the brain. Stroke can lead to coma, severe disability and eventually death if not treated promptly. 

Mechanical clot retrieval (thrombectomy) is an intervention to remove clots when the current medical treatment (thrombolysis) is not sufficient to dissolve them.

Thrombectomy to remove a clot

Current guidance from NHS England and the National Institute for Health and Care Excellence (NICE) (see below) only supports this intervention within 6 hours from stroke onset.

NHS England – Clinical Commissioning Policy on Mechanical Thrombectomy for Acute Ischaemic Stroke.

NICE – Mechanical thrombectomy devices for acute ischemic stroke. Guidance MIB153. 30 July 2018 

Our researchers compared the cost-utility of mechanical thrombectomy (MT) in addition to medical treatment versus medical treatment alone performed beyond 6 hours from stroke onset in the NHS.

Our research, published in the International Journal of Stroke, shows that MT is still cost-effective if performed up to 24 hours. The publication is now cited as health economics evidence in the latest NICE evidence review (Stroke (Update). Evidence review D: thrombectomy- Draft for consultation). and has been used to recommend the offer of MT up to 24 hours. 

The work demonstrates mechanical thrombectomy is cost-effective up to 24 hours from acute ischemic stroke symptom onset – we propose the NHS implements this intervention on the basis of improvement in the quality of life of patients as well as economic grounds.

Pizzo, E., Dumba, M., & Lobotesis, K. (2019).
Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke.
International Journal of Stroke
https://doi.org/10.1177/1747493019830587

Registration Open

Rethinking Cancer UCL Cancer Domain Symposium

Monday 13 May 2019

UCL Institute of Education

Registration for the inaugural UCL Cancer Domain Symposium is open

Cancer remains one of the major causes of morbidity and premature death worldwide; one in two people in the UK born after 1960 will be diagnosed with some form of cancer during their lifetime. UCL has a proud track record in addressing the societal, technical, and health challenges of cancer and in exploring its underling biology.

This symposium, organised by the UCL Cancer Domain, invites our broad community to assemble for the first time at scale to consider challenges and opportunities in cancer research, prevention and treatment, from biological, clinical, technical, economic and societal perspectives. The event showcases our distinctive multidisciplinary expertise and features interactive discussion sessions with our speakers and panels. Talks are scheduled on the following themes:

  • Cancer evolution: can we beat Nature?
  • Cancer detection: the earlier the better?
  • The cancer treatment revolution and how we afford it

We are delighted to announce that Professor Charles Swanton (UCL Cancer Institute and Francis Crick Institute) and Professor Mariana Mazzucato (UCL Institute for Innovation and Public Purpose) will deliver the keynote lectures at this event.


Register your place here: https://ucl-cancer-domain-symposium-2019.eventbrite.com

Join the conversation by tweeting us @UCL_SLMS using the hashtag #UCLCancerDomain

Introduction to Evaluation Online: 7th May – 4th June 2019

Do you need to demonstrate the impact of projects in your organisation?

Do you want to improve the design and implementation of your programmes?

Are you tasked with carrying out an evaluation, but don’t know where to start?

Consider enrolling in our four-week online course run by the NIHR CLAHRC North Thames Academy to address these challenges. This course has been recently updated. It is aimed at staff in frontline services at NHS Trusts, CCGs and Local Authorities, who have limited experience conducting service evaluations and would like to learn about evaluations in flexible time.

After participating in this course, you will have the skills and knowledge to undertake your own evaluation of a local programme or service. Inspired by the content of our popular face-to-face evaluation course, the online course will cover:

  • 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

Teaching will be delivered entirely online. You’ll learn by watching videos and lecture slides; interacting through activities and questions; and learning from others by taking part in the discussions that accompany each step. You’ll also develop a plan for a real life evaluation you may have to conduct. 

Who is this workshop suitable for?

Staff from NHS trusts, local authorities and clinical commissioning groups who need to evaluate local programmes or services as part of their work. The course is not aimed at academics or researchers.

What preparation is needed?

Participants should attend the course with an evaluation in mind that they may have to carry out.  No previous knowledge of evaluation is required, or experience of study design and statistics.

Participants will receive a certificate of completion if they undertake at least 80% of the course activities.

Dates – Tuesday 7th May – Tuesday 4th June 2019.

Learning hours – an estimate of 3 hours per week (12 hours in total)

Cost – £100 for staff working in NIHR CLAHRC North Thames partner organisations (please click here to see a list of our partners). There is a delegate fee of £250 for other attendees.

Registration – Registration will open between 25th February and 3rd May 2019.
To register for this course, please go to the UCL online store.

For more information please contact clahrc.academy@ucl.ac.uk

Bart’s Research Centre for Women’s Health is up and running with the EMmY study

We’re delighted to announce our latest research partnership – with the the Bart’s Research Centre for Women’s Health (BARC) .

BARC was launched in June 2017 and is led by Professors Shakila Thangaratinam and Khalid Khan.

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..

Contact Doris Lanz, BARC Senior Trial Manager for more info at d.lanz@qmul.ac.uk

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

From theoretically informed to theoretically informative improvement research

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.

Read the editorial

Engaging with theory: from theoretically informed to theoretically informative improvement research

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

Read the iQUASER paper

Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service

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.

Read our BITE sized summary of the iQUASER paper

Complications following hip or knee surgery are more likely for people with long-term illness, but benefits are still worthwhile

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.

Joint replacement benefits and harms for people with other illness

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.

Read the paper

Podmore B, Hutchings A, van der Meulen J, et al
Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis
BMJ Open 2018;8:e021784. doi: 10.1136/bmjopen-2018-021784