Evaluating a digitally-enabled care pathway for Acute Kidney Injury

A new publication highlights our work in evaluating a new patient pathway with the potential to provide clinicians with real-time data on inpatients at risk of Acute Kidney Injury.

AKI is common (affecting up to 20% of UK acute hospital admissions);  associated with significant morbidity and mortality, and expensive – excess costs to the NHS in England alone may exceed £1 billion per year.

Researchers at the Royal Free Hospital (RFH), part of London’s Royal Free London NHS Foundation Trust (RFLFT) have developed a digitally-enabled care pathway for inpatients, incorporating  a mobile software application – the “Streams-AKI” app – that “reads” routinely collected serum creatinine data in hospital inpatients and alerts health professionals where a patient is at risk of AKI.

We have published our protocol for this evaluation, and a postcard-style “need to know” summary – or BITE – of our research plans. We’ll measure its success for patients (in terms of speed and effectiveness of their diagnosis and care), NHS staff and clinicians (to find out what they think of the pathway) and for the NHS in terms of patients’ length of stay and costs to the service.

The protocol and BITE will interest NHS staff and clinicians working in renal care, as well as those interested in the potential of technology to improve detection and diagnosis via routinely collected data

Co-production in practice with young people in delivering a ‘perfect’ care pathway for diabetes

We’ve been working with young people to transform how local health diabetes services are designed and delivered for their age group.

CLAHRC researchers based at the University of East London worked with local young people to understand the options and barriers they face when given a diagnosis of diabetes and using NHS services.

We recruited a mixed young research team – in terms of age, ethnicity, faith-identities and backgrounds – who worked together over one year to help commissioners and providers better understand and address the options and barriers of delivering a ‘perfect’ care pathway.

You can see the results of this work in our latest BITE – a postcard summary of a CLAHRC research paper.

This is part of our wider work to co-design community-based diabetic services responsive to the needs of children and young people

How do older people’s social connections influence their use of preventive health care services?

Most of us have experienced the benefits of having strong and positive social relationships. We also know that a lack of these can lead to social isolation and loneliness – which are connected to illness and early death.

We know less about how social connections can influence our use of preventive health care services, such as screening, flu immunisation or health checks. Is it the quality of our relationships that matters, or how wide our networks are, or how often we are in contact with other people?

Our latest BITE – a postcard “need to know” summary of our published research – presents the findings of our investigation into whether and how social connections affect the use of recommended preventive health service programmes amongst people in their late 60s.

While it is common to target public health initiatives based on where people live or their economic and physical health circumstances, our work suggests using social connectedness indicators may also improve targeting of initiatives to increase preventive healthcare participation.

In addition, our results highlight the value of public health initiatives to increase social networks – itself a benefit beyond improving the uptake of services.

Could you be an ambassador for research?

Patient Research Ambassadors needed to promote health research from a patient point of view

We have teamed up with colleagues at the NIHR Clinical Research Network (CRN) to support their Patient Research Ambassador (PRA) initiative.

The Network is looking for patients, carers, and members of the public who have taken part in research and who are passionate about it.

The Ambassadors will help improve how local people across the North Thames patch find out about and participate in clinical research and also help to increase awareness of the importance of supporting clinical research. The PRAs will play their part in ensuring research is patient and public focussed.

Examples of the type of work PRAs do are below – 

Full training and support will be available. As well as a chance to learn new skills and improve how research is planned and carried out in your area you will be part of a network of PRAs.

To find out more contact CRN North Thames patient and public involvement manager Christine Menzies by emailing christine.menzies@nihr.ac.uk or calling 0207 679 9763

You can read a role description here..

Read tne full 10 things you can do to promote health research document here

Professor Jonathan Grigg launches new clean air coalition

CLAHRC researcher Professor Jonathan Grigg is among leading doctors, public health professionals and organizations launching a new global advocacy group to mobilize clinicians and public health professionals to advocate for clean air policies.

Inspire: Health Advocates for Clean Air (www.inspirecleanair.org) was launched in The Hague last week

Professor of Paediatric Respiratory and Environmental Medicine at Queen Mary University of London, Jonathan (below) is a leading UK paediatrician in the effects of air pollution. He is a founder member of the new interbational coalition, following his involvement in the UK based Doctors against Diesel initiative.

According to the new group nine in ten people breathe polluted air, making it the world’s leading environmental cause of death and disease. Inspire aims to bring air pollution to the forefront of health and climate agendas.

It will offer a framework to push governments to address the root causes of air pollution and advocate for clean air policies and it aligns WHO’s road map for global action, including:

  • Improve awareness in the global health community about air pollution and its health effects
  • Increase involvement of clinicians and clinical organizations in advocacy for clean air policies
  • Establish a global network of informed health-oriented champions
  • Grow public awareness of the dangers of air pollution
  • Exert political pressure on governments to encourage aggressive clean air policies

Visit www.inspirecleanair.org, where you can also join the coalition. #InspireCleanAir       

Premature mortality twice as high in most deprived areas compared to most affluent

A major new paper in the Lancet highlights rates of premature mortality that are two times higher in the most deprived areas of England (Blackpool) compared to most affluent (Wokingham).

Dr Harry Rutter, Clinical Research Fellow at the London School of Hygiene and Tropical Medicine was among the prominent experts in the field who authored the paper.

Dr Harry Rutter

Dr Rutter, a public health physician, was Principal Investigator of the CLAHRC’s evaluation of the Greater London Authority’s Healthy Schools London programme. 

All-cause age-standardised years of life lost due to premature mortality (YLL) and years lost due to disability (YLD) per 100 000 population by UK country and English Upper Tier Local Authorities, 2016

The work presents findings from a new Global Burden of Disease (GBD) Study funded by the Bill & Melinda Gates Foundation and Public Health England. 

The Global Burden of Disease includes evidence collected and analyzed by a consortium of more than 3,000 researchers in more than 130 countries and provides a tool for goverments and policy makers to measure health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and inequalties tackled

The authors of the Lancet paper used the data to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. They estimated the burden of disease by cause of death, condition, year, and sex.

You can view via an interactive ‘Lost Years’ map – which reveals the extent of health inequality across the UK.

Changes in health in the countries of the UK and 150 English
Local Authority areas 1990–2016: a systematic analysis for
the Global Burden of Disease Study 2016
Nicholas Steel, John A Ford, John N Newton, Adrian C J Davis, Theo Vos, Mohsen Naghavi, Scott Glenn, Andrew Hughes, Alice M Dalton, Diane Stockton, Ciaran Humphreys, Mary Dallat, Jürgen Schmidt, Julian Flowers, Sebastian Fox, Ibrahim Abubakar, Robert W Aldridge,Allan Baker, Carol Brayne, Traolach Brugha, Simon Capewell, Josip Car, Cyrus Cooper, Majid Ezzati, Justine Fitzpatrick, Felix Greaves, Roderick Hay, Simon Hay, Frank Kee, Heidi J Larson, Ronan A Lyons, Azeem Majeed, Martin McKee, Salman Rawaf, Harry Rutter, Sonia Saxena, Aziz Sheikh, Liam Smeeth, Russell M Viner, Stein Emil Vollset, Hywel C Williams, Charles Wolfe,  Anthony Woolf, Christopher J L Murray

How can we improve dementia care in UK black elders?

Black elders dismiss the warning signs of dementia until the condition becomes too severe to ignore or a crisis strikes. They are also less likely to receive a diagnosis of their condition, resulting in delayed treatment and
less time to plan for the future.

Our latest BITE – a summary of published CLAHRC research provides an overview of our work with black elders, their families and carers to;

  1. identify barriers and facilitators to seeking help for dementia.
  2. based on what we found, work with dementia patients and their          carers, volunteers from the public, clinicians and experts in the treatment and research of dementia to develop an intervention – a leaflet entitled Getting help for forgetfulness (below)
  3. trial the intervention with GP registered patients, who were asked to rate it and evaluate its effect on their intention to seek help from their doctor.

What are the challenges of knowledge co-production in embedded research?

The concept of knowledge co-production is used in health services research to describe partnerships (which can involve researchers, practitioners, managers, commissioners or service users) with the purpose of creating, sharing and negotiating different knowledge types used to
make improvements in health services.

The CLAHRC has researchers “embedded” in a number of our partner organisations in the NHS and local government. The “researcher in residence” model has the advantage of allowing academics to be close to the ground and gain insight into how an organisation really operates. It also presents challenges in creating and maintaining key relationships and professional independence.

In a newly published BITE-sized summary of our research we present the results of our examination of three case studies and the wider implications for this model of working.

One to one specialling and sitters in acute care hospitals; reviewing the evidence

One to one nursing, or specialling is a way of caring for patients by providing continuous observation (by “sitters”) for an individual for a period of time during acute physical or mental illness.

Some patients need more than a general level of observation on a ward, often with the primary aim of reducing risk and protecting the patient.

Our review, published in a BITE, examined published evidence on the topic of specialling and sitters, aiming to identify the challenges and concerns relating to the cost effectiveness and quality of care.

Medication adherence in asthma: can pharmacists help?

Preventer inhalers (inhaled corticosteroids) are a common medication for asthma, and people get the full benefit of the medication by taking their prescribed doses correctly. We know many patients struggle to take enough doses effectvely, which impacts their ability to manage the condition.

Could pharmacists hold the key to helping patients take medicines effectively and in the right doses?

Our latest BITE – a postcard “need to know” summary of our research – presents the findings of our review of the evidence on whether pharmacists involved in asthma care could help people take their preventer inhaler as prescribed, therefore giving them the full benefit of their medication.