The latest study from researchers at CaHRU was published this month (July 2017) in BMC Medical Infromatics and Decision Making. Entitled ‘Perceptions on use of home telemonitoring in patients with long term conditions – concordance with the Health Information Technology Acceptance Model: a qualitative collective case study‘, and co-authored by Dr Jo Middlemass (visiting fellow), Jolien Vos (doctoral student) and Prof Niro Siriwardena (director), the study formed part of the process evaluation of a large multicentre, multinational trial funded through the European Framework 7 programme, Clinical tRials fOr elderly patients with MultiplE Disease (CHROMED: clinicalTrials.gov Identifier: NCT01960907).
This was a qualitative interview study of patients aged between 60 years and over together with their partners or relatives where applicable on implementation of a telemonitoring system in their homes for chronic obstructive pulmonary disease (COPD) combined with heart disease. Patients and their relatives were largely positive about telemonitoring but they expressed concerns regarding health professional access and attachment; heightened illness anxiety and desire to avoid continuation of the ‘sick-role’; the need for good organisational processes and informal support. Ease of use was connected to equipment design being suitable for older people. Participants felt it was important to establish trends in health status, to enable detection of early signs of infection and increase the potential for patients to self-manage.
The main trial results have been previously presented at the European Respiratory Society conference and these are currently being prepared for publication. The overall conclusion of this sub-study was that to increase home telemonitoring acceptance among older people, consideration of equipment design and organisational factors was important.
By Niro Siriwardena
Julie Pattinson of CaHRU presented her work on reasons for variations in performance in the MRCGP Applied Knowledge Test at the recent International Medical Graduates’ conference at the Conference Hall, Centre for Medical & Dental Education, Pilgrim Hospital. Speakers included Dr Bijoy Sinha (GP Speciality Training Programme Director, Lincolnshire), Dr Nick Humphry (GP Speciality Training Programme Director, Lincolnshire), Dr Bevis Heap (Programme Director HEE, East Midlands) and Dr Sathya Naidoo (Associate Postgraduate Dean and ARCP Lead for the East Midlands).
The purpose of the meeting was to identify needs of IMGs to help support them in GP training with a specific focus on the trainers’ roles. There were around 50 attendees in total, with the majority of the audience being GP speciality programme directors, vocational training managers, GP trainers and General Practitioner Speciality Training Registrars (GPSTRs). Dr Humphry opened the conference talking about the challenges and opportunities for IMGs in primary care training. This was followed by a talk from Dr Heap, who spoke about the challenges identified for IMGs that are different from those of indigenous graduates. Dr Naidoo spoke about identifying ‘at risk’ GPSTRs and the RCGP iMAP.
Dr Julie Pattinson gave a presentation on ‘Understanding reasons for variation by ethnicity in performance of general practice specialty trainees in the Membership of the Royal College of General Practitioners’ Applied Knowledge Test: cognitive interview study’. Her talk was about the differences that exist in candidate performance in high stakes medical licensing examinations, specifically the Membership of the Royal College of General Practitioners (MRCGP), between black and minority ethnic (BME) compared to white British doctors. The grounded theory analysis generated insights into reasons for difficulty in answering AKT questions in all participants, but it emerged that overseas trained (OST) participants do face additional difficulties answering AKT questions compared to UKGs and this could provide the basis for developing interventions to reduce differential attainment in UK specialty training for general practice. Feedback from Dr Humphrey following her talk stated ‘There was quite a buzz about it after and it stimulated a lot of conversation. I think our trainers and GPRs will find it useful when considering how to improve success in the AKT.’
During the afternoon session Dr Sinha delivered a talk about IMG in practice and the GPSTRs’ experience. Emphasis was placed on supporting IMGs in speciality training. There was a talk from a scheme graduate how to get the best out of training, understanding examinations and how they may be challenging. Overall the conference was very interactive and group discussions followed each presentation. In the afternoon there were workshops exploring problems and solutions for IMGs.
By Dr Julie Pattinson
I have been working on sleep and health for around 7 years now. When I first started there was very little interest. A clinician, on a national funding committee, said to me “why are you worried? Sleep is natural…” I think this attitude is finally changing.
You may have seen an increased interest in the media in relation to sleep. There are news articles, nearly daily, about the new research and the ‘dangers’ of bad sleep. I suppose they need to sell papers. I was recently part of a BBC1 programme (‘The truth about…sleep’) with Michael Mosely. They approached us to conduct some sort of experiment. Working with my colleague (Dr Eleanor Scott) we recorded the blood glucose in 6 participants for a week. During this time, they were required to reduce their time asleep by 3 hours on 2 consecutive nights.
The results took us by surprise. We know that this should have some sort of impact, but all six participants had raised glucose the days after their sleep restriction. And the rise was around 0,5mmol/L which, as well as being statistically significant, is clinically significant. I am busy writing this up for a journal.
Hopefully, we are going to carry on this idea by looking at shift-workers. That is the plan….
By Prof Graham Law
Viet-Hai in his new role as Research Assistant
A new study entitled, ‘Community First Responders (CFRs) and schemes in the United Kingdom: systematic scoping review‘, conducted by members of CaHRU was published on 19th June 2017 in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. This article was the culmination of an initial idea for research proposed by Ian Trueman from the School of Health and Social Care. He undertook the scoping review with former colleague, Fiona Togher. Viet-Hai Phung took over from Fiona after the scoping review was completed and subsequently led writing the paper, with substantial constructive comments from Ian, Professor Niro Siriwardena and Dr Roderick Ørner, a consultant psychologist.
From an initial search of six databases, 15,696 publications were identified as being potentially relevant. After several stages of screening by title and abstract, narrowing the geographical focus and for relevance of content, as well as removing duplicates and full-text screening, nine studies were included in the final analysis.
A number of key themes were identified by the nine publications. The study showed that people were motivated to become CFRs through an altruistic desire to help others. They generally felt rewarded by their work but recognised that the help they provided was limited by their training compared with ambulance staff. CFRs felt that better feedback would enhance their learning. Ongoing training and support were viewed as essential to enable CFRs to progress. They perceived that public recognition of the CFR role was low with patients sometimes confusing them with ambulance staff. Relationships with the ambulance service were sometimes ambivalent due to confusion over roles.
These findings establish a baseline of evidence on the work of CFRs in the UK. The team are building on this by undertaking an interview study of CFRs. Opportunities for future research include exploring the experiences and perceptions of patients who have been treated by CFRs as well as other stakeholders, including ambulance staff, while also evaluating the effectiveness and costs of CFR schemes.
By Viet-Hai Phung
The latest CaHRU/NHS Research Forum took place on 7th June 2017 at the University of Lincoln. The Research Forum, which takes place three times a year, is an opportunity for colleagues to showcase their research particularly focussing on studies conducted within Lincolnshire. The meeting began with a lunch and was attended by NHS staff, university staff and students, and colleagues interested in health and social care research.
At the forum three researchers presented their work: Helene Markham (the University of Lincoln & United Lincolnshire Hospitals); Michael Toze, PhD student at CaHRU and Dr Murray Smith, Research Fellow in Econometrics and Health Economics in CaHRU.
Helene was first to present on her doctoral study entitled: ‘Evaluating follow-up and complexity in cancer clinical trials’. Helene explained that her study seeks to develop an objective methodology to define and quantify trial complexity, intensity and workload to improve operational management and enhance models of trial delivery.
Next, Michael Toze presented his doctoral work on older Lesbian, Gay, Bisexual and Transsexual (LGBT) people’s experiences of primary care. His study sought to elicit older LGBT people’s experience of healthcare when consulting with their GP or primary care staff.
Last but not the least was Dr Murray Smith who discussed his work relating to ‘Value of specialist shoulder physiotherapy in the perspective of cost effectiveness’ which involved a cost analysis of extended scope physiotherapy.
All three speakers gave excellent presentations of their work, and there was a lively discussion and response to questions following each. Professor Niro Siriwardena, Director of the Community and Health Research Centre (CaHRU) thanked the speakers and the attendees for helping to make the forum a successful event.
By Joseph Akanuwe