Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study

d-shawResearchers in CaHRU and East Midlands Ambulance Service NHS Trust (EMAS) have published a new study: “Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study” in BMC Emergency Medicine. The study’s lead author was Deborah Shaw of the Clinical Audit and Research Department at EMAS and visiting fellow at CaHRU. She was supported in the work by Prof Niro Siriwardena, director of CaHRU and associate clinical director at EMAS.

EMAS - A&E 9_750The authors aimed to explore paramedics’ attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence, acknowledging variations in prehospital care for asthma. The investigators interviewed paramedics and managers and their analysis identified that guidelines should be made more relevant to ambulance service care; barriers to assessment; conflicts between clinicians’ and patients’ expectations; complex ambulance service processes and equipment; and opportunities for improved prehospital education, information, communication, support and care pathways for asthma.

EMAS - PTS 2_750The service has already used these findings to improve prehospital care for people with asthma and other chronic respiratory conditions.

Improvement Science and Research Methods seminar: A journey through health economics with Prof Dr Darrin Baines

brayford_arc1In the latest in our series of Improvement Science and Methods seminars hosted by CaHRU on Tuesday 24th of June Prof Darrin Baines guided us on a ‘Journey through Health Economics’. Prof Baines was previously Associate Professor in Health Economics at the University of Nottingham and was recently appointed as Professor of health Economics at Coventry University. In his talk Dr Baines showed the different economic measures available and how we should interpret them.

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index_5The first stop of this journey was the cost benefit ratio. We were asked to consider what the ratio expresses: the price of a unit of benefits, or something we are not sure about? Most of the audience were surprised when they realised there was not a clear answer. The second stop was a comparison between two ratios of costs and benefits. Are we comparing efficiency? Are we sure about what it really means? The answer again was not certain. The comparison of ratios sometimes also gives us strange results. The next stop on our journey was Incremental Cost Effectiveness Ratios or ICERs. As was pointed out, although this measure solves some of the problems of previous measures, it also presents other problems, for example, in that it uses effects instead of benefits (money). And that is health economics: it is primarily about effects, rather than about money. Health economics is the study of decisions in an imperfect world where there is uncertainty and heterogeneity.

Nevertheless, our speaker indicated we cannot stop there, and we cannot just measure ICERs. If we want to analyse and solve a problem, if we want to understand the problem in front of us, then, we need to model it. Dr Baines finished his talk indicating the current measures we should be using: net monetary benefit (where we turn health into money) or net health benefit (where we turn money into health).

This was a very interesting talk and those present were very engaged with the topic – there was a general feeling of enjoyment and curiosity to know more about this field.

Ana Godoy Caballero

CaHRU researchers attend HSRN Symposium 2014

Togher PhOEBE qualitative HSRN 2014 [Poster]On 19th and 20th June, Fiona Togher and Viet-Hai Phung from CaHRU attended the annual Health Services Research Network Symposium (HSRN). Together, they presented three posters during the conference poster sessions entitled, ‘What do users value about the emergency ambulance service?‘, ‘Investigating the understanding, use and experiences of older people in Lincolnshire accessing emergency and urgent services via 999 and NHS 111: A scoping study‘ and ‘Systematic review: barriers and facilitators for people from minority ethnic groups accessing urgent and prehospital care‘. Another poster presented by Rachel O’Hara and Maxine Johnson entitled ‘A qualitative study of system influences on paramedic decision making and patient safety’ which included Prof Niro Siriwardena as a study collaborator won the prize for best overall poster. The posters described and explained the findings of streams of work that had been encompassed within CaHRU’s Pre-hospital Emergency Quality and Outcomes programme of research.

photo3The multi-disciplinary conference programme consisted of several plenary talks as well as parallel sessions during which presenters talked about their research. There was a wide range of NHS and academic institutions represented at the event plus numerous influential leaders in healthcare research. The parallel session streams to choose from included; Urgent Care, Patient Experience, Systems/Organisational Change, Patient Data and Improvement Science amongst many others.

The Urgent Care session on the first day was attended by Fiona Togher. This consisted of four presentations entitled, ‘Explaining variation in avoidable emergency admissions’, ‘Features of primary care and their effect on unscheduled secondary care: a systematic review’, ‘Factors that influence patient choices about where to access care in an emergency: a qualitative enquiry, ‘Why Frail Older People end up in A&E: The Patient Journey as told by Older People’.

Viet-Hai_posterKey learning points included: variation in emergency admissions within different hospitals and trusts is not ‘real’ but due to differing coding processes; if patients do not have a ‘regular’ GP this can increase accident & emergency (A&E) department use; communities need more visible information about alternatives to A&E – access details, location & opening hours; and 99% of frail older people that were taken to hospital during the course of a study were English speaking which contradicts the notion of migrant pressure.

The Patient Experience session on day one was attended by Viet-Hai Phung. The four presentations were entitled: ‘Does the availability of a South Asian language in GP practices improve reports of doctor-patient communication from South Asian patients?’, ‘Treatment outcomes in Schizophrenia: the views of patients and carers’, ‘An evaluation of interventions to support the emotional and psychological needs of patients with end-stage renal disease’, and ‘One size fits all? Acute hospital inpatient experiences of multi-bed and single room accommodation’.

Some of these themes will inform CaHRU’s work on ethnicity and patient experiences. On the second day, there was a very informative plenary presentation from Simon Denegri from INVOLVE about the extent to which the public should be involved in health service research. This presentation was very timely, given our work on patient-public involvement in PhOEBE and other studies. Attendance at the conference was informative, interesting and a good opportunity to inform colleagues from other academic institutions and health care organisations about the research that is being undertaken in the Community & Health Research Unit at the University of Lincoln.

Fiona Togher and Viet-Hai Phung

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!

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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

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,, 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.