Tag Archives: ambulance

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CaHRU study on CFRs presented to National Ambulance Forum

vhp2Viet-Hai Phung presented the findings of a University of Lincoln study on Community First Responders at a meeting of the National Ambulance Service First Responder Managers Forum at East Midlands Ambulance Service NHS Trust at Beechdale, Nottingham on 25th April 2017. The presentation set out the aims and objectives of the research, which were to explore the role of CFRs in a rural location, using a systematic scoping review followed up by qualitative interviews.

This study team of Viet-Hai Phung, Fiona Togher, Ian Trueman, Prof Roderick Ørner and Prof Niro Siriwardena, began the research in April 2016 with a systematic scoping review of CFR schemes in the UK which was published recently. CFRWordItOut-word-cloud-2426149Then followed a qualitative study involving 16 interviews of CFRs, conducted from June-July 2016. After describing the progress of the study, Viet-Hai Phung outlined the key findings of the scoping review. These included that: volunteers became CFRs mainly for altruistic reasons; they wanted more training and feedback on incidents they had attended; there were concerns about the possible emotional impact on CFRs responding to incidents; there was low public recognition of CFR schemes and sometimes confusion with ambulance staff; relationships with the ambulance staff were sometimes affected by confusion over roles; CFRs wanted local autonomy for CFR schemes but with greater sharing of best practice. Some of the findings from the scoping review were reinforced by the interview study. These findings, alongside others, were reinforced by the interview study.

The broad consensus among the regional ambulance managers was that further research was needed on CFRs and CFR schemes building on the work so far, and CaHRU is committed to working with ambulance trusts to further develop the work on CFRs. Professor Niro Siriwardena, who was also present at the event, said there were plans to discuss this further with ambulance service research leads at the next meeting of the National Ambulance Research Steering Group.

By Viet-Hai Phung

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CaHRU seminar – Incorporating ethical considerations in research – Dr Stephanie Armstrong

CaHRU_logotypeThe latest CaHRU Implementation Science and Research Methods seminar was given on November 22nd 2016 by CaHRU’s very own Dr Stephanie Armstrong. Stephanie, currently a Lecturer in Healthcare Quality Improvement at the University of Lincoln, comes from a diverse background, starting in the fields of Zoology (Trinity College Dublin) and Equine Studies (University of Coventry), moving on to studying Forensic Anthropology (University of Lincoln) and working on ethics and human rights. She is now researching the ethics of ambulance trials through a grant funded by the Wellcome Trust: Network exploring Ethics of Ambulance Trials (NEAT).

Stephanie’s talk focused on research ethics. She started the seminar by asking the participants to think about ethics Steph750 11.16and what their definition of ethics was. After a quick discussion around the participants’ thoughts, Stephanie gave an overall definition of research ethics and discussed issues around both the philosophical and legal aspects of ethics. The majority of the seminar was around the four basic constructs of research ethics: autonomy, non-maleficence, beneficence, and justice. Stephanie discussed the most relevant and important laws concerning research, such as the Mental Capacity Act (2005) and the Medicines for Human Use (Clinical Trials) Regulations (2004) – for Clinical Trials Involving Medicinal Products (CTIMPs), before reviewing the different types of participant consent used in research studies. At the end of the seminar, Stephanie reminded the attendees of the importance of ethics in animal research and discussed issues around its governance by the Animals (Scientific Procedures) Act 1986.

NThe seminar was very well presented and raised some very important issues around research ethics. The next Implementation Science and Research Methods seminar will be presented by Professor Chris Bridle, Director of the Institute for Health at the University of Lincoln, on Tuesday December 6th 2016. His topic will be “Accumulative Evidence Synthesis: fast track through the implementation pipeline”.

By Despina Laparidou

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CaHRU Research Forum November 2016

CaHRU_logotypeCaHRU, in conjunction with NHS partners including East Midlands Ambulance Service and Lincolnshire Community Health Services NHS Trusts, held its latest Research Forum of 2016 on 16th November. The forum followed its usual two-hour format with three speakers giving detailed presentations about a study they have been working on and then responding to questions.

brayford_arc1The first presentation was from Dr Murray Smith, CaHRU’s health economist and econometrician, who talked about ‘An Economic Feasibility Study on the Fluoridation of Drinking Water in the East Midlands’. This study is being led by NHS Nottingham City on behalf of all nine primary care trusts in the East Midlands. It examined the cost of setting up fluoridation plants, where they would be and the cost of ongoing maintenance. Ultimately, the feasibility study will produce a report for each of the areas covered by the nine participating primary care trusts.

Next was Professor Niro Siriwardena who presented on behalf of Dr Zahid Asghar on their study examining the performance of candidates with dyslexia in the Applied Knowledge Test (ATK) for Membership of the Royal College of Desk1General Practitioners (RCGP). A key finding of the study was that there was no evidence of differential attainment in candidates declaring dyslexia compared with those who did not once other candidate attributes such as age, gender, ethnicity and country of primary medical qualification had been accounted for.

Dr Stephanie Armstrong concluded the Research Forum by presenting findings from the Network exploring the Ethics of Ambulance Trials (NEAT) study. This is a Wellcome funded study led by the University of Lincoln and involving a number of other UK, as well as Dutch and Swiss, universities. The study has been running for less than a year but has already achieved an impressive set of outcomes. These include: a systematic review of published randomised controlled trials; a review of global and national regulations; and preliminary results of interviews with expert informants, paramedics and patients who have been involved in ambulance trials.

By Viet-Hai Phung

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Experts convene for Wellcome funded Network Exploring Ethics in Ambulance Trials (NEAT) project meeting

NOn 4th November 2016, CaHRU played host to an eminent group of researchers, ethicists and patient representatives in a meeting to discuss ethics in ambulance based trials. The group was formed as part of the Network Exploring Ethics in Ambulance Trials (NEAT) project, funded by the Wellcome Trust, which is seeking to understand the issues related to ethics in ambulance trials. The meeting had two main objectives, firstly to update the network on the findings of the NEAT project to date and secondly to discuss potential recommendations and future funding opportunities.

neat_ws1In the morning presentations by Dr Adele Langlois and Dr Stephanie Armstrong, outlined the findings of the project to date. These included a systematic review of published randomised controlled trials, a review of global and national regulations and the preliminary results of interview studies with expert informants, paramedics and patients who have been involved in ambulance trials. The morning sessions generated a lot of lively debate centring on both consent models and regulations, and in fact where there was agreement and conflict between these areas.

NAfter a pleasant lunch the discussion continued with possible recommendations of the project being that more work need to be done to clarify the guidance and regulations ultimately leading to a code of practice for ambulance trials and accompanying common ethics framework. Funding opportunities were discussed and the day ended with an agreement that there should be a commitment to continue the work of the network through collaborative research opportunities.

By Dr Stephanie Armstrong

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CAHRU/LIH improvement science and research methods seminar: Mixed methods

QIlogoThe first of this year’s series of CaHRU/LIH (Community and Health Research Unit/Lincoln Institute for Health) improvement science and research methods seminars was given by Prof Siriwardena on mixed methods on 16 February 2016. Improvement and implementation science benefits from the use of mixed research designs which combine quantitative and qualitative methods to show not only what happened but also why and how this might have occurred. Mixed methods approaches are a subset of multiple methods which involve more than one type of qualitative or quantitative method.

ascqilogoThe seminar covered principles such as definitions, theoretical approaches (such as pragmatism and transformation), basic and advanced (including case study) designs and approaches to data integration and transformation. This was then applied to examples of mixed methods designs used by CaHRU in a previous programme of research: the Ambulance Services Cardiovascular Quality Initiative (ASCQI). ASCQI was a national project, led by CaHRU and East Midlands Ambulance Service NHS Trust, designed to improve care for people presenting to ambulance services with heart attack or stroke using a large-scale quality improvement collaborative (QIC), evaluated using a multiple case-study design.

NWASami170112ASCQI involved gathering quantitative and qualitative data to describe what effect the QIC had, and how improvements, if they did occur, were brought about. Integration of data was carried out using techniques such annotated control charts showing time series data together with what was implemented, pattern matching comparing what services did and whether improvements occurred (doi:  10.1186/1748-5908-9-17), and comparison of quantitative and qualitative data from an online questionnaire (doi: 10.1111/jep.12438). Attendees were finally asked to consider a mixed methods question and think about research designs which they might use to answer it.

Thank you to all those staff and students who attended. Details of future seminars will be posted on the CaHRU and the LIH sites shortly.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2016/02/Mixed-methods_Siriwardena.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]