Developed by the Vocal Liver Network in collaboration with the British Liver Trust, the resource was created as part of the project led by SwagÖ±²¥ & SwagÖ±²¥ University NHS Foundation Trust. ID LIVER is a research and innovation initiative aiming to identify liver disease in patients much earlier than current practices.

Over 90% of liver disease cases are preventable, with the primary risk factors being obesity, alcohol, and viral hepatitis. While the liver is remarkably resilient and can regenerate itself, it has its limits and extensive damage can lead to liver disease. However, most liver diseases can be prevented through lifestyle changes.

To understand how better conversations about liver disease risk could take place, the ID LIVER team had discussions with people at increased risk of liver disease and healthcare professionals. They revealed that healthcare professionals acknowledge challenges in addressing specific risk factors, especially obesity and alcohol use. In response to these challenges, ‘Liver Talks’ provides a dynamic resource for healthcare professionals.

Pamela Healy, Chief Executive of British Liver Trust, emphasised, "One in three of us is at risk of liver disease, and the alarming increase in diagnoses necessitates action. Identifying those at risk and discussing the ways they can improve their liver health is vital to reduce their risk of liver disease.

“We know that it can be difficult for healthcare professionals to have these conversations and the ‘Liver Talks' resource will help address this challenge.  By improving conversations about risk factors, healthcare professionals can provide crucial support and empower people at risk to make lifestyle changes.â€�

This innovative resource aims to break down barriers and empower healthcare professionals to navigate sensitive topics related to liver disease risk factors effectively. It includes a one-hour session plan, a PowerPoint presentation, and a compelling animation, offering healthcare teams insights into people’s experiences and the opportunity to reflect on how best to initiate conversations and foster understanding.

, Consultant Hepatologist at SwagÖ±²¥ University NHS Foundation Trust and Honorary Senior Lecturer at SwagÖ±²¥, said:  â€œThe ID LIVER project was established to diagnose and manage liver disease at earlier, treatable stages. This is particularly important for Greater SwagÖ±²¥ and the North West of England as we have some of the UK’s highest rates of advanced liver disease. The Vocal Liver Network is a fantastic way for us to address this major healthcare challenge by working in partnership with patients and the public in the design and management of their health research, ultimately benefiting communities that are traditionally underserved by current care pathways for liver disease.â€� 

SwagÖ±²¥ and Finland’s  have entered into a strategic cooperation agreement to further health-AI research.

Aalto University’s excellence in artificial intelligence (AI), combined with SwagÖ±²¥’s strengths in data science and AI combined with health systems, will accelerate vital research and development in data-driven healthcare and related areas.

The new collaboration will apply joint expertise to the innovative use of AI and machine learning in the medical sector. In SwagÖ±²¥ the work will be focused around the existing Christabel Pankhurst Institute for Health Technology.

The Institute plays a critical role in pulling innovations through from basic research to market ready products and services, which can then be accelerated into clinical use through Greater SwagÖ±²¥’s devolved health and care system and established innovation pathway.

The new alliance with Aalto also supports the activities of the Finnish Center for Artificial Intelligence (FCAI) coordinated by Aalto University. SwagÖ±²¥ is a member organisation of the , the UK’s national centre for data science and artificial intelligence.

As a part of the agreement, Samuel Kaski, Professor of Computer Science at Aalto University, has joined SwagÖ±²¥ as part of a shared professorship between the two universities. As part of this new appointment Prof Kaski will become the Director of the Christabel Pankhurst Institute for Health Technology, responsible in particular of AI. He will continue his work as Director of the Artificial Intelligence Center of Finland and will remain as Academy Professor until the end of the current transition year.

“My main task will be to set up a strong AI Center in SwagÖ±²¥, and the Pankhurst Institute will give unique opportunities for machine learners interested in working in medicine and health. That is what caught my attention. But there will certainly be opportunities in fundamental AI research as well!” Prof Kaski said. “The mission of the whole Institute is even broader of course, and many contributors are needed and welcome. I am very glad to see a number of excellent people already engaged.”

Professor Martin Schröder, Dean of the , said “Professor Kaski has a world-leading reputation in AI, and we are delighted that he is joining us to lead the Pankhurst. Our collaboration with Aalto University strengthens our global reach to deliver new interdisciplinary research, innovation and impact for the benefit of the university, city and region.”

Community pharmacy staff are to be offered training on suicide prevention, based on findings from a new study published today. As a result, a first of its kind training video has been developed and will also be available from today to mark World Suicide Prevention Day.

The research from the National Institute for Health Research Greater SwagÖ±²¥ Patient Safety Translational Research Centre's () mental health theme was published in the journal, .

The team conducted in-depth qualitative interviews with 25 community pharmacy staff and identified 6 key themes. The first two; relationship with patient and suitable pharmacy environment formed a basis for interacting about suicide. If supported by training, staff felt that they could maximise opportunities for contact. The need to create facilitated referral pathways and understand more about restricting access to means was recognised.

Dr Hayley Gorton who led the research team whilst at SwagÖ±²¥, said: “This is the first qualitative interview study which has explored the important role of community pharmacy teams in suicide prevention. Our research discovered that, staff felt they could do more to support individuals if they were given training.

“It is heartening to see that pharmacists and their teams recognise that they can contribute to the suicide prevention agenda and welcome training to support them to do so.”

Community pharmacists are the most visited healthcare professionals in the UK, with pharmacy teams caring for over 1.6 million people in England alone every day. Yet, these teams are seldom mentioned in the suicide prevention plans, which are a current national and global priority.

Dr Gorton has worked with the Centre for Pharmacy Postgraduate Education (CPPE) to make the training a reality. They have produced a suicide awareness learning video aimed at pharmacy teams.

The innovative training video aims to prompt pharmacy staff to reflect on their current role in suicide prevention, and what it might be in the future. Three special guests, who speak about their experience in relation to suicide, also provide learning messages.

Dr Gorton, added: “We hope that the CPPE suicide awareness learning video is the first step in supporting our colleagues to have potentially life-saving conversations.”

The GM PSTRC mental health theme is also launching a campaign today to mark World Suicide Prevention Day, #seedsofhope with a photographic exhibition at SwagÖ±²¥ Town Hall. Pictures carefully selected by members of the mental health theme’s patient and carer involvement group to represent what hope means to them will be on display for the day from 10:30 until 17:30. Everyone who visits will receive a packet of seeds. Once planted pictures of the plants growth can be tweeted with using #seedsofgrowth to raise awareness of the research underway by the PSTRC to make a difference to the treatment of mental health.

A major new health research programme, led by researchers from SwagÖ±²¥, has been announced today (11 July 2019) to tackle Greater SwagÖ±²¥’s biggest health challenges, as part of a £135m national investment.

The National Institute for Health Research () is funding the establishment of 15 Applied Research Collaborations (ARCs) across England to develop innovative research projects that will directly improve patient care and treatment.

The NIHR ARC for Greater SwagÖ±²¥ will become part of from 1 October 2019, bringing together researchers, health and care providers, patients and communities to deliver large programmes of research.

Professor Ben Bridgewater, Chief Executive of Health Innovation SwagÖ±²¥, said: “Our role is to conduct research that addresses the needs of Greater SwagÖ±²¥’s 2.8m citizens and accelerate implementation of the findings and proven innovations through our devolved health and care system. This has a direct impact on people’s health and wellbeing, transforms local services and supports the creation of jobs, growth and prosperity for all.

“The ARC’s research activity will be pivotal in finding new and better ways of preventing illness and delivering care, ensuring that Greater SwagÖ±²¥ continues to be at the leading edge of health innovation, care and treatment.”

Over the next five years, the ARC will focus research on helping older people to stay healthy for longer, supporting people with mental health problems, making better use of technology, organising services to address local needs and ensuring services are sustainable. This will be underpinned by expertise in evaluation and implementation science.

SwagÖ±²¥'s , Director for the NIHR ARC Greater SwagÖ±²¥, said: “Through the ARC, we will deliver excellent research that addresses key challenges, as well as supporting professionals to translate this into practice. Our broad research themes reflect the specific priorities of Greater SwagÖ±²¥ and build on our exceptional research capabilities.

“We will work with our partners to translate their priorities into answerable research questions, ensuring that our jointly-produced research is relevant, useful and applicable to local service needs and affects policy and practice within GM and beyond.”

The ARC builds on the work undertaken by the current NIHR Collaboration for Leadership in Applied Research in Health and Care () Greater SwagÖ±²¥, which has carried out applied research and supported its impact in practice over the last six years. This includes improving care for people after a stroke, supporting carers of those requiring end of life care, developing improved access to primary care and improving complex wound care in the community.

Professor Ruth Boaden, Director of the NIHR CLAHRC Greater SwagÖ±²¥, said:

“I’m delighted that the ARC will continue to develop the work of the CLAHRC. It’s great to see how the ARC’s priorities will be aligned to the evolving needs of our local population in Greater SwagÖ±²¥. CLAHRC GM is leaving a proud legacy of new knowledge and resources addressing some of the biggest challenges in health care; as well as great relationships, and the development of research skills and capacity among our partners. I am sure that the ARC will be able to build on this excellent work when it starts in October.”

will be the host NHS provider of the ARC and the University of SwagÖ±²¥ will be the host academic institution.

SwagÖ±²¥ has been awarded funding for two Policy Research Units to explore how the health needs of the ageing population are to be met and to investigate how health and care systems and commissioning will look in the future.

The £10m funding from the is designed to ensure that the government and arms-length bodies have the best possible information and evidence available when making policy decisions about health and social care.

One of the Units, led by SwagÖ±²¥ with Newcastle University and the London School of Economics will focus on Older People and Frailty. The researchers will work closely and flexibly with policy makers on and the needs of this population and the people who provide care for them. This includes patients, carers and the public who will be part of the team throughout.

The work will be arranged in themes, such as the impact of population change on health and social care; links between frailty, disability and multiple conditions; long-term and end-of-life care; use of technologies; personalised care; self-care and healthy ageing.

There are also some issues that are so important or influential, they will be considered in every aspect of the research. These include social inequalities, experiences of family and other carers, current financial constraints, Brexit and how best to commission services for the future.

, Director of the Older People and Frailty PRU at SwagÖ±²¥, said: “The funding of this research unit offers a huge opportunity to improve the health and wellbeing of older people and those with frailty.

“We have brought together world-leading researchers who will dedicate themselves to advancing policy-related research so as to make a real difference by working with the Department of Health and Social Care to promote healthy ageing.”

The other Policy Research Unit has been renewed and has been working on the issue of Health and Care Systems and Commissioning since 2011. It will receive a further £5 million over the next five years and will also include the University of Kent and the London School of Hygiene and Tropical Medicine.

Its research focuses upon the structures and organisation that underpin how the health and care systems work. This includes evidence summaries explaining what we know about how services should be planned and paid for, research exploring how GP services are working and the pressures that GPs experience and research into how different payment mechanisms affect how organisations behave.

Deputy Director of , said: “Seventy years after its establishment the NHS is in a time of transition, with welcome additional funding providing opportunities to integrate services across the health and social care landscape.

“Our research will be at the cutting-edge of these developments, ensuring a strong evidence base to underpin the development of new approaches to service delivery.

“SwagÖ±²¥ has a growing reputation for policy-related research, and this new investment by the Department of Health and Social Care provides an excellent opportunity to extend and develop our research and engagement with the policy process.”

New research led by University of SwagÖ±²¥ data scientists reveals that primary care funding in England is not distributed according to local health needs.

GP practices in London where the population is relatively young, they say, receive disproportionately more funding, despite dealing with the lowest level of health needs in the country.

London, they calculate, has a median of 0.38 health conditions per patient based, on a measure of 19 well-recorded chronic conditions.

In contrast, the North East and North West of England have 0.59 conditions per patient and 0.55 conditions per patient, the highest and second highest health needs in England respectively.

The median for England is 0.51 health conditions per patient.

Both regions receive considerably lower funding per patient than they should, especially the North West, according to the research team from The Universities of SwagÖ±²¥, York, Keele, Michigan and Dundee. This is particularly relevant for Greater SwagÖ±²¥ and its devolved health and health social care spending, which is estimated to be £2bn in deficit by 2020, on current trends.

The team also reveal that when health care needs, deprivation and age are taken into account, rural areas receive £36 more compared to urban areas, per patient each year.

The £36 figure is more than a quarter of the median annual primary care spend per patient in England, which was £134 in 2015-16, excluding the cost of prescriptions and drug dispensing.

Practices in rural England tend to look after an older but relatively healthier, more affluent and smaller population, they say, while enjoying similar levels of staffing, when compared to the more hard-pressed practices in urban areas.

The study, led by SwagÖ±²¥’s Professor , is the first to evaluate if primary care funding in 2015-16 matched health care needs at geographical areas with an average of 1500 people.

The team examined data from 7,779 GP practices in England, covering 56,924,424 people, over 99% of the population registered with primary care, and publish their findings in the journal BMC Medicine today.

To measure health needs, the team created a chronic morbidity index (CMI), calculated as the sum of 19 chronic condition registers in the Government’s 2014-15 Quality and Outcomes Framework, divided by the total practice population.

By linking funding per person with the overall health needs for the 19 conditions, the researchers say the current funding arrangement for GP practices – known as the global sum allocation or Carr-Hill formula – is unreliable and out of date.

The formula, they argue, may excessively favour practices in rural areas, while patient need - one of the factors on which payment adjustments are made- is based on a single dimension of morbidity - Long-Standing Illness - from the 1998-2000 Health Survey for England.

Numerous calls have been made over the last decade for the formula to be reviewed, and it is expected to be reviewed by the Government this year.

Professor Kontopantelis said: “If as a society we want a healthcare system which is fair, then we must fund it according to need, and ideally account for the impact of deprivation.

“This study shows that the current allocation of resources to primary care does not do that.

“The strength of the study lies in the quality of the databases and their sizes. We investigated the whole of England: that’s over 55 million people served by a universal health system.”

Tim Doran, Professor of Health Policy at The University of York, said: “The present funding formula does not provide an equitable distribution of resources across the NHS. It is especially unfair to the North West and North East of England.

“The Carr-Hill formula, which is used to allocate NHS funding, is based on a range of data, some of which are inaccurate, unrepresentative or out of date. As a result, the formula does not accurately reflect the health care needs of local populations.

“New data sources could provide a fairer allocation of resources.”

The study was partially funded by the Medical Research Council.

The paper is called “”

Graphics:

• Map showing Ratio of Chronic Morbidity Index (measure of health needs aggregated between 19 chronic conditions) over average primary medical care spending per patient (x1000), 2015-16
• Map showing chronic morbidity index for England 2014 to 15
• Scatter plot of average primary medical care spending for 2015-16 by the chronic morbidity index (top) and the 2015 Index of Multiple Deprivation (bottom), across English regions

The primary unit of analysis was the Lower Layer Super Output Area (LSOA) in England: 32,844 administrative units of geography with an average population of 1,500

Deprivation was measured though the 2015 Index of Multiple Deprivation (IMD).[23]

To measure the morbidity burden the team created a chronic morbidity index (CMI), calculated as the sum of 19 chronic condition registers in the 2014-15 QOF, divided by the total practice population.

NHS payments to general practices for 2015-16 were reported by NHS Digital, covering all centrally managed payment schemes and also the decentralised Local Enhanced Services scheme

New figures compiled by University of SwagÖ±²¥ researchers have revealed that one fifth of practising GPs in England trained abroad and typically work in the country’s most deprived communities.

The team, based at the University’s , say overseas GPs often support the most deprived communities, work longer hours, treat more patients, but are paid less than their UK-qualified counterparts.

Uncertainties about future immigration policy caused by Brexit could impact on the retention and replacement of foreign trained GPs - even from outside the EU - in an NHS already hit by a chronic shortage, they add.

The study, published today in by BioMed Central and jointly funded by the Medical Research Council and the NIHR, reveals that 4.1% of UK GPs were trained in the EU. The figure rises to 17% for doctors trained outside the EU.

The team draw their data from more than 90% of England’s GP surgeries.

Recent figures from the Department of Health show that just 2,700 GPs were recruited in 2016, far below their target of 3,250.

Lead author from SwagÖ±²¥, said: “The NHS is already facing such a major GP crisis that in 2015 the Secretary of State for Health promised to increase the number of GPs by 5,000 by 2020.

“But given that the current workforce is ageing, it takes ten years to fully train a GP and current recruitment figures are down, it seems extremely unlikely these targets will be met.

“Overseas doctors have always been part of the solution and have provided a valuable remedy to the shortage of GPs in England, this needs to be acknowledged by policy makers and our politicians.”

Senior author , from SwagÖ±²¥, said: “Health services are under threat due to hardening public attitudes to immigration which have been enabled by Brexit. This may be a big blow to an already in crisis English primary care service and needs to be addressed urgently.”

He added: “Foreign trained doctors are a marginalised and stigmatised group of doctors, who need proper professional support. Overseas qualified doctors should be seen as part of the solution to the GP recruitment crises – as our analysis shows they play a critical role in the delivery of NHS GP services, working in the most deprived areas but providing high quality care”

The paper goes on to highlight the inequalities facing foreign doctors by revealing that despite achieving similar patient outcomes to their UK-trained equivalents (and after adjusting for academic ability) foreign doctors are more likely to fail postgraduate exams and be disciplined by their employers.

Dr Aneez, Esmail said: “Overseas doctors have less experience of the NHS and of UK GP training, understandably they need more time and support to prepare for exams and the delivery of UK primary care services. Unfortunately, GP training time is restricted by the GMC and the RCGP meaning non-UK qualified doctors face an uphill struggle from the outset.

“Rather than tightening immigration policy the Department of Health should do more to support and harness international talent in alleviating the growing GP crisis.”

The team urge the Government to see overseas-qualified doctors as part of the solution to the GP recruitment crisis.

Radiotherapy treatment for lung cancer could have a negative effect on the health of your heart new research has found.

Scientists from SwagÖ±²¥’s Division of Cancer Sciences and The Christie NHS Foundation say it could reduce survival rates in those receiving the therapy by up to 20 per cent.

Radiotherapy plays a major role in curative-intent treatment of lung cancer and advances in radiation technology have enabled doses to be delivered to a larger proportion of patients. However, over the past two years, evidence has emerged showing radioactivity of the heart from radiotherapy is increasing mortality rates.

Dr Alan McWilliam, who led this research which is publised in the , says: ‘The effect of radiation on the heart for patients treated with radiotherapy is not well understood at all, that is why we have carried out this initial study.

‘We found that the radiation may cause an extra burden on the heart and even small amounts of radiation may have an effect. We have identified the top of the heart in particular as a dose-sensitive region, where excess dose results in poorer patient survival.’

Patients receiving a higher dose of radiotherapy to this region of the heart have a 20% higher risk of early death than those getting a lower dose he says. One of the key reasons for such high numbers in lung cancer patients is that their tumours can often be much closer to the heart than other forms of cancer. This means some radiation will inevitably hit the organ, having an adverse effect.

Patients receiving a higher dose of radiotherapy to this region of the heart have a 20% higher risk of early death than those getting a lower dose he says. One of the key reasons for such high numbers in lung cancer patients is that their tumours can often be much closer to the heart than other forms of cancer. This means some radiation will inevitably hit the organ, having an adverse effect.

Dr McWilliam added: ‘This is especially true when compared to other patients groups, such as breast cancer and lymphomas, who are also usually younger and healthier than those suffering with lung cancer. These are patients who have poor cardiac health and conditions such as heart disease which also contribute to the problem.’

The researchers analysed 1100 patients, looking at where in the heart there was radiation and how long the patients survived.  They identified that the top of the heart in particular as being more sensitive to radiation than the body of the organ.

The testing showed a highly significant region across the base of the heart, where higher doses were associated with worse patient survival.

To carry out the study, a high-resolution, normal-tissue dosimetric analysis was performed. This helped identify regions in the heart that correlated with poorer survival. However, the team’s research and analysis only highlights the top of the heart as important. The next step is to further this work and do clinical studies to investigate clinical causes and ways to combat the issue.

 is one of SwagÖ±²¥’s - examples of pioneering discoveries, interdisciplinary collaboration and cross-sector partnerships that are tackling some of the biggest questions facing the planet. #ResearchBeacons

Reference: The paper 'Radiation dose to heart base linked with poorer survival in lung cancer patients' was published in European Journal of Cancer. DOI: . Alan McWilliam, Jason Kennedy, Clare Hodgson, Eliana Vasquez Osorio, Corinne Faivre-Finn, Marcel van Herk

A groundbreaking talking treatment has been developed and successfully trialled with a group of Black and minority ethnic (BME) schizophrenia service users, carers, community members and health professionals.

Dr Dawn Edge from SwagÖ±²¥ led a team that developed the model in a study funded by the National Institute for Health Research (NIHR) which she says could be a breakthrough for BME patients whose mental healthcare is both sub-optimal and costly for the NHS.

The new therapy, called Culturally-Adapted Family Intervention, or ‘CaFI’ for short, emerges in the context of decades of poor engagement between Black communities and mental health services.

People of African-Caribbean origin, including those of ‘Mixed’ heritage, are nine times more likely to be diagnosed with schizophrenia than White British people. Black Africans’ risk of diagnosis is six times greater. 

Having tried the new therapy, service users, carers, therapists and service providers reported improved symptoms and better understanding and communication between patients, families, and services.

Dr Edge, a Senior Lecturer who is also the University of SwagÖ±²¥’s Academic Lead for Equality Diversity and Inclusion, says racism, discrimination, adversity and alienation are key contributors to the problem.

She said: “People from BME communities tell us that the constant stress of racism and surviving in often hostile environments can make trigger mental illness. 

“Moreover, when a Black person is experiencing psychological distress, mental health services are often unable to distinguish between their responses to everyday stressors and illness, compounding the problem.

“Not surprisingly, African-Caribbeans and people from other BME backgrounds are often reluctant to engage with mental health services as they do not think they will be understood or treated fairly. 

“In consequence, they tend to come into contact with services much later in their illness, often in a state of crisis, involving the police and being ‘sectioned’ under the Mental Health Act.  Once in services, their care is more likely to be coercive than White British peoples.

“For example, Black patients are much more likely to be held in seclusion, forcibly given medication and regularly readmitted.

“On average, they remain in hospital twice as long as White British people and are more likely to be discharged on costly Community Treatment Orders (CTOs).”

Dr Edge added, “We have demonstrated that it is possible to develop this treatment and to improve African-Caribbean patients’ and families’ engagement with mental health services. 

“We now need to test CaFI nationally to see if it delivers better outcomes and is cost-effective in comparison to usual treatment.

“This is the first time that a psychological therapy, specifically designed to meet the needs of this community, has been developed, which is intriguing given that this is one of the most long-standing challenges facing mental health services.

“To me, equitable access to effective mental healthcare is a social justice issue. Moreover, family-focused psychological care makes good economic sense. It reduces NHS and social care costs not just for service users but also for carers.”

The research to develop and test the new treatment was conducted over three years at Greater SwagÖ±²¥ Mental Health NHS Foundation Trust. 

CaFI was trialled with 26 family units, of which 24 completed all 10 therapy sessions. Half the service users who took part had no contact with their families –and were given the support of ‘care coordinators, friends or community members from a range of ethnic backgrounds 

The research findings and future plans will be presented at an event to mark the end of the study and celebrate the involvement of the African-Caribbean community on 8 September at the Amani centre, Moss Lane East, SwagÖ±²¥, M16 7DG.

The full video is availanle

Scientists from SwagÖ±²¥ have discovered how to predict worsening frailty in men over the age of 40.

, a Clinical Research Fellow says frailty in men is less likely to get worse in 4 years if they have higher levels of the anabolic hormones vitamin D, insulin-like growth factor-1 (IGF-1) and its binding protein 3 (IGFBP3).

Also linked to a lower likelihood of frailty getting worse is higher levels of the hormone DHEA-S, but only in men older than 70, she found.

The research, published in the , could allow early identification of men who are at high risk of developing or worsening frailty.

Frailty is the gradual loss of energy, strength and physical capability that can come with aging and often leads to dependency, disability and death.

Dr Swiecicka said: “Decline in muscle mass and strength are thought to be key factors in the development of frailty however, what predisposes some elderly people to become frail and not others is unclear.

“With the aging population, frailty-related problems present an increasing challenge to health care systems worldwide.

“So the discovery that certain anabolic hormones can help predict changes in frailty could have important implications in terms the development of new treatments and prevention strategies.

“It is important to stress that clinical trials will be required to find out if supplementing these hormones to middle aged and elderly men could prevent the development of frailty.”

The study examined the relationship between certain anabolic hormone levels and changes in frailty status over 4 years among men who took part in the European Male Aging Study.

With an increasingly ageing populating, this study helps with understanding what may cause people to develop frailty, with a view to being able to identify individuals who may benefit from preventive strategies.

The Commission of the European Communities: Fifth Framework Programme funded EMAS. Additional financial support came from Arthritis Research UK, NIHR and SwagÖ±²¥ Biomedical Research Centre.

A scheme launched by the Department of Health in 2011 to help patients stick to their drug regimens has been so successful, that in its first five years, it will save NHS England £517.6m  in the long-term, a team of health economists has found.

Lead researcher from SwagÖ±²¥ says – a free scheme where community pharmacists help patients take new medicines  - has improved medicines adherence by 10%.

The study was conducted by experts at The Universities of SwagÖ±²¥, Nottingham, UCL and a Patient and Public Representative.

Even in the short term, say the team, the scheme –where pharmacists are paid £24.60 each time they look after a patient as part of NMS has saved the NHS £75.4m.

The team used self-reported adherence at 10 weeks, considered the minimum time required to demonstrate behavioural change in a sample of 503 patients.

She said “On the basis of the evidence we have gathered for this research, we strongly  recommend that NMS should continue to be commissioned in the future.

“Our study suggests NMS  increased patient medicine adherence compared with normal practice, which translated into increased health gain at reduced overall cost.

“This is a simple intervention which has been popular with community pharmacists and patients, and is transferable into most therapeutic areas.

“Some medicines, for example,  can have early adverse effects but they subside over time such as anti-depressants.

“And we also believe these findings are likely to have applicability to other health care systems, including those based on insurance.”

From inception of the NMS to the end of August 2016, 3.59 million consultations have been claimed for with over 820 000 in the year 2015/16 – according to the researchers.

Of 11,495 community pharmacies in England, 91.2% had delivered the NMS to at least one patient between November 2011 and January 2014, according to NHS Business Services Authority.

She added: “These are significant  benefits for two reasons because so many patients have experienced the service. 

“We also think our figures are probably on the conservative side given probable patient recruitment bias, use of self-report of adherence, and the assumption that all the patients in the intervention arm actually received the NMS.”

Non-adherence is common in diseases such as chronic obstructive pulmonary disease where only 33% of patients continue their drugs after 10 weeks. In  schizophrenia the figure is  52%,  asthma: 67%; and diabetes 78%.

According to previous research, the costs to NHS England of non-adherence is over £930 million per year  in just five diseases: asthma, type 2 diabetes, high cholesterol/coronary heart disease, hypertension and schizophrenia. 

To tackle the problem –which causes reduced quality of life, increased hospitalisations and premature deaths -  the Department of Health launched  the service six years ago.

The open access paper, ',' was published in PharmacoEconomics. doi: 10.1007/s40273-017-0554-9

Dying early (under age 75) is 20% more likely in northern compared with southern England according to research led by SwagÖ±²¥:

• 1.2 million more early deaths in the North from 1965 to 2015

The study uncovers a North-South divide in deaths among middle aged adults, which has been rising since the mid-90s and is now at alarming levels:

• 49% more deaths among 35-44 year olds in the North in 2015
• 29% more deaths among 25-34 year olds in the North in 2015

The team shows that a sharp increase in premature deaths among middle aged adults in the North first emerged in the mid-90s, increasingly quickly but consistently until the end of the study period in 2015.

The study used data from the Office of National Statistics on the whole English population from 1965 to 2015. It was supported by at SwagÖ±²¥ which is part of and funded through a consortium of ten partners led by .

Published today in the BMJ’s , the news raises questions over the effectiveness of government policies and billions of pounds of public investment designed to tackle the problem.

Lead researcher, from SwagÖ±²¥ said: “Five decades of death records tell a tale of two Englands, North and South, divided by resources and life expectancy – a profound inequality resistant to the public health interventions of successive governments.”

“A new approach is required, one that must address the economic and social factors that underpin early deaths, especially in younger populations, and one that focuses on rebalancing the wider economy to help drive investment in northern towns and cities.

“The devolution of centralised powers may enable civic leaders to seed the economic growth to tackle this divide, but only if they are given the proportionate northern weighting of funds to do so.”

Co-author, Prof Tim Doran from the University of York added: “These important findings were made possible by examining public health data – held by the NHS and other agencies – dating back decades. The data, technology and skills now exist to better understand population health and develop public policies to improve it proportionately.”

SwagÖ±²¥ is a member of the Northern Health Science Alliance (), a partnership of universities and NHS organisations driving innovations in health science and business growth in the region through initiatives such as the programme. SwagÖ±²¥ed Health Cities is a flagship NHSA project to harness regional data and advanced digital technologies for health science and care.

Chief Executive of the NHSA, Dr Hakim Yadi OBE, said: “Health inequalities between the North and South of the country must be addressed by government as a priority.

“The NHSA wants to harness the North’s huge potential in health innovation and life sciences for the benefit of its 15 million population. Research conducted by demonstrates the government invests much less in health research funding in the North of England than in the South, despite the huge need, as demonstrated by this research, to address inequalities”.

“The Life Sciences Industrial Strategy is one way in which to make the investment needed to readdress the health inequalities these figures so starkly demonstrate.”

A blog post on this study by Professor Iain Buchan is available on the website.

The paper, ‘’ was published in the Journal of Epidemiology & Community Health.

DOI: 10.1136/10.1136/jech-2017-209195

In hospitals, such events, known as ‘Never Events’, include operations where something went wrong (e.g. wrong limb amputated) or inadvertent administration of drug overdoses, already require mandatory reporting in hospitals. However, Never Event lists are currently not used in GP settings. A team of NIHR-funded researchers from SwagÖ±²¥ and NHS Education for Scotland wanted to see if there was any merit in developing and implementing a similar system specifically for general practice.

A survey including the list of ten potential Never Events devised by NHS Education for Scotland, was sent to a sample of GP surgeries in SwagÖ±²¥ and across Scotland, with 556 GPs in 412 practices responding.

The study, published in the Journal of Patient Safety, aimed to:

• assess the annual frequencies of the proposed ten Never Events as estimated by UK GPs
• explore the extent to which the approach is acceptable to GPs
• examine the relationship between GP’s opinions and estimates and the characteristics of the GPs and their practices.

, one of the study authors said: “We found a very different set of circumstances in GP surgeries compared to hospitals, as critical events build up incrementally over time, can arise from many settings and consequences are complex and difficult to measure systematically.”

“We suggest that the Never Events that occur more often might be useful to monitor safety in general practices and the Never Events that rarely occur could be useful for surveillance in a similar way as in hospitals.”

The study was funded by and .

‘. Journal of Patient Safety. doi: 10.1097/PTS.0000000000000380

Twenty one of the world’s leading pharmacologists have urged drugs companies and governments to help change the way the medication is dosed by signing up to a ‘roadmap for  change’.

Professor Amin Rostami from SwagÖ±²¥ – who led the move – says the NHS is slipping behind other healthcare systems in terms of dosing medicines according to individual needs.

That, he argues, costs the NHS millions of pounds, adversely affecting outcomes and patient care in areas as diverse as oncology, paediatrics, heart failure and renal failure.

According to Professor Rostami, who is also Chief Scientific Officer for biosimulation company Certara, advances in science mean a one size fits all approach is outdated.

Each patient, he argues, requires accurate individual dosing, according to their individual genotype, phenotype, body chemistry, weight, social circumstances, time of day, diet and other personalised factors.

But because drugs are dispensed in standardised units, this is done hardly anywhere in the NHS, says Professor Rostami.

The roadmap is outlined in a paper published in the journal Clinical Pharmacology and Therapeutics. The idea was first mooted at a healthcare summit in 2016, held in SwagÖ±²¥.

He said: “It’s difficult to accurately calculate the cost to patients and the NHS, but there is no doubt the figures are significant so there is an urgent need to bring drug dosing into the 21st century.

“Because science has advanced so much nowadays, patients can be dosed far more accurately, relatively easily.

“But though precision dosing is possible in most therapeutic areas, it is more or less not happening anywhere in the NHS.”

He added: “We feel there is no overall strategy for health care in precision dosing and certainly a disconnect between academic research and clinical care in this area.

“There needs to be a regulatory system in place. Funding bodies should put more emphasis on cost analysis. There has been little involvement of UK policy makers.

“NHS investment in precision dosing will save millions of pounds in the long run, as well improve outcomes and patient care.”

Dr Adam Darwich, also from SwagÖ±²¥, has developed computer models on drug absorption after weight loss surgery.

The models have been used in some research centres across the world to predict drug exposure in patients before clinical data is produced and to help inform clinical trial design.

He is now to focus on the challenge of bringing personalised dosing models into health care for a range of conditions.

He said: “Our research demonstrates that it is possible to achieve personalised dosing in healthcare.

“Many of the tools to enable this already exist, the main challenges are to do with how we can practically incorporate these into healthcare and test cost-benefit in clinical practice.”

Highly effective current treatments for vision loss need to be allied with careful counselling to ensure patients maintain good psychological health as well as good vision, new research recommends.

wAMD is the commonest cause of vision loss in the western world, but modern treatments have dramatically improved the level of vision patients can expect to retain. These treatments involve regular injection of vascular endothelial growth factor inhibitors (anti-VEGF) into the eye.

However, a new study conducted at SwagÖ±²¥ Royal Eye Hospital and published in the , demonstrates high levels of undiagnosed anxiety and depression persisting in patients receiving treatment, despite their improved visual outcomes.

SwagÖ±²¥ researchers say that the study findings demonstrate the value of human interaction between clinician and patient in offering reassurance around the efficacy and safety associated with anti-VEGF injections.

, Senior Lecturer in Ophthalmology at SwagÖ±²¥, Consultant Ophthalmologist, at Central SwagÖ±²¥ University Hospitals NHS Foundation Trust (CMFT), and lead author of the study, said: “There have been amazing scientific achievements in diagnosing and treating serious eye diseases, such as wAMD, which have revolutionised our ability to reverse life-changing vision loss. However, we must not forget the human element when applying all this to ensure all our patients can reap the full benefits of this cutting-edge science.

“This study represents one of the largest and most detailed examinations of patients undergoing anti-VEGF therapy to date. It helps us understand how factors such as patients’ understanding and building strong relationships with healthcare professionals may help alleviate anxiety around receiving injections.”

The report suggests that patients may benefit from additional assurances from clinical staff regarding; success rates in halting disease progression with anti-VEGF therapy, how it can reduce the risk of becoming blind in the future, and the low likelihood of serious problems occurring following the injections.

Dr Hugo Senra, the Clinical Psychologist who conducted the study, said: “This study also highlights the importance of considering specialised counselling for certain wAMD patients. Literature has shown that tailored psychological and psychosocial interventions can be effective to reduce anxiety and depression in wAMD patients, and contribute to their adjustment to illness and medical treatments.”

The research found as many as 89% of patients who showed anxiety, and 91% who showed depression were not receiving appropriate psychological and psychiatric treatment.

Although levels of depression reduce once anti-VEGF therapy is established, doctors should be vigilant to such symptoms and their potential to impair quality-of-life. Use of standardised tools to screen wAMD patients for symptoms of anxiety and depression in the macular treatment unit could better help identify patients at risk. Further research and controlled trials will be needed to better understand anxiety and depression in wAMD patients and develop new intervention tools at patient and clinical level to reduce symptoms and improve quality-of-life.

This study was supported by the National Institute for Health Research (). It was also funded by a grant from , in order to support the ophthalmology community in transforming care and supporting people living with retinal conditions.

Dr Jackie Napier, Medical Director for Ophthalmology at Bayer, said "At Bayer we are dedicated to working in partnership with the ophthalmology community to help transform lives, and an important element of this is working together to improve the holistic support that is provided to patients, carers and their families. We are proud to support this study, which is one of the first of its kind in the UK to investigate the experience of patients with wet AMD receiving anti-VEGF therapy. This type of research can help shape improvements in patient education and support, and thus enable people with wet AMD to get the most from their treatment."

The article 'Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration', by Hugo Senra, Konstantinos Balaskas, Neda Mahmoodi, Tariq Aslam (), appears online at , published by .

People taking a common rheumatoid arthritis medicine are not at increased risk of liver damage if they stick to 14 units of alcohol a week or fewer, a new study from SwagÖ±²¥ has found.

Methotrexate is a drug taken, often over long periods of time, to limit or prevent joint damage and disability. People who take methotrexate are often advised to abstain from alcohol as both methotrexate and alcohol are known to increase the risks of liver damage. However, it is not known whether drinking modest amounts of alcohol is safe during methotrexate therapy.

The new study by SwagÖ±²¥, published in the journal Annals of the Rheumatic Diseases and funded by , has drawn upon the medical records of almost 12,000 people with rheumatoid arthritis taking the drug who had a record of the levels of alcohol they drank and who had routine blood monitoring test results.

The researchers found that increased use of alcohol did indeed correspond to increased liver damage, but at 14 units or fewer there was no heightened risk.

Dr Natalie Carter, Head of Research Liaison and Evaluation at Arthritis Research UK, said: “We know that methotrexate can be an effective drug for treating arthritis. As it can interact with other medicines and alcohol it is important that people with arthritis have information about their medication in order to manage their arthritis safely and effectively.

Arthritis Research UK invests in exceptional science to find treatments and information that let people push back the limits these conditions cause. This research adds to the knowledge we have around methotrexate and its effects in people with rheumatoid arthritis, which can help people make informed decisions about their treatment. We would recommend that people who take methotrexate to speak to their rheumatologist for advice about drinking alcohol whilst on this drug.”

, an NIHR Clinical Lecturer at SwagÖ±²¥’s , led the study. She said: “In the past there’s not been clear guidance on what effects different amounts of alcohol have on these people, so doctors often err on the side of caution and recommend abstinence.

“As a result, some people choose to decline methotrexate so they can continue to enjoy a drink, thereby missing out on the possible benefits of the medication. Alternatively, some people may go totally without alcohol after starting methotrexate: if they like to drink in moderation, the quality of their life may be affected.”

With a pint of 5.2% ABV beer containing three units and a 250ml glass of 14% ABV wine containing 3.5, the findings show that people can drink in moderation, while still benefitting from the drug.

The data used in the study came from the , a UK general practice database. The researchers identified 11,839 people with rheumatoid arthritis who were taking methotrexate and had at least six liver function test results per year. Of these, 530 developed abnormal liver function tests.

Although there was no increased risk associated with drinking 14 units or less compared to people who drank no alcohol, people who drank 15-21 units had a 33% increased probability of liver damage and this rose to 81% in the group that drank more than 21 units.

, Director of the Arthritis Research UK Centre for Epidemiology at SwagÖ±²¥, who is also a rheumatologist at Salford Royal NHS Foundation Trust, believes that the results can provide important guidance for doctors who are prescribing methotrexate.

Paper: , Jenny H Humphreys, Alexander Warner, Ruth Costello, Mark Lunt, Suzanne MM Verstappen, William G Dixon. Published in the Annals of Rheumatic Diseases.

People who come to hospital after self-harm are unlikely to be helped by the use of risk scales when they see mental health staff, according to new research published in the British Journal of Psychiatry.

The study, led by from SwagÖ±²¥ and funded by a NIHR Programme Grant for Applied Research (), casts a critical light on the use of risk scales as part of assessments for people with self-injury or self-poisoning, a major problem in the UK.

Risk scales, they find, are no better at identifying who will go on to self-harm again than asking a clinician or patient a single question about how likely they think a repeat episode is to occur.

Good quality assessment and treatment of people who present to hospital after taking an overdose or injuring themselves is a core part of clinical practice and can help reduce risk of repeat self-harm and even suicide.

Clinical checklists or scales to predict risk are more controversial but they remain in widespread use.

Scales typically collect information on a range of risk factors such as age, sex, previous self-harm, psychiatric treatment, and the method of injury.

The research team investigated the use of risk scales in actual practice: several widely used scales were compared to patient and clinician estimates of risk.

Nurses and psychiatrists carried out risk assessments in 514 patients referred to psychiatric liaison services following self-harm in five large hospitals in England.

Overall, 145 patients (30%) repeated self-harm within six months. The scales, they discovered, were generally poor at predicting repeat self-harm.  The single item clinician and patient questions outperformed the other risk scales, including the widely used, ´SAD PERSONS Scale´.

However, the researchers concluded that even clinician and patient ratings of risk were not good enough to be used in practice because they would miss nearly 20% of repeat episodes and over half of people identified as being at high risk, would not go on to repeat self-harm.

, the project manager and main researcher on the project explained: “Our earlier research showed that scales are widely used in hospital services despite controversies over their use. This study provides robust evidence that they have limited clinical utility following self-harm and are probably unhelpful. The use of scales in assessments may actually damage the potential for the patient and clinician to collaboratively assess the risk of future self-harm and determine appropriate care plans.”

Professor Kapur added: “The NICE guideline on the longer-term management of self-harm is clear. It suggests that risk scales should not be used to predict risk of repeat self-harm or determine patient management. Our previous work suggested services across the country were not following this guidance. This study confirms that the notion of risk assessment as risk prediction is a fallacy. Instead of being preoccupied with scores on a scale we should be focussing on doing the simple things well and providing high quality care.”

The paper, '', was published in the British Journal of Psychiatry. DOI: 10.1192/bjp.bp.116.189993

A £6.7 million financial boost has been awarded to Salford Royal NHS Foundation Trust (SRFT) to create a city-wide early translational patient safety research programme, along with its fellow MAHSC partner, SwagÖ±²¥.

Provided under the (PSTRC) Scheme, this latest award by the Department of Health will be used to fund cutting-edge research by the NIHR Patient Safety Translational Research Centre Greater SwagÖ±²¥ (Greater SwagÖ±²¥ PSTRC) for a further five years.

The winning bid was coordinated by the SwagÖ±²¥ Academic Health Science Centre (), demonstrating the benefits of bringing together clinical and research expertise from across healthcare and academia to deliver both patient safety and patient-orientated, translational research.

The new funding will enable to continue innovative research into patient safety in primary care and across transitional care settings on important issues such as informatics, medication safety and safer care for marginalised groups.

The award builds on the earlier £28.5m investment in SwagÖ±²¥’s Biomedical Research Centre () scheme and the £12.5m investment provided under the NIHR Clinical Research Facility (CRF) scheme, both of which were announced towards the end of last year.

Greater SwagÖ±²¥ PSTRC is a partnership between SRFT and the University of SwagÖ±²¥. It also has strong links with the University of Nottingham, Central SwagÖ±²¥ University Hospitals NHS Foundation Trust (CMFT) and The Christie NHS Foundation Trust (The Christie).

, who is Director of the PSTRC and Professor of Primary Care Research in the Faculty’s Division of Population Health, Health Services Research and Primary Care said: “We are delighted to receive this investment, which will enable us to build on the world-leading research infrastructure we already have in here in SwagÖ±²¥.

“It will be a multi-sector partnership and future facing, aiming to focus not just on patient safety retrospectively, but also ways of predicting and preventing patient safety incidents in primary care and in transitional settings. It will help us create a world leading learning health system that will improve safety and reduce costs.”

Chris Brookes, Executive Medical Director at , said: “Patient safety is at the heart of everything we do. We are committed to ensuring that every patient receives safe, clean and personal care and our work with the Greater SwagÖ±²¥ Primary Care Patient Safety Translational Research Centre contributes greatly to that. This investment will enable us to carry out further work across our integrated healthcare systems.”

Public Health and Innovation Minister, Nicola Blackwood said: “SwagÖ±²¥ has huge potential to shape global medical research and this Government is backing this talent by investing heavily in their medical research capabilities. We hope this will improve the lives of people in SwagÖ±²¥ and, in fact, people across England.

“We want every patient to receive the best and safest NHS treatment and care as possible. Investing today in research to improve patient safety is essential for making the NHS the best today, and for tackling the challenges of tomorrow. SwagÖ±²¥ is one of the leading places in the UK for cutting edge health research and our investments through the NIHR will help our researchers strive for global excellence.”

, MAHSC Director and Vice-President and Dean of the Faculty of Biology, Medicine and Health at the University, added: “This welcome funding boost is as a result of the joined up approach to health care research and services that is a major strength of the Greater SwagÖ±²¥ region. As a result of working across agencies and forming strong partnerships we can deliver projects like this which ultimately benefit the health of people in the region and further afield.”

Fewer doctors are choosing to train in acute hospital specialties as a result of turbulence surrounding last year’s junior doctors' contract, according to an academic survey.

The study was carried out by researchers at SwagÖ±²¥’s Division of Population Health and Economics, supported by staff at the UK Foundation Programme

It was funded by the National Institute for Health Research School for Primary Care Research

Recruitment was supported by staff at UK Foundation Programme Office and regional offices

The study is published in BMJ Open today.

All second-year foundation doctors in England were invited to take part in an online survey, and 819 responded. This represents 12.6% of the population of year two foundation doctors.

These doctors were at a pivotal point where they could apply for a specialty training (ST) programme leading to their preferred future career.

Email invitations to take part focused upon choice of career and did not refer to contractual issues. In addition, the team carried out 20 qualitative interviews to explore attitudes and experiences in more detail.

Respondents were asked if their career decision had been affected by recent uncertainties and proposed changes in contracts for junior doctors.

The survey did not ask any wider questions about the terms of the contract, nor did it address broader attitudes to the contract dispute. Interviews explored the factors which were affecting career choices.

On completion of two years of Foundation Programme training, doctors can progress directly to a specialty training programme, switch to a different ST programme, defer decision or entry to an ST programme, or quit medical work.

Of the sample, 64% attributed no career choice changes to the contract.

However, contract issues lay behind 11% changing specialty, 9% deferring application and 5% leaving the UK, with the remaining 11% indicating some combination of the 3.

In addition, about 20% said that as a result of the contract they were uncertain about whether or not to switch specialty training programme.

Among the 819 survey respondents, those who chose to switch specialty training because of contract-related issues were less likely apply for hospital work (16.5%) and more likely to apply for community-based posts (30.1%) - mostly general practice.

The proposed new contract for junior doctors applying for training posts in hospital and community-based specialties in England was associated with an extended period of negotiation and uncertainty about the outcome.

Dr Sharon Spooner from SwagÖ±²¥ says many doctors do not go on to take specialty training posts immediately after they have completed their five year degree and two year Foundation Programme training.

Dr Spooner said: “From 2011 to 2015, the proportion of doctors not proceeding directly from Foundation training to specialist training increased from 29% to 48%.

“And it’s also clear that the recently implemented junior doctors’ contract has had an impact on an already worrying situation.

“Our survey shows that some newly qualified doctors have altered their career plans as a result of the contract.

“Junior doctors also reported feeling under-valued in the NHS, and were concerned that there could be less support during their training. They reported feeling uncertain about their future plans.”

Dr Spooner added: “The NHS is at risk of losing some doctors in training, and uncertainty about their future is a factor in their decision.

“Doctors are aware that their skills have global value, and some are prepared to change their personal and career plans to achieve their goals, including working abroad, and some may leave medical work entirely.”

“These findings are worrying because delivery of services depends on sufficient qualified staff for all roles within the NHS, and retaining doctors in training is an important contributor to this,” she said.

“Understanding the factors underlying career decisions is important in supporting action to improve retention.”

‘’ is published in BMJ Open. DOI: 10.1136/bmjopen-2016-013756

Author and co-authors: S Spooner, Jon Gibson, Dan Rigby, Matt Sutton, Emma Pearson, Kath Checkland - all from SwagÖ±²¥

This research is funded by the National Institute of Health Research School for Primary Care Research (NIHR SPCR).

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website ().

Five blind SwagÖ±²¥ patients will be among the first in the country to receive revolutionary bionic eye implants funded by the NHS.

NHS England will provide funding for further testing of the Argus II, also known as the Bionic Eye, for ten patients with Retinitis Pigmentosa (RP), an inherited disease that causes blindness.

Five of these procedures will take place at the SwagÖ±²¥ Royal Eye Hospital (MREH) from 2017, with the other half at Moorfields Eye Hospital in London.

Surgeons at SwagÖ±²¥ and Moorfields made history by delivering the world’s first trial of the Argus II bionic eye implants in RP . MREH surgeons also performed the first ever bionic eye implant on a patient with age-related macular degeneration (AMD) in 2015.

NHS England will fund this through its Commissioning through Evaluation (CtE) scheme, designed to gather vital evidence for treatments that show significant promise for the future. NHS England will assess how the Bionic Eye helps patients function with everyday tasks.

One of the first implanting surgeons was Professor Paulo Stanga from SwagÖ±²¥ Royal Eye Hospital, University of SwagÖ±²¥ and SwagÖ±²¥ Vision Regeneration (MVR) Lab at NIHR/Wellcome Trust SwagÖ±²¥ Clinical Research Facility. Prof. Stanga, who has played a crucial role bringing the bionic eye to patients on the NHS, says: “I’m delighted that our pioneering research has provided the evidence to support NHS England’s decision to fund the bionic eye for the first time for patients. It surpassed all of our expectations when we realised that one of the RP patients in SwagÖ±²¥ using the bionic eye could identify large letters for the first time in his adult life.”

This news comes just weeks after the Department of Health announced a £12.5m investment into SwagÖ±²¥’s clinical research facilities.  The NIHR/Wellcome Trust SwagÖ±²¥ Clinical Research Facility has provided the dedicated space, specialist staff and equipment to support the Bionic Eye studies, which demonstrated that the bionic eye device restores a degree of visual function to patients who have suffered complete vision loss due to RP. 

“Our work also has the potential to improve the lives of thousands of other patients with the more common condition, age-related macular degeneration – SwagÖ±²¥ is currently the only site in the world to be trialing the bionic eye in AMD”, added Prof. Stanga.

Patients using the system, developed by American company Second Sight Medical Products, are given an implant into their retina and a camera mounted on a pair of glasses sends wireless signals direct to the nerves which control sight. The signals are then ‘decoded’ by the brain as flashes of light.

Grandfather-of-five from Lancashire, Keith Hayman, 68, was one of three people who had been fitted with the bionic eye at SwagÖ±²¥ Eye Hospital by Professor Stanga during a trial for Retinitis Pigmentosa in 2009. He has been blind for 25 years having been diagnosed in his 20s while working as a butcher and was forced to give up work in 1981 when he was registered blind. He says; "Having spent half my life in darkness, I can now tell when my grandchildren run towards me and make out lights twinkling on Christmas trees. When I used to go to the pub, I would be talking to a friend, who might have walked off and I couldn't tell and kept talking to myself. This doesn't happen anymore because I can tell when they have gone. These little things make all the difference to me."

Grégoire Cosendai, VP of Europe for Second Sight Medical Products Inc, said: “Second Sight wishes to congratulate NHS England for this decision to make this truly revolutionary and life-changing technology available for patients. Argus II makes a real difference to blind people. It may be, for some patients, the difference between staying at home alone, or being able to find your way outside. Now this treatment is to be offered free of charge to blind patients in the UK. This is a major victory for blind people in the UK who have supported us in our six-year mission to fund Argus II in England.”

Dr Jonathan Fielden, Director of Specialised Commissioning and Deputy National Medical Director, NHS England said: “This highly innovative NHS-funded procedure shows real promise and could change lives. The NHS has given the world medical innovations ranging from modern cataract surgery, new vaccines and hip replacements. Now once again the NHS is at the forefront of harnessing ground-breaking science for the benefit patients in this country."

Procedures will take place during 2017 and patients will then be monitored for a period of one year, during which they will be assessed on how the implants improve their everyday lives.
 

A Nigerian public health professional has graduated from a world-leading SwagÖ±²¥ course, and she now hopes to use her skills to improve the health of young people in her home country.

Ogochukwu Okoye, a physician and lecturer at Delta State University Teaching Hospital in Nigeria, took the University’s online Master of Public Health course, and wrote her dissertation about the risk of chronic kidney disease in young Nigerians exposed to crude oil - a major concern in the country, as the oil industry has left areas of the Niger Delta heavily polluted.

She now hopes to apply for a grant that will enable her to carry out this research in reality, with the intention of influencing Government policy, improving the local population’s health and instigating a clean-up of the environment.

The University’s Master of Public Health course offers an innovative training approach for public health professionals, or those interested in a career in the area. It equips students with the skills and knowledge to apply to public health concerns at local, national and international level, and the ability to apply theory and scientific principles to practical situations.

The course can be studied entirely online, and most students spread the programme over 3-5 years, remaining in their own country and in employment. Participants come from over 40 countries worldwide, including many in Africa.

"I registered for this course to improve myself in areas of medicine that are key for a wholesome practice," said Ogochukwu. "The team at SwagÖ±²¥ exposed me to a highly effective manner of teaching, thus made learning worthwhile."

“Our programme teaches students to develop a critical evidence-based approach to the discipline of public health.” said Isla Gemmell, a senior lecturer on SwagÖ±²¥’s Master of Public Health Programme.

“Throughout her studies, Ogochuckwu demonstrated a great deal of self-motivation and willingness to learn. She is in a unique position to make a real difference to the health of the population in Nigeria through her research and her teaching.”

If you would like to learn more about the Master of Public Health course, .

Linking GPs’ pay to their performance has no discernible effect on their job satisfaction, a University of SwagÖ±²¥ study of almost 2,000 UK doctors over a four-year period has found.

Based on a belief that income is a key motivating factor, many countries have introduced performance related pay for GPs. In the UK this is known as the Quality and Outcomes Framework (QOF).

There have been concerns that this payment method can have adverse effects on GP morale and the UK scheme has been watered-down and may be withdrawn. But there has been no research to back up this claim. The new findings provide evidence that performance related pay does not reduce morale.

A linked blog by the study authors is available from .

For the first time the University of SwagÖ±²¥ study links levels of payment through the QOF to the GP Worklife Survey (also carried out by SwagÖ±²¥) at three time points – 2004 before the QOF was introduced, 2005 and 2008.

This group comprised 1,920 GPs who were assessed on overall satisfaction and 12 other measures including hours of work and levels of autonomy, recognition and responsibility.

, from the University’s , led the study. He said: “Policy makers have experimented with a number of ways to prevent GPs leaving their jobs, but dropping the link between pay and performance is not one that will work.”

The time-frame covered a point (2004) when GP satisfaction was very low, and the introduction of performance-related pay was one measure that tried to address this. The findings from the year after introduction and four years later in 2008, showed satisfaction had improved across the board and was not related to the proportion of income at risk.

Further changes to QOF were made in 2013, outside of this study period, which reduced the exposure of GPs to performance related pay and returned more to an older model of payment per patient.

Maintaining high satisfaction is an important issue, not just for retaining GPs, but also for ensuring the best possible quality of care is provided.

The authors of the study believe that their findings have important implications for further changes to the source of GP income. “Policymakers should not believe that dropping performance-related pay for GPs will increase their satisfaction,” Dr Allen said.

The paper, ‘’ was published in the journal Social Science & Medicine. DOI: 10.1016/j.socscimed.2016.11.028

Current approaches to dealing with burnouts in doctors on an individual case-by-case basis is not effective and the issue should instead be tackled with organisation-wide initiatives, according to researchers at SwagÖ±²¥ and the University of Southampton.

A meta-analysis study, which brought together the results of previously conducted research, was carried out to explore the effectiveness of interventions in reducing burnout in doctors. It explored the comparison between doctor-directed interventions that target the individual and organisation-directed interventions that target the working environment. The strength of the doctor’s experience and the particular healthcare setting they worked in was also assessed.

The research concluded that while doctor-focused tactics such as mindfulness and cognitive behavioural are important, the greatest success at preventing and reducing burnout in doctors can be achieved through the adoption of organisation-directed approaches such as improved working environment and organisational culture.

Burnout is a major problem in the healthcare industry and is often driven by excessive workload, imbalance between job demands and skills, a lack of job control and prolonged stress. It is a syndrome consisting of emotional exhaustion, depersonalisation, and a diminished sense of personal accomplishment. Importantly, burnout can result in an increase in medical errors, reduced quality of patient care, and lower patient satisfaction.

It was found that organisations that combined several elements such as structural changes, fostering communications between members of the health care team, and cultivating a sense of teamwork and job control tended to be the most effective in reducing burnout. However, such intense organisation-directed interventions were rare and had not been evaluated sufficiently.

What’s more, the evidence indicated that young doctors starting out in their career, are at higher risk of burnout compared to those with more experience, and interventions focused on enhancing teamwork, mentoring, and leadership skills might be particularly suitable for this group.

Dr Maria Panagioti, Research fellow in Primary Care at the University of SwagÖ±²¥ who led this study said: ‘Our findings clearly show that we need more effective intervention models to prevent burnout in doctors. Such models could be organization-directed interventions which promote healthy individual-organization relationships and view burnout a problem of the whole healthcare systems.’

George Lewith, Professor of Health Research at the University of Southampton who supervised the research, said: “This work suggests that if we want to retain safe and professionally competent NHS clinicians working in very demanding front line jobs we need to support their mental and physical health and creating appropriate and enabling working environments for them. Efforts need to be focused on finding appropriate ways of reaching doctors who work in stressful environments to ensure their wellbeing is taken care of. If we don’t patient safety could be at risk.”

The work is published in the JAMA Internal Medicine. To obtain a copy, please email Deanna Bellandi, Senior Public Information Officer Deanna.Bellandi@jamanetwork.org

In a second boost for SwagÖ±²¥ in as many months, a single city-wide bid has been awarded £12.5m by the Department of Health to fund the cutting-edge research space, highly trained staff and specialist equipment required to develop and deliver pioneering new treatments across three NHS sites in Greater SwagÖ±²¥.

This new award is a major achievement for Greater SwagÖ±²¥ Devolution, demonstrating synergy that can only be achieved by bringing together clinical and research expertise from across health and academia to deliver patient-orientated commercial and academic clinical research studies.

It will enable expansion of existing clinical research capacity across SwagÖ±²¥ and is hosted by Central SwagÖ±²¥ University Hospitals NHS Foundation Trust (CMFT) in partnership with The Christie NHS Foundation Trust (), University Hospital of South SwagÖ±²¥ NHS Foundation Trust () and SwagÖ±²¥.

Clinical Research Facilities (CRF) at CMFT, The Christie and UHSM, currently facilitate a total of 6500 visits per year from patients and healthy volunteers involved in research studies. They provide 24-hour, seven-day inpatient and outpatient research services, including those for children and infants, with over 50 research beds and 20 outpatient consultation rooms across Greater SwagÖ±²¥.

SwagÖ±²¥’s unique proposal will make research more accessible to people of all ages and backgrounds across the city region, as well as expanding the volume and types of research undertaken.

In September, the Department of Health announced under its Biomedical Research Centre (BRC) scheme, which recognises SwagÖ±²¥’s international reputation and will drive forward research in the areas of musculoskeletal disease, hearing health, respiratory disease, dermatology and three themes (prevention, radiotherapy and precision medicine).

This latest investment is provided under Clinical Research Facility Scheme and will enable the SwagÖ±²¥ CRFs to support researchers working in these areas and many others, representing major causes of premature death and disability for patients in SwagÖ±²¥ and beyond. The SwagÖ±²¥ CRFs are supported by the SwagÖ±²¥ Academic Health Science Centre ().

Lord Peter Smith, Chair of Greater SwagÖ±²¥ Health and Social Care Partnership Board said: “This reinforces SwagÖ±²¥’s strong credentials in experimental medicine. The CRFs will play a key role in working with patients, academic and commercial research partners to implement the Greater SwagÖ±²¥ Health and Social Care Devolution.”

Professor Nick Webb, Director of the SwagÖ±²¥ CRF explained: “Our new One SwagÖ±²¥ approach consolidates assets across our CRFs and will explore novel ways to drive efficiencies and maximise the impact of our research across Greater SwagÖ±²¥.

“We know that disease burden remains disproportionately high in SwagÖ±²¥ and especially in socially disadvantaged groups. Working with the BRC and NHS organisations across SwagÖ±²¥, our focus will be to increase accessibility of research for people of all ages and backgrounds right across the city region and beyond.”

Sir Michael Deegan, Chief Executive at CMFT said: “Experimental medicine studies can be extremely complex and intensive, requiring specialist facilities. This investment will enable us to expand our world-leading research in this area and provide more patients in SwagÖ±²¥ with the opportunity to trial new medicines.”

, President & Vice-Chancellor at SwagÖ±²¥, added: “We’re delighted to receive this investment, which recognises the excellent research infrastructure we already have in SwagÖ±²¥ and will help to further accelerate the translation of basic laboratory research through to treatments that benefit patients.”

Minister for Public Health and Innovation Nicola Blackwood said: “Our investment in this area so far has led to a variety of breakthroughs, including the first new asthma treatment in a decade, and a promising treatment for peanut allergies in children, to name just two.

“We know that such ground breaking clinical research simply would not happen without the support of these Clinical Research Facilities.

“I’m delighted to announce this funding to support the skilled personnel and cutting-edge facilities we need to keep SwagÖ±²¥ at the forefront of clinical research.”

A new type of academic research will investigate treatment and management of rheumatoid arthritis (RA), by using software to analyse thousands of real life experiences of RA drugs.

The research study, launching in November, is being run by three distinct organisations - the social network HealthUnlocked, National Rheumatoid Arthritis Society (NRAS) and SwagÖ±²¥. It will review and assess first hand experiences of drug usage and side-effects from thousands of people living with the condition through conversations, engagement and discussions happening about the condition on social media.

The research will provide helpful insights about potential harms of drugs prescribed by doctors every day and seek to devise new drug safety profiles, by better understanding the occurrence and impact of adverse drug reactions (ADR) and the context within which they happen. With around 690,000 people affected by rheumatoid arthritis in the UK alone, this is potentially big news for people with the autoimmune disease.

The data will be collected directly from within the HealthUnlocked web platform. Data and information on side effects will be extracted into an anonymous and aggregated form that can be provided to SwagÖ±²¥. The information will be sourced from a dedicated RA support forum, run by NRAS on the HealthUnlocked web platform, which has over 13,000 members and over 18,000 posts within it. This data rich information provides accurate accounts of what real people with the condition are going through and their experiences.

SwagÖ±²¥ will analyse this data and collate the beneficial and harmful responses of RA medication.

Will Dixon, Professor of Digital Epidemiology at SwagÖ±²¥ and a Consultant Rheumatologist at Salford Royal Hospital said: “We are excited to get the opportunity to work with NRAS and HealthUnlocked in order to analyse patients’ real experiences. When studying drug safety, it is common to focus on side-effects that doctors consider important, or on newer drugs whilst forgetting the more established treatments.

“We will start by examining the safety of glucocorticoid, or steroid therapy, a drug that has been used for over 65 years and is still used in half of patients with RA. In addition to looking at the occurrence of a range of known side-effects, we are interested in examining the impact of these side-effects on patients’ lives. We know, for example, that weight gain and insomnia are of top importance to patients."

Dr Matt Jameson Evans, Chief Medical Officer at HealthUnlocked, said: “This is a brand new way of studying a disease, starting from the patient’s perspective. By looking at patterns in experiences of people with a condition or disease within a social network, we can access and understand a large mass of data showing what is happening to real people every day.

“Conversations within social media do not conform to usual routine trials - their discussions rarely use medical terms or concepts to describe their health conditions, and conversations are with peers, which can be dramatically different from those they have with clinicians or researchers. We will be fascinated to see how this data corresponds to existing medical knowledge about rheumatoid arthritis.”

Ailsa Bosworth, CEO of NRAS said: “We are very interested to see how using real patient data in this way helps researchers to understand what really matters to people with RA in relation to side effects and impact of taking specific medications, as opposed to using clinical outcome data where the outcome tool has been designed by health professionals. We would like to see more patient defined outcomes starting to be used and this research is exactly what could help that to become a reality.”

An early intervention for autism aimed at helping parents communicate with their child has been shown to have an effect on reducing the severity of autism symptoms, and this reduction continued for six years after the end of treatment, according to a study published in The Lancet.

The study led by SwagÖ±²¥, King’s College London and Newcastle University (UK) and funded by the Medical Research Council is the first to identify a long-term effect of an early intervention for autism, and is consistent with UK guidance supporting the use of early intervention.

The researchers found that children who had received the intervention aged 2-4 had less severe overall symptoms six years later, with improved social communication and reduced repetitive behaviours, although no changes were seen in other areas such as language or anxiety. However, they say that difficulties remain and additional ongoing support will usually be needed as the children get older.

“This type of early intervention is distinctive in being designed to work with parents to help improve parent-child communication at home,” says Professor Jonathan Green of SwagÖ±²¥ and Royal SwagÖ±²¥ Children’s Hospital, who led the study. “The advantage of this approach over a direct therapist-child intervention is that it has potential to affect the everyday life of the child. Our findings are encouraging, as they represent an improvement in the core symptoms of autism previously thought very resistant to change.”

Autism spectrum disorder is a developmental disorder that affects about 1 in 100 people; it can have a profound effect on children’s social development into adulthood and results in an estimated £1-1.5 million in lifetime costs for families and the community. The type of early intervention used in this study focuses specifically on working with parents.

Through watching videos of themselves interacting with their child and receiving feedback from therapists, parents are able to enhance their awareness and response to their child’s unusual patterns of communication; they become better able to understand their child and communicate back appropriately in a focused way. Parents take part in 12 therapy sessions over 6 months, followed by monthly support sessions for the next 6 months. In addition, parents agree to do 20-30 minutes per day of planned communication and play activities with the child.

In the original trial, 152 children aged 2-4 with autism were randomised to receive the 12 month early intervention or treatment as usual. The study published today is the follow-up analysis of the same children approximately 6 years after the end of treatment. 121 (80%) of the 152 original trial participants were assessed as part of the follow-up study. Of these, 59 children had previously received the intervention and 62 had received treatment as usual. Autism severity was measured using the international standard measure of autism symptoms (ADOS CSS), which combines social communication and restricted and repetitive behaviour symptoms into an overall measure of severity scored 1-10, with 10 being the most severe.

At the start of the trial, both groups had similar scores (8.0 in the intervention group, 7.9 in the treatment as usual group). At follow-up, children in the intervention group scored an average of 7.3, and 46% (27/59) of the group were in the severe range. By comparison, children in the treatment as usual group scored an average of 7.8, with 63% (39/62) in the severe range. This corresponds to a reduction of 17% in the proportion of children with severe symptoms in the intervention group compared to treatment as usual.

At follow-up, there were also improvements in children’s communication with their parents for the intervention group, but no differences in the language scores of children. Additionally, parents in the intervention group reported improvements in peer relationships, social communication and repetitive behaviours. However, there was no significant difference between the two groups on measures of child anxiety, challenging behaviours (eg, conduct/oppositional disorder) or depression.

The authors note that the study included children with core autism symptoms rather than wider autism spectrum disorder, and therefore cannot be sure how these results would apply to children with less severe symptoms. They also add that the study was a follow-up at age 7-11 years so does not provide information in how children’s symptoms will develop in adulthood.

.

According to new research in the BMJ Quality & Safety journal, previous studies showing an increased risk of mortality following admission to hospital at weekends have failed to take account of the higher severity of patients’ conditions.

The research, carried out by a team from the SwagÖ±²¥ Centre for Health Economics at SwagÖ±²¥, directly contradicts established wisdom that mortality rates increase at the weekend – a core argument for the Government’s push for a seven day NHS.

The key factor identified by the research team was that a higher proportion of patients admitted to hospital at the weekend have arrived by ambulance. This is an important marker of increased illness severity. Once severity is taken into account, there is no increased risk of mortality following admission during the weekend except a very small increase on Sunday daytime.

The authors re-analysed the same data on emergency admission used by the previous studies that have been repeatedly quoted by Government as showing a ‘weekend effect’. They examined over 3 million records for patients admitted to hospitals across England via A&E in the 2013/14 financial year.

The proportions of patients brought in by ambulance were substantially higher on Saturdays (61%) and Sundays (60%) compared with 57% on weekdays. Patients arriving by ambulance had much more severe problems, with a mortality rate of 5.5% compared to just 0.8% for patients who did not arrive by ambulance. This important marker of severity, which differs between weekdays and weekends, has not been taken into account in previous studies.

The authors also examined whether patients were at higher risk of dying if they were admitted at night. Patients admitted to hospital at night were more likely to be more severe, having arrived by ambulance, and this factor accounted for their higher death rates. The fact that there is no increased risk of mortality at night raises further doubt about whether the presence of senior doctors and rapid access to diagnostic services is a key determinant of mortality rates.

Professor Matthew Sutton, lead of the research and Professor of Health Economics at SwagÖ±²¥, said the findings questioned the ‘weekend effect’ and therefore the planned expansion of emergency hospital services at the weekend.

“We have shown that much of the weekend effect identified in previous studies is likely to be explained by a smaller and on average sicker population of patients being admitted at weekends. Arrival by ambulance is a marker of illness severity that has been omitted from the previous studies on which the seven-day services policy is based. Other measures of severity would likely explain the weekend effect away altogether.”

“The seven-day services policy is based on very little evidence. This major omission from the previous studies shows that much more robust evidence is needed to justify the major changes in hospital services that are underway.”

The research – ‘Arrival by ambulance explains variation in mortality by time of admission: retrospective study of admissions to hospital following emergency department attendance in England’ – appears in the BMJ Quality & Safety Journal.

Over 200 suicide deaths per year now occur in patients under mental health crisis teams, three times as many as in in-patients, according to a report by SwagÖ±²¥’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). The full report is available .

One third of patients under crisis resolution/home treatment (CRHT) who died by suicide had been using the service for less than a week, and a third had been discharged from hospital in the previous two weeks. The report questions whether CRHT was the most suitable setting for their care, and raises concerns that crisis teams are increasingly used due to pressure on other acute services, particularly in-patient beds.

Professor Louis Appleby, Director of NCISH, said: “This year’s report reflects the increasing reliance on crisis teams in response to the strains felt by acute mental health services. Our findings suggest that we are accepting too much risk in the home treatment these teams offer, and that the crisis team is now the priority for suicide prevention in mental health.”

The authors also found that over half the 1700 mental health patients per year who died by suicide across the UK had a history of alcohol or drug misuse. However, only a small proportion had received specialist substance misuse treatment, suggesting a need for these services to be more widely available, working more closely with mainstream mental health care.

Professor Appleby said “The report looks at the growing impact of economic adversity. More patients who died by suicide were reported as having been unemployed or homeless, and 13% had experienced serious financial difficulties in the previous 3 months. We also identified a rising incidence of suicides by patients who had been in the UK for less than 5 years who may be less well connected to services that could support them."

The team reviewed 20 years of evidence from National Confidential Inquiry research, and found a changing pattern of risk factors facing mental health patients, with higher rates of isolation, recent self-harm, alcohol and drug misuse and economic adversity in those who died by suicide. They also found improvements in some aspects of suicide prevention, such as ward safety and acceptance of medication.

Professor Nav Kapur, Head of Suicide Research at NCISH said “The 20 year review has helped us to identify ways in which mental health care is safer for patients. We now know what services can do to reduce suicide risk, for example care planning and early follow-up on discharge from hospital, personalised risk management without routine checklists, and implementing guidance on depression and self-harm”.

NCISH also report on homicide by people who have been in contact with mental health services. The figures show a fall in patient homicides overall but a possible increase by patients with schizophrenia In England since 2009.

Professor Jenny Shaw, Head of Homicide Research, said "The numbers are small, so it is difficult to confirm a clear pattern, but it may be that homicides in this group have risen. Services can help by addressing drug and alcohol misuse and ensuring that contact is maintained for those patients who are likely to disengage from mental health care".

The Mental Health Clinical Review Outcome Programme, delivered by NCISH, is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, the States of Guernsey and the States of Jersey.

The aging population across the UK and the EU, combined with the widening gap between available carers and those who need care, has prompted researchers at SwagÖ±²¥ to conduct research on a range new technologies to encourage healthy and active ageing.

To mark International Older Person’s Day (1 October 2016), the University has announced preliminary findings from two technology projects to promote active lifestyles among older people currently underway – a mobile app and a series of ‘exergames’ – video games incorporating exercise and movement.

The World Health Organisation (WHO) is marking this year’s International Day for Older People by asking people across the globe to ‘take a stand against ageism’ – and there isn’t a stronger area of ageism than the perceived wisdom of technology use among the older population.

More than a third of older people use the internet on a regular basis, and a quarter of the population use online banking services as well as health information, news sites and other content providers. Therefore, the appetite for technology across all areas of our lives is strong and growing.

In one project PreventIT a mobile app measures activity levels of users and utilises unique motivational cues to ensure fitness and activity regimes are maintained. In another project, exergames involve interactive videogame technology; through playing the games users improve balance and strength – in the current trials the confidence levels of the gamers were vastly improved.

Dr Emma Stanmore, senior lecturer in SwagÖ±²¥’s School of Health Sciences and lead consultant on the exergames project, said confidence is the key to improved mental and physical health among the older community.

“Our current trial has shown an increased level of confidence among the gamers, and they seem to be happier and more fulfilled”.

“For example, one 83 year old trial volunteer recorded significant improvement in her overall lifestyle. Over the 12 weeks in the trial her strength and balance improved and she felt this gave her the confidence to build up from six minutes to 14 minutes three times a week. This confidence spurred her on to start driving again after giving this up four years ago.

“She would often use her mobility scooter indoors at the sheltered accommodation where she lives. By the end of the trial she would very rarely use her scooter at all.”

According to the University researchers, inactivity is the fourth leading cause of death worldwide; inactive lifestyles also lead to increased adverse health outcomes such as shortened life expectancy, cardiovascular disease, diabetes and cancer. It has been well documented that physical activity improves health and function and reduces disability at old age.

Demographic change is undeniably affecting Europe; the EU population aged 65+ increased from 13.7% in 1990 to 17.4% in 2010. Predictions are that by 2060 approximately 30% of the EU population will be aged 65+ and the rise of the ‘oldest old’ – those aged 80+ - is particularly significant.

Engaging with this growing aged community and encouraging them to adopt a more active lifestyle is a key part of the two research projects underway at the University of SwagÖ±²¥.

Professor Chris Todd, principal investigator on the PreventIT project (), a multi-site partnership project funded by the European Commission, said:: “There is little use in developing novel technologies without the full engagement and contribution of those it is aimed at, we want to understand the motivational components as well as how long it takes for a new behaviour to become a daily habit for people trying to become more active”.

“Investigating this will help ensure our mobile technology works together with the individual and is tailored to their preference and needs.”

Professor Todd, who also leads the Healthy Ageing Research Group, concluded: “Our work with European partners delivers critical innovation and knowledge transfer in all areas of falls prevention and the promotion of active ageing, we are pleased to hear that the UK Treasury will continue to support this critical collaborative research work beyond the date the UK is set to leave EU.”

Access to interpreter and translation services is an essential requirement to ensure integration – according to a new study carried out by a team from SwagÖ±²¥’s Multilingual SwagÖ±²¥ project, in collaboration with the NHS Clinical Commissioning Groups for SwagÖ±²¥.

The pilot research was undertaken in order to establish whether there are any barriers to the use of language provisions that potentially affect access to health care.

The team, led by Professor Yaron Matras, tracked all requests for interpreter and translation services across both SwagÖ±²¥’s GP surgeries and the Central SwagÖ±²¥ University Hospitals NHS Foundation Trust (CMFT). Additionally, interviews with medical practitioners, interpreters, and users of health care services from a variety of backgrounds including the city’s Pakistani, Somali, Arab and Roma communities were carried out.

In the finance year 2014-2015, Central SwagÖ±²¥ Hospitals responded to around 48,000 interpreting requests (including both face to face and telephone interpreting), for 99 different languages. During the same period SwagÖ±²¥’s GP surgeries responded to around 18,000 requests for 53 different languages; half of those requests were in the central SwagÖ±²¥ area. The highest level of demand in central SwagÖ±²¥’s hospitals and GP surgeries was for Urdu and Arabic. There was also relatively high demand for Cantonese, Polish, and Bengali in the hospitals, and for Romanian, Somali and Bengali in GP surgeries.

Despite the volume of requests, the report found that patients’ reliance on language provisions is transitional, and that over time increased familiarity with the system, and individuals’ rising level of proficiency in English reduce their dependency on interpretation services.

For eastern European languages in particular, the team found that a sharp rise in demand at the beginning of a three-year observation period was followed by a fall in the number of requests for interpreters, by typically around 40-50%, toward the end of the period.

The research team found no evidence to suggest that lack of adequate interpreter provisions is driving patients with lower levels of English to turn to emergency or other hospital services rather than to primary care.

There is also no evidence that particular language groups either engage, or fail to engage, disproportionately with individual services.

Yaron Matras, Professor of Linguistics at SwagÖ±²¥’s School of Arts, Languages and Cultures commented: “The dynamics of constant population changes in a global city such as SwagÖ±²¥ mean that the availability in principle of interpreter provisions in the health care system is a permanent necessity. Regular compilation and analysis of data can help us understand trends and plan provisions in a cost-effective manner”.

Speaking on behalf of SwagÖ±²¥'s three Clinical Commissioning Groups, Dr Mike Eeckelaers, said: "As commissioners we want to make sure that we remove any barriers to healthcare so that the people who live in this city can have equal access to services. This is why we wanted a comprehensive study of where translation services are needed, which languages this covers, and the impact that having interpreter provision can have for patients."

The full report can be accessed . 

New guidelines issued by the National Institute for Health & Care Excellence (NICE) for managing patients with more than one long-term condition recommend a tailored approach to patient care focused on individual preferences, needs and priorities.

To coincide with the guidelines, a new online resource has been launched to help patients with several long term conditions – multimorbidity – not only self-manage their treatment approaches across their multiple conditions but help influence the tailored nature of treatment required by NICE in the new guidelines.

The “living with multiple health problems” section presents patients’ experiences of coping with the complexities of multiple illnesses; users of the website are able to access more than 200 extracts in video, audio or written format from interviews with real patients discussing various aspects of living with multimorbidity as well as advice on self-management of treatments and juggling all the required medication across multiple conditions.

It is estimated that approximately one quarter of the UK population are living with two or more health conditions – including diabetes, arthritis and heart disease – and this figure is set to rise as the population ages.

The main challenges facing patients with multiple conditions are managing sometimes conflicting treatments, deciding what to prioritise, coordinating the care received from different professionals and generally overcoming sometimes poor communication from those professionals.

Communication is the key to managing multimorbidity, according to Dr Gavin Daker-White, Research Fellow at SwagÖ±²¥’s School of Health Sciences who led the analysis of the interviews for the web resource.

“Getting a new diagnosis on top of existing diseases can be a bit of blow. Patients will quite likely be asking themselves – and their healthcare providers – what does it all mean now and how am I going to cope?

”healthtalk.org aims to take users on a person-based journey through the issues of multimorbidity; users can see and hear 38 people sharing their stories about the effects of health problems on their lives and their experiences of using health services. They talk about how they deal with the challenges brought by multiple health problems, for example by prioritising which health problem is the most important. They talk about where the health service has worked well for them and where it hasn't. Their advice for other patients and recommendations for improving care are offered – along with advice on taking control of their multiple medicines and other treatments.” 

Development of the multimorbidity section was funded by the National Institute for Health Research (NIHR), and is part of the wider healthtalk.org website. healthtalk.org (formerly dipex then healthtalkonline and youthhealthtalk) was created in 2001 by Oxford GP Dr Ann McPherson CBE and Dr Andrew Herxheimer after their own experiences of illness. Ann had been diagnosed with breast cancer and although she knew about the medical side, couldn't find anyone to talk to about what it was really like to have the disease. This, and Andrew's experience of knee replacement surgery, prompted them to come up with the innovative idea of a patient experience website.

The website has sections on more than 90 diseases, conditions and other health issues – all sharing experiences in video, audio or written format from people affected by each individual illness or health issue. Healthtalk.org is primarily a resource for patients, their families and friends, but is also valuable in educating health and social care professionals about patient perspectives of illness.

The Centre for Primary Care has produced a outlining the safe, integrated, and effective care for people with multimorbidity.

Patients who had access to GP surgeries with longer opening times in evenings and at weekend visited accident and emergence departments far fewer times than those who did not have similar access to primary care.

The findings of the report published in PLOS Medicine have implications for the British Government’s desire to implement a seven-day NHS service. Funding given to GP surgeries to extend their hours may reduce demand on emergency hospital service especially at the weekend – but the cost of doing so may outweigh the benefits.

The study analysed data from nearly three million patients from 525 GP surgeries in North West England. NHS England (Greater SwagÖ±²¥) provided £3.1 million to enable 56 GP surgeries to open longer in the evening and at the weekend during 2014. These 56 surgeries had 346.024 patients in total, while the wider patient population in the non-funded 469 surgeries was 2,596,330.

The research team looked at total emergency department visits by each cohort; the extended-access GP surgeries had a 26.4 percent relative reduction in patient-initiated emergency department visits for minor problems – equating to nearly 11,000 fewer visits. The cost saved by those fewer admissions was only £767,976 – less than a quarter of the extra funds allocated to surgeries to extend their hours.

However, the study solely focused on emergency department admissions, and did not collect any data on health outcomes – either from a post-A&E visit or from seeing a GP in extended hours. Therefore the analysis does not take into consideration the potential benefits to those patients using additional appointments who would not have visited emergency departments otherwise.

William Whittaker, Research Fellow in Health Economics at SwagÖ±²¥, was the lead author of the report and notes caution for 7-day services if solely aimed at reducing emergency department visits.

“There’s a need for evidence that 7-day primary care has benefits to patients as on the basis of emergency department savings alone, extending primary care is unlikely to be cost-effective.

“Our study suggests that extending opening hours in primary care may be a useful addition to policies aiming to reduce pressures on hospital services, potentially reducing patient-initiated use of the emergency department for minor problems—but at a significant cost,” Mr Whittaker concluded.

ENDS

In the first study to consider these two adverse outcomes in the same cohort, researchers have shown a strong correlation between parental psychiatric disorder and the increased risk of suicide attempts and violent behaviour in their children.

The research was conducted by a collaborative team of epidemiologists from SwagÖ±²¥’s Centre for Mental Health and Safety and Aarhus University’s National Centre for Register-based Research ,using records of all children born in Denmark between 1967 and 1997 - a total of 1,743,525 people. The cohort was cross-referenced and linked to any recorded history of mental illness in their parents via the Danish Psychiatric Central Research Register. First episodes of suicide attempt and violent offence conviction were investigated from the time when these children turned age 15 years.

Risks for offspring suicide attempt and violent offending were raised across almost all parental psychiatric disorders. The highest risks were found among families where one or both parents were diagnosed with antisocial personality disorder, cannabis misuse disorder or prior suicide attempt. On the contrary, parental mood disorders, and bipolar disorder in particular, conferred more modest risk increases.

A history of mental illness in both parents was associated with double the risks of suicide attempt and violent offending in offspring compared with having just one affected parent.

Dr Roger Webb, the study’s principal investigator based in the Division of Psychology and Mental Health at SwagÖ±²¥, said the research has profound implications for both healthcare providers as well as social services.

“Psychiatrists and other professionals treating adults with mental disorders and suicidal behaviours should also look to the children of their patients – and assess their mental health and psychosocial needs. Early interventions could benefit not only the parents but also their offspring.”

The paper, ‘Parental psychiatric disease and risks of attempted suicide and violent criminal offending in offspring: A population-based cohort study’, is published in the journal JAMA Psychiatry ().

Interviews carried out by SwagÖ±²¥ with GPs of parents whose children have died by suicide have revealed a lack of knowledge and confidence on how best to respond to and support those bereaved.

The new study, published in the British Journal of General Practice, explored GPs’ experiences and perceived needs (emotional, practical and training) when caring for parents bereaved by suicide.

The study was led by the University of SwagÖ±²¥ in collaboration with , and funded by the Research for Patient Benefit (RfPB) programme. They recruited parents whose adult children (aged between 18-35 years) had died by suicide between 2002 and 2012 to identify their experiences and perceived needs.

With the parents’ consent, the research team interviewed their GP to identify their experiences and perceived needs caring for the bereaved parents. Thirteen GPs were recruited to the study.

Those bereaved by suicide are also significantly at risk of dying by suicide and an important focus of government strategy to help reduce the suicide rate amongst this vulnerable population. Those who have lost love ones struggle to cope and often feel isolated, stigmatised and unsupported. The bereavement has a serious effect on their own mental health and as a result many people turn to their GPs in the first instance.

The interviews revealed that the GPs know this to be the case but as non-specialists, needed support to deal with the difficulties these patients face. They were sometimes personally affected by the suicide of a patient as well and this impacted on their ability to work with the parents.

specialises in suicide bereavement research and as a result of this work her research team has designed training for primary care practitioners, such as GPs.

Bereaved families contributed their stories for use in the training which has been very well evaluated. Dr McDonnell is hoping to open this out across the UK.

Findings in this study have also informed the development of the first evidence-based suicide bereavement training internationally which guides health professionals on how to respond to and care for parents bereaved by suicide.

Dr McDonnell added: “This study has advanced our understanding of the vulnerability and perceived needs of GPs caring for parents bereaved by suicide. Findings have the potential to inform policy and practice.”

Paper, . Br J Gen Pract 2016; DOI: 10.3399/bjgp16X686605. The British Journal of General Practice

A new study from SwagÖ±²¥, prompted by current government policy for a ‘seven-day NHS’, has found that suicide deaths by mental health patients are actually lower at the weekends.

A current government policy priority is to extend health services to a full ‘seven-day NHS’, partly due to claims that patients admitted at the weekend are more likely to die because of lack of specialist staffing and services.

The new paper, published in the British Journal of Psychiatry, is one of the first to explore the weekend effect in mental health. In contrast to previous studies of all hospital deaths, the paper found that the incidence of suicide was 12-15 percent lower at the weekend. The study was carried out by researchers at .

, from SwagÖ±²¥ and , led the study. He said: “We wanted to explore a possible weekend effect on patient suicide. We looked at specific groups being treated in hospital or the community who might be particularly vulnerable to changes in care. We actually found a markedly reduced suicide risk at the weekend. We also found a reduced risk in people who were admitted at the weekend.”

The researchers analysed 5,613 suicide deaths in England between 2001 and 2013. They examined deaths by suicide in inpatients, those who had been discharged from psychiatric hospital within the previous three months and those under the care of crisis resolution home treatment teams. By looking at the deaths and the days they occurred, they found that in all groups, suicide was less likely to occur at the weekend.

The study also investigated the idea of an August effect – a month when final-year medical students become doctors and junior doctors become a grade more senior. Some previous research has suggested this could affect patient care but the current study found no evidence of an increase in suicide during this month.

The study was unable to investigate causal reasons for the decline in deaths at the weekends, but the authors consider the possibility that because mental health services are more multi-disciplinary and community-based than some other medical specialities they are insulated from a reduction in the availability of doctors at the weekend. Alternatively the lower rate of weekend suicide could reflect increased social contact between patients and their families and friends.

It is also possible that in the case of a lower rate of death among admissions at the weekend, there is a lower threshold applied to admitting patients because highly specialised community services may not be as available.

Professor Kapur said: “Although the causes of suicide are varied and complex, we do know from our previous work that the way services are organised and staffed can have an effect. In this case however, our results did not suggest a weekend effect on suicide.”

, Director of the National Confidential Inquiry and one of the authors of the study, added that: “We should recognise that extending NHS services could have a number of potential benefits such as improving access to services, enhancing continuity of care, reducing morbidity, and improving the quality of care. However, our study of suicide in high risk patient groups does not support the claim that safety is compromised at weekends, at least in mental health services.”

The paper, ‘’, was published in the British Journal of Psychiatry. DOI: 10.1192/bjp.bp.116.184788

SwagÖ±²¥ has announced the launch of a major new initiative as part of the project, designed to improve the health of communities in the north of England.

Alongside Professor Sir Michael Marmot’s at UCL, and researchers based at in London, the new collaboration will implement the six Marmot domains into practice – using real world evidence from his international reports translated into better health of the North.

The initiative will also disseminate research into healthier neighbourhoods to an international audience and provide better access to communities, politicians and other policy makers through the combined efforts of the research teams involved.

The launch will be at today’s in SwagÖ±²¥. , who leads the organising committee and the evaluation of Well North said: “We are so pleased to see the development of this collaboration which has already led to many new projects where we are sharing research experience to improve the lives of the most disadvantaged in our communities.”

Lord Andrew Mawson, Executive Chair of Well North and President of the BBBC, said: “As Executive Chairman of Well North, I’m passionate about our work in helping to unleash healthy communities across the North of England. This new partnership is an exciting opportunity to learn from international experts, and share their insight with the local people involved in creative and inspirational ways of improving health and wellbeing across the region.”

Professor Sir Michael Marmot said: “Many communities in the north suffer disproportionately from poor health and low life expectancy compared with the rest of England; this is driven largely by poor social, economic and environmental conditions which harm health and other life chances.

“We are delighted to partner with Well North in the work to support flourishing, resourceful communities in the region – to create the conditions for people to take the control of their lives. All the evidence and experience we have, shows us that these are hugely important ways to bring improvements to health and a range of other life chances.”

The launch will be part of the activities associated with the late Prof Aidan Halligan memorial tribute that was organised by Prof Ian Jacobs, immediate past Dean and Vice-President of the Faculty of Medical and Human Sciences at SwagÖ±²¥ and now President and Vice-Chancellor of the University of New South Wales.

Dr Verma added: “The day is a fitting tribute to the memory and legacy of Aidan’s tireless work on helping communities, patient safety and the homeless. We are so grateful to Prof Jacobs for his contribution to all of the five Festivals, but especially this one as he has travelled from Sydney, Australia to commemorate and remember a remarkable man.”

High workload, rigid rules, and conflicting pressures from their employers are all leading to community pharmacy staff deviating from standard procedures at times to ensure patients receive the tailored care they require, a new study from SwagÖ±²¥ has found.

The research which was funded by the National Institute for Health Research () and published in , analysed interviews with 24 practising staff working at a variety of levels in pharmacies. The interviewees discussed their views and experiences of complying with procedures that had been laid down either for safety or for other company purposes. Participants came from a variety of pharmacy types and from a range of locations across England and Wales.

In this study, funded by the NIHR Greater SwagÖ±²¥ PSTRC, some interviewees raised concerns that they were asked to follow rigid procedures that didn’t allow staff to use their professional judgement when caring for patients. In such circumstances, pharmacists felt that they should do what they judged to be best for safe patient care rather than following procedures to the letter. A further challenge for pharmacy staff was the need to balance safe patient care with the achievement of company targets for services such as medicines usage reviews. However, some respondents felt that they weren’t able to express their concerns about strict adherence to the procedures.

The study also highlighted that during peak times, staff were still expected to follow procedures but often had many tasks to complete at the same time, which made following procedures more difficult. For example, one participant said: “Easter weekend, the week before Christmas [and] the end of [a] week [are] usually very busy…[then] sticking to the rules becomes less of a priority.”

Lead researcher, said: “It’s clear that pharmacists under pressure don’t always follow procedures exactly. In the interests of individual patients this isn’t always the wrong thing to do, but the scale, complexity and inefficiency of some of these procedures is creating an atmosphere where staff think it isn’t realistic to know or follow every procedure to the letter.

“Pharmacy companies should look to involve their staff more in developing procedures and ensuring they can be used in practice.”

Ms Thomas added: “The study highlights the tension between standardising practice on the one hand and the need, at times, for greater flexibility on the other hand to deliver effective patient care.”

“These findings should help to inform policy makers and practitioners with regards to the factors most likely to influence the implementation, or not, of procedures in community pharmacy settings.”

The paper, ‘When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff,’ was published in the BMJ Open. It is freely available here:

SwagÖ±²¥ researchers and  (PRUK) have published research exhibiting the valued role pharmacists can play in supporting young people with juvenile arthritis to self-manage their condition.

Researchers, including SwagÖ±²¥’s Dr Janet, explored the role of pharmacy for young people with long term conditions (LTCs) through the exemplar of juvenile arthritis. It builds on an earlier PRUK funded project (Arthriting) exploring young people and parents’ experiences of using medication to treat juvenile arthritis by bringing together pharmacists and rheumatology staff to explore how pharmacy might develop and promote a vision for the care of young people with long term conditions.

Although 59 per cent of young people with LTCs take medication, there is limited evidence around young people’s experiences and use of pharmacy services. The study demonstrated the potential for pharmacists to support young people in better self-managing their condition. Establishing positive relationships is at the heart of the results – pharmacists building trust and rapport with young people, better communication between hospital and community pharmacists, and meaningful integration of pharmacists into multidisciplinary clinical teams.

Rheumatology lead, who also works at the , said: “The previous Arthriting project showed us that young people with arthritis were largely unaware of the pharmacist’s skills and relevance to their medicine-related needs. Parents generally go in to collect prescriptions alone, and opportunities to build relationships with a very accessible healthcare professional are missed.”

The project lead, pharmacist Dr Nicola Gray, said that: “We know that young people find it difficult to access health services and that young people with arthritis are largely unaware of the pharmacist’s skills and relevance to their medicine-related needs. This new project shows that pharmacists have the potential to help young people to build general healthcare skills, and to respond to their queries and concerns about their medication.”

Miss Lamis Mullgrave, one of the original Arthriters (youth participant) and advisor to the project, said: “From my own experiences and from speaking to other young people, it is clear there is not enough information out there to promote the role of pharmacists, or awareness of the pharmacy services currently available.

“It is important for young people and their families to have easy, accessible support with regards to medicines, and help with managing them, so to highlight this issue I believe is important as a means of improving healthcare for young people, [and] to encourage building relationships with pharmacists to support them in managing not only their medicines, but their health. I feel the findings from this project are of great value, and we should seek to implement these recommendations to improve health services for not only young people, but for service users of all ages.”

By comparing UK mortality data with that of other high-income countries, researchers from SwagÖ±²¥’s Health eResearch Centre have shown that a £10 billion incentive programme has no direct impact on reducing mortality.

Since its launch in 2004, the Quality and Outcomes Framework (QOF) has been used as a pay-for-performance finance model, contributing up to 25% of a GP’s annual salary. The programme works by rewarding GPs for offering quality care services in over 100 individual treatment indictors. Almost all of the UK’s GP practices participate in the scheme.

Using information from the World Health Organization’s mortality database, the research team – (a partnership between The Universities of Michigan, York and SwagÖ±²¥) was able to compare UK-based outcomes with those of 27 like-for-like countries including the USA, Australia, France, Germany and Sweden over a 17-year period.

By aggregating data from these statistically-similar countries, investigators were able to create a single weighted combination which allowed a more direct comparison. This so-called ‘synthetic UK’ permitted researchers to compare mortality data from specific disease areas, such as heart disease (which is heavily targeted by the QOF indicators) and cancer, to fully understand the impact of the programme. The team was also able to make an accumulated analysis which factored all of the QOF disease indicators into a single, overall evaluation.

Although the research team noted small mortality reductions for the direct comparison of QOF indicators the current pay-for-performance model was not associated overall with any significant changes in mortality.

Lead researcher at SwagÖ±²¥’s £18 million said: “Our results clearly show that the Quality and Outcomes Framework is not significantly associated with changes in population mortality for the diseases that are targeted by the programme.

“By comparing mortality between the UK and other countries that are not exposed to national-scale pay for performance, this study provides the first cross-national evidence of the effects that pay-for-performance can have on population health.

“. This work is probably the final piece of the puzzle and highlights that if these schemes continue to be used in UK primary care and around the world then policymakers need to make sure that the indicators are more closely aligned with evidence-based outcomes, specific to the primary care setting.”

The full study ’’, was published in The Lancet on 17 May 2016.

Your shoe fits the size of your foot, so why is your drug dose not tailored to your own personal characteristics in the same way? To answer this question, some of the world’s leading experts in health care and pharmaceutical science are coming to SwagÖ±²¥ this week.

The conference, organised by SwagÖ±²¥ and sponsored by global biosimulation and regulatory writing company, , aims to bring the latest research in ‘precision dosing’ together – this is the first time that experts in this field have got together at a dedicated event to debate and tackle barriers to introducing these advanced techniques into every day health care

This could be manifested in, for example, an app that will be used by doctors and a 3D printer in the local pharmacy making a tablet that exactly fits a patient’s need.

Professor Kay Marshall, Head of and a speaker at the conference, said: “Everyone is different and this means that they react to drugs in different ways. The emerging precision dosing field is all about harnessing the explosion of genomic data and various markers of bodily functions using mathematical modelling to make sure that individuals or groups get the best possible treatment.”

However, the use of this technique is currently restricted to research hospitals. Barriers such as legal issues, training and the availability of software all contribute to preventing precision dosing benefitting as many people as it could.

The Health Care Summit on Model-based Precision Dosing, which runs 19-20 May at Shrigley Hall Hotel, Cheshire, will seek to address these issues. It includes speakers such as Professor Catherine Knibbe from Leiden University, Netherlands, who will talk about the difficulties of making sure that children get the right doses, based on size and other individual factors.

The former Director of the Office of Clinical Pharmacology at the US FDA, Professor Larry Lesko, will talk about the challenges regulatory agencies face regarding implementation of more personalised dose recommendations at the stage of drug approval.

The Summit comes at the same time that has been appointed Certara Lecturer in Precision Dosing at the SwagÖ±²¥ Pharmacy School. Certara has endowed this lectureship, which is part of the University’s precision medicine initiative. A leader in the field, SwagÖ±²¥ is one of six initial regional centres of excellence for The Precision Medicine Catapult, the UK’s innovation centre for precision medicine.

Dr Darwich will co-chair the Summit, which also includes speakers from the United States, France, Germany, Switzerland and Australia. Discussions will range from the application of precision dosing for patients with conditions such as HIV infection and cancer, to heart failure and transplant recovery. In all of these cases, the dosing level of drugs can be optimised based on factors such as age, sex, weight and genetics – assuming the right environment exists to enable the use of the technique.

Professor of Systems Pharmacology, , convened the conference. He said: “We have the mathematical techniques to ensure that patients receive the correct drug dose for their individual needs, and to minimise any interactions that could occur with other medications they may need to take. However, the current framework in which this science works is restrictive.

“While these rules are in place for good reason, they are beginning to look outdated and by gathering this global panel of experts we hope to be able to make concrete recommendations for change leveraging various new technologies.”

A University of SwagÖ±²¥ analysis of all patients across England receiving emergency hospital care has shown that, contrary to popular belief, fewer patients die after being admitted to hospital at the weekend compared to during the week. The death rate following a hospital admission at the weekend is higher only because the number of patients admitted to hospital at the weekend is lower.

The NHS is extending hospital services at weekends because it is believed that patients are at higher risk of dying if they are admitted at the weekend. This is based on research showing that the rate of mortality is higher amongst patients admitted to hospital at the weekend, compared to those admitted during the week. It has been assumed, but not demonstrated, that this is due to reduced availability of senior staff and diagnostic services in hospitals at weekends.

However, previous studies have considered only those patients who were admitted to hospital. The new research, conducted by SwagÖ±²¥’s instead looked at all patients attending Accident and Emergency departments between April 2013 and February 2014. Although similar numbers of patients attended A&E each day at weekends and weekdays, hospitals admitted 7% fewer patients at the weekend.

Professor Matt Sutton led the research, which looked at deaths in hospital within 30 days of admission. He said: “Hospitals apply a higher severity threshold when choosing which patients to admit to hospital at weekends – patients with non-serious illnesses are not admitted, so those who are admitted at the weekend are on average sicker than during the week and more likely to die regardless of the quality of care they receive.

“As a result, the figures comparing death rates at weekends and weekdays are skewed. The NHS has rushed to fix a perceived problem that further research shows does not exist.”

The study, published in the Journal of Health Services Research and Policy, shows that patients attending A&E at the weekend are no more likely to die than patients attending A&E during the week.

Rachel Meacock, lead author of the study, said: “The so-called ‘weekend effect’ is a statistical artefact and extending services will not reduce the number of deaths. Instead, the most likely impact of the planned service extensions will be an increase in the number of less severely ill patients who are admitted at the weekend, further pushing up NHS costs.”

The paper, ‘’, was published in The Journal of Health Services Research and Policy.

doi: 10.1177/1355819616649630

Read a blog by the study authors on the .

Increasing specialist community services like crisis resolution, helping make the transition to adult services smoother for young people, and implementing clinical guidelines are just some of the service changes that are linked to significantly reduced suicide rates in mental health services in England over the last 16 years, according to new research from SwagÖ±²¥.

The study, published in The Lancet Psychiatry journal, by researchers at at The University SwagÖ±²¥ also finds that suicide rates were higher in mental health trusts with higher levels of staff turnover, suggesting that organisational factors may be equally important in preventing suicide.

Previous studies examining which aspects of mental health service provision are most effective in preventing suicide are scarce, have been inconsistent in their findings, and limited in scope. This is the first study to look at the impact of specific mental health service improvements in a range of organisational contexts, on suicide rates.

In this study, the authors analysed the impact of 16 recommendations and service changes in all NHS mental health services across England on patient suicide rates between 1997 and 2012. They also looked at whether suicide deaths were related to the way mental health services were organised (using measures such as staff turnover, staff and patient satisfaction, patient complaints).

The research included data from 19,248 individuals who died by suicide in England over the 16-year period and were in contact with mental health services in the 12 months before they died. This represents over a quarter of all suicide deaths in England during this time. The researchers compared suicide rates before and after these recommendations and service changes were introduced.

By 2012, 58 services (94%) had implemented at least 10 of the service changes and 34 (55%) had implemented all 16. The individual service changes that were most widely implemented were removal of non­collapsible ligature points on wards, policies to reduce absconding on in-patient wards, and a mechanism to implement National Institute for Health and Care Excellence (NICE) guidelines.

The five mental health service changes linked to the biggest falls in suicide were: increasing the availability of specialist community services like crisis resolution and home treatment; better management of patients with dual diagnosis (ie, drug or alcohol misuse as well as major mental illness); reviews and information with families after suicide; introducing policies to help manage the transition to adult mental health services for young people; and implementing the NICE guidelines on depression.

The researchers found that implementing recommendations and service changes was associated with significantly lower suicide rates. Each of the 16 recommendations and service changes were linked with 20-30% decrease in the suicide rate (from around 12 suicides per 10,000 contacts with mental health services to approximately 9).

The study also linked suicide rates to some wider organisational factors including higher levels of non-medical (e.g. nursing) staff turnover and reporting of patient safety incidents. However, other factors like staff sickness and patient satisfaction did not appear to affect suicide rates.

Importantly, implementing the five most promising changes had a greater impact in mental health services with low levels of non-medical staff turnover and higher levels of overall reported safety incidents. “A workforce that is constantly changing is likely to affect the continuity of care and this could compromise safety,” explains Professor Nav Kapur, lead author and Head of Suicide Research at at SwagÖ±²¥.

“High numbers of safety incidents might suggest a culture of openness in which staff and the organisation learn from adverse incidents, but they may also be a warning that there are real patient safety issues.”

According to Professor Kapur: “Our study suggests that many of these interventions may prevent suicide and save lives. The data also show that at least as important as these initiatives might be the organisational context in which they are introduced. These are important findings for mental health services worldwide, particularly in those countries where there is a focus on community care such as the USA, Europe, and Australasia.”

Professor Louis Appleby, Director of the National Confidential Inquiry and one of the co-authors of the study added: “This study shows that how clinical staff work can make a difference to patient suicide risk. Mental health trusts with low staff turnover, and where staff reviewed suicide deaths with families had lower suicide rates suggesting that healthy, learning organisations may also be safer.”

Paper, ‘’, was published in The Lancet Psychiatry Journal.

The Healthcare Quality Improvement Partnership () commissions the Mental Health Clinical Outcome Review Programme, NCISH, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety (DHSSPS), and the States of Jersey and Guernsey.

Women who had a caesarean section in a previous pregnancy are much more likely to have a vaginal birth if their antenatal care is led by a midwife, according to a new study from a University of SwagÖ±²¥ researcher, which was carried out in Southampton.

Although caesarean sections are safe, research is increasingly showing that vaginal birth and labour protects against long term-risks such as impaired immune response, asthma, obesity and type 2 diabetes in the baby. As a result there is a growing emphasis placed by health authorities on promoting vaginal birth after caesarean (VBAC) where it is safe to do so.

The new study, published in the journal Birth, is the first to evaluate the influence on VBAC rates of midwife-led antenatal care as opposed to care led by an obstetrician.

Using patient records, 405 women giving birth at one hospital after a previous caesarean were examined in two groups. The first group was from 2008 when antenatal care was led by obstetricians and, following a change in hospital policy in 2009-2010, the second group was drawn from women who had received midwife-led antenatal care in 2011.

The number of women who intended to give birth by VBAC in 2011 was 90.3 percent, against 77 percent in 2008. Those who actually achieved VBAC was also higher in the midwife-led group with 61.2 percent instead of 46.9 percent. Both represented significant increases in VBAC when antenatal care was led by a midwife.

, a midwifery lecturer in the University’s , carried out the research at the University of Southampton. She said: “There were few differences between the two groups of women we studied, so the main variance was the professional responsible for their care.

“Where it can be achieved safely, vaginal birth is preferable, but there’s a real issue with women who have had a caesarean once, opting for the same again. There aren’t many initiatives out there to break this cycle so this finding is important for providing evidence that midwives are best placed to promote vaginal birth.”

The authors of the study are not proposing that women should reject caesarean birth when they are advised to do so, but suggest that midwives are important figures in promoting VBAC in suitable women.

There is a three year gap between the two groups of women but in terms of age, socio-economics, ethnic group and other variables, the groups are similar. The only significant change was the change in policy to midwife led care in the hospital. The results are also unlikely to be due to cultural changes over time as the VBAC rates across England more generally did not change during the study period.

Dr White added: “The more we understand the role of the microbes living in the vagina, the more we are uncovering the protective effects of labour and natural birth against conditions such as diabetes and obesity.

“Midwife led care is cost-effective and, if it safely reduces the number of repeat caesarean sections, then it’s even more beneficial for mothers and babies.”

The paper ‘’, was published in the journal Birth.

SwagÖ±²¥’s Professor Louis Appleby has concluded a review for the General Medical Council, making recommendations to reduce the risk of suicide in doctors facing investigation.

Twenty-eight doctors with an open GMC case died by suicide 2005-2013. To address this issue, began working with the GMC in December 2015, reviewing the fitness-to-practise process with the aim of reducing the risk of suicide in doctors facing investigation. He delivered his findings last week.

Detailed proposals have now been drawn up by Professor Appleby, a psychiatrist and Director of . The presentation was attended by Royal Colleges, the British Medical Association and other senior figures in health across the UK. The proposals will now be developed by the GMC and published in final form.

These include working towards having fewer doctors referred for investigation, and having a dedicated medical post ensuing mental health is factored in to decisions.

Importantly, investigations should be handled sensitively and communicated through one individual. Employers should also play a greater role and more funding should be identified for support services.

Professor Appleby said: “The GMC can now turn a tragic problem into positive steps that others can follow. It can make mental health safety a thread that runs throughout the organisation, influencing training, standards, leadership and culture.

“A permanent focus on mental health safety will help doctors who might otherwise be at risk of suicide, but it can go further – in time it can extend the potential benefits of these proposals to patients and staff.”

More information these proposals can be found on , written by Professor Appleby.

Increased vulnerability due neglect and abuse, the absence of a supportive adult in their lives and a lack of mainstream effective sex and relationship education due to placement moves, are some of the reasons identified by children’s charity as to why standard sexual health education may need re-thinking for care experienced young people, to reduce unplanned pregnancy.

The findings have emerged from a review of academic papers and research from 2000 to 2014 undertaken by experts from SwagÖ±²¥ and Lancaster University to ascertain how best to improve outcomes of this vulnerable group of young people.

found that non-targeted methods to prevent unplanned pregnancy did not help to prevent unplanned pregnancy and childbirth for young people with experience of care leaver due to the following reasons:

• increased vulnerability due to pre-care experiences (such as abuse or neglect) contributing to a higher likelihood of mental health problems;
• increased chances of missing out on effective mainstream sex and relationship education due to placement moves;
• the absence of a supportive adult in their lives;
• being more likely to choose to continue with an unplanned pregnancy due to a desire for a loving attachment in their lives

, lead author from SwagÖ±²¥’s , said: “For me, one of the key messages of this review is the paucity of publications that focus on interventions that aim to prevent unwanted pregnancy in looked after young people. That is not to say that good work is not taking place - but if it is, we all need to know about it. It is therefore vital that interventions are evaluated and published so the good practice can be shared and costly mistakes avoided."

Karen Broadhurst, co-author and Professor of Social Work Lancaster University, said: “The findings from the review are helpful in thinking about where we might start in developing and testing pilot projects that aim to help young people avoid an unplanned pregnancy, make positive choices about partners and be better prepared for parenthood. There are some excellent initiatives in the US and we can learn from the evaluation of the initiatives we have described in our report, to develop bespoke programmes in the UK.”

Professor Broadhurst referred to her related on-going research funded by the Nuffield Foundation, which included interviews with 72 birth mothers. “40-50% of these women had a care background, and 100% were either in care or on the edge of care. Interviews revealed the complexity of factors associated with early unplanned transition to motherhood which included young women finding themselves in highly coercive relationships with older men where domestic violence was a feature of their daily lives."

Director of Operations at Coram, Renuka Jeyarajah-Dent said: “The context of this review is a situation in which young people who have been in care are falling pregnant, some repeatedly so, (British Journal of Social Work (2015) 45, 2241–2260 while at the same time reduced teenage pregnancy overall suggests that the messages about sex education and healthy choices are showing great success.

“There are few examples of evidenced programmes to prevent pregnancy for young people who have been in care. The report concluded that the lack of published evidence of effective unplanned pregnancy programmes in the UK means that successes cannot be replicated and mistakes are likely to be repeated. It also found that the results which have been published are not necessarily evaluated in a robust manner.

“However, our review also identifies models where programmes have been successfully tailored for the needs of care leavers, mainly in the US. Now we have to think about what could be adapted from these, applying our increased understanding of the issues so that vulnerable young people get a better level of support and can make educated choices about what’s right for them.”

Read the full review on (PDF)

An exercise programme devised by researchers at SwagÖ±²¥ has dramatically reduced symptoms among young people with first-episode psychosis.

The long-term prospects for young people who are diagnosed with psychosis are typically poor, with high rates of relapse, unemployment and premature death. The antipsychotics they are prescribed also cause rapid weight-gain.

Although exercise has been shown to be an effective treatment for people with long-term schizophrenia, no studies have assessed its effects on psychiatric symptoms in young adults with early psychosis, until now.

SwagÖ±²¥ study recruited 31 people aged 18-35 who had been referred to local mental health trusts for treatment. With the participants help, the team designed personalised exercise regimes which were carried out under the supervision of a researcher for ten weeks at local leisure centres.

, the lead author on the study, said: “Establishing an exercise regime for people with psychosis is likely to be much more effective when they are younger, and in the earliest stages of treatment. Getting people into a routine early on also helps set habits for life, which can make a huge difference to their long-term physical and mental health.”

The participants in this study actually exceeded the target amounts of exercise; achieving 107 minutes of vigorous exercise training each week for 10-weeks.

This compares favourably with exercise programmes in healthy populations as well as in schizophrenia.

“Personalising exercise training to the activities which patients find most motivating helps them stick to their programme.”

At the end of the 10-week period, the participants completed a variety of standardised mental and physical health tests. As a control group, seven people who were treated by mental health services without an exercise programme were also tested.

On the standardised tests, the exercise group displayed a 27 percent reduction in psychiatric symptoms, which was significantly better than the control group. Their brain functions also improved, and they achieved a slight reduction in body weight – going against expected weight gain from normal treatment.

Joseph added: “This was only a pilot study, but the improvements, particularly in psychiatric symptoms, were dramatic. Personalised exercise at local leisure centres seems to be a cost-effective and successful way to help these young people recover”.

“By reaching people early on, exercise can provide a healthy and empowering add-on treatment for young people with psychosis. This could massively improve their social functioning and mental health, hopefully preventing long-term disability from ever arising.”

The study, ‘’, was published in the journal Early Intervention in Psychiatry. DOI: 10.1111/eip.12329

Additionally, feedback from the participants themselves has also been published in the journal BMC Psychiatry, as ‘ DOI: 10.1186/s12888-016-0751-7