PCPH eMagazine Summer 2019

RussianGasMask © Valerio Quattrucci – Creative Commons (Photo is cropped) Summer 2019 Living in a warzone is linked with an increased risk of heart attack and stroke among civilians, even years after the conflict ends.

Summer 2019 We were delighted to learn that NW London was awarded funding to establish an NIHR Applied Research Collaboration. This £9M five-year programme, starting in October, will bring together academic, NHS, local government, and patient and public partners to carry out research that will address key local health challenges. We are also very pleased to learn that our primary care education team won three Imperial College President’s Awards. Congratulation to Sonia Kumar, Nadine Engineer, Arti Maini and the rest of team for their awards. Congratulations also to Antonio Vallejo-Vaz who won the European Atherosclerosis Society (EAS) Young Investigator Award. Finally, congratulations to Emeritus Professor of Medical Ethics, Raanan Gillon, who is the British Medical Association (BMA) President for 2019-2020. Professor Azeem Majeed Head of Department of Primary Care and Public Health Imperial College London We welcome feedback on the ARCHIVE PRIVACY NOTICE newsletter and are taking submissions for future issues. Email your news, events, achievements and stories to us. [email protected] PCPH eMagazine Team Subscribe Unsubscribe Javier Gallego Mehrosa Memood Copyright © 2019 Department of Primary Care & Public Health, Imperial College London

IS IT Photo by Marco Verch - Creative Commons 2.0 - BG colour and pill changed GETTING EASIER TO OBTAIN ANTIBIOTICS IN THE UK? In the UK, antibiotics are, with very few exceptions, only prescribable by doctors or other health professionals with prescribing qualifications. This has meant that, until recently, access to antibiotics has been possible only through face-to-face medical assessment in primary or secondary care, providing a significant disincentive to seeking antibiotics unnecessarily. Inappropriate prescribing of antibiotics in UK primary care remains of concern, but antimicrobial stewardship initiatives are having a measurable effect, with prescribing rates falling in response to interventions. However, novel routes to obtaining antibiotics, associated with either a lower threshold for prescribing or issuing of antibiotics without medical assessment, undermine these strategies and are likely to increase inappropriate use. These issues are discussed further in an article published in the British Journal of General Practice.

DEPARTMENT NEWS Child Health Unit: Asian Women of Achievement Novel approach to Delphi for young Prof Sonia Saxena was one of 5 finalists People for the Asian Women of Achievement (Women of the Future international In April, Dr Dougal Hargreaves (pictured awards) 2019 (Science). centre) and his team organised a consensus building event about Quality “I didn’t actually win but had a fun Measures for Infants, Children and Young evening at the Park Lane Hilton with People in England with help from RCPCH. family and celebrities, including Riz Latif - The entire Delphi process was undertaken compere, speakers and prizes given by in one day, to make it as CYP friendly as Sadiq Khan, Meera Syal, Shami possible, and involved 3 groups – Chakrabarti and Cherie Blair. Prof Jenny professionals, parent/carers and CYP. Higham formerly from Imperial was Consisting of two rounds of voting split by among the judges!”. facilitated discussions throughout the day and made accessible with ice breakers and Flying the flag a mastermind quiz to the research team. Everyone enjoyed the day and the team Richard Ma was will publish the method to enable more flying the flag for CYP input in future research. Imperial PCPH at the FAC of Sexual New article and Reproductive Medical student Emma Sharland Health ASM 2019 published an article in Arch Dis Childhood with his poster showing that early dosing of penicillin V showing impact of was founded on expert recommendation. financial incentive Dosing has remained unchanged ever policy for GPs to since a UK GP in 1955 treated a child with advice about long half the usual adult dose. term contraceptives in primary care on abortion and contraception rates. Papers All cause pneumonia in children attending GP practices fell by 40% and antibiotic prescribing, most commonly amoxicillin, fell by 23% in the period to 2012 after the introduction of pneumonia vaccination to the infant immunisation schedule in England. High uptake rates of 94% have helped achieve this but we need to keep coverage rates high to avoid outbreaks similar to those we are seeing with measles. PDS

PhD Success RDS: Huge congratulations to all those who New starters have successfully completed their PhD in the last few months, including Jack Elkes is a Elizabeth DuBois, Mohammed Al-Juaid, biostatistician Richard Patterson, Mashael Alshaikh who recently and Rocco Friebel. We hope you have joined the enjoyed a well earned rest before RDS team at embarking on your next endeavor! Imperial College WHO CC for Public Health London. He Training & Education: completed his Masters in Re-establishing links Medical Statistics at the London School of Hygiene in 2017 before working at IQVIA The WHO CC welcomed Professor Ali (formerly QuintilesIMS) in their Amokdad, Chief Strategy Officer of biostatistics team. He has worked on Population Health; Associate Chair for numerous projects across phase I, II and III Collaboration from the Institute of trials in disease areas like rheumatology, Health Metrics and Evaluations. oncology and respiratory failure. He is now working on a set of trials with the The conversation identified areas for Imperial Clinical Trials Unit which involves collaboration and re-established researching the impact of a digital health existing links. The institutions have intervention to improve disease self- been collaborating on research papers management. One thing he couldn’t live covering ‘Maternal Mortality and without is music – he loves to attend live causes of death’ and also the concerts and music festivals. Implementation of a long-term health care policy for the SDG in the EMR. Toqir Mukhtar is an epidemiologist and joined the department and the RDS group New collaboration in April of this year. Prior to coming to Imperial, she held positions at Oxford, WHO CC recently formed a new UCL, Princeton, as well as spending a year collaborative link with Diabetes.org.uk, as a Visiting Scientist at Harvard. Her an NHS organisation dedicated to research interests are consultation rates supporting people affected by diabetes. The North West London in primary branch has been particularly successful care, and pioneered the introduction of a routinely Remission Plan. The collaboration will collected data be based on academic exchange. (such as CPRD, and The WHO CC has also welcomed Dr HES), and the Mohammed Alzamil, Family Medicine genetic doctor from Saudi Arabia with interests epidemiology in immunisations and geriatrics. He will of cancer. be with us until December 2019.

There is growing appreciation that the success of digital health – whether digital tools, digital interventions or technology-based change strategies – is linked to the extent to which human factors are considered throughout the design, development and implementation. A shift in focus to individuals as users and consumers of digital health highlights the capacity of the field to respond to recent developments, such as the adoption of person-centred care and consumer health technologies. In an article published in the journal, income countries and the impacts of BMC Medicine, we argue that this project machine learning. is not only incomplete, but is fundamentally ‘incompletable’ in the face Digital health research will create most of a highly dynamic landscape of both value by retaining a clear focus on the role technological and human challenges. of human factors in maximising health These challenges include the effects of benefit, by helping health systems to consumerist, technology-supported care anticipate and understand the person- on care delivery, the rapid growth of centred effects of technology changes and digital users in low-income and middle- by advocating strongly for the autonomy, rights and safety of consumers.

Robot © ThaQeLa - Creative Commons

Brainade! The Brain Grenade © Emilio Garcia – Creative Commons

A study has found that Living in a warzone is linked with an increased risk of heart attack and stroke among civilians, even years after the conflict ends. The findings come from the first systematic review of the effects of armed conflict on heart disease risk, led by PhD student, Mohammed Jawad, from the Public Health Policy Evaluation Unit.

In the review, published in Heart, the team re-analysed data from a number of studies on associations between armed conflict and the health of civilian adults of armed conflicts on civilian adults in low - and middle - income countries – including Syria, Lebanon, Bosnia, Croatia, Palestine, Colombia and Sudan. They found that conflicts were associated effects of living in a conflict zone itself can with a litany of negative health outcomes increase stress and anxiety, leading to for civilians, including increased risk of higher blood pressure, as well as coronary heart disease, stroke, diabetes, worsening risk behaviours such as increased blood pressure and cholesterol, drinking more alcohol and smoking more. as well as increased alcohol and tobacco Furthermore, the destruction of use. healthcare systems can eliminate screening programmes, reduce patient The team say the findings could help access to working hospitals and inform international health policy in the healthcare staff, reduce the availability of prevention of heart disease in politically medicines and make taking regular unstable countries where conflict is taking medications – such as statins or insulin – a place, or likely to occur. They also offer lower priority for people facing conflict. recommendations, including prioritising primary healthcare during and after conflicts and training healthcare professionals to focus on both the cheapest and effective ways to prevent heart disease, such as prescribing generic medicines instead of branded ones and helping people to quit smoking. In one example, researchers included studies looking at the causes of death before and after the 2003 US-led invasion of Iraq. Data collected from household surveys showed the rate of deaths from heart attack or stroke increased significantly, from 147.9 per 100,000 people before the invasion to 228.8 per 100,000 post- invasions. In a similar study, heart disease was the principal cause of about half of non-violent deaths during the US-led invasion of Iraq. The review was unable to identify clear mechanisms underlying the findings, but these are likely to be complex and numerous. The direct

Professor Christopher Millett, a Professor civilians and health services failing to of Public Health at Imperial and senior register deaths, or their causes. However, author of the paper, said: “The experience study findings were largely consistent of armed conflict, be it specific traumatic when the researchers restricted their events or displacement from your home, analysis to higher quality studies. They appears to place civilian populations at add that evidence for links between greater risk of increased blood pressure, armed conflict and other health outcomes alcohol use and smoking, which are is lacking, but more, better-designed established risk factors for heart disease. studies could help. Even if civilians are willing and able to seek healthcare services during armed The review also found a number of gaps in conflict, access is often limited due to the literature, including a lack of studies hospital closures, road blockades, lack of from the Middle East, or about refugees. available medications, and more”. Refugees in particular are exposed to a ‘double burden’ – the impact of the Dr Jawad highlights that the findings are armed conflict itself, and the impact of limited, with two-thirds of the 65 included forced migration following armed conflict, studies being of ‘low quality’, and that this so a better understanding of how wars may be in part due to the nature of data affect their risk of different diseases is collection during times of conflict – with important. Jawad M, Vamos EP, Najim M, et al Impact of armed conflict on cardiovascular disease risk: a systematic review, Heart, Published Online First: 28 May 2019. doi: 10.1136/heartjn l-2018-314459 Brainade! The Brain Grenade © Emilio Garcia – Creative Commons

Staff Success Stories L-R Christine Douglass, Nina Dutta, Tom Durley, Sonia Kumar & Alice Gast (Imperial College London President) Dr Sonia Kumar and the Undergraduate Primary Care Education team have received a President’s Award for Excellence in Societal Engagement The team’s commitment to addressing the students. Learning through service in the health and social needs of patients and community has driven medical students to communities is at the centre of their vision, become active members of primary care directing their work with medical students at teams, being given roles to meaningfully Imperial. They have won 9 President’s contribute to patient care, learning medicine awards in three years, including two Medals, in context. and were the recipient of the national Advance HE CATE award last year. They are a Examples include, longitudinal placements busy educational team, teaching nearly 2000 where medical students take on the role of medical students every year across the six patient advocate; community action projects years of the MBBS degree. allow students to learn about quality improvement through conducting projects They have occupied a space between with local communities; students act health education and service, creating a multitude of coaches improving patient health literacy and novel educational opportunities for medical behaviour change; the WATCCH scheme

(supported by HEE NWL) improves access to national think tanks, hosted local and national primary care careers for local school pupils, conferences and have won a bid to run from widening participation backgrounds and CLIC2021, and an international medical medical students work with a local primary education conference. school, delivering co-created teaching sessions. The Undergraduate Primary Care Education team strives to meet the health and social This year, they have also established a centre needs of all sectors of society, redressing of medical education innovation and inequality and promoting the compassionate research, collaborating with leading delivery of healthcare, to the benefit of educational figures nationally and thousands of future doctors and their patients internationally, leading and driving a every year. momentum to rethink medical education in the UK and beyond. They have founded Dr Arti Maini has been awarded the President’s Medal for Excellence in Teaching presented her work at national and international conferences. To widen the reach Arti works as a GP and Deputy Director for of her work, she has developed an Undergraduate Primary Care Education, open access Massive Open Online Course teaching students and overseeing (MOOC) in Coaching for Educators in undergraduate primary care courses in the conjunction with EdX and the Imperial Digital MBBS degree. She is also an accredited Learning Hub, due for launch later this year. coach and has led a robust, systematic coaching strategy within the School of Arti has excelled far beyond expectations not Medicine over the past few years. She has only in her role helping to grow and lead the led the design and delivery of interactive Undergraduate Primary Care team, but also training for faculty, students and the wider with her clarity of vision and commitment to community in inclusive coaching skills for leading alone a coaching strategy across the education and health. School of Medicine that will have far reaching, long-lasting benefits to our students, faculty The impact of her coaching work has been and the patients they work with. transformational, changing their approach to the conversations with the students, patients, community and each other. Her work has attracted national and international attention to help develop similar initiatives at other key institutions. She actively contributes to the development of College coaching strategy and also works as a coach for the Imperial Coaching Academy. She co-authored the book ‘Coaching for Health-Why it works and how to do it’, has written a number of publications and

Nadine Engineer has received the President’s Award for Excellence in Supporting the Student Experience Nadine has built and leads the Faculty She has developed a robust quality assurance Development team (composed of herself and framework whereby all new GP teachers and two clinical academics) within the practices undergo a specially designed Undergraduate Primary Care Education approval process, optimising the experience team, the only provider of community based the students will receive in the community. primary care education for Imperial School of This student centred and quality assured Medicine with over 10 placements in the approach to the recruitment of practices and community across the MBBS programme. teachers has led the primary care placements consistently receiving the highest ratings on Nadine has worked tirelessly to review both SOLE for student’s satisfaction across the the quality and quantity of student School of Medicine, testimony to the positive community placements in North West and impactful experiences they receive whilst London, significantly increasing the volume on placement. and range of GP Practices for student placements. These practices reflect a range of Nadine in so many ways has gone beyond, communities; in particular many are local building from ground up the faculty areas of deprivation serving marginalised development team, conducting research communities. Nadine has directly supported projects within her team and presenting her the student experience, giving students the work at national conferences, with others opportunity to understand the breadth of learning from her exemplary systematic and medicine in context, working with patients strategic approach to faculty development. and front-line NHS staff on authentic learning placements in the community.

European Atherosclerosis Society (EAS) Young Investigator Award & Late Breaking session at EAS Congress 2019 on results from 4S trial Antonio J Vallejo-Vaz presented a talk in the contribute to the advancement of knowledge Late-Breaking session at the last European in the field of atherosclerosis and linked Atherosclerosis Society (EAS) Congress, 27 metabolic disturbances. The award was May 2019, Maastricht. He shared his results presented and given during the EAS Congress of the study they carried out on the prior 2019 Opening Ceremony on May 26, 2019. landmark clinical trial 4S with statins. Antonio also won the Young Investigator More Info - EAS Website Award. These annual EAS prizes for young 4S analysis: higher risk, greater benefit from LDL lowering scientists are intended to recognize distinction shown by publications that TCTMD Report Lale Tokgözoglu, EAS President, presents Antonio with his award EAS President

A week of Zen: Our first international conference experience in Kyoto

On Her Way to the Teahouse: A Geisha's Path by Andrew Lull - Creative Commons

A week of Zen By Dr Neha Ahuja & Dr Bhakti Visani As two GP trainees currently taking an OOPE to do a medical education fellowship, we were both extremely lucky to go to Kyoto, Japan, for the WONCA Asia Pacific Region (APR) Conference 2019 in May this year, to present our experiences and learning in this post. We learnt from many inspiring talks, than our wonderful colleague, Dr including co-creation of research with Maham Stanyon! patients in local communities in New Zealand, preventing harms of Kyoto itself was beautiful to explore; overdiagnosis, and the unique role of full of Shrines, Pagodas and Zen GPs amongst many others. gardens as if out of a dream. The biggest take home was perhaps As an added bonus, we had an extra truly appreciating the role that few days before the conference to try Primary Care plays in society. Many some local delicacies like Japanese countries in this region are trying to curry, Ramen, Mochi and Melon-Pan! establish Primary Care as a specialty, We dressed up in traditional kimonos an important move to improve and even came across geisha down overall health outcomes whilst an unsuspecting alley. reducing costs in an ageing society. It is often so taken for granted in the Speaking about our personal UK. experiences from this year in front of such a broad audience was affirming We also had the pleasure of learning and we hope it will leave a small seed about the cultural considerations in with the potential to grow when teaching and learning in a truly cross- deciding the future of primary care. cultural workshop run by none other At the WONCA Conference in Kyoto with Maiko Dr Maham Stanyon

Kinkakuji Kyoto by Natee P - Creative Commons – (Image has been cropped due to space constraints) The Golden Pavillion – Kinkakuji Kyoto

Impact of GP gatekeeping on quality of care, health outcomes, health care use, and spending

In many health systems, primary care physicians (sometimes referred to as general practitioners or family physicians) regulate access to specialist medical services and investigations. This process is sometimes described as ‘gatekeeping’ and is a response to a shortage of specialists and a need to control healthcare spending. In gatekeeping systems, patients are required to visit a GP or primary care physician to authorise access to specialty care. However, the effectiveness of gatekeeping remains unclear. In a systematic review published more primary care visits. in the British Journal of General Gatekeeping may also lead to Practice, we examined the impact lower healthcare use and of gatekeeping on areas such as expenditure. Primary care the quality of health care, clinicians have conflicting views healthcare spending and use, and on gatekeeping, whereas patients health-related and patient- are often less satisfied with related outcomes. gatekeeping schemes, preferring health systems where they have We found an association between direct access to specialists. gatekeeping and better quality of care, especially in terms of As with many areas of health preventive care, and appropriate policy, the impact of gatekeeping referral for specialty care and on key health system metrics investigation. However, we found needs further investigation to one study that reported help devise more efficient and unfavourable outcomes of equitable health systems that patients with cancer under improve health outcomes and gatekeeping. lead to high patient satisfaction whilst at the same time, keeping Gatekeeping resulted in fewer spending on health services at hospitalisations and lower sustainable levels. specialist use, but also led to



2500 children from 45 schools got together in June to run in Battersea Park. At the event Prof Sonia Saxena’s DETAIL (Daily Mile Evaluation Team at Imperial) received an award from Elaine Wyllie of The Daily Mile Foundation. The Daily Mile and Imperial College Imperial College London, with the London have announced a support of The Daily Mile collaborative research partnership Foundation, will aim to address two at the children’s ‘GO Run London’ key questions: whether schools who event at Battersea Park, London. participate in The Daily Mile have The three-year project will delve better physical health and deeper into the benefits of The educational attainment, and Daily Mile to analyse the long-term whether these improvements are impact on primary school children sustained over primary school life. and will be supported by INEOS. Prof Sonia Saxena is the project’s This study will provide the first large principal investigator, supported by scale assessment, of the benefits of a team of researchers, co-funded by The Daily Mile on the health and the National School for Public educational achievement of pupils Health Research. The research will in primary schools across England. analyse data from a range of The study will also assess the sources, including national data socio-demographic profile of sets, such as the National Childhood schools who do The Daily Mile, to Measurement Programme and explore how the programme information gathered from primary impacts schools in area of schools across England, to answer disadvantage. the research questions.

Prof Sonia Saxena (far left) receives award from Elaine Wyllie.





Photo by Corey Nolan for UGA CAES – Face altered – Creative Commons

I’ve just finished medical school, got my results and passed exams. Now what? I’m a doctor supposedly? These are my last few weeks in Imperial now! I start my FY1 in Sheffield, so it’s not just bye bye Imperial, it’s bye bye London! But before I leave, I had one last act to finish; my elective. Ever since participating in the ICA (the Integrated Clinical Apprenticeship) at Imperial College, I’ve started to develop a fond interest in medical education and Primary Care. Partly to blame for this are 2 of my most inspiring role models, Dr Ravi Parekh and Dr Andy McKeown who ran the ICA course which had been the best learning experience I’ve had at Imperial College. Since I’d become quite acquainted with the Department of Primary Care through my participation in the ICA and I had really enjoyed my specialty choice placement in medical education, I decided to do 3 weeks of my elective with the department. I’m also starting my foundation job as an Academic Foundation Doctor in medical education and hope to incorporate medical education into my career; I thought a short glimpse into the future might be useful for me. WEEK 1 supervisors for the projects we’re working on arranging meetings, reminders and So, I’m in the middle of packing all my decorating my calendar with dates, things and moving out of my London locations and times. We take the first few accommodation. My contract expires in a days relaxed, just getting to know week and I’ve also got an Airbnb booked everyone and doing some of the for two weeks to complete my elective. background reading for our projects and Things are quite hectic with packing and planning, lots and lots of planning and tenancy related paperwork etc. But I look timetabling. While also taking time to forward to starting my elective. I’m register where one can acquire free tea getting to work with my favourite and biscuits. department and I’ve still got two of my fellow Imperial students and good friends Worst of all, there was a slight Ann and Seraphina who are still around miscalculation, next week was Easter! doing their medical education elective Meaning I’d have to get some initial work with me. done ASAP and get all the information I need to make sure I know what I’m doing In our first week, we got to meet Ravi who next week. Thankfully, I managed to plan on day one gave us a rundown of what we my next few weeks with just enough time might expect for the next few weeks. He to spare. shows us a big excel spreadsheet with all the activities we would be doing, from Most of my work involved designing teaching, mock-PACES, working on e- content for e-learning modules with Dr Ali modules, the F-Zero Course and other Dhankot, Dr Sian Powell regarding clinical projects going on in the department. reasoning and for the lifestyle and We’ve got a lot to do and so little time! prevention module with Dr Ed Maine. I We rush off, sending emails to our

Bhakti Visani takes the opportunity to help me out with some of my project work. also got to work with the F-Zero team be working with the other students to including Ravi, Andy and Neha to help design a mock PACES and clinical design in-course assessments. I would also communications stations for the current ICA cohort. WEEK 2 helpful during the elective. They had their own work to do but both took on the This is where all the work gets crammed responsibility of baby-sitting us, providing in. Lots of tea and coffee was drunk, lots us with much needed guidance whenever of hours typing and lots of jumping up and we got stuck. down on the exercise ball in the office to get the blood pumping. I managed to do more reading into the literature around the content I was Even though it was Easter, I still had the creating for the e-modules and the F-Zero company of Ann, Seraphina and Dr Bhakti Visani and Dr Neha Ahuja who were so

assessments. I also made a start on the Georgina Neve. When I arrived at the cases for the ICA students by interviewing room I was teaching in, it was printed ‘Dr some of the current Year 5 Specialty Gautham Benoy’, now that definitely hit Choice Placement students on what cases me. I have responsibilities now! I started they thought would be helpful for their to worry if the students would actually year group. After going through all my trust me to be a tutor despite being a specialties knowledge and thinking hard student a few weeks ago. I wanted to about the cases, I managed to come up make sure my students would benefit with some cases designed to challenge the from the session, so I reflected on 5th years and hopefully improve their teaching I’d already done through the preparation for specialties. We also spent student union and how GP tutors ran a lot of time planning and arranging the mini-PACES sessions. I incorporated all the mock, considering things like rooms, knowledge and teaching I’ve had on timings and how it’ll be supervised. This medical education to deliver a mini-PACES was a good independent project for us session which was really immersive for me since we were arranging an event as a tutor. I felt like I had been given that ourselves. responsibility as an educator and I really managed to reflect and learn from this I also had the chance to run my own mini- experience where I was given full control PACES while being assessed by Dr over the tutorial. WEEK 3 and I felt like I had genuinely contributed to the improvement of the medical Everyone’s back from Easter! Now I’ve got school. I was happy with what I had done to show my supervisors all the work I’d and the whole experience. I felt fulfilled done. But I still had a lot to do before my by the end of the week and also went on a meetings spread throughout the week. I lunch social with the department in my crammed a lot of work in, writing content last week which was really good fun. for the e-modules and finishing the assessment forms for F-Zero while With my elective over, I’m really going to simultaneously having multiple meetings miss Imperial College. I’d learnt so much and catching up with everyone. I got a feel over the elective and I’m so glad to have for what it really is like working in the been involved. It had driven me even department and chasing deadlines. It was more to pursue my career in General hard work, but it was definitely enjoyable Practice and medical education. I met and useful to experience. some amazing, inspirational people and the department was really friendly. I’d I’d managed it all in the end and with all definitely hope to take all I’ve learnt my tasks complete I had my final debriefs forward in my career, but I’d also love to with everyone. It turned out a lot better keep in touch with the department even than I expected. Having rushed some into the distant future since this is where tasks and always questioning whether my career began. what I produced was good enough, all my supervisors found my work really helpful

The Imperial College medical education elective dream team (L-R) Seraphina Rong, Gautham Benoy, Ann Sebastian

Synthesising evidence from randomised controlled trials of digital health education is challenging. Problems include a lack of clear categorisation of digital health education in the literature; constantly evolving concepts, pedagogies, or theories; and a multitude of methods, features, technologies, or delivery settings. The Digital Health Education Collaboration inclusion and exclusion criteria; running the was established to evaluate the evidence on searches jointly with librarians and digital education in health professions; inform information specialists; managing abstracts; policymakers, educators, and students; and retrieving full-text versions of papers; change the way in which these professionals extracting and storing large datasets, critically learn and are taught. In a paper published in appraising the quality of studies; analysing the Journal of Medical Internet Research, they data; discussing findings; drawing meaningful presented the overarching methods we use to conclusions and drafting research papers. synthesize evidence across our digital health education reviews and to discuss challenges The approach used for synthesising evidence related to the process. from digital health education trials is the most rigorous benchmark for conducting systematic For their research, they followed Cochrane reviews. Although the team acknowledge the recommendations for the conduct of presence of certain biases ingrained in the systematic reviews; all reviews are reported process, they clearly highlighted and according to the PRISMA (Preferred Reporting minimized those biases by strictly adhering to Items for Systematic Reviews and Meta- scientific rigor, methodological integrity, and Analyses) guidance. This included assembling standard operating procedures. The paper will experts in various digital health education be an asset for researchers and fields; identifying gaps in the evidence base; methodologists undertaking systematic formulating focused research questions, aims, reviews in digital health education. and outcome measures; choosing appropriate search terms and databases; defining Full Article

© Digital City by Nikk - Creative Commons – Colour changed

World War II Safety Poster - Public Domain

By Ben Stone “Look mister, there are some rules that you’ve got to follow” “Yeah, what kind of rules?” “First of all, keep him out of the light, he hates bright light…Second, don’t give him any water, not even to drink…But the most important rule…never feed him after midnight”. You’re probably wondering one of two things at this stage, depending on your knowledge of 1980s pop-culture. What on earth is this blog about and why is this blog referencing Joe Dante’s 1984 comedy-horror cult film: Gremlins? Prior to a recent teaching session, I was instinctual cognitive reaction to all these discussing with a colleague about how we felt events probably protects us from curling up the session may go: “I suppose you have into sobbing balls of human anxiety: always got to be prepared for the gremlins” I said, and we chuckled. We repeated the same “That will never happen to me!” phrase a few days later, realising that our wireless clicker had inexplicably reversed left I recently wrote another blog “From taught to and right. I can’t count the various mishaps teacher: the dark side of the moon” in which I that occurred in sessions I have witnessed: introduced myself as a Foundation Year 2 computers failing, tutors disappearing, trainee, preparing a teaching session on printers misprinting, and the list goes on. Our Prescribing Safety. Like we should with all sessions, see this blog as the debrief; an

epilogue to the prologue. As you may have utilised for other means. Whilst we could anticipated already, it did not all go to plan. fortunately share the room space, I no longer had use of the computer. The Gremlin of As Edward Jenner and Randall Peltzer, of technology, the Gremlin of misfortune and smallpox and Gremlins fame respectively, the Gremlin of “…” all at once. both teach us: prevention is key. On the day of my session delivery I had prepped my Gizmo is the name of the original mogwai facilitators, adjusted my clinical hours and gifted to the protagonist in ‘Gremlins’, whom, organised my printing materials into one despite the actions of his kin, never becomes electronic folder. However, I had not mischievous or ultimately murderous. It prepared for the actions of those would have been very easy for this string of photophobic, hydrophilic and nocturnal mishaps to derail the session completely, like hyperphagic beings. No, not the students. the mogwai upon Kingston Falls, but that never happened. It was at this stage I The first mishap occurred 25 minutes before appreciated the journey here, to the dark side the start of the session; a facilitator emailed in of the moon. It wasn’t perfect, but the unwell. A vital component to my session was materials and content I had prepared could be to have facilitators for each group to answer utilised by the students. It was adaptable. I questions and, well, facilitate. I am fortunate learnt that even when it looks like everything to have colleagues willing to step in at the last is going wrong, there will still be something minute, but this meant the countdown to right: not every Gizmo becomes a Gremlin. showtime was spent trying to condense two hours of material into a 20-minute rundown. In the final moments of Dante’s film, Randall The Gremlin of others. gives the following advice: The second occurred 25 minutes into the start “If your air conditioner goes on the fritz, or of the session. “Is this everybody for today?” your washing machine blows up, or your A familiar question for regular teachers. The video recorder conks out, before you call the need to appropriately introduce students to a repairman, turn on all the lights, check all the session vs having enough time to deliver your closets and cupboards, look under all the material. The devilish realisation that you beds, ‘cause you can never tell. There just wasted the 20 minutes you spent prepping might be a gremlin in your house”. the extra facilitator that is no longer needed. The Gremlin of time. It is many months since I first made that prescribing error. I have learnt about The third occurred shortly after that. A face at educational theory. I have learnt about the door. human error. I have learnt that teaching is not just about turning up on the day, with your “Knock-knock” colleague’s slides and hoping to ‘wing it’. I have even learnt about fictional villains from “Who’s there?” 80s cult films. But most importantly, I have learnt that there is always more to learn in “Sorry, I’ve actually booked this the educational sphere. So, in true reflective room” fashion, what are my three things to take away from this day? “’Sorry, I’ve actually booked this room,’ who?” Be prepared. Be adaptable. But most importantly: Like a punchline delivered by an overexuberant parent at a teenage house Don’t let Gizmos become Gremlins. party, it had me in tears. The room, seemingly booked on an eternal rolling reservation, had been available on the booking system and

World War II Safety Poster - Public Domain

HOME & AWAY 9th Round of Geneva Trip and soak up the expertise they seek. The feedback has been very positive and each This year marks the 9th year where Imperial year the event is stirring a lot of interest WHO Masters students (pictured above with Prof CC are pleased to be contributing to the Salman Rawaf, centre) visit Geneva to students experience at the School of Public experience talks with experts in the field of Health. Public Health. Sustainable Development Goals (SDGs). The students visit WHO Headquarters where Supporting the work of WHO, they participate in talks and presentations Imperial College London WHO CC is organising a study tour on Maternal and WHO CC Study Tour in Switzerland Paediatric health management in The World Health Organization Global Strategy on Human Resources for Health aims at a workforce that is fit for purpose to attain the targets of the

Switzerland and London. The training is WHO CC for Public Health Education and offered to Chinese Directors of maternal and Training at Imperial College London focuses children’s Hospitals this year. on providing training for healthcare professionals. Alongside established courses, It will begin in Bern, Switzerland with the visit such as Advanced Leadership for Healthcare to the University Children’s hospital followed Management, WHO CC also offers bespoke by talks with the Maternal and Child Health training carefully tailored to participants’ Unit experts at WHO. The participants will learning needs. then travel to London to learn from British experiences in the field. The study tour has MORE INFO the potential to forge collaborations and academic exchange. Royal College of Paediatrics and Child Health Annual Conference This year's conference took place at ICC Professor Sonia Saxena was invited to give the Birmingham in May and brought together keynote address to start the conference. Her the paediatric community - in what is a address followed 4 presentations by children turbulent time for the profession - to explore and young people from different current challenges and how we can work backgrounds, setting the tone for this year’s together to secure a bright future for theme. paediatrics and child health. FHSC and FH Europe Partnership FH, challenges they face in their countries, sharing what they have learned from their The FHSC is one of the main projects we are experience, improving FH care, establishing currently running at the department. It is an national patients’ groups and how clinical international collaboration involving practitioners can support them. Antonio co- investigators from 68 countries worldwide chaired this meeting together with one FH who are led and coordinated at PCPH patients organisation representative. Imperial College. Prof Kosh Ray is the lead and Dr Antonio Vallejo-Vaz is the Chief Scientist and Coordinator. During this time, an important partnership has been established with FH Europe, the network of European patients’ organisations (related to familial hypercholesterolaemia or cholesterol) including over 25 countries. During the recent EAS Congress 2019, on May 25, in Maastricht, the Netherlands, they carried out the first ‘EAS FHSC - FH Europe meeting’. Here, over 25 lead investigators and patient organisation representatives from around the world came together to meet and discuss topics such as, identifying

Prof Raanan Gillon © The History of Modern Biomedicine Research Group, Queen Mary University of London (photo has been cropped, filtered and coloured)

Photo by Dr David Wrigley In June, Emeritus Professor of Medical Ethics Raanan Gillon (pictured centre, with Professor Dinesh Bhugra and Dr Chaanad Nagpaul) was installed as British Medical Association (BMA) President for 2019-2020 at the BMA’s Annual Representative Meeting in Belfast. In his Presidential Address Raanan acknowledged that the role was essentially honorific but was delighted that it also involved a Presidential Project that the BMA could support. His own project would be to encourage the BMA to encourage the World Medical Association to add a sentence about fairness to the Declaration of Geneva, the WMA’s contemporary version of the Hippocratic Oath, and also to the companion document, the International Code of Medical Ethics. Reminding the BMA meeting that in 2017 the in which speakers from a variety of relevant World Medical Association had added respect disciplines – among them bioethics, medical for patients’ autonomy to its Declaration of law, health economics, public health, the Geneva ‘an excellent addition’ – he said that social sciences, politics, religion - would be in his view it was now essential for the WMA tasked to explain the notion of fairness/justice to add ‘a balancing commitment to fairness from their disciplinary perspectives and offer and justice’. Respect for autonomy was, he practical proposals. said, a fundamentally important ethical commitment, but it tended to focus on He ended his address by reiterating that the individuals. The Declaration therefore needed BMA was ‘the UK’s most inclusive professional ‘a balancing concern for the interests of membership organisation as well as its largest groups, communities, populations - a concern, medical trade union. We have a double that is, for justice or fairness’. function: the support and welfare of our members and the pursuit of our professional His ‘basic’ Presidential Project would be to ethical commitment to our clients, the encourage the BMA to try to persuade the patients and populations we serve. Both these WMA to add a commitment to ‘strive to functions are equally important and in fact practise fairly and justly throughout my they are mutually supportive. It is blindingly professional life’ to the next revision of the obvious that an unhappy, dispirited, Declaration of Geneva and to its companion disempowered and underpaid workforce of document, the International Code of Medical doctors is not an optimal basis for pursuing Ethics. He added that he had been delighted the best interests of their patients and to have already obtained the support for this populations, let alone their own best proposal of the two BMA committees of interests. The remedies may sometimes need which he was a member, the Medical Ethics tough uncompromising defence of our Committee and the International Committee. members’ interests, even strike action as we As supplementary projects he would try to recently experienced. But our iron trade union obtain the BMA’s support for adding fairness fist should surely always be clothed in the (and preferably also helpfulness) to its own velvet glove of our professionalism, and its internal organisational values; for an essay core ethical concern, which is for our patients prize under the title ‘A widely acceptable and the populations we serve. Our function as theory of fairness/justice and its practical the BMA is and surely must always be a implications for health care’; and for a combination of those two components - a fair conference on fairness/justice in health care combination’.

NEW BOOKS Prof Mitch Blair, pictured front row, centre-right Putting child health at the centre of EU policy at the Hague Professor Mitch Blair (Paediatrics and Child Public Health) who led an 80 strong team EU H2020 funded Project, MOCHA, has recently published an Open Access book reporting on a study of how primary care services are delivered to children; the first of its kind, with 20 scientific partners in 11 countries, and an expert agent in each of 30 European countries. Summarising the current policies for professional education, e-health and children’s primary care in each country in other supports. Download the book from the EU/EEA, authors consider the the Emerald website and browse the differences of structure and delivery, and MOCHA website for other publications. of outcomes including financing,

Imperial team: Prof Mitch Blair, Prof Michael Rigby Dr Denise Alexander Prof Azeem Majeed, Shalmali Deshpande and Christine Chow

School of Public Health Athena SWAN Lecture Dr Margaret Heffernan

Science is an inherently collaborative activity, though it is infused with competition. Where does the balance lie between the two? And what kind of leadership will the 21st century require? So-called scientific management is now a bust — but scientific leadership could provide a greater opportunity for a more diverse and adaptable approach to the huge threats and challenges of our age. Margaret Heffernan, author and CEO of three technology companies, argues that the need to integrate men and women, scientists and people from other disciplines, has never been more urgent. Watch Lecture About the Athena Lecture The Athena Lecture was established by the College in 2001 to celebrate the achievements of women in science, engineering, technology and medicine. It is given annually by a distinguished woman with a background in science, engineering or industry who has made outstanding contributions in any of these fields. Find out more about how the Imperial College School of Public Health achieved its Athena SWAN Silver Award for supporting the careers of women in science.

Five minutes with… Ela Augustyniak WHO CC PROJECT MANAGER What is your role within the department and how long have you been here? I am a project Manager at the WHO Collaborating Centre for Public Health Education and Training. I work on various educational projects within the Centre: training, courses, Fellowship, Study Tours. I also recently rewrote an online course on SDGs (Sustainable Development Goals) into an interactive version for WHO. I also support the West London Research Network. I have worked in the Department for 9 years now. What does your role involve and what do you enjoy about it? I coordinate the organisation of our training, manage our Postgraduate Fellowship programme, do day-to day admin tasks, work with our Digital Officer to update our unit website and we have also been working on the production of a video. My role is evolving constantly. I have great colleagues and I enjoy the opportunity to be creative and contribute to education, as well as the chance for me to learn. What were you doing prior to this? I graduated in Applied Linguistics and had been a teacher for a number of years. My main interests are Education and Teaching, and they have always been part of my career life. Tell us about your outside interests? My lifelong passion has been horses: I have been horse-riding since the age of 10. I then trained as a horse-riding coach but sadly never pursued it as a career, although I am considering doing it on the side. I was also a journalist for a horse-riding magazine, I have travelled places devoted to horses and the art of horsemanship, attended courses in natural horsemanship and interpreted one of them too. I now have a little buddy who goes horse-riding with me, my daughter. In all honesty, I had wanted to become a vet… but unfortunately never did. My other big passion is ballet: I have my favourite dancers I love to watch, I am still discovering the history of ballet and enjoy dancing myself. I love cooking and experimenting in the kitchen and the best reward is seeing my little one munching with pleasure. When I have a moment, I play my piano and constantly try and learn some more languages: my next plan is Russian. I do love cinema and books and travelling to new places. My ‘re-charge’ is being surrounded by trees hearing birdsong or…skiing in beautiful white scenery. Here’s our PCPH version of Desert Island discs: What 3 tunes and luxury item would you choose to be marooned with? Firstly, Chopin: Revolutionary Etude. I cannot live without Chopin’s genius and it has been with me all my life. Secondly, a polish folk song that appeared in the film, ‘Cold War’, Dwa Serudszka Cztery Oczy. Thirdly, ‘Havana’ by Camila Cabello, a hit in our house. My luxury item would be my own bed!!!



SEMINAR CITY Self-Care for 21st Century Living- Dr Austen El-Osta Dr Austen El-Osta is Director of the Self-Care Academic Research Unit (SCARU), which is the first university academic unit dedicated specifically to the study self-care. SCARU is a three-way collaboration between Imperial College London School of Public Health, the International Self- Care Foundation and the UK Self-Care Forum. Self-care is fundamental for behaviours to support vitality and healthy ageing the health and wellbeing of all people. Through fit for 21st century living. It shows how the rising self-care, people can delay or even prevent the epidemic of chronic long-term diseases the world appearance of many non-communicable diseases is facing today results directly from our inability and so called ‘lifestyle diseases’ including to self-care. The talk also signals a new direction diabetes, stroke, heart disease and many types of of travel for self-care thinking and R&D priorities cancers that are crippling health systems following the recent publication of the WHO worldwide. consolidated guideline on self-care interventions for health. This talk urges us to self-care or to die This presentation illustrates the importance of trying, for there is indeed a self-care revolution adopting good self-care habits and health-seeking happening around the world! Watch this presentation There are many more fascinating seminars ready for you to view on the PCPH Website (Check out the ‘Past Seminar Recordings’ section)