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‘Improving health and wellbeing through Research’ Preston Football Club 17 th October 2014 Improving health and wellbeing through research – October 2014.

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Presentation on theme: "‘Improving health and wellbeing through Research’ Preston Football Club 17 th October 2014 Improving health and wellbeing through research – October 2014."— Presentation transcript:

1 ‘Improving health and wellbeing through Research’ Preston Football Club 17 th October 2014 Improving health and wellbeing through research – October 2014

2 Medical Directors’ Office

3 Professor Heather Tierney-Moore Chief Executive Event Welcome Improving health and wellbeing through research – October 2014

4 Dr Heather Iles-Smith Research & Innovation Lead “Improving health and wellbeing through research – LCFT strategy refresh” Theme: Research Successes Improving health and wellbeing through research – October 2014

5 Medical Directors’ Office Overview National picture Local picture Research strategy  Objectives Current research Challenges

6 Medical Directors’ Office Why we do research - To develop new medicines, medical devices, therapies and clinical services - To facilitate access to new medicines/devices /therapies for LCFT Service Users - To develop new medicines, medical devices, therapies and clinical services - To facilitate access to new medicines/devices /therapies for LCFT Service Users - To add to the evidence base - To embed evidence based practice within LCFT services - To add to the evidence base - To embed evidence based practice within LCFT services NHS Constitution

7 Medical Directors’ Office National Picture Transformations of NIHR Research Networks- 25 to 15 nationally  Clinical Specialities 6 Divisions NW Coast Clinical Research Network (NWC CRN)  includes Liverpool, Merseyside, Lancashire & South Cumbria Division 1- Cancer Division 2- Diabetes, stroke, cardiovascular disease Division 3- Children, reproductive health and childbirth Division 4- Dementias and neurodegeneration (DeNDRoN), mental health Division 5- Primary care, Ageing, Health services research, dental health, Public health, Muscoskeletal disorders Division 6- Anaesthesia and pain management, critical care Division 1- Cancer Division 2- Diabetes, stroke, cardiovascular disease Division 3- Children, reproductive health and childbirth Division 4- Dementias and neurodegeneration (DeNDRoN), mental health Division 5- Primary care, Ageing, Health services research, dental health, Public health, Muscoskeletal disorders Division 6- Anaesthesia and pain management, critical care

8 Medical Directors’ Office Local Picture Overall LCFT has a balanced research portfolio- grant based and NIHR portfolio research Lack of equilibrium between mental health and community services and between professions Clinical academic researchers  6 in mental health (all medical)  0 in community services  0 joint appointments for Nurses, Allied Healthcare Professionals, Pharmacists or Psychologists Contribution to the NIHR portfolio (2012/13)  24% mental health  76% community services

9 Medical Directors’ Office Local Picture- Performance

10 Medical Directors’ Office Research strategy Vision To improve the health and wellbeing of patients and service users within Lancashire Care Foundation Trust (LCFT) through embedding research and evidence based practice in clinical services Vision To improve the health and wellbeing of patients and service users within Lancashire Care Foundation Trust (LCFT) through embedding research and evidence based practice in clinical services

11 Medical Directors’ Office Research Strategy Objectives Main objectives:- Objective 1: Increase access to research for our patients and service users Objective 2: Increase research capacity building within the Trust particularly within the Community Services Objective 3: Increase research culture of the organisation and embed research within each of LCFT Clinical Networks Objective 4: Increase service user/carer involvement in the research process Global enabler Establish financial security for LCFT research activity

12 Medical Directors’ Office Current Research TechCare- Dr Husain, Consultant Psychiatrist, Senior Lecturer  A mobile assessment / therapy for Psychosis  An intervention for clients within the early Intervention service. Randomized, double-blind Placebo-Controlled, Trial of Gantenerumab in Patients with Mild Alzheimer’s Disease - Dr S Karim, Consultant Psychiatrist Older adults  To reduce or slow down amyloid plaque build up (one cause of Alzheimers)  May improve cognition and function in early Alzheimers

13 Medical Directors’ Office Current Research Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial- Professor Max Marshall, Medical Director  The Lancet, May 2013 (381:9878: ) C-GLOVES. An evaluation of the effectiveness of compression gloves in arthritis: a feasibility study- Jenny Welsby, Specialist OT, Rheumatology Department  Occupational therapy study investigating the use of pressure gloves in rheumatoid arthritis.

14 Medical Directors’ Office Challenges Development fit for purpose Clinical Research Facility Financial stability  Maintaining/growing grant income  Increasing industry studies Capacity building  focussing on nurses, AHP’s, pharmacists and psychologists  Fellowship applications

15 Medical Directors’ Office Thank You for listening….. Web page:- us/Research-Innovation.php Please contact us at:-

16 Professor Jenny Shaw Clinical Director for Specialist Services & R&D Director Mental Health Screening in Police Custody In England: Developing a screening tool and referral pathway Theme: Research Successes Improving health and wellbeing through research – October 2014

17 Mental Health Screening in Police Custody in England: developing a screening tool and referral pathway From the inside out: Healthcare in custody and the criminal justice system

18 Detecting mental illness in Police Custody Higher rates of mental health problems amongst people in contact with the criminal justice system Prevalence amongst police detainees – estimates vary – 2%-20% of police detainees have mental health issues (Bradley 2009) Early identification of mental ill health is a current UK Government priority

19 Policy Priority Early intervention Liaison and Diversion Increasing access

20 The Problem Mental health screening procedure is not sufficiently robust – identifying the ‘known knowns’ Non mental health trained personnel – Whose job? Inconsistent mental healthcare services in custody – Lack of 24 hour cover

21 Research Team Dr. Jane Senior University of Manchester Miss. Heather NogaLancashire Care NHS Foundation Trust Prof. Jenny Shaw Lancashire Care NHS Foundation Trust / University of Manchester Miss. Susan Tighe Lancashire Care NHS Foundation Trust Dr. Elizabeth WalshUniversity of Leeds This presentation outlines independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (PB-PG ). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

22 Aims/Objectives Oct 2010 – Sept 2013 Aims – Improve current practices in police custody – Develop a referral decision tool Objectives – Identify and critique current procedures – Develop a mental health referral tool – Develop accompanying training and implementation package

23 Method Participants – Mental Health Professionals – Police Officers – Service Users

24 Method Understand current practices Views on requirements of screening referral tool Intervie ws (n 58) Review of existing screening tools Consensus on scoring (routine/urgent ) Creation of referral pathway Consult ations (n 58) Service Leads from Mental Health, Social Care, Police, Private Healthcare, City Council, Service Users Implementatio n and training package Action Learning Groups (n 8)

25 Results Agreement that a screening tool should be; – short, simple language – questions mixed with free text observations – current issues – mental health, risk of suicide / self-harm – sensitive – facilitate dialogue

26 CMHS “In a custody environment it would need to be shorter and simplified- detention officers would have difficulties” “Not relevant for custody, too complicated and vague” “The questions don’t really get to the core of the problems and would miss people with severe mental health issues”

27 PriSnQuest “Simple and straight forward” “It is brief, therefore quick to complete and less likely to be overlooked or cut short” “Questions are clear, specific, easy to understand and likely to get the answers that they are looking for”

28 PolQuest PriSnQuest - Historical issues -Depression - Serious Mental Ill Health Police Custody Risk Assessment - Historical issues -Self Harm -Medication

29 PolQuest 14 Item Screening Questionnaire Administer in 5 minutes All Adult Detainees Corresponds to a referral pathway

30 Scoring High Risk Current symptoms/sig ns of psychosis, depression, self harm, suicide Highly distressed Urgent Referra l Eg. ‘Have you recently found yourself wishing you were dead and away from it all?’

31 Scoring Low Risk Historical issues Known to/currently engaged with services Routi ne Referr al Eg: ‘Are you currently in contact with mental health services?’

32 Referral Pathway

33 Training and Implementation Implementation Manual ‘How to’ practical guidance

34 Impact Screens everyone in custody Clear referral process Early identification Economic use of services Provides standardisation of care

35 Future Directions Feasibility Study Implement in real life-one custody suite Identify issues in application Design full scale trial

36 Thank you

37 Dr Waquas Waheed Consultant Psychiatrist “Partners 2” Theme: Research Successes Improving health and wellbeing through research – October 2014

38 PARTNERS 2 Development and Pilot Trial of Primary Care Based Collaborative Care for People with Serious Mental Illness

39 Overview of the Purpose of the PARTNERS2 Programme Grant We aim to help primary care and community based mental health services work more closely together. Develop a system of collaborative care based in GP surgeries where service users are seen regularly by a mental health worker who acts both as overall co-ordinator (supporting individuals to access other services and activities) and therapist. At the end of the 5 year Programme, we will know if collaborative care for people with schizophrenia and bipolar disorder in England is likely to work.

40 Work stream 1: Assessment of local care pathways and current services for people with severe mental illness Work stream 2: Development of a core outcome set for use in mental health trials involving people with schizophrenia or bipolar disorder in a community based setting. Work stream 3: Development of the system of collaborative care.

41 1: Reilly S, Planner C, Hann M, Reeves D, Nazareth I, Lester H. The role of primary care in service provision for people with severe mental illness in the United Kingdom. PLoS One. 2012;7(5):e : Reilly S, Planner C, Gask L, Hann M, Knowles S, Druss B, Lester H. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev Nov 4;11:CD Developing the grant application

42 Building the team Experts in 1.Collaborative care 2.Primary care 3.Schizophrenia and Bipolar disorder 4.Qualitative researchers 5.Trial Methodologists 6.Health economics 7.Biostatistics 8.Service users 9.International partners

43 Contact details: Dr. Waquas Waheed, Consultant adult psychiatrist at Lancashire Care NHS Foundation Trust and North West Hub Lead , Maria Cox, PARTNERS 2 Research Assistant at Lancashire Care NHS Foundation Trust, Lantern Centre, Vicarage Lane, Fulwood, Preston, PR2 8DW , Jill Barlow, Research Studies Officer, Liverpool Science Park, Innovation Centre 1, 131 Mount Pleasant, Liverpool, L3 5TF , Or Visit:

44 Dr Lizzy MacPhie Consultant Rheumatologist “Finding Time for Research in a Busy Rheumatology Department” Theme: Developing Clinical Research Improving health and wellbeing through research – October 2014

45 Finding Time for Research in a Busy Rheumatology Department Lizzy MacPhie Rheumatology Department Minerva Health Centre Preston

46 Overview The Rheumatology Service The challenges & solutions PPI Portfolios studies

47 Rheumatology Service Transferred to community in Sep 2010 Based at the Minerva Health Centre Complete service redesign – 0.6 WTE consultant at transfer – 3 WTE consultants now in post

48 Service Developments Weekly MDT & lunchtime educational meetings Pathway days to inform service development Regular patient support group meetings Launch of website

49 Challenge 1 Limited Research Experience Historically patients considered for clinical trials all sent to Wrightington No engagement with portfolio studies No engagement with CLRN Consultants little academic experience

50 Solution Networking – Met with CLRN (Prof Goodacre) – Introduced to CLRN nurses – Spoke to Rheumatology colleagues “The Alliance”

51 Challenge 2 Lack of dedicated research resources No dedicated research time in job plans – Consultants or nurses – Team too busy in clinic to recruit patients Managers very worried about impact on activity Limited room availability No storage/processing facilities for bloods

52 Solutions CLRN Support – All the team have to do is identify pts Simplifying recruitment process – study, pt name, contact no to CLRN nurse Met with managers Careful selection of Portfolio Studies – Simple, observational eg registers, genetics – Not requiring lots of clinician input Room Availability – Discussion with lead clinic nurse

53 Challenge 3 Raising Awareness Research not seen as a priority CLRN nurses not part of the team

54 Solution Consultant Meetings – Fixed item on agenda Lunchtime meetings – Research update every 6 months, no’s recruited Posters in clinic rooms Leaflets in clinic rooms about all the studies CLRN nurses attend MDT

55 RAMSRheumatoid arthritis or undifferentiated IA starting MTX (1 st /2 nd line, mono or combination therapy) Need to recruit before starting MTX DELAYRheumatoid arthritis or undifferentiated IAWithin 6 months of diagnosis BSRBRRheumatoid arthritis - starting certolizumab or tocilizumab (1 st /2 nd line) -biologic naïve & starting etanercept, adalumimab or infliximab Within 6 months of starting biologic BSRBR-ASAnkylosing spondylitis -biologic naïve & starting etanercept or adalumimab Within 6 months of starting biologic Myositis Genetics study Diagnosis of inflammatory myositisAny time following diagnosis SLE Genetics study Meets ACR criteria for SLEAny time following diagnosis Think Research! If you have any potential patients please provide them with a patient information leaflet about the relevant study and details (Name, MIN No & Contact No) to Sue or Gill or

56 Challenge 4 Keeping up the Momentum

57 Solution Recruitment figures recording on TIB Recognition – Invited to Present to Network Research Meeting – Invited to Present today Regular review of portfolio for new studies Clinical trials…….. Dedicated research PA…….

58 PPI Posters & leaflets in waiting area Research stand in foyer Patient support group meetings – Research stand Pathway days – CLRN nurse attended NASS research engagement event

59 Timeline BSRBR 16 patients BSRBR 16 patients RAMS 37 patients RAMS 37 patients MTX pneumonitis 0 patient MTX pneumonitis 0 patient Myositis genetics 4 patients Myositis genetics 4 patients SLE Genetics 11 patients SLE Genetics 11 patients BSRBR-AS 6 patient BSRBR-AS 6 patient Genetics in AS 6 patients Genetics in AS 6 patients Noisy Knees 1 patient Noisy Knees 1 patient Delay 19 patients Delay 19 patients

60 BSRBR “BSR Biologics Register” Long term hazards of biologic therapy in rheumatoid arthritis Observational study: baseline & FU questionnaires Certolizumab or tocilizumab (1 st /2 nd line) Comparison cohort: etanercept, adalumimab, Recruitment – 51 historical patients still actively collecting data – Recruited 16 patients

61 BSRBR-AS “BSR Biologics Register” Long term hazards of biologic therapy in ankylosing spondylitis Observational study: baseline & FU questionnaires Recruitment – Started Sep 2013 – Recruited 6 patients

62 RAMS “Rheumatoid Arthritis Medication Study” Predicting response to MTX Observational study: bloods & questionnaires Recruitment – Started April 2012 – Recruited 37 patients to date

63 SLE Genetics Study Investigation of genetics of SLE Observational study: bloods & CRF Consultant completes CRF Recruitment – Rare condition – Recruited 11 patients

64 Myositis Genetics Study Investigation of genetics of myositis Observational study: bloods & CRF Consultant completes CRF Recruitment – Rare condition – Recruited 4 patients

65 AS Genetics Study Investigation of genetics of ankylosing spondylitis Invite letter, postal consent Recruitment – 6 patients

66 Drug Induced Pneumonitis in RA Patients Investigation of factors influencing drug induced pneumonitis Observational study Recruitment – Very rare complication – Possible 1-2 pts during study period

67 “Noisy” Knees Acoustic Emission in Knee Arthritis – AE as a non-invasive biomarker for OA Observational study: questionnaires & clinical assessment Recruitment – Target: 3 patients in a year

68 Thank-you for listening Any Questions


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