Author Archives: Niroshan Siriwardena

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CaHRU goes to the 999 EMS Research Forum in Sheffield

photo3Viet-Hai Phung, Fiona Clapton, Dr Karen Windle, Dr Zahid Asghar, Professor Niro Siriwardena attended the 999 EMS Research Forum in Sheffield on 19 February 2014. Also attending were Nadya Essam, Debbie Shaw, Mohammad Iqbal and Anne Spaight, visiting research fellows at CaHRU based at East Midlands Ambulance Services NHS Trust. This conference was aimed at emergency care practitioners, health service managers, policy makers, as well as academics and researchers like ourselves. Fiona, Zahid and Nadya presented posters and fielded questions on our work on the use of 999 and NHS 111 in Lincolnshire, ethnic differences in cardiac chest pain and the use of Modified Early Warning Scores (MEWS) to inform decision-making among ambulance clinicians respectively.

photo2Viet-Hai , whose abstract submission was among the four most highly-rated, gave an oral presentation on the systematic review he has been undertaking with Dr Windle and other members of the team on the barriers and facilitators for minority ethnic groups in accessing prehospital care. The presentation was well-received, with thought-provoking questions both from delegates on the conference floor and outside. The day began with International Exchange Prize Winner, Rachael Wallen, a paramedic from New Zealand, presenting her work on women’s attitudes to 12 lead electrocardiogram acquisition in the ambulance setting. This was followed by Professor Siriwardena and Jo Coster from the University of Sheffield’s School of Health And Related Research (ScHARR) providing an update on the Pre-hospital Outcomes for Evidence-Based Evaluation (PhOEBE) programme.

photo6The afternoon session began with representatives from two Patient Public Involvement (PPI) bodies talking about how best to involve patients and the public in pre-hospital emergency care research. This was followed by keynote speaker, Professor Keith Willett from NHS England who presented his organisation’s review of urgent and emergency care and potential future directions. The conference concluded with a panel discussion of the issues raised by Professor Willett’s presentation with Professor Siriwardena and others with particular perspectives on urgent and emergency care.

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Influenza vaccination associated with reduced risk of stroke

VLUU L110, M110 / Samsung L110, M110A new study from CaHRU published online this month in the journal Vaccine, ‘Influenza and pneumococcal vaccination and risk of stroke or transient ischaemic attack – matched case-control study’ has shown that influenza vaccination is associated with a 24% reduction in risk of stroke. The study involved statistical analysis of a large routine primary care dataset from the Clinical Practice Research Datalink (previously the General Practice Research Database).

zahidThe analysis was carried out by Dr Zahid Asghar (senior lecturer and statistician at CaHRU pictured left) supported by Dr Carol Coupland (University of Nottingham).This was the latest in a series of studies funded by the National Institute for Health Research (NIHR), Research for Patient Benefit Programme led by Professor Niroshan Siriwardena into the link between influenza vaccination and cardiovascular disease.

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Previous studies published in Vaccine and the Canadian Medical Association Journal showed a similar link between influenza vaccination and prevention of acute myocardial infarction (‘heart attack’). The study provides further reasons for people to have their flu jab each autumn.

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Ambulance Services Cardiovascular Quality Initiative findings published in Implementation Science

EMAS-PTS2_750The results of a national Quality Improvement Collaborative study, the Ambulance Services Cardiovascular Quality Initiative (ASCQI) were published this week in the international academic journal Implementation Science. The article entitled The effect of a national quality improvement collaborative on prehospital care for acute myocardial infaction and stroke in England showed large and significant improvements in the quality of care provided by 11 ambulance services (out of 12) in England for people with heart attack and stroke. Members of the CaHRU team involved in the study included Professor Siriwardena, Dr Zowie Davy and Fiona Togher together with visiting fellows at CaHRU who are members of the research team at EMAS including Anne Spaight, Debbie Shaw and Nadya Essam. Professor Michael Dewey, chair in epidemiological statistics in London was the statistician on the project.

EMAS - A&E 9The project has been part of a programme of work, Prehospital and Emergency Quality and Outcomes, developed through collaboration between academics from the Community and Health Research Unit and ambulance services across the United Kingdom, particularly East Midlands Ambulance Service NHS Trust (EMAS). This collaboration has enabled a strategic partnership between the University of Lincoln and EMAS to undertake research which is relevant to ambulance services, focusing on health issues of regional and national importance, and conducted with ambulance staff in order to increase the impact of the research by improving prehospital care for emergencies.

EMAS - A&E 6bThe study examined the period between January 2010 and February 2012. Across England overall, the percentage of emergency cases where care bundles (packages of essential care) were delivered in full increased from 43% to 79% for heart attack and from 83% to 96% for stroke. ASCQI supported frontline staff, and their management, to introduce improvements using checklists, aide memoires, individual and group feedback and sharing of information within and between different trusts to improve the reliability of care for people with heart attack and stroke. The project was shortlisted for an HSJ award in 2012.

 

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New health economist Ana Godoy Caballero joins CaHRU

Ana2Ana Godoy Caballero joined the Community and Health Research Unit this January 2014 as a research fellow in health economics. Ana completed her undergraduate degree in Business Administration and Management at the University of Extremadura (Spain), in which she graduated first in her class. This was followed by an MSc in Economic Research at the same University in which she explored performance of primary health centres in a Spanish region, investigating whether the each of centres varied with different aspects of quality of the units.

Desk1In 2012 Ana completed her MSc in Health Economics at the University of York where she focused on analysing the quality of health care provision to identify reasons why some health centres varied in quality of care compared with others. Ana will be working on a number of projects with the CaHRU team exploring the economics of quality of primary and prehospital healthcare including the European (Framework 7 Programme) study investigating the Quality and Costs of Primary Care (QUALICOPC) in the UK.

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Comprehensive model (SKIPE) for diagnosing and managing causes of medical underperformance

Meeting1Tim Norfolk and Prof Niro Siriwardena have recently published a discussion paper in Quality in Primary Care describing ‘A comprehensive model for diagnosing the causes of individual medical performance problems: skills, knowledge, internal, past and external factors (SKIPE)‘.

SKIPEThe SKIPE model, developed by Tim Norfolk, an occupational psychologist, through his work with underperforming doctors, sets out in logical relationship and progression the causal factors determining effective medical performance or underperformance. It highlights how the relationship between competence and performance is moderated by specific, discrete causal factors both within the individual and external to the individual.

meeting2This model builds on a previous paper describing a unifying theory of clinical practice, the RDM-p model, which captures the primary skill sets required for effective medical performance (relationship, diagnostics and management), and the professionalism that needs to underpin them. The SKIPE model is currently being used, in conjunction with the RDM-p model, for the in-depth assessment and management of doctors whose performance is a cause for concern.