Author Archives: Niroshan Siriwardena

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Paramedics’ views on their role in an ambulance based trial of ultra-acute stroke

N0013781 Cerebral infarctNovel treatments for stroke are increasingly being tested and delivered in the ultra-acute period during initial presentation to ambulance services. In the first feasibility trial of nitroglycerin (glyceryl trinitrate) in ultra-acute stroke (RIGHT) there were early indications of improvements in outcomes and disability at three months. The research team was led by Prof Philip Bath and his team at Nottingham University, together with Sandeep Ankolekar, Prof Niro Siriwardena from CaHRU and researchers at East Midlands Ambulance Service NHS Trust.

N0029297 Young man using a nicotine patchA nested qualitative study entitled ‘Views of paramedics on their role in an out-of-hospital ambulance-based trial in ultra-acute stroke: qualitative data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT)‘ explored facilitators and barriers to paramedic involvement in clinical trials. The fieldwork was conducted by Dr Sandeep Ankolekar and the team. Barriers to participation included the pressure of the emergency setting, difficulties  obtaining informed consent, institutional support for research, the steep learning curve for research naive staff and relative rarity for individual paramedics of clinical conditions seen, and difficulty in attending training sessions.

N0030773 Paramedic driving an ambulanceSuggestions for improvement included a simple diagnostic tool for stroke, use of assent and proxy consent on behalf of patients (as in the trial), and simpler trial processes.Recruitment became easier with each new randomisation attempt. Paramedics in the study were motivated to participate in research. Treatment of acute stroke in the out-of-hospital environment was feasible, but important barriers needed to be addressed.

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New study on genetic tests for cardiovascular disease in primary care

jo1In a world where genetic tests for coronary heart disease (CHD) are becoming increasingly commercially available, how do patients make sense of the results particularly when considered alongside the results from routine cardiovascular risk assessments undertaken by their general practitioner? This was the subject of a qualitative study with Dr Jo Middlemass, research fellow at CaHRU, as lead author: ‘Introducing genetic testing for cardiovascular disease in primary care: a qualitative study’. The authors interviewed 29 patients from 12 practices in Nottingham, who had received a routine cardiovascular risk assessment, followed by genetic testing to assess their CHD risk, to assess their understanding and response to both tests.

B0007708 Molecular model: DNAThe results showed that genetic testing procedures were acceptable for patients. However, there was limited recall of the results for either the genetic test or the conventional cardiovascular disease (CVD) assessment undertaken in the practice. There was also some confusion on how to interpret the results, for example was being ‘above average risk’ better than being ‘average’? In addition there were sometimes contradictory findings in terms of being ‘above average genetic risk’ but ‘average’ conventional CVD risk and vice versa. Patients dealt with these conflicting findings in different ways. Some thought that healthy behaviour had mitigated their increased genetic risk while others were falsely reassured when their genetic risk was ‘average’ but their conventional risk was ‘above average’.

B0005637 Enhanced image of a human heartPatients often said that their main motivation to have genetic test for CHD was because they had a perceived family history of CHD and wanted to be able to share the genetic predisposition results with their adult children. However, despite this, very few did actually discuss the results with their offspring. The findings indicate that health professionals should discuss patient’s perceptions about the results of CHD risk assessments (both conventional and genetic) in order to facilitate greater awareness and understanding and to maximise any potential for behaviour change.

For the full article see Br J Gen Pract 2014; DOI: 10.3399/bjgp14X679714. Authors: Jo B Middlemass, Momina F Yazdani, Joe Kai, Penelope J Standen and Nadeem Qureshi.

By Jo Middlemass

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Best poster for CaHRU student at the 2014 Postgraduate Student Conference

On the 3rd April 2014 three PhD students from CaHRU, Fiona Togher, Mohammad Iqbal and Jolien Vos attended the eighth Annual Postgraduate Student Conference at University of Lincoln’s Riseholme Park Conference Centre at which Jolien won a prize for the best poster!

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2014/04/Poster_JolienVos.pdf” width=”300″ height=”300″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

The conference, which focused on Methods & Methodologies, sought to bring together interested postgraduate and undergraduate students with staff across various disciplines. After a warm welcome from Prof Mike Neary (Dean of Teaching and Learning at the University of Lincoln), Dr Marcello Ruta (Senior Lecturer in Life Sciences) opened the conference with a keynote on “Rates and Evolution: A step-by-step guide”.

This inspiring presentation was followed by four parallel sessions in which postgraduate students took the lead and presented their work. Attendees in each session were treated to three presentations from a diverse range of Jolien_posterbackgrounds: Psychology, Life Sciences, Sport & Exercise, Business, Humanities and Computer Science. This was followed by an opportunity to talk to colleagues before the second set of presentations. The second parallel session included work presented from the field of Social & Political Sciences, Media, Art & Design and Performing Arts. Lunch followed, accompanied by a speech based performance monologue on the concept of method. Attendees had further the chance to take a look at the exhibits and posters.

The second half of the conference was launched with an interactive networking session that gave delegates the opportunity to meet and talk with others from different disciplines. This flowed into the next poster session and the afternoon continued with four parallel workshops: philosophy of research, ethical practice in research, what’s next in our postgraduate career and raising your profile on social media.

A recap of the day brought the conference to an end. Prizes for the best presentation, exhibit and poster wrapped up this wonderful day! The University of Lincoln’s Graduate School can look back on a very successful day.

By Jolien Vos

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CAHRU host the 2014 SAPC Trent Regional Meeting

brayfordnight750The Trent Regional meeting of the Society for Academic Primary Care took place on Tuesday 25th March at the Doubletree by Hilton Hotel in Lincoln. The conference, hosted for the first time by CaHRU and the University of Lincoln, was attended by 86 delegates from the Universities of Nottingham, Lincoln, Sheffield and Leicester as well as local GPs and staff from the Research and Development Departments at East Midlands Ambulance Service and the Lincolnshire Community Health Service NHS Trusts.

JdMThe day began with a welcome from Professor Sara Owen, Pro Vice Chancellor of the College of Social Science at the University of Lincoln. An exciting program was launched with a keynote from Prof Jan De Maeseneer (Ghent University, Belgium). As a national and internationally acknowledged guru in the field of Primary Care, his presentation on “Multi-morbidity, goal-oriented care, the community and equity” set a positive and inspiring note for the rest of the day.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2014/04/SAPCkeynoteJDM_Lincoln2014.pdf” width=”700″ height=”300″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

Following this inspiring keynote, the conference continued with two parallel sessions and a workshop. Participants could move between the presentations on topics such as prevention of childhood accidents care for children and long term conditions, diabetes mellitus and a well-attended workshop about sharing evidence based ideas for the future of general practice. The morning continued with another impressive keynote, this time by Prof Jonathan Mant (University of Cambridge). His lecture entitled, “How can primary care research inform stroke prevention” elaborated on how research in primary care can inform and shape stroke prevention.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2014/04/SAPCkeynoteJM_Lincoln2014.pdf” width=”700″ height=”300″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

Viet-Hai_posterThe afternoon program included a poster viewing covering a range of topics. This was followed by the opportunity to attend three further parallel sessions. Research studies on alcohol misuse, ethnic variations in care and patient reported outcome measures were presented. A strong active involvement from the CaHRU team was visible in presentations concerning the use of emergency and urgent services, differences in pre-hospital care delivery between non-white and white patients and barriers and facilitators for accessing pre-hospital care by people in minority ethnic groups. The meeting closed with the presentation of prizes for the best poster and presentation wrapped up the excited conference day.

Attendees found the programme “useful and varied” and valued the opportunity to network with fellow researchers from the Trent region. Delegates welcomed the opportunity to inform themselves of current developments in primary care and to participate in discussions and networking. The next meeting of the Society for Academic Primary care will be the national conference to be held in Edinburgh from 9th – 11th July.

By Jolien Vos and Sue Bowler.

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NIHR ‘Focus on Stroke’ features IPVASTIA study

B0008077 Blood clot forming in arterial plaqueThe recently published ‘IPVASTIA’ study (Siriwardena AN, Asghar Z, Coupland C. Influenza and pneumococcal vaccination and risk of stroke or transient ischaemic attack – matched case control study. Vaccine 2014;32 (12): 1354-1361. doi: 10.1016/j.vaccine.2014.01.029) was one of the case studies featured on the National Institute of Health Research (NIHR) ‘Focus on Stroke‘, launched at the end of February 2014.

B0008609 Blood clotThe study was funded by the NIHR Research for Patient Benefit programme. Since its publication the findings have featured in news articles from around the world including the UK (Telegraph, Times, Pulse, Nursing in Practice, NHS Choices), United States (HNGN, Fox 7, Philly.com), South America, Europe (French Tribune), Russia and the Far East (Anninh)

 

B0008613 Pencil and ink illustration of an angiogramThe study found that the flu vaccine reduced the risk of a person having a stroke by about 25%. The reduction in risk occurred only if the vaccine was given early in the flu season (September to mid-November, was greatest within the first three months of vaccination, and persisted for up to a year.