Category Archives: Publications

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New systematic review published on interventions to reduce risk of overweight and obesity in infancy and childhood

A new study has been published by led by Prof Sarah Redsell of Anglia Ruskin University and a team of researchers at the Universities of Cambridge, Nottingham and Lincoln, including Prof Niro Siriwardena of CaHRU. The study, published in Maternal and Child Nutrition, was entitled ‘Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood’.

<This new review sought to identify randomised controlled trials of interventions delivered antenatally or during the first 2 years of life and designed to reduce the risk of overweight/obesity from birth to seven years of age. The authors identified 35 eligible studies published from January 1990 to September 2013 in six electronic databases. This included 27 unique trials of interventions including nutritional and/or responsive feeding, breastfeeding promotion and lactation support for mothers, parenting and family lifestyle, maternal health changing formula milk composition or diet, and modifying parental responsiveness to infant cues. The interventions had variable effects on feeding practices, behaviour and weight in infancy or childhood.

There were few intervention studies for pregnant women that continued during infancy. The authors are developing and testing the feasibility of a complex intervention comprising an interactive, educational programme (ProAsk) for health practitioners to guide and enhance communication with parents of infants about obesity risk identification and prevention strategies, funded by the Medical Research Council.

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Comparison of coronary heart disease genetic assessment with conventional cardiovascular risk assessment

jo1A new study, published in April 2015 in the journal Primary Health Care Research and Development, entitled ‘Comparison of coronary heart disease genetic assessment with conventional cardiovascular risk assessment in primary care: reflections on a feasibility study‘ was led by Prof Nadeem Qureshi of the University of Nottingham and included CaHRU researcher Dr Jo Middlemass as a co-author. The study assessed the feasibility of collecting genetic samples and the changes in self-reported outcomes after cardiovascular risk assessment (conventional and genetic), particularly lifestyle changes or anxiety.

B0007708 Molecular model: DNAAs part of Government Guidelines, general practitioners (GPs) routinely offer their patients an assessment to assess their risk of getting heart disease over the next ten years. These conventional cardiovascular risk assessments capture environmental risk factors and gene-environment including family history of premature heart disease. However, there are also genetic tests assessing genetic predisposition. Commercial direct-to-consumer CHD genetic tests are being actively marketed, and patients, particularly those with a perceived strong family history, may opt to access these services without prior consultation with their health providers. What is not known is the level of discrepancy between the results of conventional and genetic tests and also what, if any, lifestyle changes patients will make as a consequence of having the genetic test.

B0005637 Enhanced image of a human heartIn an observational feasibility study in ten British general practices in Central England, 320 individuals, who had completed conventional cardiovascular risk assessment, were offered CHD genetic test, with follow-up outcome questionnaire at 8 months for lifestyle changes and anxiety. Over a third of individuals offered genetic testing in primary care, as part of an enhanced CVD risk assessment, took up the offer and returned genetic test specimens, with over a third reporting family history of CHD in a specified relative. This study found that most participants (82%) classified at above-average risk on conventional CVD risk assessment in primary care were classified at only average risk using genetic-based assessment. In contrast, fewer participants (39%) at above-average risk on genetic assessment were classified as average risk on conventional CVD risk assessment.

Study participation was not associated with increased anxiety between baseline and follow-up or between participants at average and above-average risk based on genetic assessment. Considering lifestyle change from baseline to eight month follow-up among participants reporting at both time points, the proportion in the action/maintenance phase of change increased by 13% (from 54 to 61) for diet, 2% (from 51 to 52) for exercise, and decreased by 3% (from 35 to 34) for smokers.

B0008609 Blood clotThis feasibility study had limited ability to demonstrate the relationship between change in anxiety and lifestyle risk-reducing behaviour with genetic risk identification. This may be explained by the CHD genetic test following the conventional assessment because there may have already been some lifestyle change due to the previous cardiovascular risk assessment undertaken prior to the genetic test. The current research suggests GPs will face the challenge of patients presenting with direct-to-consumer genetic results that are inconsistent with conventional cardiovascular risk assessment, suggesting that GPs and practice nurses should explore patients’ rationale for undertaking genetic test-based risk assessment and their perceptions of family history and conventional risk assessment.

Dr Jo Middlemass

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Discussion paper on improving care for people with asthma through patient stories published in Chest

A new paper entitled ‘Using a narrative approach to enhance clinical care for patients with asthma‘ has been published online in the journal Chest. The paper was authored by Dr Helen Owton, previously of De Montfort University and now a lecturer at the Open University, Dr Jacqueline Allen-Collinson, Reader in the School of Sports Science at the University of Lincoln, and Professor Niro Siriwardena from CaHRU.

steth4The paper describes an approach to foster better patient self-care in patients with asthma by enabling clinicians to empower individuals to take more control of their condition by enhancing patient-clinician communication and relationship through patients’ stories. This is based on previous work from Drs Owton and Allen-Collinson on patient narratives in asthma and work on the consultation from Prof Siriwardena.

The discussion paper, published in the Topics in Practice Management section of the journal, describes the history of narratives in asthma, outlines the evidence on how narratives can provide insights into how people perceive and manage their asthma, and discusses how these ideas might be applied. The paper finally discusses how these notions might be practically implemented in the clinical consultation and how this has potential to improve outcomes for people with asthma.

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EU: FP7 QUALICOPC study shows potential for improving primary care in 34 countries

VTeams from the Netherlands Institute for Health Services Research (NIVEL) and the Scuola Superiore Sant’Anna have recently published a paper in the WHO Bulletin, ‘Assessing the the potential for improvement of primary care in 34 countries: a cross-sectional survey (Schäfer et al., 2015). The paper was based on data from the Quality and Costs of Primary Care in Europe (QUALICOPC) study, funded by the EU Framework 7 programme, for which data for England were collected by Dr Sirdifield from the Community and Health Research Unit (CaHRU).

Meeting1Schäfer et al’s paper draws on data from questionnaires on patient experiences and values relating to general practice assessing what patients from each of the 34 countries felt there was to improve five aspects of primary care: accessibility, continuity, comprehensiveness, patient involvement in treatment decisions, and doctor-patient communication. Overall, the authors concluded that “accessibility and continuity of care show relatively low potential for improvement, while in many countries comprehensiveness was indicated to be a priority area”. Nine countries had a moderate level of improvement potential for patient involvement in decision-making about treatment but all countries performed well on doctor-patient communication. The UK data indicate low patient-perceived improvement potential across all aspects of care with the exception of ‘comprehensiveness’, which had  moderate potential for improvement.

Desk1The team from CaHRU (Dr Coral Sirdifield, Ana Godoy Caballero, Prof Niro Siriwardena and Dr Karen Windle ) are currently working with colleagues in the College of Social Science (Prof Steve McKay and Dr Christine Jackson) and Nivel (Dr Willemijn Schäfer) to further explore the data for England, investigating how satisfied patients are with primary care by identifying their expectations of care, the extent to which expectations are being met, variations in expectations and experiences, and how patient satisfaction could be improved.

Reference: Schäfer et al., (2015) Assessing the potential for improvement of primary care in 34 countries: a cross-sectional survey, Bull World Health Organ, 93: 161-168. doi: http://dx.doi.org/10.2471/BLT.14.140368

 

Coral Sirdifield

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CaHRU researchers present at EMS999 Research Forum Conference, Nottingham

Chiral_logoA team from CaHRU including Prof Niro Siriwardena, Fiona Togher and Viet-Hai Phung were represented at the EMS999 Research Forum Conference on Quality Improvement and Innovation Research in Prehospital Care in Nottingham on 4th February 2015. The conference, supported by the Health Foundation through their Spreading Improvement Programme, brought together the latest research and best practice in prehospital care. The conference featured several posters from ambulance services in England participating in the IMPACT-ASCQI project led by CaHRU.

Christopher Preston presentationProfessor Siriwardena kicked off the Conference with a keynote lecture on the evolution of quality improvement in prehospital care, ‘Prehospital quality improvement; past, present and future‘ which, innovatively, used some familial anecdotes to illustrate the links between principles of quality improvement and lessons for life!

Following the keynote was Richard Pilbery from Yorkshire Ambulance Service to talk about his experiences of speaking at the Paramedics Australasia Conference on the Australian Gold Coast. This was the prize that Richard won at last year’s EMS 999 Research Forum for producing the best poster. Following the first session, Matthew Booker from the University of Bristol presented his work on why ambulances are called for primary care problems followed by Mohammed Iqbal from EMAS on development of a novel pain assessment tool for improving prehospital pain management. Both presentations generated much interest, with Matthew winning the prize for best presentation at the end of the day.

photo3Just before lunch, Fiona Togher presented her poster, which showcased her doctoral study on development of patient-related experience measures for the ambulance service. The presentation was both well-delivered and well-received, with some thoughtful questions from the audience in response. In the afternoon, there was a workshop presented by Niro Siriwardena with Janette Turner from ScHARR on ‘Disseminating and Publishing Improvement Research’. This workshop was useful for all those with an interest in publishing articles, dealing with a number of themes including how to structure an article to which journals it should be pitched at.

The range and content of the posters and presentations demonstrated the continuing importance of the EMS 999 Research Forum for anyone with an interest in undertaking research in prehospital care.

Viet-Hai Phung