CLAHRCs have been all about building the infrastructure and capacity to undertake applied health research. There are of course the big and visible achievements such as in the NIHR CLAHRC Wessex building a thriving Data Science hub for responding to the most pertinent questions asked of us by the NHS. Another less visible achievement is building the skills of local clinical academic and health services researchers in writing for publication. We know that evidence shows that institutional support provides an enabling environment in terms of writing for publication1. So, this has formed a key focus of our capacity building efforts.
After several months of thinking ‘I think I’d like to learn how to swim’, last year, I finally made the decision to enrol in adult swimming lessons. I was motivated, I felt fit and so was confident this was something I was capable of doing (and I must admit the lessons were also convenient to get to). Psychologists might say that I had high “self-efficacy”. Self-efficacy is the belief that you will successfully be able to complete a task, activity or performance.
However, my high self-efficacy did not necessarily mean that everything went smoothly or to plan. In the hours leading up to the first lesson I started to make excuses to myself and almost (spoiler alert!) didn’t go. I suspect you’re wondering what has all this got to do with anything?
One week on from the atrocity that took place in Christchurch, New Zealand that resulted in 50 people’s lives being taken, communities across the world have come together to show #WeAreOne. Here in Southampton the Muslim Council and Southampton’s Council of Faiths held a Peace Vigil this week to remember those lives lost. Today however, the significance of standing side by side with our Muslim friends, neighbours and colleagues really hit home.
“The idea of the qualitative support group was initiated by Dr Kinda Ibrahim who felt that establishing a peer support network for members within CLAHRC Wessex and the wider University could be helpful to facilitate the use and development of qualitative research in health, illness and care.
This group has been massively supported by CLAHRC central team and Professors Cathy Pope and prof Anne Rogers.
The goal of this group is to encourage an intellectually dynamic yet supportive atmosphere for debate and discussion that examines the place of qualitative research in health research, its core concepts and methods.
The group meets every 2-3 months to share experience and research and are looking to possibly organise training workshops to staff, postgraduate and undergraduate candidates who are conducting or interested in conducting qualitative research. The agenda of this group is driven by its members and their interests and needs.
Dr Teresa Corbett suggested starting a “Qualitative journal club” to form the basis of the discussion in our group and has recently put a call out for recommendations for a “MUST READ LIST” for qualitative researchers on Twitter. The response was fantastic with over 50 replies. Many of those who replied on Twitter asked us to share the list with them once it was compiled.
So we have decided to build this dedicated resource to help and advise people”.
We have also started building up a resource that to be shared so that we can look up the best person(s) within our group that could help, advise, and support. If you would like to add your details, please click here
Following my entry on the frailty project I was involved as a patient and public representative looking at the ways in which health professionals can try to integrate and work together to provide the best outcomes for frail patients, I have been thinking about how it relates to my role as an unpaid carer for my husband and mother.
I still believe that it is extremely hard to determine who is frail and who is not. Using geriatric guidelines for people who may only be in their 60s, like my husband, but whose degenerative condition (in his case, Parkinson’s) can lead to more falls and admission to hospital is not ideal. Staff, especially in hospital wards, quite rightly want training and definitive guidelines on how to deal with frail patients. But it cannot be a ‘one size fits all’ approach. I was amused during a long stay in hospital watching how the nurses and care assistants focused on people with grey or white hair, assuming that they would be the ones who were frail and needed the most support.
The concurrent use of 5 or more medications by one individual – is becoming increasingly a challenging phenomenon that demands attention at clinical policy and practice level. In the past decade, the average number of items prescribed for each person per year in England has increased by 53.8% from 11.9 to 18.3. It is 35-50% of community older people aged 65 years and above take 5 or more medications. The King’s fund ¹ published in November 2018 a report “Polypharmacy and medicines optimisation: Making it safe and sound” where they distinguished between the terms ‘appropriate’ and ‘problematic’ polypharmacy.
Appropriate polypharmacy: means prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimised and the medicines are prescribed according to best evidence.
Problematic polypharmacy where multiple medications are prescribed inappropriately, or where the intended benefit of the medication is not realised.
Here at NIHR CLAHRC Wessex we have had the privilege to work with some very talented and determined people who have signed up to become an NIHR Trainee. It’s a demanding process where you are supported to carry out research, normally for a PhD, while continuing often in your day job, be that in the NHS or University. The NIHR has now set up an Academy to support trainees.
More than twenty have made it through the process and we wanted to capture their experience to help others who may be considering the idea. We asked them four questions:
- What have I got from being a trainee?
- What advice would you give to someone who’s thinking about applying?
- How did you manage juggling PhD and work?
- What is your best single piece of advice
Here is what they had to say..
Dr Kate Lyle is a Research Fellow in Health Sciences at the University of Southampton and Professor Catherine Pope (right) is Deputy Director of NIHR CLAHRC Wessex
As academics, practitioners, and users of healthcare services we are all used to hearing about examples of successful interventions that have improved health services and care. Indeed one of the core aims of the NIHR CLARHC programme is to improve patient outcomes locally and across the wider NHS. Here in Wessex we have been working hard over the past 5 years to do just that, spreading best practice and evidence based research throughout the NHS.
But what about the things that don’t work? Attempts at service improvement or innovation that went nowhere? Often these are the things we don’t hear about. Yet, arguably there is as much to learn from our failures, as there is from successful innovations.
Continuing our series of blogs on the findings from our evaluation of the training element of four projects aimed at enhancing frailty care across Wessex, this blog reflects upon some of the information systems challenges that staff described when identifying and delivering health services to people at risk of or living with frailty.
A key concern for staff was information integration and access to it.
Have you ever thought about the convenience element of setting up direct debits or payments from your online bank system? Imagine having to use individual companies’ websites with online forms that did not share common data (name, address, bank account details) so that you had to enter it for each transaction? And even though we are able to check payments on the online systems of suppliers (using separate accounts e.g. for electricity, gas, water, council tax), the convenience of logging into only one system, our bank account, to review all our transactions surely saves time and allows us to better manage our funds. The notion behind the functionality of online banking is the centralisation of information for the benefit of the end user. Even if it is not always perfect, the convenience and ease of use has been a significant factor in enhancing the use of online services.
Now, let’s think about health systems and the same idea of information centralisation. Staff from the NHS organisations that participated in our study all agreed that integrating systems across the community, social, primary and acute sectors that hold information on those diagnosed with or at risk of frailty, would benefit patients and enable staff to provide better care. Intuitively, in their view, access to better quality information in terms of completeness and being up to date would enhance their decision-making. However, information integration is not simple in the health sector. Continue reading Improving the I T in Frailty care – By Dr Alex Recio-Saucedo and Dr Melinda Taylor
Dr. Sara A Morgan is an NIHR CLAHRC Research Fellow in Public Health – based at Southampton General Hospital
What’s the problem?
Official crime figures from 2013/14 show that 8% of women and 4% of men have experienced domestic violence within the previous year. In the past there has understandably been a strong focus on supporting these victims, but later there was a move to tackle the root cause, involving community programmes aimed at the perpetrators of domestic violence.
“I think there’s always been just the priority being the victim and there’s a lot of sense behind that because obviously those people need to be protected but, unless we actually deal with the source of the problem which is the perpetrator, we’re never going to stop that victim cycle.”
(Interview with stakeholder)