A practising GP in South West London, Sonia “Children are healthier now than everSaxena was promoted to Professor of Primary before and we have had global successesCare last year and is Head of the Child Health in combating many infectious diseases.Unit she set up in 2013. Her research uses However, there are new emergingroutinely collected data to establish how epidemics of non-communicable diseasescontact with primary care can influence early such as asthma, obesity, diabetes andlife exposures to health risks and improve mental health. These are driven by ourhealth later in life. Her work has a particular behaviours such as diet, sedentaryfocus on non-communicable diseases such as lifestyle and risks to exposures that havediabetes, asthma and obesity. come with changes in the wider built and social environment. It’s important toThe findings from her research have attracted tackle the ones we can influence early, forattention from both media and policy with our long-term health.”wide-reaching implications on a local andglobal scale. Imperial College News Interview View the lecture on YouTubeDr Alex Chen: winner of outstanding Taiwan youth awardDr Alex Chen was honoured to receive the given speeches in the UK parliament, Scottishhighest civilian award in Taiwan due to his parliament several times, as well as theprevious human rights works. Taiwan European Union committee. Alex alsoPresident Tsai Ing-wen and Taiwan Prime provided several speeches organised byMinister Dr Lai received him at this year’s ‘10 Amnesty International in many topOutstanding Young Persons Awards’, at the universities in the UK.Office of the President and the Office of thePrime Minister, respectively. The Chair of theTaiwan Parliament presented the award atthe ceremony.From 2003-2006, Alex also worked for a radiostation, while studying medicine,broadcasting a health promotion radioprogram to enhance the health literacy forrural area residents. From 2010-2013, heworked as an occupational medicine physicianand enhanced public awareness of labourissues as well as occupational injuries oroccupational diseases. In 2012, Alex joined‘Doctors Against Forced Organ Harvesting’(DAFOH), the Nobel Peace Prize nominee, tostop organ trafficking and organcommercialism around the world. He has
Imperial researchers are among a team of international scientists,who in some findings published in The Lancet, suggest there is nosafe level of alcohol consumption – the health risks outweigh thebenefits.Previous research has suggested including injuries and self-harm inlow levels of consumption can have people aged 15-49 and cancers,a protective effect against heart which account for a third of deathsdisease and diabetes. These findings in women and 19% of men agedhowever show that any protective over 50 years. The adverse effects,effect of 1-2 units of alcohol per day increased with the number ofon ischaemic heart disease was alcoholic drinks consumed each day.offset by the risks, and overall the Therefore, the authors concludedhealth risks associated with alcohol that there is no safe level of alcohol.What does this mean for the UK?Professor Sonia Saxena from one drink a day. More than 10Department of Primary Care and million people in England drinkPublic Health is one of the authors above current low risk levels of 14on the paper. Speaking to the BBC, units per week. Drinking patternsshe said: “One drink a day represent vary a lot. For example, Britishonly a small increased health risk to middle-aged men drink around 5individuals but adjust that to the UK drinks per day. This is well in excesspopulation as a whole, and it of the recommended limits andrepresents a far bigger number, and women are catching up with anmost people are not drinking just
Photo © Beer by Scyrene. Creative Commons
Photo © James Hill. Creative Commons
average of 3 drinks per day, putting alcohol consumed, abstinence,British women in the top ten tourism data and estimates of theglobally for alcohol consumption. In levels of illicit trade and homeEngland there are about 23,000 brewing”.alcohol-related deaths per year,including just over 17,000 from liver The authors also found that globallydisease, caused by alcohol. Those one in three people drink alcoholaged less than 50 years tend to (equivalent to 2.4 billion people),binge drink. Around 20% of people including 25% of women (0.9 billionin the UK abstain altogether from women) and 39% of men (1.5 billiondrinking alcohol and that number men). On average, each day womenseems to be rising”. consumed 0.73 alcoholic drinks, and men drank 1.7 drinks. Alcohol wasProfessor Saxena told the BBC that associated with 2.8 million deathsthe study was the most per year worldwide. They called forcomprehensive study ever stronger policy actions on alcoholconducted on the subject. She taxation, control of availability andexplained: \"This study provides hours of sale and advertising.more robust estimates bycombining alcohol sales data, self- Full Storyreported data on the amount of BBC NEWS DAILY TELEGRAPH PODCAST THE LANCET
Home & AwaySee you in Casablanca!In Collaboration with the International School of Public Health, University of HealthSciences in Casablanca, the Arab Public Health Association is organising the 2ndConference on Public Health in Casablanca, 4-6 April 2019.Arab Public Health Association is an standards, practice strengthening andorganisation closely linked to WHO support to all public health professionals,Collaborating Centre that champions the organisations and all those whohealth of all people and all communities in contribute to the health of the populationthe Arab world. Strengthening of the from all disciplines in their practice arepublic health profession, defining the main goals of the organization.The programme of the Conference will soon be available on the APHA website.Global Conference on Primary HealthCare: Alma-AtaWHO CC were formally invited by WHO, Geneva, to the ‘Global Conference on PrimaryHealth Care: from Alma-Ata Towards UHC and the SDGs’ held in Astana, Khazakhstan inOctober.The Conference brought together In 1978, a pivotal conference was held inMember States, international Almaty, Kazakhstan, bringing togetherorganisations, civil society, academic health experts and world leaders toinstitutions and other partners to commit to health for all. The Declarationcommemorate the 40th anniversary of the of Alma-Ata, endorsed at that conference,Declaration of Alma Ata and present a formed the foundation for the last 40bold vision for PHC in the 21st Century. years of global primary health care efforts.The conference aimed to renew a In October, the world will reunite tocommitment to primary health care to reinvigorate and reaffirm primary healthachieve universal health coverage and the care, endorsing a new declaration whichSustainable Development Goals and was emphasizes the critical role of primaryheld at the Palace of Independence, co- health care around the world, refocusinghosted by the Government of Kazakhstan, efforts to ensure that everyoneWHO and UNICEF. everywhere is able to enjoy the highest possible attainable standard of health.From patient to provider, from policy maker to educator – it doesn’t matter who you are orwhere you are from, primary health care is important to us all.
Presenting at the anniversary of the Alma-Ata declarationAs well as WHO CC, Thomas Hone social determinants of health, enhancing(pictured) from PCPH was also in equity, and community participation, willattendance to soak up the Kazakhstani be best placed to maximise synergies asatmosphere, sample the local delicacies, part of the SDGs.and present his work at the launch of theLancet’s special issue on primary care.His recent paper looks at the global PHCagenda forty years on, and its interactionswith actions towards Universal HealthCoverage (UHC) and the sustainabledevelopment goals (SDGs). Examining abroad range of literature reveals thatcountries who orientate their healthsystems towards primary care are well-placed to make progress towards theSDGs and advance UHC. However,countries which embrace the broaderprinciples of PHC including intersectoralaction for health, addressing the widerImperial at the RCGP Annual ConferenceImperial PCPH once again had a great presence at the Royal College of GeneralPractitioners (RCGP) annual conference, which was held in sunny Glasgow in October,where colleagues from the department showcased a range of work of the Department.Richard Ma presented a poster reporting Thailand to present a poster on ahis research on financial incentivization of systematic review on the gatekeeping rolelong acting reversible contraception of primary care he completed whilst onprescribing, while Dani Kim and Benedict attachment to the Department last year.Hayhoe gave oral presentations on the Benedict Hayhoe and colleagues from thediagnosis of heart failure in primary care, University of Oxford, Kings Collegeintegration of pharmacists in primary care London, University of Liverpool, and thepractices, and ethical issues relating to West London Clinical Commissioningguidelines in primary care commissioning. Group, had a prize winning poster describing a qualitative interview study onGeorgina Neve presented a poster on her the ethical issues faced by clinicalwork on a teaching intervention on cow’s commissioners and their needs for ethicsmilk protein allergy for GPs, and training and support.Poompong Sripa travelled back fromThe RCGP Annual Conference is an important event, and we hope to maintain this quality ofresearch and engagement in years to come.
Petronas Towers by Camillo Sars© Creative Commons
Dr Foster Unit in MalaysiaInternational Society for Quality inHealth Care (ISQua) is a not-for-profit community and organisationdedicated to promoting qualityimprovement in health througheducation, knowledge sharing,external evaluation and supportinghealth systems worldwide. ISQuahave an annual conference which isthe leading international conferenceon quality and safety in healthcare,and so is the natural forum fordisseminating the units’ researchfindings. This year it was held inKuala Lumpur, Malaysia.
The Dr Foster Unit had 4 abstracts failure. He gave a presentationaccepted for oral presentations about the variation in the routes of(plus several posters), so Professor HF diagnosis by key patientPaul Aylin, Reader in Medical characteristics. The findings of thestatistics Alex Bottle Violeta study suggested unequal access toBalinskaite and Lizzie Cecil, headed the NICE-recommended route to HFto the tropics to disseminate their diagnosis. Older, deprived,work. The conference opened comorbid females and those(against the amazing backdrop of presenting with fatigue only, arethe Petronas towers) to a beautiful, less likely to follow this route, whichcultural presentation of dance and could translate to higher hospitalmusic. His Royal Highness Sultan diagnoses and worse outcomes.Nazrin Muizzuddin Shah, thenwelcomed the delegates to Furthermore, he presented a posterMalaysia. The conference theme related to HF patients which havewas 'Heads, Hearts and Hands: the highest healthcare use. Lizzie’sWeaving the Fabric of Quality and work with the Imperial PatientSafety’ offering an inspiring mix of Safety Translational Researchtalks and workshops over the 3 Centre (PSTRC) on identifyingdays, including Violeta’s two primary care indicators ofpresentations summarizing her deterioration also featured. Herrecent work investigating the presentation, ‘Children and Youngassociation between antimicrobial People’s Contacts in Primary Carestewardship and adverse clinical Within 3 Days of an Admission tooutcomes. Hospital with Meningitis’,The results demonstrated a mapped thesignificant reduction in antibiotic journeys ofprescribing following the young patientsimplementation of the stewardship, with meningitisand that there was no overall using nationalassociation between antimicrobial primary carestewardship and unintended research dataconsequences such as increased GP linked withconsultations and hospital hospital dataadmissions. To attend this ISQua and found thatconference, Violeta partly was 60% of youngfunded by a travel award from the patients who didBritish Infection Association. Alex visit theirpresented his work related to heart
GP in the 3 days prior to an admission with meningitis had no record of GP referral to hospital. Within the busy conference schedule, the DFU crew still managed to network, wander the markets and sample the delicious food on offer in Kuala Lumpur. Both Violeta and Lizzie managed to extend their stay to further explore the beautiful peninsula of Malaysia. An enjoyable and productive time was had by all, and hopefully, a strong team will be able to join the 36th ISQua conference next year in Cape Town, South Africa. Clockwise from top:Lizzy and Violeta during Networking Reception, Team dinner, Batu Caves, Paul, Alex and Tina Hernandex-Boussard.
Hand and wrist fractures are the mostcommon fracture presentation toaccident and emergency departmentswithin the UK. Complications followingboth simple and complex hand andwrist fractures can have devastatingconsequences.The British Orthopaedic Association recommendsinitial assessment in a fracture clinic should take placewithin 72 hours and any surgery should be performedwithin one week. It was the experience of RaymondAnakwe (Consultant Trauma & Orthopaedic Surgeon)of Imperial College Healthcare NHS Trust (ICHNT) thatadult patients presenting with hand and wristfractures, experienced delays in: attending fractureclinics; operative treatment; and in referral torehabilitation. This resulted in extended recoverytimes, sub-optimal outcomes, an increased number ofhospital visits, and overall poorer patient and staffexperience.An initial retrospective clinical audit, showed that 31%(13/42) patients waited over 15 days and another 28%(12/42) patients waited between 8-14 days for surgeryfollowing fracture. Further analysis of these delayedpatients showed that the most frequent reasons fordelay is delay in initial clinical review at fracture clinic.Introduction of a new pathwayThe Hand and Wrist Virtual Fracture Clinic planned toensure prompt access for patients with fractures toreceive expert review within 72 hours, to achievebetter patient outcomes, improve quality of care andimprove efficiency of the system. In the pre-intervention clinical review model, 100% of patientswere referred from A&E to the Hand Clinic for a face-to-face consultation with an orthopaedic consultant(average 10 days from referral to expert review, audit2016).A new pathway (See Table 1), incorporatingimplementation of e-referral and virtual reviewsoftware was implemented to reduce the timebetween presentation and expert review. This led toaccelerated triage of patients to one of threedestinations: fracture clinic, hand therapy and directdischarge after initial presentation via Urgent carecentres or ICHT A&Es.
A series of interventions were implemented:• On-line referral system replacing paper referral• Text message / email system providing supportive information about injury, pathway and Virtual Fracture Clinic contact details• Telephone support clinic• Follow-up phone call to discharged patients responding to questions / providing specific advice• Patient information leaflets developed and uploaded onto a public website• Education sessions delivered to healthcare professionals working in four of the five affiliated referral sourcesFollowing the introduction ofthe Hand and Wrist VirtualFracture Clinic, 2,449 patientswere referred to the service:60% of patients (1,451) werereferred to the Hand Clinic;22% of patients (549) weredischarged with informationon how to self-manage theirinjury; and 18% (449) weredirectly triaged to handtherapy. The time to expertreview reduced from anaverage of 10 days to an average of 1 day.The tariff for face-to-face initial hand (fracture) clinic consultation is costed at £151 perpatient. For this project, 2449 patients were referred to Virtual Fracture Clinic. In thetraditional pathway, all these patients would have been referred to the hand (fracture) clinicincurring a cost of £369,799. With the introduction of the Virtual Fracture Clinic Pathway,only 1451 patients were referred for a hand (fracture) clinic consultation costing £219,101and resulting in a potential cost saving of £150,698 (setup and running costs not included).
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Five minutes with… Dr Rowan MyronEducation Lead and Fellowship Co-Director What is your role within the department and how long have you been here? I started with the NIHR CLAHRC NWL in 2009 as Collaborative Learning and Delivery lead, then in 2014 I moved to be Education Lead and Associate Professor of Healthcare Management. What does your role involve? I lead the improvement leader fellowship for CLAHRC and contribute to the Collaborative Learning (Capacity Building) theme. I work two days a week for CLAHRC and three days a week for the University of West London where I lead an MSc in Improvement Science and a Professional Doctorate course in healthcare. What do you enjoy most about your role?I hugely enjoy working with the improvement leader fellows, such a variety of fascinating people who are all passionate andworking hard to make improvements in their services or contexts. I also greatly enjoy supervising doctoral and Master’sstudents, again interesting people in many different roles all trying to make improvements or answer important questions inhealthcare.What were you doing prior to this/what is your background?I did my PhD in child psychology in Goldsmiths College, then taught developmental psychology for a while in the University ofHull. I got a bit fed up of the large gap between research, publishing and impact on the public, so I left academia to work for acharity, The Mental Health Foundation and found a lot of satisfaction in working with service users and service user researchers.Tell us about your favourite achievement.I’m not so much focussed on my own achievements as to the amazing things my fellows and students have achieved, the recentvideo produced by my CLAHRC improvement leader fellows that made everyone at the session speechless was just such a greatmoment. And I guess more traditionally, I finally managed to get published an article on my fellows work after what felt likeyears of trying. So that was a proud moment also.Tell us about your outside interests?I love stories in all forms, books, movies, good TV. I try to write fiction sometimes but don’t always find the time. I’m a singer,have my grade 6 singing but again don’t find a lot of time for it formally. I gave up singing with a choir and now sing to my iTuneson a weekend.You’re marooned on a desert island – which 3 people (real or fictional, dead or alive), 3 tunes and luxuryitem would you choose to be marooned with?Well I love old Hollywood and I would say Judy Garland or Marilyn Monroe for the fascinating stories and the singingopportunities. I think I’d have to go with James Mandeville as a survivalist and psychologist to get us through the ‘not dying’ on adesert island. Then for the stories, author JK Rowling for the potentially endless yarns of mystery, magic and humanity.Three tunes are harder for me; how could I just choose three? I think perhaps a classic Pachelbel’s cannon in D or Lakme’s flowerduet for the singing, then maybe Wicked’s Defying Gravity and then there must be some Sondheim – perhaps Being Alive for thesetting.Luxury item would have to be my iPad, there may be no Wi-Fi but the endless books and entertainment on there would get methrough even without the internet.
Fellows from NIHR CLAHRC NWL 2017 atqulturum. Rowan top right.
Seminar CityRound up of the latest talks and seminars held at PCPHMedicineAfrica - Bringing the world to the bedsideDr Alexander Finlayson“MedicineAfrica is an organisation which basically consists of twocomponents, one of which is a global health communications platform:an on-line technology to enable health workers in different locationsto communicate. And then some programmes that we’ve built off theback of that to enable capacity building efforts to be scaled up at adistance on-line”.MedicineAfrica helps isolated healthcare MedicineAfrica has also played a key role inworkers connect with each other and access supporting the King’s THET Somalilandlife changing education. Their system enables Partnership (KTSP), which has close links withone to one mentoring with a paired expert or leading medical schools, professionalpeer, to work on an individual issue or associations and major regional hospitals inresearch project. Supporting the individual is Somaliland. It is also being developed toone of the system’s greatest strengths; often support healthcare providers, for instance init is these people who go on to be drivers of sourcing vital employee data, coverage andchange. potential gaps or training needs. Watch this presentation (College members only)There are many more fascinating seminars ready for you to view on the PCPH Website (Check out the ‘Past Seminar Recordings’ section)
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