“It’s a matter of building bridges”…involving carers in the treatment of inpatients with severe mental illness

New research published by CLAHRC researchers based at the Queen Mary University of London highlights the value of family and friends being involved in the care of mental health inpatients.

The paper, published in BMC Psychiatry details how feasible it was to implement carer involvement in four inpatient wards across East London, and explores the experiences of participants.

The intervention was of particular value soon after admission to an inpatient ward, which can be a traumatic and frightening experience.

The researchers, working out of the University’s Unit for Social and Community Psychiatry, found that despite the challenges of implementing carer involvement in hospital treatment for mental illness, a simple structured approach can make a positive difference. The research also found that patients, clinicians and carers appreciated this approach to care.

The intervention will be of value to clinicians as it offers clear procedures to follow. The authors conclude that wider organisational support is vital to make the intervention work, in particular from senior managers and clinical leaders.

“It’s a matter of building bridges…” – feasibility of a carer involvement intervention for inpatients with severe mental illness
Kaselionyte et al. BMC Psychiatry (2019) 19:268
https://doi.org/10.1186/s12888-019-2257-6 

NEON short film highlights improved nutrition and feeding practices among East London’s Bangladeshi children

NEON (Nurture Early for Optimal Nutrition) is a participatory female health volunteer-led intervention to promote healthy nutrition in children of Bangladeshi origin in East London, who have a  higher risk of diabetes, obesity and heart disease in later life than the average child in the UK.

Childhood nutrition can impact adult health status and the likelihood of chronic diseases such as diabetes as well as oral health complications – making it important to act early to prevent long term problems.

NEON used a proven model from South Asia where the introduction of female health workers into local women’s groups has significantly improved maternal and neonatal survival rates.

A new short film highlights the impact of the NEON approach in local communities, and the improvements it has made to nutrition and feeding practices.

New research and short film highlights benefits to patient care of mobile APP

New CLAHRC research shows the impact of the “Streams-AKI” app

Detection of one of the biggest killers in the NHS – Acute Kidney Injury (AKI) –  has been cut from hours to minutes thanks to the introduction of a new mobile app.

Working in partnership with Deepmind and the Royal Free London NHS Foundation Trust, CLAHRC researchers based at UCL evaluated the impact of the digital intervention-  an App called Streams – and the clinical pathway it underpins – on safety and clinical outcomes for inpatients at risk of AKI.

The STREAMs app sends an instant alert to NHS staff if a patients test results show they are is at risk of Acute Kidney Injury

AKI is a sudden episode of kidney failure or kidney damage defined by changes in urine output or serum creatinine – a waste product filtered by our kidneys. AKI can affect other organs such as the brain, heart, and lungs. It is common in hospital inpatients, in intensive care units, and especially older adults. AKI is estimated to cause 40,000 deaths and cost the NHS over £1 billion every year.

We compared results between the hospital site using the app versus another site not using the app. The evaluation of Streams highlighted a significant improvement in the reliability of recognition, time to treatment and reduced costs.

A short film summarises the results of our evaluation which took place from May 2017 across the Trust.

Mary Emerson, lead nurse specialist for the patient at risk and resuscitation team, with patient Edgar Ferrante.

The short film accompanies three papers published today (July 31st)

The research generated a great deal of media coverage which included an appearance on BBC Breakfast by CLAHRC Director Professor Rosalind Raine

..and a news item on the BBC website


Read the papers below

Connell A, Raine R, Martin P, Barbosa EC, Morris S, Nightingale C, Sadeghi-Alavijeh O, King D, Karthikesalingam A, Hughes C, Back T, Ayoub K, Suleyman M, Jones G, Cross J, Stanley S, Emerson M, Merrick C, Rees G, Montgomery H, Laing C
Implementation of a Digitally Enabled Intervention to Detect and Treat Acute Kidney Injury Arising in Hospitalized Patients: Evaluation of Impact on Clinical Outcomes and Associated Health Care Costs
J Med Internet Res 2019;21(7):e13147
http://www.jmir.org/2019/7/e13147

Connell A, Black G, Montgomery H, Martin P, Nightingale C, King D, Karthikesalingam A, Hughes C, Back T, Ayoub K, Suleyman M, Jones G, Cross J, Stanley S, Emerson M, Merrick C, Rees G, Laing C, Raine R
A Qualitative Evaluation of User Experiences of a Digitally Enabled Care Pathway in Secondary Care
J Med Internet Res 2019;21(7):e13143
http://www.jmir.org/2019/7/e13143/

Alistair Connell  Hugh Montgomery, Peter Martin Claire Nightingale Omid Sadeghi-Alavijeh, Dominic KingAlan Karthikesalingam, Cian Hughes, Trevor Back, Kareem Ayoub, Mustafa Suleyman, Gareth Jones, Jennifer Cross,
Sarah Stanley, Mary Emerson, Charles Merrick, Geraint Rees, Chris Laing and Rosalind Raine
Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions
npj Digital Medicine (2019) 2:67
https://www.nature.com/articles/s41746-019-0100-6

 

 

 

 

Evaluation in Public Health and Care, Level 2 – Tuesday 5th November 2019; 09:00 – 17:00

Are you tasked with carrying out or commissioning an evaluation, but would appreciate guidance on what questions to ask, what outcomes to look for, or how to plan for an evaluation?

This one day, hands-on workshop, run by the NIHR CLAHRC North Thames Academy, addresses these challenges. It is aimed at staff from NHS Trusts, CCGs and Local Authorities. By attending, you will gain expert tips on how to design an effective evaluation, and have opportunities to consult with other delegates and facilitators about information directly related to planning your evaluation.

Having attended the course, delegates will broadly be able to:

  • Develop an evaluation question
  • Apply a logic models and programme theory to address their evaluation questions and identify evaluation outcomes
  • Design a plan for conducting or commissioning an evaluation

This workshop is suitable for staff from NHS Trusts, Local Authorities and CCGs. It is not aimed at academic and/or researchers. Delegates should attend the course with an evaluation in mind. They should have previously attended our “Introduction to Evaluation” course (in person or online). As part of the course, some pre-programme preparation (approximately 3 hours) will be required.

All delegates 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 a delegate fee of £250 for other attendees.

Registration – Please complete the registration form and email to clahrc.academy@ucl.ac.uk by 5pm, 30 August 2019.

Please note, a cancellation fee of £100 will be charged to both partner and non-partner delegates in the event of non-attendance without notice after 5pm, Tuesday, 29th October 2019.

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

Becoming Research Active: 27th November 2019; 9am – 5pm.

Are you a nurse, allied health professional, public health or local government member of staff who is interested in research or who has had some exposure to research?  Our workshop is suitable for staff from NHS Trusts, CCGs, and Local Authorities who are keen to become involved in research.

Engaging in research is a great way to address the questions that often arise in health care.  It can also play a vital role in producting new evidence and new knowledge for decision-making to improve health care.

This one day, practical workshop provides an introduction to the research process to enable NHS and local government staff to engage in research activity.  The course is run by the CLAHRC North Thames Academy, together with the Research Design Service London (east London arm) and Clinical Research Network North Thames.

This introductory level course is a first step on the journey towards becoming “research active”, either by developing your own small project or getting involved in other ways e.g. collaborating on research studies, assisting clients / patients in your care to take part in research, being a (critical) research ‘consumer’ or helping to shape research priorities, design and delivery.  We ask that participants attend the workshop with a research idea, innovation, or change that they would like to plan for, or collaborate on with researchers.

By the end of the course participants will:

  • Understand the research process, including the principles behind good research design and planning for dissemination and impact
  • Understand the different roles within a research team and identify the points at which you can become involved
  • Be able to apply criteria to judge the potential value and feasibility of a research project idea
  • Have a basic understanding of research governance and ethics requirements, and know where to find out more
  • Know how to involve patients and the public in every stage of research, and understand how it could benefit the research
  • Know how to access relevant resources or the help available across North Thames to design, plan and fund research

This workshop is not aimed at academics and/or researchers.

*e.g. you might have done a Masters level module in collecting and analysing data, or critical appraisal of research, or have helped to support research in your organisation or attended another one of our Academy courses.

All participants will receive a certificate of attendance.

Cost – This course is free for staff working in NIHR CLAHRC North Thames partner organisations (a list of our partners is available on our website). There is a delegate fee of £250 for other attendees.

Venue – Central London

Registration – Please complete the registration form and email to clahrc.academy@ucl.ac.uk by 5pm, Monday 20th September 2019.

Please note, a cancellation fee of £100 will be charged to both partner and non-partner delegates in the event of non-attendance without notice after 5pm on 20th November 2019.

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

Breaking down the barriers to research

What is preventing research with children and young people (CYP) with life-limiting conditions and life-threatening illnesses (LLC/LTI)?


Barriers to Research Access: Voices, Experiences and Solutions, or BRAVES is a programme of research aiming to explore the barriers to conducting research and some possible solutions


The team recently presented two posters at the 17th World Congress of the European Association for Palliative Care (EAPC)


 

 

The first gives an overview of the whole project

This poster was recognised as 1 of 3 best/highest scoring poster abstracts in the Palliative care in Children and Adolescents category

 

 

The second focuses on work with research ethics committees who provide approval for work to take place with this vulnerable group of patients

How can we help Emergency Departments better prepare for the arrival of patients with acute mental health problems?

New CLAHRC research offers the NHS a great opportunity to better support patients with mental health issues arriving at Emergency Departments.

CLAHRC researcher Dr Helen Barratt and colleagues have used NHS data to describe the population of patients who attend Emergency Departments in England, including their sociodemographic characteristics. As part of the first national study of Emergency Department mental health attendances, the researchers analysed over 6 million adult visits at 97 English NHS Trusts between April 2013 and March 2014.

The data will be invaluable to the NHS in estimating the demand for liaison psychiatry services, and resourcing A & E departments to deal with patients presenting with mental health issues in what is already a stressful environment. This work is timely as recently new NHS Access standards for emergency mental health care have been proposed – obliging Trusts to strengthen the availability of care ‘out of hours’ and the provision of resources for individuals requiring admission.

“Those coming to A&E will receive a response from a 24/7 liaison psychiatry team (or equivalent children’s and young people’s service) within the first hour of their referral, and will receive the appropriate, timely support to meet their needs and an evidence-based package of care.”
Clinically-led Review of NHS Access Standards Interim Report from the NHS National Medical Director

You can see the key figures in the infographic below

 

You can see more of the key figures in a presentation Helen put together below

 

 

What adaptations are needed to deliver psychological therapies in inpatient settings?

Psychological therapies (sometimes referred to as ‘talking therapies’) offer a chance for patients to explore difficulties in a safe and confidential setting. The therapy is delivered by a qualified professional, working in partnership with a patient to help them better understand feelings that arise from their past experiences, and attitudes towards them. Evidence suggests these therapies can make a big impact on psychiatric patients current and future wellbeing. However, they are a challenge to deliver in inpatient environments due to the short-term nature of many inpatients’ stay, added to the complex needs they often present with.

Dr Lisa Wood is a Care Pathway Lead Psychologist at North East London NHS Foundation Trust (NELFT) as well as a Lecturer in Clinical Psychology at the University of Essex. Dr Wood spent a year with the CLAHRC as part of a Fellowship funded by HEE NCEL to hone her research skills and develop research interests in her specialist area – understanding the lived experience of psychosis from a service user perspective.

In newly published research, Lisa explored the adaptations required to deliver psychological therapies to this population from the perspective of inpatient psychological practitioners. Through interviews with inpatient psychological practitioners, Dr Wood and her research team sought the adaptations required to deliver psychological interventions in this context.

Read the paper

Qual Health Res. 2019 Apr 23:1049732319843499. doi: 10.1177/1049732319843499
Psychologists’ Perspectives on the implementation of Psychological Therapy for Psychosis in the Acute Psychiatric Inpatient Setting.
Wood L Williams C Billings J Johnson S
https://www.ncbi.nlm.nih.gov/pubmed/31014190

 

After the trial: how a programme to improve the health care response to domestic violence and abuse fares in the real-world NHS

How does an intervention developed and tested by researchers make its way to the front-line of health care?

This is the topic of a new blog by Dr Natalia Lewis, a Research Fellow at Centre for Academic Primary Care in the University of Bristol.

Natalia is part of the research team investigating the impact of IRIS (Identification and Referral to Improve Safety), a general-practice-based Domestic Violence and Abuse (DVA) training, support and referral programme.

After the trial: how a programme to improve the health care response to domestic violence and abuse fares in the real-world NHS