Professor Niro Siriwardena led the recent Lincoln Institute for Health (LIH) research development seminar entitled, ‘Things that go bump in the night’: exploring the problem of tinnitus and sleep.
This seminar brought together researchers at the University of Lincoln with a common interest in sleep research to explore interdisciplinary research into insomnia. Several research centres, groups and experts from a number of disciplines are members of the LIH and each have a record of funded studies investigating sleep and insomnia in a variety of conditions. The work builds on the University of Lincoln’s 4* impact case study on insomnia from REF2014.
The seminar focused on how to combine different research approaches to explore how the team might improve the management of insomnia linked to tinnitus. This began with presentations from each participant on their experience and current work in this field:
- Niro, who is professor of primary and prehospital care, began by describing CaHRU’s translational research focus, seeking to improve health care processes and outcomes. A key area has been in primary care for people with insomnia which includes systematic reviews, qualitative studies and the development and evaluation of psychological interventions for insomnia.
- Prof Alina Rodriguez, professor in psychology, presented her approach combining methodological strategies including psychological, epidemiological, and molecular to understand the development of behavioural, cognitive, emotional or physical problems across the lifespan, seeking to identify factors amenable to change that can be translated into public health policy or interventions.
- Prof Graham Law is professor in medical statistics and has worked extensively in epidemiology and medical statistics, focussing on sleep and the consequences of good and poor sleep on metabolic and cardiovascular health.
- Dr Simon Durrant, senior lecturer in psychology, initially trained as a musician (counter tenor) before developing his expertise in the cognitive neuroscience of sleep. He leads the sleep lab at Lincoln using techniques such as polysomnography, EEG and actigraphy to understand the physiological basis of sleep and its disorders.
The group then discussed, together and with other academics present, the problem of tinnitus (noise generated internally in the body) which affects around 10% of adults and is associated with insomnia in over three-quarters of those with the condition, particularly causing difficulty getting off to sleep (so-called sleep latency). There followed an exploration of potential ways to investigate the problem of insomnia linked to tinnitus (e.g. using evidence synthesis, analysis of large datasets, and qualitative designs) together with the potential for intervention develop (e.g. using CBT for insomnia together with CBT for tinnitus) and evaluation of these.
The seminar ended with suggestions and proposals for how to take this work forward.
[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2017/11/Tinnitus_insomnia_finalrevised.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]
A. N. Siriwardena
This year’s British Sleep Society (BSS) conference, held in Brighton at the Hilton Metropole, featured an invited presentation from Prof Niro Siriwardena, director of CaHRU, entitled ‘Tribulations and trials in primary care insomnia’.
After a welcome to the conference by Professor Mary Morell, President of the BSS, the opening keynote was given by Professor Franco Cappuccio, from the University of Warwick on the topic of ‘Healthy sleep’. This was followed by the opening session of the conference on ‘Sleep and health’ chaired by Professor Graham Law, secretary of the BSS and a member of CaHRU. This session included three presentations. The first was on ‘Sleep and chronic pain: moving from association to causation?’ give by Dr John McBeth, Reader at the University of Manchester. He described the bidirectional relationship between chronic pain and sleep, with pain giving rise to insomnia and sleep disturbance exacerbating or even causing pain. Studies had shown that treating insomnia in people with chronic pain, for example due to fibromyalgia led to improvements in wellbeing and quality of life but no improvement in pain.
Prof Siriwardena next talked about how he had initially developed an interest in the problem of insomnia through initial research into use of sleeping tablets by general practitioners. ‘Tribulations and trials in primary care insomnia’ went on to describe the studies that showed that hypnotic drugs like benzodiazepines and z-drugs though often prescribed for insomnia did more harm than good, and that primary care trials of cognitive behavioural therapy for insomnia (CBT-I) showed positive effects. He went on to describe the work on the Resources for Effective Sleep Treatment (REST) project, a quality improvement project which successfully implemented CBT-I in general practice which led to reduced hypnotic prescribing in those practices. Because of the low uptake of CBT-I in primary care, there was increasing evidence that online or self-help CBT-I was effective with similar effect sizes to face-to-face individual or group therapy. Finally he presented the evidence on short behavioural therapies such as sleep restriction therapy including a forthcoming HTA funded trial led by Oxford University’s Simon Kyle and involving the Universities of Manchester (Peter Bower) and Lincoln (Niro Siriwardena).
The final talk in the session was Dr Eleanor Scott, Senior Lecturer at Leeds University and Consultant Diabetologist at Leeds Teaching Hospitals, who spoke on Sleep and metabolic health, describing the relationship between insomnia and diabetes, obesity and cardiovascular disease. This was followed by Dr Jason Rihel,of University College London discussing his work on sleep in zebrafish and Dr Claire Sexton of Oxford University on her work on sleep related to dementia. Brighton was an excellent setting for a well-attended BSS conference.
By Niro Siriwardena
Viet-Hai Phung presented his work on the perceptions and experiences of Community First Responders (CFRs) in Lincolnshire at the recent Mediterranean Emergency Medicine Congress (MEMC). The Congress, organised by the American Academy of Emergency Medicine (AAEM), took place in the very smart surroundings of the Corinthia Hotel in Lisbon, Portugal from 8-10 September 2017. Despite the title of the Congress, this was a truly international conference, with delegates from North America, the Middle East, Africa and Australasia presenting.
Professor Lee Alan Wallis, Head of Emergency Medicine for the Western Cape Government, was the keynote speaker at the opening ceremony. He talked about the particular challenges of emergency medicine provision in southern Africa, where in some countries the infrastructure is extremely basic. Other plenary speakers included: Professor James Ducharme from McMaster University in Toronto, who talked about the complex relationship between pain relief, patient satisfaction and addiction and Dr Eveline Hitti from the American University in Beirut, who spoke about the glass ceiling for women working in emergency medicine.
Viet-Hai presented the interview study that has been undertaken with colleagues Prof Niro Siriwardena, Ian Trueman and Prof Roderick Ørner on the first morning of the conference. The presentation was well-received with only minor points of clarification from the audience concerning the extent of their use in the UK and the levels of training they undertake.
What was interesting about the conference was the sharing of best practice from around the world on many salient problems in emergency medicine, such as alleviating patient overcrowding in the emergency department. All this within the setting of the wonderful city of seven hills, Lisbon.
By Viet-Hai Phung
Despina Laparidou, Research Assistant at CaHRU, together with Antony Chuter, a patient representative for Scaling Up PINCER (pharmacist-led information technology intervention for reducing clinically important errors) recently attended the International Society for Quality in Health Care (ISQua) Conference at the Queen Elizabeth II Conference Centre in London (1st – 4th October 2017) and presented the preliminary findings of the Scaling Up PINCER project, funded by the Health Foundation.
The Main Conference offered a combination of exciting plenaries, short oral presentations and longer themed sessions, while poster and e-poster presentations were also presented throughout the duration of the conference. One of the most interesting sessions was the “A Mile in My Shoes”. A Mile in My Shoes is an interactive shoe shop that invited delegates to “(literally) step into someone else’s shoes and embark on a mile-long physical, emotional and imaginative journey to see the world through their eyes”. The session involved listening to, while wearing their shoes at the same time, unique audio stories from people working within health and social care, sharing their experiences and showing the remarkable contribution and challenges faced by those working in, and using, our health and social care system.
Despina and Antony gave their presentation on the morning of Tuesday 3rd October during a session on “Health Foundation Improving Quality in Community Health Services” and was very well received by the audience. PINCER is a pharmacist-led information technology intervention for reducing clinically important errors in medication management in general practices and the study’s preliminary results show early indications of improvement in most of the study’s safety indicators for gastrointestinal bleed, stroke, heart failure and acute kidney injury, but not for the two asthma indicators. The session, chaired by Will Warburton from The Health Foundation, also showcased studies, such as the “Ophelia Project” on improving health literacy for vulnerable people in the community, and “Making Waves” on Promoting a positive experience for people with COPD.
The Conference came to an end with Wednesday’s plenary and the promise to meet again in 2018 for an even more exciting ISQua Conference in Malaysia!
By Despina Laparidou
Three members of the CaHRU team, Professor Niro Siriwardena, Dr Stephanie Armstrong and Greg Whitley (paramedic and doctoral student) led an interactive exploration of the latest research and innovation in ambulance care in a session entitled ‘Innovations in ambulance service care: ‘bangs, brains and hearts’ as part of the Lincoln Get Hold of Technology and Science (LiGHTS) Expo on 29 September 2017.
The seminar was presented twice to around 40 members of the public in all aged 7 to 60+ years. It explored the kind of care we can expect currently from ambulance services. The team explained how today’s ambulance service is about far more than transporting people to hospital. Prof Siriwardena discussed how ambulance services should be measured using an animation from the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme. Steph Armstrong discussed ‘Why do ambulance research and how difficult is it?’ exploring the difficulties of randomising patients and gaining consent in this setting. Prof Siriwardena then spoke about the use of GTN (also known as nitroglycerine, a component of dynamite) for stroke in the RIGHT2 trial and Greg Whitley, paramedic on the AIRWAYS2 trial explained the different airways device being tested in the study.
The seminar continued with a hands-on exercise involving cardio-pulmonary resuscitation, looking at airway devices and listening to heart sounds with a stethoscope. There was also plenty of audience participation with questions, answers and prizes! Prof Siriwardena and Dr Stephanie Armstrong gave an interview to Melvyn Prior at BBC Radio Lincolnshire as part of the event.