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This blog was created to keep healthcare professionals, researchers, methodologists, and patients up to date with the latest primary care research. For more information about the Research Institute, visit our website; keele.ac.uk/pchs

Monday, 30 October 2017

Symptoms of trauma: beyond PTSD

Written by Professor Athula Sumathipala | www.keele.ac.uk/pchs | @PCSciences

Professor of Psychiatry, Athula Sumathipala attended the 16th Congress of the International Federation of Psychiatric Epidemiology in Melbourne, Australia from 17th-20th October. This year’s event focussed on the priorities in global health - taking psychiatric epidemiology to scale. In this blog,  Athula summarises his keynote address which focused on the epidemiology of conflict, migration and mental health in Sri Lanka, where he stresses that Common Mental Disorders (CMD) and unexplained physical symptoms are often ignored because of an undue emphasis on post-traumatic stress disorder (PTSD).



PTSD has always been considered to be the main consequence of patients who have experienced trauma. Recent research which has been conducted in Sri Lanka shows us though, that non-PTSD psychiatric diagnosis has a higher prevalence in patients exposed to trauma than PTSD itself.

Citizens in Sri Lanka have experienced considerable trauma over the decades. The country was victim to two uprisings since the 1970s by its predominant Sinhala ethnic group, as well as ongoing armed conflict by the Tamil rebels for over 30 years. A devastating tsunami also displaced over 500,000 citizens, killing 35,000 victims and significant outward migration abroad has occurred due to economic crisis.   

A National Mental Health Survey which was commissioned by the Ministry of Health in Sri Lanka assessed a population of 6,000, revealing that 1 in 10 Sri Lankans have some form of common mental health disorder because of experienced trauma. Overall, depression was most prevalent at 9.1%, with Somatoform Disorder (unexplained physical symptoms) at 2.9%. PTSD was only reported at 1.9%.

Reports of common mental health disorders were considerably more prevalent (19%) in a group of individuals who were forcibly displaced by the Tamil Tigers from the Northern Province of Sri Lanka over the last 20 years. Depression was reported at 12% and Somatoform disorders at 14%, PTSD was under 3%.

An alternative study conducted in the Colombo district which has a sample size of 6,000 also showed that although traumatic events were reported at 36.3%, 2% of those individuals experienced PTSD and 19% experienced non-PTSD mental illness over their lifetime.  

On a whole, we know that 1 in 10 Sri Lankan adults experience some form of mental disorder, which doubles in specific groups, such as trauma affected groups. Somatic distress appears to be considerably high, but receive inadequate attention from healthcare professionals.  

These findings have been invaluable in demonstrating that the domination of PTSD as the main psychiatric consequence of trauma is misguided, particularly in Sri Lanka. Mental health clearly has a much wider focus and needs to include depression, anxiety and somatic symptoms. The research has also raised awareness that child and adolescent mental health is a crucial issue which also needs addressing. child and adolescent mental health is a crucial issue which also need desperately addressing.

About the author:


Professor Athula Sumathipala 
Athula qualified as in Sri Lanka and trained as a family physician before re-training as a psychiatrist a the Maudesley and Bethlem Royal Hospitals. Athula later followed an academic career, and completed a PhD at the University of London. Athula has a particular interest in inter-connected disciplines such as the epidemiology of chronic disease and morbidity, the evaluation of complex interventions, using twin methods in study of illness aetiology and ethics related to research. 

Thursday, 26 October 2017

Utilising patient power to evolve research implementation

Written by Robyn Till | www.keele.ac.uk/pchs | @PCSciences | @KeelePPIE



Friday 13th October was anything but unlucky for the Research Institute’s (RI) Patient and Public Involvement and Engagement (PPIE) Team, who were joined by over 80 patients, stakeholders and researchers for their annual Research User Group (RUG) event. This year’s event entitled ‘accelerating the impact of research using patient and public involvement’ was a huge success, leaving all those involved feeling rather inspired to make a difference to the way the RI implements research into practice.

Dr John Bedson showcasing the Keele Pain Recorder

Keele Hall’s ballroom was buzzing with enthusiasm as participants made introductions or caught up over their morning coffee and cake. Delegates could be found talking to representatives from Arthritis Research UK (ARUK) and the National Institute for Health Research (NIHR), or chatting to our very own Dr John Bedson, who was showcasing the Keele Pain Recorder (a mobile app designed by Keele’s Research User Group, aimed at improving pain management).
 

RI Director, Professor Elaine Hay, who was stepping in for Professor Krysia Dziedzic (Director of the Impact Accelerator Unit and PPIE) set the scene for the day. She welcomed the development of the Impact Accelerator Unit over the past 12 months and recognised the positive changes this has made to PPIE - which is now an integral part of Implementation as well as research. Promising it wasn’t something straight out of a Star Trek movie, Elaine summarised that the unit was about proactively managing the process of implementing research findings into health care by using patient power. She congratulated all of those involved in PPIE over the years for all their hard-work and dedication, which put PPIE on the research map.
Professor Sophie Staniszewska, Warwick University

Our keynote speaker took the stage next - Sophie Staniszewska, Professor of Public Involvement and Engagement at Warwick University. Sophie highlighted that studies often fall victim to ‘research waste’, where findings are either not implemented into routine healthcare or take up to 17 years to be implemented.  But, she feels that the promising concepts of co-production and knowledge mobilisation can go a long way in improving the research to implementation gap.


So what does she mean? Quite simply, it’s ensuring that clinicians, economists, academics and patients are all involved in the co-production of each element of the research cycle. This includes study design, research output design, development of guidelines and implementation activities. This can be done through a ‘knowledge mobiliser’ or ‘knowledge broker’ - a champion that bridges the gap between all of these structures.
Research jargon out the way, it was time to hear from the stars of the show, our patients.
Patricia Callaghan, LINK Group Member
Magdalena Skrybant, a member of our LINK (Lay Involvement in Knowledge Mobilisation) group, highlighted that as a patient involved in the research process, it can be really satisfying to see that research published in a journal, but fast forward ten years and it’s still not been translated in practice. Aware that processes are slow, she reiterated the importance of patients in improving the design and delivery of research by providing their patient insights and experiences, whether it’s helping to create publications that signpost patients to the right places, or helping disseminate a mobile app that a researcher has developed. Patricia Callaghan, also provided her insights as a LINK group member as she pulled on a few heart strings, taking the audience through her journey to becoming a member.
Breaking up the day with a bit of light comic relief, we welcomed back our two favourite Grannies, Ethel and Agnes. Ethel and Agnes (played by two budding actresses, and members of the PPIE team) helped demonstrate how daunting the process can be joining the research - and now implementation - world as a non-academic. This year they were joined by a member of RUG on stage, who played the part of Ethel’s husband.
Ethel (Adele Higginbottom) struggles to understand the
research terminology
Following a morning which focussed on how patient power needs to be better utilised to improve implementation, the afternoon looked at how Keele has successfully done this, through the JIGSAW-E (osteoarthritis) and STarT Back (back pain) implementation projects. The role of Patient Champions in the European wide JIGSAW-E project were showcased by Implementation Project Manager Nicki Evans and LINK member John Murphy, whilst Knowledge Broker Laura Campbell and Consultant Physiotherapist / NIHR Knowledge Mobilisation Fellow Kay Stevenson presented the global progress of STarT Back through a novel ‘Mastermind’ format.

The LINK group, which was mentioned a number of times throughout the day, was created over a year ago, and is made up of people with a passion and enthusiasm for improving healthcare using the best possible research evidence. This group is tasked with providing guidance to the Impact Accelerator Unit project team by drawing on their knowledge, contacts and experience of the NHS and healthcare practice.

Sue Ashby, PPIE Implementation Fellow, has been researching the work of the LINK group and the impact of the patient voice over the last 12 months. With the help of RUG members Katie Tempest, Ruth Haines and John Haines, Sue explained that although there is a lot of literature out there which tells us how we can meaningfully involve patients in research, it isn’t telling us how its done in implementation. In reaction to this, Sue researched how to use PPIE in implementation by reviewing case studies and literature, interviewing patients, researchers and clinicians at Keele, and observing LINK meetings. 
It wouldn’t be an RI event without some audience participation, and Helen Duffy, NHS Partnerships and Engagement Manager and co-director of the Impact Accelerator Unit was on hand to facilitate. Delegates were asked to think about how they, as an individual, could improve research implementation.
The consensus around the room was that using networks, exploiting communication methods such as the media, improving clinician’s mind-sets, educating healthcare professionals and ensuring consistency across healthcare practices would make a real difference.  

All in all, the event was a great success and it was fantastic to see so much enthusiasm for PPIE from not just the patients, but from the academics and stakeholders as well. The work that has been done by the team has put PPIE on the research agenda  and ensured that it has become best practice. Now it’s about opening up a dialogue and changing perspectives of all those involved in research by emphasising the importance of patient power.

Visit the our Patient and Public Involvement and Engagement website for more information about the Research User Group.

Tuesday, 19 September 2017

A NIHR In-Practice Fellowship: Growing evidence-base for self-harm in primary care

Wtitten by Dr Faraz Mughal | www.keele.ac.uk/pchs | @PCSciences | @farazhmughal


As a GP and Royal College of General Practitioners (RCGP) Clinical Fellow for Children and Young People’s  Mental Health, I was delighted when I heard the news that my NIHR (National Institute for Health Research) In-Practice Fellowship application was successful. The fellowship will not only allow me to develop research skills and evolve as a clinical academic, but will also allow me to further understand self-harm within primary care, a subject which personally, really troubles me. 


But what is an In-Practice fellowship?


More often than not, General Practitioners will go through their training and have little to no involvement with research. This isn’t to say we have no interest in it, on the contrary, we often come across conditions that need further research to better inform practice, but we often don’t know how  to contribute.

In short, the fellowship offers an academic training opportunity to fully qualified General Practitioners who may have already spent  time in NHS practice or fresh from general practice training, but have had little formal academic training so far. Training opportunities are flexible, however provide structured supervision within a research setting to ensure attainment of academic goals and will often include the completion of a Master’s degree. 


What will I be doing?


My fellowship will lead to the completion of an MPhil, which will be supervised by Professor Carolyn Chew-Graham and Dr Lisa Dikomitis.  I will spend part of my time developing my research skills, completing two studies within the Mental Health Research Programme of  Keele University’s Research Institute for Primary Care and Health Sciences. I will spend the rest of my time continuing with my clinical commitments as a practising GP.

The first study is a systematic meta-synthesis of qualitative studies of primary care practitioner attitudes and knowledge of self-harm in young people. The second will be a qualitative study, where I will be interviewing young people between the ages of 16 and 25 about their experiences of self-harm, help seeking behaviour, and their access to care with a general practice focus. 


Why self-harm?


I developed an interest in self-harm in young people early in my career as a GP. Being a young person today, is very different to what it was like 20 or 30 years ago, and the accumulation of stressors on these young people may result to the feeling of wanting to self-harm, or indeed carry out the act of self-harm. However, even as a GP, I still find it difficult to fathom what inflicting (or wanting to inflict) pain onto one’s self could be like.

We are seeing more and more cases of self-harm within primary care, and I hope that the research conducted through this fellowship will be beneficial to the small but growing self-harm evidence-base in primary care, and form the basis for further research.  

Tips for a successful application


Because of the great opportunities that these fellowships offer, competition is often fierce where applicants must be able to demonstrate that they have an outstanding potential for development as a clinical academic in research, or research linked to medical education.

The selection process is intense, so if you’re considering applying for an In-Practice Fellowship my tips for writing a successful application would be; 

Gain some research skills

Even if it’s self-funded, gaining research skills will give you some extra weight in your application, and help you through the fellowship process. I’ve conducted some previous research during my training and in the early years of becoming a GP (unfunded), which resulted in a few research publications on tobacco and medical education  and non-research peer reviewed publications. I also had the opportunity to present at international and national conferences. 

Find a mentor

Finding a mentor to guide you through this process is invaluable. The RCGP and the Society for Academic Primary Care both offer mentorship opportunity that are definitely worth considering. 

Take your time

Take the time to focus on your research question, identify a suitable supervisory team, and plan your application. A mentor once advised me not to rush into applying and to ensure you apply at the right moment, and in hindsight, this was crucial advice for me. 


I am thoroughly looking forward to beginning my fellowship later this year, and starting my journey into clinical academia. It will give me the opportunity to learn from a team of experts from one of the top Primary Care Research Institutes in the UK and I know the experience will be invaluable as a practising GP. 

More information about these fellowships can be found on the NIHR website