A CLINICIAN-ASSISTED DIGITAL COGNITIVE BEHAVIOURAL THERAPY INTERVENTION FOR SMOKING CESSATION
In a study published in the journal Nicotine and Tobacco Research, we evaluated the secondary effectiveness outcomes for Quit Genius, a digital clinician-assisted cognitive behavioural therapy (CBT) intervention for smoking cessation. Adult smokers (N=556) were weeks 26 and 52 for Quit Genius randomly assigned to Quit Genius was 27.2% and 22.6% respectively, (n=277), a digital, clinician-assisted compared to VBA which was 16.6% CBT intervention or Very Brief and 13.2% (RR=1.70,95% CI,1.22- Advice (VBA) to stop smoking, an 2.37;p=0.003, 26 weeks; evidence-based, 30-second RR=1.71,95% CI,1.17-2.50; p=0.005, intervention designed to facilitate 52 weeks). Biochemically verified quit attempts, coupled with referral abstinence was significantly to a cessation service (n=279). different at 26- (p=0.03) but not 52 Participants were offered weeks (p=0.16). Quit Genius combination nicotine replacement participants were more likely to therapy (patches and gum) tailored remain abstinent than those who to individual nicotine dependence. received VBA (RR=1.71,95% CI 1.17- Analyses (N=530), by intention-to- 2.50;p=0.005). treat, compared Quit Genius and VBA at 4, 26, and 52 weeks post- This study provides secondary quit date. evidence for the long-term effectiveness of Quit Genius in The primary outcome was self- comparison with VBA. Future trials reported seven-day point of digital interventions without prevalence abstinence at 4 weeks clinician support and comparisons post-quit date. Consecutive seven- with active treatment are needed. day point-prevalence abstinence, defined as abstinent at two or more The long-term effectiveness of consecutive timepoints, was clinician-assisted digital smoking examined at weeks 26 and 52 to cessation interventions has not indicate long-term effectiveness. been well-studied. This study Abstinence was verified using a established the long-term random sample of participants with effectiveness of an extended CBT- carbon monoxide breath testing of based intervention; results may <5 parts per million (n=280). inform implementation of scalable approaches to smoking cessation in Self-reported consecutive seven-day the health system. point prevalence abstinence at
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DEFINING THE DETERMINANTS OF VACCINE UPTAKE AND UNDER-VACCINATION IN MIGRANT POPULATIONS IN EUROPE Our new article in Lancet Infectious Diseases discusses why some migrants in Europe are at risk of under- immunisation and show lower vaccination uptake for routine and COVID-19 vaccines. Addressing this issue is critical if we are to address vaccination inequities and meet the goals of WHO’s new Immunisation Agenda 2030.
We carried out a systematic review significant determinants of under- exploring barriers and facilitators vaccination in migrants, including of vaccine uptake (categorised African origin, recent migration, and using the 5As taxonomy: access, being a refugee or asylum seeker. awareness, affordability, acceptance, activation) and We did not identify a strong overall sociodemographic determinants of association with gender or age. under-vaccination among migrants Tailored vaccination messaging, in the EU and European Economic community outreach, and Area, the UK, and Switzerland. behavioural nudges facilitated uptake. Migrants’ barriers to We identified multiple access accessing health care are already barriers—including language, well documented, and this Review literacy, and communication confirms their role in limiting barriers, practical and legal barriers vaccine uptake. to accessing and delivering vaccination services, and service These findings hold immediate barriers such as lack of specific relevance to strengthening guidelines and knowledge of health- vaccination programmes in high- care professionals—for key vaccines income countries, including for including measles-mumps-rubella, COVID-19, and suggest that tailored, diphtheria-pertussis-tetanus, culturally sensitive, and evidence- human papillomavirus, influenza, informed strategies, unambiguous polio, and COVID-19 vaccines. public health messaging, and health system strengthening are needed to Acceptance barriers were mostly address access and acceptance reported in eastern European and barriers to vaccination in migrants Muslim migrants for human and create opportunities and papillomavirus, measles, and pathways for offering catch-up influenza vaccines. We identified 23 vaccinations to migrants. FURTHER READING Data from the NHS is playing a key role in guiding vaccination policies globally General practitioner perceptions of using virtual primary care during the COVID-19 pandemic The future of the Covid-19 pandemic in the UK – the essential role for vaccination Impact of COVID-19 on primary care contacts with children and young people in England
A book by Dr Sophie Farooque In this concise guide, Dr Sophie Farooque – a Consultant in Allergy at St. Mary’s Hospital in London and one of the UK’s leading experts on the treatment of allergic disorders – gives an excellent overview of allergies that will be a very useful guide for the public and also for health professionals. Allergic disorders have increased substantially in prevalence in recent decades. This is shown in our personal experience as well as by research on the epidemiology of allergic disorders. When I was in school, problems such as hay fever and food allergy were all uncommon in my classmates. This in contrast to now, when many families will have a member who suffers from an allergic disorder. In milder cases, these disorders can be irritating and reduce people’s quality of life. But in more severe cases, they can lead to hospitalisation and sometimes even to death. Hence, some knowledge of allergies and how they can be managed is very helpful to families who have a member who suffers from an allergy; and can improve their quality of life, as well as allowing them to make better use of NHS services for allergy, whether these are received from general practices or specialist allergy clinics. It is a sad fact that the provision of specialist allergy services by the NHS is well below the need for them, leading to many families and allergy sufferers relying on self-management or on advice from their general practitioners. In her book, Dr Sophie Farooque covers the most common allergic disorders – such as allergic rhinitis, food allergy, and drug allergies; as well as anaphylaxis, a potentially life-threatening condition. She also discusses ‘red herrings’; problems that people think are due to an allergy but which in fact have another cause. She also gives very useful advice on self-management and on when medication would be beneficial. A better understanding of allergies and their treatment is essential for many people, and this this very readable book is highly recommended for anyone who wants to learn more about the topic and manage their allergies better or improve the treatment of allergies in their children. Understanding Allergy is published as part of the Penguin Life Experts series and is available from Amazon and other book sellers.
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The underuse of effective self-care interventions and the ineffective application of scarce resources is widening the gap between supply and demand against a backdrop of stark inequalities exacerbated since the advent of COVID-19. Innovation can play a significant role in addressing these challenges, and in particular those products and services that deliver ‘self-driven’ healthcare solutions to promote citizen engagement and streamline access to evidence-based self-care interventions.
Key literature and technology market healthcare infrastructure around people indicators predict that self-tracking and using consumer-focussed monitoring mastering self-care (including self- and diagnostic tools connected to online quantification by monitoring health portals. The vision for SDH is that these including blood pressure, exercise, etc.,) personal healthcare management will be an increasingly growing trend systems are then integrated with the that will positively impact how wider healthcare system, including the healthcare is delivered, whilst informing NHS. This would support better online the development of new person-driven interaction with healthcare healthcare models. The patient role is professionals and improve the exchange also rapidly shifting away from being a of information, including shareable passive actor and information receiver personal healthcare records and self- to becoming an empowered self-carer. generated data. By building a personal We now have the ability to share self- healthcare infrastructure capability that generated data and participate in connects people to the wider healthcare decision-making to inform our own system, SDH has the potential to health and wellbeing journey. This improve quality of life, drive up health, paradigm shift is rapidly disrupting the wellbeing, and quality of life outcomes, prevailing paternalistic healthcare model reduce costs and support the net-zero and creating a new opportunity for agenda. value co-creation in healthcare using a Self-Driven Healthcare (SDH) approach. Imperial SCARU is collaborating with UKRI to develop thought leadership Self-Driven Healthcare (SDH) is an around the concept of SHD. Specifically, umbrella term introduced by Innovate the Unit is developing the ‘Self-Care UK to conceptualise aspects of 2030 Insights Report’ to consider how healthcare delivery that can support the future may look like and what that people in becoming more engaged in means for self-care and the growing SDH their own health and wellbeing movement. The Unit is also conducting a management rather than being passive qualitative research study with a wide receivers of healthcare. The defining range of stakeholders to assess the characteristics of SDH include activities opportunities & challenges of the SDH that empower people to play a more approach and determine if this is an effective role in maintaining their own area of healthcare UKRI should support. health and wellbeing, including those activities concerned with primary Please let Austen El-Osta know if you’re prevention and health promotion (e.g., interested to take part in the study. As detecting diseases earlier and SDH is a new term, Innovate UK proactively collaborating with established an SDH Open Advisory healthcare professionals to manage Group on LinkedIn, and we’re looking their illnesses). for stakeholder feedback & assistance to develop a roadmap for how this sector The SDH approach is facilitated by could be supported. building a more personal and private
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Self-generated data could be shared by the individual ‘self-carer’ (who could be a healthy person or a patient), to a blockchain-secure SDH portal.
The SDH portal can provide personalized feedback & actionable insights to empower the self-carer and help improve their mental and physical health and wellbeing
GLOBAL DEVELOPMENT HUB HOSTS EVENT ON GLOBAL HEALTH IN A TIME OF PANDEMICS, CLIMATE CHANGE AND POLITICAL TURMOIL With the world emerging from COVID-19, a panel discussion hosted by Imperial’s Global Development Hub explored the impact of pandemics, climate change and political turmoil on global health, including what can be learnt from high impact healthcare innovations in low- income countries and the concept of healthcare workers as agents of change. The event was Chaired by Dr Matthew healthcare in a global context and the Harris, Clinical Senior Lecturer in need to reflect on the experiences of Public Health at the School of Public low and middle-income countries to Health, Imperial College and featured help improve healthcare outcomes a panel of Lord Nigel Crisp, Co-Chair globally. of the All-Party Parliamentary Group on Global Health and former Chief Powerful, high-income countries can Executive of the English NHS and learn significantly from the experience Permanent Secretary at the UK of people and practitioners in lower Department of Health, Susan Edjang, income countries, and he advocated Adviser for Policy and Partnerships combining learning from all countries (South-South and Triangular and all parts of communities to bring Cooperation for the World Food real change and sustainable Programme) and Professor Francis progress. Lord Crisp reiterated the Omaswa, Executive Director at the important role of power in global health African Centre for Global Health and and that this must be more equitably Social Transformation (ACHEST). The distributed. He reflected that event marked the launch of Turning researchers and practitioners must the World Upside Down Again: Global think about global solidarity and health in a time of pandemics, climate lessons to be learnt from low-income change and political turmoil by Lord countries and low-income communities Crisp, a follow-up to his 2010 book in our own countries. For more Turning the World Upside Down: The information on what the DPCPH is search for global health in the 21st doing to improve learning from low- Century. income countries, visit https://www.arc- nwl.nihr.ac.uk/research/innovation- Lord Crisp spoke about the impact of and-evaluation the pandemic on our understanding of
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I-EXPLORE SOCIAL ACCOUNTABILITY IN ACTION In January 2021, our Undergraduate Primary Care Education team launched an exciting and innovative self- selected module for year 2 Imperial students called I-Explore: Social Accountability in Action. This module was developed in collaboration with Hammersmith and Fulham council and local schools, including Fulham Cross Academy, Phoenix Academy, Hammersmith Academy, and Fulham Cross Girls School. Three Imperial Student Shapers, Huriye Korkmazhan, Nadia Zaman & Ray Wang also helped with co-design, with input from Hammersmith and Fulham Youth Council, Mosaic Trust, and Young Hammersmith and Fulham Foundation. We are also grateful to Matthew Chisambi, a TeachFirst Ambassador and the Innovation Lead at Imperial College Health Partners, for his support and input. Photo by Ernest Brillo on Unsplash
Definition of Social Accountability Source: International Federation of Medical Students Association (IFMSA) video on Social Accountability of Medical Schools Through the module, students local school pupils on these topics explore the topics of power, and on this backdrop, started privilege and the importance of discussions on careers and inclusivity and collaborative university life. Some students working. As well as campus-based found the experience to be so sessions, students engage in a rewarding, they went on to real-world project, working with volunteer in further community local schools to design and engagement work hosted by the implement inclusive science- university. based after school sessions for secondary school pupils. Through this project, our students are gaining invaluable In 2021-2022, students focussed experience of working in their sessions on topical issues partnership with schools, and identified by local schools as with young people from a wide priority areas, including the range of backgrounds and COVID-19 pandemic and abilities, whilst developing their sustainability. Harnessing the critical thinking, teamworking and power of inclusive and interactive problem-solving skills. Students learning, students aimed to excite shared powerful reflections
Snapshot from a video used to discuss power and privilege in central campus sessions Source: NHS Health Scotland and GCPH video on Power and Social justice inspired by this work, relating to beneficial project. Earlier this their own roles in this society and year, two students, Lauren the potential impact they have. Wheeler and Shahmeer Feedback from the schools and Mohammad, presented their i- from the pupils themselves has Explore work at a global WHO been very positive. seminar. Three of our students, Nagme The i-Explore: Social Bilgeham, Ashwin Goyal, and Accountability in Action module is Yoon Kyoung, recently showcased an innovative example of how our their work and reflections at the faculty and students can work in Annual Teachers Conference on partnership with local schools on 15 June 2022. We were also a real-world project, inspiring joined by Michael Davis, the Head children in science and learning, of Science from Fulham Cross and enabling our students to Academy to share the school’s develop key lifelong skills and positive experiences of reflections on their professional involvement in this mutually identities and impact in society.
FREQUENT USERS IN PRIMARY AND SECONDARY CARE – UNDER THE RADAR? By Geva Greenfield and Benedict Hayhoe Photo by Finn on Unsplash
The NHS, as many other healthcare systems around the world, has seen a growing need for primary, secondary and urgent care over the last decades, due to the growing population, increasing life span, increase in long-term care, multimorbidity and mental health needs. Such increase in demand has clear impact on costs, staff workload, waiting times, quality of care and clinical outcomes. Increasing healthcare costs amid decreasing budgets, alongside a dwindling workforce, particularly during the COVID pandemic, call for reshaping healthcare systems with a view of a different reality. Most of us will seek some form of systematic reviews and a HES data healthcare across our life span. analysis. However, some patients, often those with co-occurrence of This illustrates the complex clinical, multimorbidity, mental health mental and psychosocial needs of problems, and social problems have frequent attenders. Amidst the significantly elevated health needs. stigmatic approach to patients who People who seem to use health use service frequently, frequent services more often than others are visits to primary, secondary or frequently described in both the urgent care likely represent a failure media and academic literature in a of the system to provide holistic, negative light; commonly labelled as person-centred, integrated care for ‘frequent flyers’, ‘repeat attendees’, patients with complex needs. ‘misusers’ and ‘abusers’, and ‘doctor-shoppers’. Targeted identification of frequent attenders and provision of truly Frequent users often have complex integrated, joined-up care is clinical, and psychosocial needs; needed, accommodating the their care might ‘fall between complexity of multimorbidity, cracks’ in traditional siloed mental health and challenges, to healthcare systems improve quality of care for these individuals, as well as alleviate We have conducted a line of pressures across the health system. research on this topic, including 3 References • Al-Saffar M, Hayhoe B, Harris M, Majeed A, Greenfield Get al., 2020, Children as frequent attenders in primary care: a systematic review, BJGP Open, Vol: 4, ISSN: 2398-3795 • Greenfield G, Blair M, Aylin P, Saxena S, Majeed F, Bottle Ret al., 2021, Characteristics of frequent paediatric users of emergency departments in England: an observational study using routine national data, Emergency Medicine Journal, Vol: 38, Pages: 146-150, ISSN: 1472-0205 • Greenfield G, Blair M, Aylin P, Saxena S, Majeed F, Hoffman M, Bottle Aet al., 2020, Frequent attendances at emergency departments in England, Emergency Medicine Journal, Vol: 37, Pages: 597-599, ISSN: 1472-0205 • Greenfield G, Okoli O, Quezada Yamamoto H, Blair M, Saxena S, Majeed F, Hayhoe Bet al., 2021, Characteristics of frequently attending children in hospital emergency departments: a systematic review, BMJ Open, ISSN: 2044-6055
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DO CALLERS FOLLOW THE ADVICE GIVEN BY NHS 111? The National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost- effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. In a paper published in the journal PLOS ONE, we examined patient and call-related characteristics associated with compliance with advice given in NHS 111 calls. The importance of health interactions that Practitioner (GP) or other local services are not face-to-face has recently been (18.2%) with varying times scales. Overall, highlighted by the COVID-19 pandemic. In callers followed advice given in 49% of this retrospective cohort study, NHS 111 calls. call records were linked to urgent and emergency care services data. We Compliance with triage advice was more analysed data of 3,864,362 calls made likely in calls for children aged <16 years, between October 2013 and September women, those from Asian/Asian British 2017 relating to 1,964,726 callers across ethnicity, and calls made out of hours. The London. A multiple logistic regression was highest compliance was among callers used to investigate associations between advised to self-care without the need to compliance with advice given and patient contact any other healthcare service. and call characteristics. This is one of the largest studies to Caller’s action is ‘compliant with advice describe pathway adherence following given if first subsequent service telephone advice and associated clinical interaction following contact with NHS and demographic features. These results 111 is consistent with advice given. We could inform attempts to improve caller found that most calls were made by compliance with advice given by NHS 111, women (58%), adults aged 30–59 years and as the NHS moves to more hybrid way (33%) and people in the white ethnic of working, the lessons from this study are category (36%). The most common advice key to the development of remote was for caller to contact their General healthcare services going forward. FURTHER READING Clinical vignettes in benchmarking the performance of online symptom checkers
A FRUGAL COOLING MATTRESS TO TREAT HYPOXIC ISCHAEMIC ENCEPHALOPATHY IN THE NHS
Frugal innovations are simple but effective solutions often developed in resource- constrained settings to respond to lack of access to treatment. They have the potential to improve healthcare in high- income settings, by saving costs and increasing efficiency. The I&E Theme recently published a review of MiraCradle, a frugal cooling mattress developed in India to treat hypoxic ischaemic encephalopathy (HIE), discussing its potential for adoption in the NHS. HIE happens when a baby does not receive sufficient oxygen to the brain at birth. It affects about 3 out of every 1000 babies in the UK and can cause long-term disability or even death. The current standard of treatment is therapeutic hypothermia, that consists of cooling down the new-born’s body temperature to 33.5°C for 72 hours, starting as soon as possible after the incident. Very expensive servo-controlled devices are used in high-income settings, including the NHS, to induce cooling. The review shows that MiraCradle (pictured), a simple cooling mattress made of phase change materials that is as effective as servo-controlled devices, offers a promising and affordable alternative to initiate treatment in geographically remote areas of the UK that are not equipped with servo-controlled devices. This would ensure that treatment is started on time while waiting for transport to the nearest neonatal unit. Given that there is no evidence on the use of MiraCradle in the NHS, a team of neonatologists from East of England have expressed interest in conducting a feasibility and acceptability study and are currently drafting a proposal to apply for funding.
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Children and young people’s mental health suffered due to covid-19 with closures in schools, sports, and social clubs during lockdown. Children and young people missed out on key development opportunities in educational, social, and physical health. This intensified health inequalities, and existing physical and mental health complications. Since COVID-19, there has been a rise in the number of young people presenting at A&E with emergencies related to mental illness, such as eating disorders, self-harm, and alcohol/substance use disorders. There is a need to intervene early, as well at the point of crisis. WHO WE ARE The ARC NWL Multimorbidity and Mental Health Theme is a translational research department located at Imperial College London. We are comprised of research academics, lecturers, clinicians, and improvement scientists. We work with healthcare providers, clinicians, charities, philanthropists, public and patient representatives, and community organisations, to test and enhance healthcare for people with multiple health conditions through the life course, including mental health and frailty. We know that mental illness increases risk of developing chronic disease later in life, which commonly coexist, hence – multimorbidity and mental health.
OUR VISION FOR YOUNG PEOPLE’S MENTAL HEALTH: Our Theme for Multimorbidity and Mental Health is dedicated to enhancing early intervention and emergency response for young people experiencing mental health difficulties. We will… ‘Respond to the Mental Health needs of vulnerable populations during COVID-19’ WHY? Northwest London’s (NWL) mental health burden is high relative to the rest of England, and boroughs such as Brent have been amongst the worst affected by the COVID-19 pandemic, with a direct impact on children and young people’s mental health. Northwest London is an area of high ethnic diversity and socioeconomic deprivation with large inequalities in health status and healthcare access; some of the wealthiest people in England live alongside some of the poorest. WHAT WE ARE DOING Project 1: Evaluating a New Model of Care for Young People’s Psychiatric Services within Emergency Settings
Project 2: Building Research Infrastructure for Young People’s Mental Health OUR ASPIRATIONS To build a sustainable children and young people’s mental health infrastructure to support research and address health inequalities in access to mental health care. ESTABLISHING A NWLCHILDREN AND YOUNG PEOPLES MENTAL HEALTH NETWORK By establishing a multi-agency and multi-sectoral network of stakeholders focused on research that has children and young people’s voices involved at every stage. BUILD ON NWL’S INFRASTRUCTURE FOR RESEARCH USING BIG DATA Working with our collaborative network, we will build on existing experience in undertaking research using large datasets, to identify and prioritise children and young people living in NWL benefit from earlier preventative support. DEVELOPING A SCHOOLS’ MENTAL HEALTH NEEDS ASSESSMENT We want to help NWL schools access evidence-based interventions and resources to improve mental health care for children and young people and their families. READ FULL STORY
LET’S KEEP COOL ABOUT ANXIETY-INDUCING MONKEYPOX In early May, a case of Monkeypox was reported in London, followed by reports of further cases in the UK and in many other countries. Understandably, people are anxious whenever an outbreak of an unusual infectious disease occurs, likely more so because of their experiences during the Covid-19 pandemic. Although we need to take the disease seriously, Monkeypox is much less of a threat to global health than Covid-19 and won’t have the same impact on societies or lead to the type of control measures we have seen for Covid-19 over the past two years. The virus that causes Monkeypox is found primarily in small animals, like rodents, in parts of West and Central Africa – but was first identified in monkeys (hence the name). It can sometimes spread to humans and because of international travel, then spread to other parts of the world. But unlike Covid-19, which is easily transmissible and has caused huge waves of infection globally, Monkeypox spreads much more slowly, requiring close contact with an infected person or animal to spread. Monkeypox outbreaks can generally be contained through conventional public health measures – like identifying and isolating cases early on, tracing contacts to identify people who are at risk of infection, and good infection control practices when dealing with people who are infected. We know that smallpox vaccines also provides some protection against infection and can be used if necessary in health care workers or in close contacts to reduce their risk of becoming infected. However, use of vaccination will be very limited, and we won’t see it used widely in the UK. Our public health agencies are well-placed to manage the Monkeypox outbreak in the UK. We now have much more experience in areas such as contact tracing and in isolating people with infections than we did before the Covid-19 pandemic. Although we will continue to see cases of Monkeypox in the UK and elsewhere, our public health system has the capacity to limit the outbreak and prevent it from having a major effect on our society. The Monkeypox outbreak does however reinforce the need for the UK to maintain a strong infection control system so that we are prepared to deal with this and any future infectious diseases that may enter the country. Finally, although people should not become unduly anxious and have a very low risk of coming into contact with a person who has Monkeypox, everyone should remain vigilant and seek medical advice if they become unwell and develop an unusual skin rash. A version of this article was first published in the Evening Standard.
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TRANSFORMATION OF MUSCULOSKELETAL SERVICE AT CENTRAL LONDON COMMUNITY HEALTH NHS TRUST Rupal Parikh is an Advanced Physiotherapy Practitioner and Spinal Pathway Lead at the Musculoskeletal Service and co-chair for the north central division Race Equality Network Forum at Central London Community Health NHS Trust. In this blog she explains how our Improvement Leader Fellowship supported her project, digitalising a key patient service. THE VISION The vision for the MSK service has always been to move towards digital platforms to support patients in engaging with their self-management. [My project aim was to] develop a dedicated suite of Musculoskeletal (MSK) webpages to promote self-management in patients with long-term MSK conditions in the community and develop digital assessment and screening tool, to improve efficiency and staff and patients’ satisfaction. MEETING AN UNMET NEED During COVID-19 pandemic lockdown MSK services had to step down and be redeployed, at the time there was no webpage in existence to signpost the patients to manage their long term MSK condition. So, it became necessary to develop dedicated MSK webpages to allow early and timely access to specialist information. This will support and empower patients in their ability to independently self-manage their musculoskeletal condition when appropriate. It can be accessed in any language, and it also has facilities for reading aloud for anyone with vision impairment. READ FULL BLOG ACCESS CENTRAL LONDON COMMUNITY HEALTHCARE NHS TRUST MUSCULOSKELETAL PHYSIOTHERAPY WEBPAGES
NEW AUTOMATED PLATFORM TO ASSESS THE GEOGRAPHIC ORIGIN OF COURSE READING LISTS Have you ever wondered about where in the world the research you teach on your modules comes from? Researchers in the PCPH have collaborated with a team of bibliometrics analysts from the Central Library and ICT to answer just that. They have developed a tool to automatically analyse data on the geographic origin of research articles used on the College’s reading lists. Using metadata from the Web of Science, information on author institutional affiliations is compiled and visualized using Microsoft PowerBI. PowerBI generates a map, allowing module leads to see immediately where the research they are including in their courses comes from. Aggregate results across the College show a preponderance of citations from Western Europe and North America, with little coming from countries in South America, Africa, and Southeast Asia. Research by PCPH’s own Matthew Harris suggests that English clinicians rate scientific research as worse if it is attributed to universities in low-income countries, as opposed to identical research from universities in high-income countries. Given the skew in the College’s reading lists, the tool can serve as a departure point for conversations about potential subconscious bias, and whether we are providing our students with an accurate depiction of the global research landscape. PCPH PhD student Mark Skopec is investigating implementation of the tool across the College. Along with Matthew Harris, he is being supervised by Laura Lennox (Improvement Science Lead) and Mark Anderson (Senior Teaching Fellow in Education Development). For more information about the online tool, please contact Robyn Price. Helpful links: Harris M, et al 2017. Explicit Bias Toward High-Income-Country Research: A Randomized, Blinded, Crossover Experiment Of English Clinicians. Health Aff (Millwood) [Internet]. 36(11):1997–2004. Available via Health Affairs Read Geographic bias in curricula
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Our Annual Teachers Conference returned to campus on Wednesday 15 June 2022, and it was a great joy to see many of our colleagues from the GP community gathered together again. This year the Undergraduate beautifully shared their Primary Care Education Team were understanding of what belonging delighted to welcome three means to them within the medical Imperial College London medical school and reflected on the students as keynote speakers. This relationships and connections that was the first time we have invited have helped shape their identities students to be our keynote, and I as our future doctors. To listen to can firmly say it was a great success! each ten minute student keynote The theme for the day was ‘the talk please go to our conference stories that connect us’. Students webpage, Annual Teachers Thivyaa Gangatharan, Hamza Ikhlaq Conference 2022. and Hareef Asunramu (pictured) each shared their own stories of There were a variety of workshops unique and inspiring journeys into throughout the day to support GP medical school and the experiences tutors with CPD. These ranged from that have shaped them as medical ‘Inclusive medical education’ and students. ‘Integrating sustainable healthcare into the undergraduate medical Each spoke movingly about their curriculum’ to workshops in formative years pre-medical school coaching, personalised care and and the paths that lead them to ‘training the workforce with study medicine. They also generalist skills’. We received some excellent feedback from delegates who attended the day: “Really touching to hear the student's stories and made me think about my own connections. Listening to the student presentations, being able to think about new topics like sustainability and bounce off ideas with colleagues”. Thank you to all our students, community tutors and faculty who helped make the day such a success.
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The MeCare study is investigating the impact of the covid-19 pandemic on the mental health and wellbeing of frontline healthcare workers and questions if the support available is fit for purpose. The impact of the pandemic on the mental health of healthcare workers has been significant. As NHS staff work through another demanding winter, the backlog of unmet need among waiting patients continues to grow. While the vaccination programme remains the primary “route out of the pandemic”, attention needs to pivot to the needs of those expected to deliver care to others: healthcare workers. MEASURING THE IMPACT Within this challenging environment, Senior managers should devote the ARC Northwest London Mental attention to if and how their Health and Multimorbidity theme, colleagues at the frontline of based at Imperial College London combating the impact of the virus have conducted a study among NHS staff to been physically, and importantly provide data to achieve that mentally, affected, asking themselves understanding. Baseline findings from key questions: To what extent have the second wave of the pandemic our staff been impacted? Are the demonstrate the deleterious impact of support services we offer fit for the pandemic on staff. Of the 1,065 purpose, being accessed by those who respondents to the online survey of need them, and having the desired clinical and non-clinical staff working in effect in helping staff overcome the community and acute NHS settings, problems they encountered? What over half exceeded the score for a should future interventions look like to probable mental disorder, with ensure they can return to, and fully approximately 30% likely to have function in, the workplace? Ensuring anxiety or depression. Over 50% of mental health and wellbeing participants scored 5 - 8 out of 10 for challenges are identified and physical and emotional exhaustion, addressed effectively is premised on and nearly one in five scored 9 or 10. understanding the lived experience of staff members. THE WORRYING MENTAL HEALTH BURDEN Additionally, around 30% reported fatigue that was not only greater than post-traumatic stress disorder (PTSD) usual (67%) but which, for over half of symptoms. Worryingly, a comparable respondents, interfered with their percentage had experienced suicidal ability to work. Whilst survey thoughts, with one in ten reporting respondents were not necessarily suicidal ideation in the last two representative of all front-line months. Over 30% were likely to have workers, these figures nonetheless occupational burnout, and a level of suggest a significant mental health
burden in the NW London region delivering was poor quality had the needs to be addressed as part of a worst mental health. These are both recovery plan. factors that could potentially be changed at an organisational level. The study also looked at some factors Thirty percent of respondents were that might influence the likelihood of using or had used some form of staff developing mental health problems support service – wellbeing activities, and help seeking. It found that those such as mindfulness, therapy or staff with poor social connectedness – counselling, or other employee those who felt less supported by family assistant programmes. Among these, or friends, or who perceived that just under two-thirds used wellbeing people treated them negatively due to services, and only approximately one- working in a care setting - and who fifth used employee assistance perceived that the care they were programmes. MAKING 'DIFFICULT CHOCIES' Northwest London, and Principal Investigator of the study, commented: As Dr Dasha Nicholls [pictured], lead for the Mental Health and Multimorbidity theme at the NIHR ARC “These results show that NHS workers might be particularly affected by fears of infection transmission, disruption of normal supportive structures, and work stress. Many will have to make difficult choices to deliver care they know is not necessarily the best, explain difficult decisions to relatives, or make decisions that jar with their personal values” The study, which is ongoing, focuses and 18 on the short- and medium-term months, to see how staff feel over psychological impact of the pandemic time and what is helping or not. on North-West London NHS staff, “The study promises to provide very identifying psychosocial indicators of rich data on vulnerable staffing resilience and vulnerability, and groups by role, socio-economic status evaluating the effectiveness of staff and ethnicity,” added Dr Nicholls. support programmes offered through “Further research is needed to explore employer organisations. Data how the psychological burden of collection is being repeated at 3, 12 providing care during the pandemic changes over time” For further information on the study, visit the NIHR website.
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SPOTLIGHT ON… BREATHING NEW LIFE INTO PCPH: INTRODUCING THE RESPIRATORY EHR GROUP, THE NEWEST MEMBERS OF THE PCPH DEPARTMENT The Respiratory EHR group, led by Professor Jennifer Quint has recently joined PCPH. The group brings together skills from several backgrounds, including clinical medicine, statistics and mathematics, qualitative research, computer science, nursing, and the core medical and biological sciences, to explore the epidemiology of respiratory diseases from multiple aspects. The result is a team that works on numerous and diverse projects, evaluating core epidemiological principles, such as prevalence and incidence, of COPD (Philip Stone, Ann Morgan, and Sarah Cook), asthma (Sarah Cook, Ann Morgan, Costas Kallis), and ILD (Sarah Cook, Ann Morgan, and Rikisha Shah). The group also builds prediction models to evaluate various aspects of respiratory diseases, including cardiovascular disease outcomes (Hannah Whittaker, Costas Kallis, and Anne Ioannides), exacerbation events (Hannah Whittaker, Alex Adamson), and pharmacological intervention (Hannah Whittaker, Ann Morgan).
As well as investigating the epidemiology of respiratory diseases themselves, the team also investigate the healthcare received by patients for these diseases, including patient pathways (Anne Ioannides), new means of patient communication via social media platforms (Costas Kallis), and qualitative research on the communication between patients and their healthcare practitioners, and developing tools to assess this communication (Xiubin Zhang). Finally, in order to obtain a well-rounded and robust epidemiological understanding of the diseases studied, the team also researches validated definitions of respiratory diseases, and disease and diagnostic coding practices in clinical settings, and how these definitions and coding practices then affect research outcomes (Ann Morgan, Philip Stone, Alex Adamson, Hannah Whittaker, Rikisha Shah, and Georgie Massen). A review of the group’s research to date and its vision going forward was the topic of Jenni’s inaugural lecture, “Big on data but short of breath”, which took place on July 6, 2022. When not churning data, the team can be found having a laugh about their mutual dislike of photographs and their consequential inability to get a decent group picture. Back row (left to right): Costas Kallis, Mark Weeks, Jenni Quint, Xiubin Zhang, Rikisha Shah, Georgie Massen Front row (left to right): Philip Stone, Alex Adamson, Anne Ioannides, Sarah Cook, Ann Morgan, Hannah Whittaker
'Speaking authentically' is a GMC/ASME funded research project aiming to explore students’ sense of authenticity within the medical school and its impact on their sense of belonging and wellbeing. The project is focused on the experiences of ethnically minoritised medical students, whose ability to express their true self might be disproportionately affected by societal, structural, and institutional factors, such as racism, discrimination, and socioeconomic inequities. The short films aim to raise awareness of strategies that can foster a more inclusive educational environment, such as better reporting mechanisms and wellbeing signposting, widening participation initiatives, provision of mentoring or couching, role modelling, and active practising of self-reflection and cultural humility.
WATCH BEING ME WATCH BELONGING WATCH SUPPORTING ME
Five minutes with… JENNIE PARNHAM RESEARCH ASSOCIATE
What is your role within the department and how long have you been here? I am a research associate in the Public Health Policy Unit. I did my PhD in the department, so I’ve been here for three and a half years so far. What does your role involve? Currently, I am working with Anthony Laverty and Charlotte Vrinten on a Cancer Research UK funded project examining e-cigarette use in adolescence. My contribution to the project is assessing complex pathways into and out of e-cigarette use using Markov models. It’s been fascinating and I’ve really learnt a lot. Next, I’ll move onto a SPHR funded project on Food Policy with Eszter Vamos. Why PCPH? Came for the research, stayed for the people. What do you enjoy most about your role? Working with and learning from everyone in my research team. What were you doing prior to this? My undergraduate degree was in Nutrition (University of Leeds), I went onto study Social Epidemiology MSc at UCL and then my PhD involved evaluating nutrition welfare policies in the UK. So I have a strong interest in Public Health Nutrition. Tell us about your outside interests In my view, there’s nothing better than listening to some good music, slowly preparing dinner for friends with a nice glass of wine. Before I started in academia, I wanted to be a Chef. I got the kit, did some courses, and had a few jobs in kitchens. However, I quickly realised the reality of working in kitchens was an entirely different thing from cooking at home (the film Boiling Point is very accurate). The science around food is much more suited to me than the actual preparation. Aside from that, I’m a big supporter of my local library and love reading and, on the weekend, I often try to get the train out of London to walk in the country. What are your goals for the next few years? Establishing myself as an independent researcher, fingers crossed for some successful fellowship applications. You’re to be marooned on a desert island – which 3 people (real or fictional, dead or alive) would you choose to be marooned with and what three tunes would you take with you? The real answer would be my family. However, to be fun: Dumbledore (practical and interesting), Graham Norton (many funny chats and lots of celebrity gossip) and Beyonce (pure entertainment). My three tunes would be: This must be the place – Talking heads The Promise of Love – Delegation Ain’t no way – Aretha Franklin Luxury item – A kindle loaded with lots of books and a solar panel
Our drop-in sessions provide an opportunity for you to get advice on your research idea or grant application. It doesn’t matter where in London you are based, you can book onto any drop-in session. As these sessions are currently taking place online, please submit this brief form in advance of your chosen date and we will set-up an online meeting with you. To make the most of your time, we recommend that you have to hand an overview of your research and can outline the areas in which you need support or feedback. If your research proposal is more developed, you can always fill in our detailed ‘request for support’ form. Once submitted, if your project is eligible, you will be allocated a dedicated RDS adviser.
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