Newsletter

Unit Aims

NMAHP Research Unit Quarterly Newsletter

Contents Director’s Blog

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Nursing, Midwifery and Allied Health Professions Research Unit

The Nursing, Midwifery and Allied Health Professions Research Unit is a multidisciplinary national research unit, funded by the Chief Scientist Office (CSO) of the Scottish Government Health Directorates. We produce high quality research which aims to inform and improve patient care. We work closely with NMAHP practitioners and are increasingly concerned with involving patients and carers as research partners. Please contact us for more information.

Glasgow Caledonian University

0141 3318100University of

Stirling01786 466341

To conduct high quality applied research that enables Nurses, Midwives and Allied Health Professionals to make a difference to the lives of the people of Scotland and beyond. To create an internationally renowned and innovative Centre of Excellence that demonstrates the very best NMAHP Research.To develop a highly supportive multidisciplinary environment that develops research capacity & capability across the professions and provides a foundation for the NMAHP researchers and research leaders of tomorrow.

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Volume 24Spring 2012

Page 1• Directors blog• Unit aims• Contact details

Page 2• Research

Page 3• Highlights

Page 4• Spotlight• Publications

Success of the POPPY trial

1) The problem being investigated/addressed and/or potential solution falls sufficiently within the domain of Nurses, Midwives or Allied Health Professionals to justify Unit involvement.2) The issue is sufficiently significant in terms of size, severity, costs and patient/policy priority to justify investigating.3) It is sufficiently likely that a series of projects (the proposed workstream) are feasible, fundable, and could potentially make a significant and demonstrable impact on the issue.4) The Unit has sufficient skills and resources to deliver rigorous and original research over the course of the necessary workstream.5) Pursuit of this project would not replace pursuit of another project currently needed to further the progress of another workstream.

Those who know the Unit will be aware that it has always had a central focus on applied research, ensuring that the work we do is meaningful to both patients and practitioners. Over the past year we have introduced two systems that will enhance this applied focus and increase the likelihood that our work will produce real impact. The first is the introduction of the workstream model mentioned in a previous newsletter: the Unit wide commitment across our two programmes of work (NMAHP Interventions and Quality & Delivery of Care) to pursuing a declared series of projects in order to achieve significant impact on an important issue falling within the NMAHP domain. The second is a set of screening questions that guide selection of workstreams and thus ensure a strategic focus for the Unit that maximises the likelihood of achieving impact. These include:

The adoption of this quality assessment system at the very outset - coupled to the commitment to addressing an issue rather than just delivering on a single project - will enhance our applied focus and longer term impact. Although only recently introduced, much of the Unit’s on-going work already falls within this framework. A number of examples are presented in this newsletter. These include patient safety and pelvic organ prolapse.

Brian Williams, Unit Director.

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ResearchFocus On: Our ‘workstream’ approach to researchAt the Unit we want research to actually be useful to practice and to make a positive difference for patients and health professionals. We believe that the most effective way to do this is to focus research into workstreams. A workstream is the flow of research carried out to fully investigate a specific clinical problem. Having that focus helps us design projects that build on previous knowledge to ultimately feed useful information into practice. We work closely with health professionals and patient groups and pride ourselves on carrying out a body of related research, getting the results integrated into practice, and then assessing the impact they have had. Below are a couple of our workstreams, visualised to let you see what we are doing on a larger scale than project-by-project reports.

Improving Patient SafetyThis workstream focuses on improving the safety of ambulance clinicians’ practice. Recent years have seen considerable changes in ambulance clinicians’ practice: from a service where a positive outcome was the rapid transfer of all patients to an emergency department, to a more sophisticated service where ambulance clinicians are making complex treatment and transport decisions in everyday practice. Where appropriate, patients are now assessed, treated and left at home when they would previously have been unnecessarily taken to hospital. However, such decisions bring new challenges and can have unintended consequences. This workstream addresses these important issues and ensures that patient safety is central to service innovation. To date, amongst other projects, we have conducted research and knowledge implementation studies to improve the safety of post-hypoglycaemic care, reduce unnecessary thrombolytic therapy, and develop evidence-based processes to avoid equipment is present and functioning. Contact Edward.Duncan@stir.ac.uk.

Pelvic Organ Prolapse Pelvic organ prolapse has been a long-standing workstream within the Unit and an extensive, internationally recognised body of research has been developed. A Cochrane review of conservative management, focusing on Pelvic Floor Muscle Training (PFMT) for prolapse was first published in 2004 and most recently updated in 2011. Three additional Cochrane reviews relating to treatments for prolapse have also been published, and serve as the foundation for other work in the prolapse area. A UK survey of over 500 specialist women’s health physiotherapists was carried out in 2003 to establish current conservative practice in treating women with prolapse. This informed a feasibility study for a large multicentre trial of PFMT for prolapse, and also provided essential information about commonly used outcome measures and respondents’ willingness to be involved in this research. Upon successful completion of the feasibility study, we carried out an international, multi-centre trial of PFMT for prolapse was carried out between 2007-2011 (Pelvic Organ Prolapse PhysiotherapY; the POPPY trial). Twenty-five UK centres and two international centres recruited to this trial, in which 447 women were involved. An implementation study is now being planned to investigate the best mechanisms for changing practice in line with the trial findings. This thriving workstream has had many successful offshoots and achievements, highlighting the benefits of taking this type of long-term focused approach. For more information contact S.Hagen@gcu.ac.uk

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Highlights

PREDI-NU Commended by EU Policy Officer for Mental Health Prof. Margaret Maxwell and Dr. Fiona Harris (pictured with colleagues from the ten countries involved in the project) recently attended a project meeting hosted by the EU Commission in Luxembourg. They gave an update on their progress in reviewing the literature on internet-based CBT and websites providing online CBT. The team in Stirling working on the review, which includes Dr. Purva Abhyankar, will use this evidence to inform the development of an online self-management tool for mild to moderate depression. After piloting and evaluation in six countries, the website will be made accessible in nine European

languages. The meeting was addressed by Jürgen Scheftlein, policy officer in charge of mental health in the Health Determinants Unit of the European Commission’s Directorate-General for Health and Consumers. He commended the group for a really effective collaboration across a large multi-disciplinary, multi-cultural research-group and for the group’s progress in meeting deadlines and objectives thus far. Of additional note, two of this research-group (Prof. Kopp, Hungary and Prof. Hegerl, Germany) have been elected to the Joint Action on Mental Health and Well-being, which will bring the EU Commission and member states together under the EU Public Health Programme. We will update you with key news from this innovative and important research in future Newsletters. For more information contact Margaret.Maxwell@stir.ac.uk.

Help us raise money for The Stroke Association!The NMAHP RU is entering four teams into the Edinburgh Marathon this year to raise money for The Stroke Association. The Stroke Association funds research into prevention, treatment and better methods of rehabilitation, and helps stroke survivors and their families directly through its Life After Stroke Services. Approaching 2012, the group were 16 slightly unfit researchers with a penchant for coffee and cupcakes. They considered how they could promote the health of our nation, so now they are practicing what the Unit preaches by putting on their trainers, putting in the miles and hopefully raising lots of money for the Stroke Association! We hope you appreciate that this is a great personal challenge for each of the team. Training is well underway and it’s fantastic to see the effort that everyone is putting in (plus a little bit of panic as the event approaches)!If you would like to help us reach our target of £1800 you can donate using the following link http://www.justgiving.com/NMAHP or text UXLQ50 along with how much you want to donate to 70070. Every penny you donate will spur us on towards that finish line and it’s all for a great cause! For more information contact Karen.Semple@stir.ac.uk.

Competition WinnerWe would like to congratulate Joan McDowell of NHS Education for Scotland, the winner of our last Newsletter competition and the highly coveted NMAHP RU mug! Joan correctly guessed the two anagrams in the last issue as ‘Glasgow and Stirling’ and ‘Directors Blog’

A fond farewell to Ros This quarter, one of our longest serving staff members retired. Rosemary Farrell was the Unit Administrator since the 1990s, when the Unit was much smaller and based at St. Andrews House. Through several geographical moves and the Unit expanding, both in terms of size and in terms of the quantity and quality of our research, Ros was at the centre of the Unit. She supported us through numerous Directors and Scientific Reviews, new Chief Scientists and CSO Research Managers, and through the Unit’s many achievements over the years. Whilst with the Unit, Ros also had her own academic achievements along the way, gaining a Masters Degree. On behalf of the Unit, we would like to thank Ros for all that she has done for each of us.

Mental Health

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Sylvia DicksonTrial Co-ordinator

Suzanne HagenProgramme DirectorI joined the Unit in 1996 and I currently direct the Unit’s Interventions Programme. The purpose of this programme is to undertake research which addresses the effectiveness of NMAHP interventions in the Unit’s priority clinical areas. I graduated from Paisley University in 1988 with an Honours degree in Mathematical Sciences. Since then I have worked as a statistician, primarily in the field of health services research: from 1988 to 1990 at the Health Services Research Unit, University of Aberdeen; from 1990 to 1994 at the Institute of Occupational Medicine, Edinburgh; and from 1994 to 1996 at Ayrshire and Arran Health Board, on secondment from the Department of Public Health, University of Aberdeen. In 1993 I obtained an MSc by research from the University of Aberdeen on the topic of day surgery practice in Scotland. I went on to be awarded Chartered Statistician status in 1997, and in 2006 I gained a PhD relating to the psychometric properties of outcome measures for urinary incontinence. I was promoted to Chair in 2010. I have a specific interest in urogenital and pelvic floor problems, such as urinary incontinence and prolapse, where my research has focused for some years, attracting grants from bodies such as CSO, Wellbeing of Women and HTA. For more information contact S.Hagen@gcu.ac.uk.

I studied Biology at the University of the West of Scotland. Following graduation, I went on to work in clinical trials of herbal products for 3 years, where my principal responsibilities were the conduct and management of clinical trials to ICH GCP guidelines. I then joined NMAHP Research Unit in 2004. During my time at the Unit I have worked in stroke and urogenital related research, using both qualitative and quantitative research methods. For the last five years I have been working in the area of urogenital prolapse, conducting and managing multi-centre randomised controlled trials. I was the Trial Coordinator for the POPPY Trial; a multi-centre, randomised controlled Trial of a pelvic floor muscle training intervention for women with prolapse. I am currently managing a multi-centre randomised controlled Trial of pelvic floor muscle training to prevent pelvic organ prolapse in women (PREVPROL). We hope these trials will provide rigorous evidence regarding effectiveness and cost-effectiveness of pelvic floor muscle training for the treatment and prevention of prolapse symptoms. This will provide help physiotherapists, gynaecologists, and women with prolapse make informed choices about treatment and preventative strategies in the future. For more information contact Sylvia.Dickson@gcu.ac.uk.

Spotlight

This newsletter was created by the NMAHP RU Newsletter Team. If you would like to comment on any of the stories please contact us: Jennifer Murray (Editor, Jennifer.Murray@stir.ac.uk); Mary Steele (Designer, Mary.Steele@stir.ac.uk); Christine Hazelton (Christine.Hazelton@gcu.ac.uk); and Keir Liddle (Keir.Liddle@stir.ac.uk).

PublicationsPublicationsAli, M., Bath, P., Brady, M., Davis, S., Diener, H.C., Donnan, G., Fisher, M., Hacke, W., Hanley, D.F., Luby, M., Tsivgoulis, G., Wahlgren, N.G., Warach, S., & Lees, K.R. on behalf of the VISTA Steering Committees (2012). Development, Expansion and Use of a Stroke Clinical Trials Resource for Novel Exploratory Analyses, International Journal of Stroke, 7(2), 133-138. doi:10.1111/j.1747-4949.2011.00735.x.

Duncan, E. A. S., & Murray, J. (2012). The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC Health Services Research, 12: 96. doi:10.1186/1472-6963-12-96

Fader, M., Cottenden, A., Gage, H., Williams, P., Getliffe, K., Clarke-O’Neill, S., Jamieson, K., & Green, N. (2012). Individual budgets for people with incontinence: results from a ‘shopping’ experiment within the British National Health Service. Health Expectations. [online ahead of print]. doi:10.1111/j.1369-7625.2011.00750.x

Fitzpatrick, D., Duncan, E. A. S., & Maguire, D. (2012). Preventing pre-hospital hyperoxygenation during acute exacerbation of COPD. Journal of Paramedic Practice, 4(2), 77-83. Retrieved from http://www.paramedicpractice.com/

Hoskins, G., Williams, B., Jackson., C., Norman, P., Donnan, P. (2012). Patient, practice and organizational influences on asthma control. Observational data from a national study on primary care in the United Kingdom. International Journal of Nursing Studies, 49, 596-609. doi:10.1016/j.ijnurstu.2011.10.017

Herd, C., Tomlinson, C. L., Deane, K. H. O., Brady, M. C., Smith, C., & Clarke, C. E. (2012). Comparison of speech and language therapy techniques for speech problems in Parkinson’s disease. Cochrane Database of Systematic Reviews, 2, Art. No.:CD002814. doi:10.1002/14651858.CD002814.

Herd, C., Tomlinson, C. L., Deane, K. H. O., Brady, M. C., Smith, C., Sackley, C., & Clarke, C. E. (2012). Speech and language therapy versus placebo or no intervention for speech problems in Parkinson’s disease. Cochrane Database of Systematic Reviews, 2. Art. No.:CD002812. doi:10.1002/14651858.CD002812.

Kolehmainen, N., Francis, J. J., McKee, L., & Duncan, E. S. (2012). Beliefs about responsibilities, the aims of therapy and the structure of the therapy process: a qualitative study of caseload management issues in child health occupational therapy. Child: Care, Health and Development, 38(1), 108-116. doi:10.1111/j.1365-2214.2011.01220.x

Pollock, A., Hazelton, C., Henderson, C. A., Angilley, J., Dhillon, B., Langhorne, P., Livingstone, K., Munro, F. A., Orr, H., Rowe, F. J., & Shahani, U. (2012). Interventions for visual field defects in patients with stroke. Stroke, 43, e37-e38. doi:10.1161/STROKEAHA.111.639815

Pollock, A., St George, B., Fenton, M., & Firkins, L. (2012). Top ten research priorities relating to life after stroke. Lancet Neurology, 11(3), 209. doi:10.1016/S1474-4422(12)70029-7.

Robertson, R., Robertson, A. R. R., Jepson, R., & Maxwell, M. (2012). Walking for depression or depressive symptoms: a systematic review and meta-analysis. Mental Health and Physical Activity (MENPA). [online ahead of print] doi: 10.1016/j.mhpa.2012.03.002

Mercer, S. W., Jani, B. D., Maxwell, M., Wong, S. Y. S., & Watt, G. C. M. (2012). Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland. BMC Family Practice, 13: 6. doi: 10.1186/1471-2296-13-6

Styles, M., Williams, B., & Humphris, G. (2012). Is the effectiveness of tobacco image-based labels likely to vary by socio-demographic variable? Findings from an online survey of 19,000 members of the UK Public. Health Education Journal. [online ahead of print]. doi:10.1177/0017896912445237

GrantsHoskins, G., Williams, B., Duncan, E.A.S, Donnan, P., Sheikh, A., Pinnock, H., van der Pol, M. Can eliciting and addressing health-related goals improve asthma control and asthma-related quality of life? Feasibility Phase II pilot randomised controlled trial of a brief intervention. CSO. £144,528.

Maxwell, M., Rutherford, A., & Kelly, F. Evaluating the impact of mental health nursing initiatives in Scotland. Scottish Government. £45,000.

Pollock, A., Morris, J., & Forster, A. Physical rehabilitation treatment approaches following stroke: Cochrane systematic review of the evidence. CSO. £49,951.

Williams, B. Clinical Academic Research Careers for Scotland - retaining, supporting and developing future research leaders. CNO. £1,500,000.

Williams, B. The Scottish Person-Centredness Intervention Collaboration (ScoPIC). Scottish Government. £1,250,000.