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.
Viet-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. Then 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
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
On Wednesday 27th April, Professor Siriwardena, Viet-Hai Phung and Fiona Togher attended the launch event of the National Institute for Health Research (NIHR) themed review of prehospital care. This was held at Firth Court, University of Sheffield. The session was action-packed and included four presentations from senior prehospital care researchers whose work had been included as part the review. Within these presentations Professor Siriwardena spoke about patient outcomes and experience in relation to the ambulance service and detailed some of the work that has been undertaken within CaHRU and collaboratively with EMAS and the University of Sheffield. This included the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme – focussing particularly on the qualitative work we did to explore what was of value to patients that needed to access emergency ambulance care. Professor Siriwardena’s presentation was informative, insightful and particularly well received by the patient and public involvement group members that were in the audience.
Professor Tom Quinn also gave a fascinating presentation about the work undertaken by Kingston University and the University of London around the effectiveness of introducing a mechanical chest compression device into front-line emergency response vehicles. They hypothesis was that the use of mechanical devices (rather than administering manual resuscitation) should improve survival from out of hospital cardiac arrests. Interestingly though, the research team concluded from the evidence that adopting these devices routinely would not improve patient outcomes.
Following the research presentations the session continued with Daniel Mason, a member of the National Ambulance Commissioners Network sharing some of his thoughts on the research presented in the review in relation to the provider-commissioner relationship. One of the key points he highlighted was a need to include commissioners in the dissemination of key research findings that could have an impact on policy and practice. Finally, Derek Prentice, the chair of the lay group of the Royal College of Emergency Medicine reminded the delegates that ultimately the purpose of undertaking any healthcare research, not just prehospital research, is to improve the quality of care and the quality of experience provided to patients. It is patients that must remain at the centre of everything that we as researchers do.
Overall the event was a wonderful opportunity to hear about some of the major prehospital care research projects that have been undertaken with the support of NIHR funding during the last ten years. As the official event due to a close the delegates gathered over lunch and networking with colleagues with similar interests resumed. Upon reflection it was exciting to get a glimpse of the progress that has been made in the field of prehospital care research and to look forward to the contribution that CaHRU will continue to make in this area of healthcare research.
By Fiona Togher