Congratulations to CLAHRC HEE NCEL Fellow Pinkie Chambers

Pinkie Chambers, a senior pharmacist at UCLH and former CLAHRC HEE NCEL Fellow is celebrating success in securing a prestigious NIHR Fellowship award.

After spending a year with the CLAHRC to hone her research skills, and against stiff competition, Pinkie secured a Doctoral Research Fellowship (DRF), which offers 3 years full-time funding (or 4 or 5 years part-time) to undertake a PhD.

The DRF is aimed at individuals, of outstanding potential, early in their research careers.

The Fellowship scheme aims to fast-track them through a customised research training programme in an environment reflecting their individual talents and training needs.

It is anticipated that successful applicants would become independent research leaders within 6 to 10 years of completing the DRF award.

During her year with us as a CLAHRC/HEE NCEL Fellow Pinkie developed her skills and worked on her application to the NIHR.

Her areas of interest include improving the chemotherapy pathway for cancer patients, and supporting patients to self-administer some of their blood tests to avoid hospital visits.

As well as her work as a Senior pharmacist at UCLH, Pinkie is also Joint Chair of the London Cancer Chemotherapy Expert Reference Group.

In particular Pinkie was commended by the NIHR for her efforts to involve patients and the public in her work which were described as “exceptional” – thanks in no small part to the CLAHRC’ Research Advisory Panel who Pinkie worked with during her CLAHRC/HEE NCEL Fellowship and who she presented to twice.

Read more about Pinkie’s time with us here

Our congratulations to Pinkie and best wishes for her future career

We need your views on how innovation spreads in the NHS

We need your views; complete the DECIDE Survey

Decisions in health Care to Introduce or Diffuse Innovations using Evidence (or DECIDE) is a two year study funded by the Health Foundation to investigate the role of evidence in decisions to introduce innovation. This survey is asking for your views about different types of evidence that are used when making decisions to adopt or diffuse innovations in the NHS.

Innovation in the NHS can take many different forms. It usually involves developing a new idea to meet a health care need. Often innovation may be related to clinical or administrative processes, but it may also involve the development of new medical technologies or clinical tools.

Examples of health care innovations might be information systems, surgical equipment, new drugs and new therapeutic uses for drugs or medical devices. An innovation does not have to be completely novel – for example, you can adopt a service development that is being done elsewhere and it is still an innovation in your organisation and in your local context.

We are interested in your experience of decision-making in the NHS and the kinds of evidence that you prioritise in your decision-making when deciding whether or not to adopt an innovation.

Taking part in this survey is voluntary. No personal details will be asked of you in this survey, and published reports about this survey will not contain any personal details

The survey should take no more than 10 minutes to complete.

Is screening for HIV in primary care cost-effective?

Our recently published research on the cost-effectiveness of screening for HIV in primary care has caused a great deal of interest and widespread media coverage.

We have produced a BITE sized summary of the paper with the headline findings and links to further information of interest.

The research, published in The Lancet HIV, represents the first time a model to explore the cost effectiveness of screening for HIV in primary care has been applied to the UK.

Our data provide the most reliable analyses to date and justify the investment needed to deliver HIV screening in primary care in the 74 localities considered to have high HIV prevalence – essentially most UK metropolitan areas.

Researcher and practicing GP Dr Werner Leber from Queen Mary University London said:
“We’ve shown that HIV screening in UK primary care is cost effective and potentially cost saving, which is contrary to widespread belief. This is an important finding given today’s austerity. Financial pressures, particularly within local authority’s public health budgets, mean that the costs of HIV testing are under intense scrutiny, and in some areas investment in testing has fallen.”

CLAHRC asthma awareness video is making an impact

Our Behind the Jump video is impacting young people with asthma.

Our asthma schools study worked with Greenwich and Lewisham Young People’s Theatre (GLYPT) to produce the short asthma awareness film shot at the LEAP Parkour Park in Westminster, London.

A recent comment has high praise for the film

“The timing of the release of this video after the recent tragedy within our community felt particularly important. I’ve been asthmatic since I was three years old, and have a lung capacity so pitiful that it shocks and confuses doctors every time I get retested (“are you sure you did the test right??”) but when I’m out training Parkour I always feel my healthiest. I should be less lazy about using my inhalers, this was a good reminder. Great video.”

 

CLAHRC PhD student Ryan Palmer enjoys success at the Health Services Research UK conference

CLAHRC PhD student Ryan Palmer enjoyed success at the recent prestigious Health Services Research UK conference in Nottingham.

Ryan (pictured above) is a Health Foundation Improvement Science PhD Student working under the primary supervision of Professor Martin Utley.

His research, part of our Methodological Innovation theme, focuses on patient flow between community and hospital services and he won one of the runner up prizes for best oral presentation held at the conference, which brings together researchers and NHS organisations, alongside third sector bodies, professional groups and private sector associates.

Ryan’s poster (below) and oral presentation focused on patient flow within community healthcare.

Ryan is based at one of our CLAHRC partner organisations – North East London NHS foundation Trust – where is he is helping the Trusts leaders and managers model patient flow and referral patterns so they can better design and plan services.

GP-based testing for HIV is cost-effective in areas of high prevalence and should be rolled out in 74 local authorities

New CLAHRC research published in The Lancet HIV has found that offering HIV testing to people on registration with a new GP in areas of high prevalence of the disease is cost-effective and will save lives.

Researchers based at the London School of Hygiene & Tropical Medicine and Queen Mary University of London (QMUL) carried out the study in areas with high prevalence of HIV – involving 86,000 people from 40 GP surgeries.

The promising results prompted CLAHRC researchers to call for a roll-out of HIV screening to all 74 high HIV prevalence local authorities in England (those with more than two diagnosed HIV infections per 1,000 adults).

HIV treatment is expensive, particularly when diagnosis is late. Early diagnosis means earlier intervention and treatment, saving the NHS money.

Building on earlier research from a trial in Hackney – a socioeconomically deprived inner London borough with an HIV prevalence rate of 8 per 1000 adults – the trial involved 40 general practices where they tested the effect of rapid fingerprick HIV testing as part of the standard health check during registration. They found it led to a four-fold higher HIV diagnosis rate.

Using a mathematical model that includes all the costs associated with HIV testing and treatment, the team now show that primary care HIV screening in high prevalence settings becomes cost-effective in 33 years (according to National Institute for Health and Care Excellence [NICE] criteria).

The CLAHRC North Thames study was carried out in partnership with NHS City and Hackney and involved University College London, Homerton University Hospital NHS Foundation Trust, University of Warwick, and University of British Columbia.

Dr Werner Leber from QMUL said: “We’ve shown that HIV screening in UK primary care is cost effective and potentially cost saving, which is contrary to widespread belief. This is an important finding given today’s austerity. Financial pressures, particularly within local authority’s public health budgets, mean that the costs of HIV testing are under intense scrutiny, and in some areas investment in testing has fallen.”

Read the full paper

Rebecca F Baggaley, Michael A Irvine, Werner Leber, Valentina Cambiano, Jose Figueroa, Heather McMullen, Jane Anderson, Andreia C Santos, Fern Terris-Prestholt, Alec Miners, T. Déirdre Hollingsworth, Chris J Griffiths.

Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.

The Lancet HIV. DOI:10.1016/S2352-3018(17)30123-6

Changing general surgery procedures could improve care for patients and save the NHS millions

The Getting it Right First Time (GIRFT) programme has completed a review of general surgery and stated that the NHS could see a significant reduction in the amount of people unnecessarily admitted for emergency general surgery if more acute hospitals introduced consultant-led surgical assessments at their ‘front door’.

Analysis by the GIRFT team shows this change could lead to up to 30% fewer general surgery emergency admissions a year where no operation is delivered, and could cut the NHS’s annual cost for this (£361million) by £108m.

CLAHRC North Thames is evaluating the planned changes to orthopaedics, to identify lessons to inform future efforts to improve the organisation and delivery of services.

Quality of life in dementia: do staff and family share the same beliefs in care homes?

Sarah Robertson is a PhD student with funding from the NIHR Collaborations in Leadership in Applied Health Research and Care. Sarah is currently supervised by Professor Gill Livingston, Dr Claudia Cooper & Dr Juanita Hoe.

The MARQUE project

In 2012, the UK government announced that in the face of “one of the biggest health challenges ever” that it was time to “fight back” against dementia. In response, the ESRC & NIHR pledged £9 million towards “Improving Dementia Care”. One of the projects funded by this initiative is the Managing Agitation Raising Quality of LifE (MARQUE) project at UCL led by Professor Gill Livingston. MARQUE began in 2014 and aims to improve our understanding of agitation in care homes and improve the quality of life of people with dementia. Sarah has been working as part of the MARQUE team at UCL and this work inspired her thesis comparing the perspective of paid and family carers in quality of life.

Proxy rated quality of life

Measuring quality of life in dementia presents unique challenges. With the stakes so high, it is important that we understand what we are actually measuring to know whether our interventions to enable people to live well are successful. Many people with dementia in care homes cannot provide ratings on their own quality of life so we rely on the perspectives of people close to them. We call these proxy reports. These reports differ to self-reported quality which has raised questions about the validity of this outcome. However, we do not know how staff and family proxy reports compare.

How do staff and family ratings compare?

MARQUE collected the perspectives of both staff proxies and family proxies from 86 care homes across England; providing 1,054 pairs of proxy ratings in the largest sample to date. For the first time, we used mixed method to explore staff and family ratings.

Our results suggest that staff and family proxies think differently about the quality of life of the same individual with dementia. Quantitative data from this study reveals that staff generally perceive the quality of life as better than family. Staff and family are affected by their own understandings of dementia and their experiences with care. Staff often viewed quality of life as synonymous with quality of care, whereas, family were more influenced by their past experiences.

Many relatives found that the person with dementia had changed. For some, this change centred on loss which they felt evidenced a poor quality of life. Other relatives felt that quality of life is simply not possible living in a care home. Transitioning into a care home is not only stressful at the time, it may leave a lasting impact on how relatives view the quality of life of a person with dementia in the future. Relatives need support to think about how the person with dementia feels in the present moment, focusing on their enjoyment of life with an acceptance of the current situation. Better communication and transparency in care routines helped facilitate relative involvement within care homes, establishing trust which improved perceived quality of life and reduced family carer stress.

What does this mean for dementia research?

  • Proxy reports provide valid measures of perceived quality of life.
  • Proxy raters are influenced by their own context and experiences.
  • Proxy ratings by different raters cannot be used interchangeably.
  • Different proxy ratings may be differently sensitive to interventions.
  • The different opinions of all key stakeholders should be considered.

What does this mean for clinical practice?

  • Within care homes, there are context specific factors that influence resident quality of life.
  • Psychological interventions that target loss, focus on acceptance and enable proxies to find meaning could improve perceived quality of life.
  • Improving the relationship between staff & family could improve perceived quality of life.
  • There may a link between perceived quality of life and carer quality of life.

 Contact –      Email: sarah.robertson@ucl.ac.uk                  Twitter: @1SarahMae, @MARQUEproject                

How can we all best use scientific evidence?

Media coverage of the use of statins to prevent cardiovascular disease, of Tamiflu to treat flu and of the HPV vaccine to prevent cervical cancer have opened up public debate about medical and scientific claims.

CLAHRC researcher and leader of our behaviour change theme Professor Rob Horne (pictured below) has helped produce new resources for professionals and patients to improve the way evidence about medicines is communicated.

Professor Horne is part of a prestigious Oversight Group within the Academy of Medical Sciences looking at how scientific evidence around medicines can best be communicated and understood.

Their report entitled Enhancing the use of scientific evidence to judge the potential benefits and harms of medicines aims to address problems that can arise from poor-quality evidence about medicines, or misrepresentation or misperception of evidence.

The report and associated resources will help health professionals to improve the use of scientific evidence to judge the potential benefits and harms of medicines. This will lead to better, more informed conversations between professional and patient about the benefits and risks of prescribing (or not prescribing) a particular medicine.

Other resources produced as part of this work include a pocket guide for patients entitled Helping you decide whether to take a medicine

 

Sexual health clinics should ask about abuse

Training clinicians to proactively ask patients about domestic violence and abuse (DVA) is feasible for sexual health clinics to implement and could increase referrals to specialist services, according to a joint CLAHRC North Thames/CLAHRC West study led by researchers at Queen Mary University of London (QMUL) and the University of Bristol involving over 4,300 women.

The risk of gynaecological and sexual health problems (including sexually transmitted infections, painful sex, vaginal bleeding and recurrent urinary tract infections) is three-fold higher in women who have suffered DVA. Meanwhile, 47 per cent of women attending sexual health services will have experienced DVA at some point in their lives.

Sexual health services can be the first point of contact for women who have experienced DVA, and were listed by the National Institute for Health and Care Excellence (NICE) as a setting in which all patients should be asked about DVA. However, most sexual health professionals have had minimal training in identifying and responding to DVA.

The study looked at the feasibility of sexual health clinics adopting a programme called IRIS (Identification and Referral to Improve Safety) – a DVA training and referral programme endorsed by NICE, the Royal College of GPs and Department of Health, originally aimed at encouraging GPs to ask patients whether they are experiencing DVA and to make referrals to specialist domestic violence services.

The team tested the intervention in two female walk-in sexual health services; an east London clinic serving an inner-city multi-ethnic population, and a Bristol clinic serving an urban population.

In the east London clinic over seven weeks, 267 out of 2,568 women attending were asked about DVA, with 16 of those (6 per cent) saying that they were affected by abuse. Overall, eight of the women affected by abuse (50 per cent) were referred to specialist services.

In the Bristol clinic over twelve weeks, 1,090 out of 1,775 women attending were asked about DVA, with 79 of those (7 per cent) saying they were affected by abuse. Overall, eight of the women affected by abuse (10 per cent), were referred to the specialist services.

Lead CLAHRC North Thames researcher Dr Alex Sohal (pictured left) said:

Women attend sexual health clinics for care of their sexual health but little thought is given to whether the relationship with the person that a woman has sex with directly harms her health. Without training, system level changes and senior managerial support, clinicians end up ignoring DVA in consultations or have an arbitrary approach that fails many women affected by DVA.

Not only is this a feasible intervention for a sexual health clinic setting, but we also found that clinical leads and busy local DVA service providers were incredibly supportive, with many people understanding the importance of making this work.”

 

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Read the full paper:
Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention
Sohal AH, Pathak N, Blake S, et al. Sex Transm Infect Published Online First: doi:10.1136/ sextrans-2016-052866