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

Thursday, 27 April 2017

Celebrating innovation within iPCHS

Written by Tom Kingstone | @PCSciences | keele.ac.uk/pchs | Published Thursday 27th April 2017

The Research Institute for Primary Care and Health Sciences (iPCHS) has been awarded not just one, but two funding awards from the Keele Innovation Fund. Athula Sumathipala (Professor of Psychiatry) and Tom Kingstone (Research Associate) from the Mental Health Research Programme and their teams were the recipients of the awards for their projects ‘Student Link’ and ‘FRRESH’. Tom Kingstone talks us through both of these projects in this week’s iPCHS blog. 

What is the Keele Innovation Fund?

The Fund is designed to fund small-scale original projects proposed by individual staff members or groups.  Both of these successful projects have been able to demonstrate true innovation in their approach, aspirations and delivery model whilst promoting Keele’s aims to improve community engagement and deliver new research initiatives. Successful applications have to be in areas which are allied to current university activity, and are funded to a maximum of £5,000. 

‘Student Link’: enhancing patient and public involvement and engagement with ethnic minority populations in research


The first of the successful projects is ‘Student Link’, which aims to overcome the current challenges that researchers face in improving ethnic diversity within patient and public involvement and engagement (‘PPIE’) within research.

The project is led by Athula Sumathipala, Carolyn Chew-Graham, Steven Blackburn Tom Kingstone and Keele Medical Student, Beth Seale, who will be inviting Keele University students to become ‘PPIE champions’ to support their community engagement agenda, but why do we need such an initiative?

iPCHS is recognised for its dedication to patient and public involvement and engagement in research on both a local and national scale. The iPCHS Research User Group, which is a group made up of members of the public who either have a direct experience of living with a long term condition or are carers/close relatives of someone who does, are involved in over 70 different research and implementation projects on a range of health conditions and interventions (musculoskeletal conditions, pain, long term conditions and mental health). They are involved in giving advice on research design, reading and giving feedback on research materials (e.g. questionnaires, letters to patients, consent forms etc), proving comment on research proposals, becoming members of project steering committees and even becoming co-applicants on grant submissions.

Recruiting patients from black and ethnic minority communities’ to the become members of the group though, is a persistent challenge and the funding received from the Keele Innovation Fund aims to help us overcome those challenges and better reflect the demography of the local population.

If you would like further information, or wish to get involved – then please contact Professor Athula Sumathipala (a.sumathipala@keele.ac.uk). 

Forum for Rural Research on Health and Wellbeing ('FRRESH')

The second innovation project to receive funding was ‘FRRESH’ which is led by Tom Kingstone, Carolyn Chew-Graham, Athula Sumathipala, Mihaela Keleman, Bernadette Bartlam, Tom Shepherd and Tim Lewington.

The team has recognised that rural perspectives on health and wellbeing remain under-represented in research and have joined up with the Community Animation and Social Innovation Centre (CASIC), South Staffordshire and Shropshire NHS Healthcare Foundation Trust (SSSFT) and the New Vic Borderlines to develop a new initiative.

The funding will support the establishment of ‘FRRESH’, which will support community engagement and research development by providing a platform to identify local rural health challenges, agree priorities for research and identify innovative methods that emphasise collaboration and knowledge translation between academia and rural communities across Cheshire, Shropshire, and Staffordshire.

For more information about ‘FRRESH’, please contact Tom Kingstone (t.kingstone@keele.ac.uk).
Make sure to follow us Facebook, Twitter and the Blog to keep up to date with these projects.

Thursday, 20 April 2017

Learning from the Experts: Clinical Academic Training

Written by Dr Annabelle Machin & Dr Randula Haththotua | @PCSciences | keele.ac.uk/pchs | Published 20th April 2017  


On Thursday 6th April 2017, the Research Institute for Primary Care and Health Sciences ('RI') at Keele University hosted a Clinical Academic Training event which brought together clinical academic trainees from the universities of Birmingham, Keele and Warwick. The event was chaired by the RI's Professor Carolyn Chew-Graham, Director of Clinical Academic Training, who brought both trainees and experts together to discuss the merits of different research methods and give trainees the opportunity to showcase their research through both oral and poster presentations. GP Academic Clinical Fellows, Dr Annabelle Machin and Dr Randula Haththotuwa, have summarised the day in this week's blog. 

Lorna Clarson, Academic Clinical Lecturer 
Dr Lorna Clarson, an Academic Clinical Lecturer (Keele University) kicked off the event, providing valuable advice on how to navigate clinical academic training and develop a competitive CV. In short, she emphasised the importance of developing a strong research network and finding inspirational mentors, whilst ensuring that you find the time to maintain a work-life balance. 

Feeling inspired from the first session, four of the trainees presented engaging oral presentations on their current research; 




Randula Haththotuwa, GP Academic Clinical Fellow
Randula Haththotuwa (GP Academic Clinical Fellow) was first to present her systematic review and meta-analysis of pre-eclampsia and future risk of cardiovascular disease, illustrating how pre-eclampsia is independently associated with an increase in future incidence of heart failure, stroke and death related to cardiovascular disease. 

Second to present was Dr Chun Shing Kwock (Honorary Clinical Lecturer at Keele University and Academic Clinical Fellow in Cardiology and Cardiology Registrar at University Hospitals of North Midlands), who discussed an interesting obesity paradox, where an elevated BMI is associated with reduced mortality after coronary angioplasty.

 William Scotton, Winner of Best Oral Presentation
Next up was Dr Rebecca Ward from the Department of Clinical Biochemistry (University Hospital of North Midlands) who presented an audit showing poor rates of postpartum screening for dysglycemia in women with gestational diabetes mellitus. She highlighted that patient education and shared responsibility for care are a way to ensure adequate monitoring.  

Best oral presentation prize winner, Dr William Scotton (Neurology Registrar and academic trainee, Birmingham) ended the first session by sharing his results from a survey, which explored the experiences of patients with idiopathic intracranial hypertension of diagnostic lumbar puncutres ('LP'). He discussed how pain and anxiety in relation to LPs, could be reduced by providing better pre-procedural information and by performing LP's in dedicated day-case units. Audience members highlighted the potential value of qualitative interviews to explore more detailed patient perspectives. 

 Lisa Dikomitis, Senior Lecturer
Five senior academics joined the event, presenting inspiring talks on each of their specialised research methodologies. Mamas Mamas, Professor of Cardiology (Keele University) focussed on 'cardiovascular big data', sharing examples of how his research using electronic data records has been used to answer research questions on quality, health economics, rate outcomes and risk/prognosis modelling in the real world setting with large population samples. Mamas was able to demonstrate how through 'the power of numbers', he has been able to answer questions not feasible through randomised controlled trials. 

Dr Clare Jinks, a Reader in Applied Health Research (Keele University) summarised 'mixed methods research', sharing interesting examples of how combining quantitative and qualitative methods within her projects has enabled her to respond to research questions in health services research. 

Focussing on qualitative research, Dr Lisa Dikomitis (Senior Lecturer in the Sociology of Health, Keele University) described the social construction of reality through her experiences of obstetric care. She was able to highlight how qualitative research can bring a new dimension that other research methods are unable to reach. 

Simon Davies, Nephrologist and Professor of Renal Medicine, presented an intriguing talk about making a trial a success. When designing a trial, he advised 'whatever the answer, try to make it interesting'. He resonated Lorna Clarson's earlier talk on the importance of strong collaboration and inspiring role models, leaving us with an inspiring quote from one of his previous mentors "Good researchers do trials that answer the right questions; excellent researchers find the smartest way of doing it". 

Finishing off the morning sessions was Professor of Epidemiology, Danielle van der Windt, highlighting how prognosis research can provide a better understanding of disease processes, predict outcomes and inform clinical decision making to improve outcomes. 

During the break, attendees were invited to network and take a look at the number of posters on display. A number of methodologies were present amongst the research showcased. Topics ranged from knee osteoarthritis, co-morbid mood problems, rheumatoid arthritis, peritoneal inflammation, readmissions after acute coronary syndrome and treatment of human papillomavirus associated disorders. The award for best poster presentation went to our very own Dr Annabelle Machin (GP Academic Clinical Fellow). 

Re-fueled, three more trainees showcased their research with an oral presentation. Amar Karia (Academic F2, Keele) presented their work on perinatal outcomes following antenatal detection of ventriculomegaly, highlighting that the majority of cases were mild with good outcomes. 

Matthew Tabinor (Renal Registrar and ACF, Keele) demonstrated that bioimpedance-defined overhydration predicted mortality rates in dialysis patients, emphasising the need for further research to explore the relationship between fluid overload, loss of lean body mass, structural myocardial changes and mortality amongst the dialysis population. 


Nuthana Prathivadi Bhanyankaram (Academic F2, Keele) was the last to present her research on patterns of musculoskeletal pain in children presenting to general practice. She reported how female children were more likely to consult with back pain with increasing age. 

The event was a success, not only inspiring the trainees but also providing us with a better understanding of the different methodologies and their role in producing excellent research. 

A special thanks goes to Claire Ashmore and Zara Richards for their organisation and help in ensuring that the event ran smoothly. 








Tuesday, 4 April 2017

Shoulder Pain Research at Keele: The Past, Present and Future

Written by Dr Chris Littlewood | @PCSciences | keele.ac.uk/pchs


Network with like-minded clinicians and researchers and understand what Keele University have done, are doing and will be doing to improve health care for patients suffering with shoulder pain at our afternoon seminar on Monday 15th May 2017. Dr Chris Littlewood, Physiotherapist and Senior Clinical Lecturer in Clinical Trials summarises below, why shoulder pain is at the forefront of our research. 


How common is shoulder pain? 

Shoulder pain is one of the most common musculoskeletal pain problems with up to one in four people suffering at any one time. Shoulder pain can have a significant impact on quality of life including an effect on work, hobbies and sleep. It has been suggested that four out of every ten people who suffer with shoulder pain will continue to experience problems one year later. And, for those people who do recover, a recurrent episode of shoulder pain is likely. So, musculoskeletal shoulder pain is clearly not a short-lasting condition.

What do we already know? 

Even though shoulder pain is a common and burdensome problem, it is surprising how little is known about the causes and most effective treatments. Some of this uncertainty is due to limitations of the tests and scans we use to try to diagnose shoulder pain problems. One example of this is that ‘problems’, e.g. a tear of one of the muscles and tendons of the shoulder, can be seen on a scan but we also see similar ‘problems’ in people without shoulder pain. Furthermore, patients can report that their shoulder pain is improving but the findings on the scan do not change. These findings serve to question our current use of scans and tests and how we formulate diagnoses for people with shoulder pain.

How do we currently treat it? 

In terms of treatments, there are a range of different options that might be offered to a patient complaining of shoulder pain. These options include advice, pain medication, injections, physiotherapy, including exercise, acupuncture, and surgery to name but a few. However, it is unclear which treatments should be offered to which patients to get the best effect. Also, it is apparent that many of our current treatments only have small effects in the short-term. Even though surgery is seen as the definitive treatment by some, the research evidence to date suggests it is no more effective than exercise for some types of shoulder pain.


Why research it?

There is clear scope to challenge how we think about shoulder pain and what constitutes effective diagnostic and treatment pathways. This seminar will explore some of these challenges by reflecting on research that has been undertaken by researchers at Keele University over recent years as well as research that is currently on-going and also research that is planned for the future to help reduce the burden of shoulder pain for our patients.

Sign up to the event 

Full details of the event can be found on our website. The event will take place on Monday 15th May at 2.00-5.00pm at Keele Hall, Keele University. Please ensure that you book your place for this event, as spaces are limited.  


About the author: 

Chris is a Physiotherapist and Senior Clinical Lecturer in Clinical Trials at the Research Institute for Primary Care and Health Sciences. He has extensive experience in relation to musculoskeletal disorders and has a special interest in the ‘rotator cuff’ borne out of clinical observation in tandem with the assumed complexity and mystique that surrounds these disorders.

In addition to his clinical training, Chris completed an MSc in Health Services Research and Technology, and was later awarded a UK Department of Health Fellowship to undertake his PhD which related to the assessment and management of the rotator cuff.

Chris has published a number of peer-reviewed papers with a focus on the ‘rotator cuff’ and regularly presents at both national and international conferences. 

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Why does Health Literacy matter?

Gordon, Jason. "Why does health literacy matter?" Blog Post. Text Help. Published 23 March 2017. Click to view the original article.


What exactly is health literacy? And why’s it so vital for the NHS and its patients? These big questions were answered by Dr Joanne Protheroe at our recent ‘Building Accessible, Inclusive Digital Health & Social Care Services’ seminar, hosted in London by healthcare charity The King’s Fund.

A practising GP in central Manchester, Jo is a senior lecturer at Keele University who also chairs Health Literacy UK. An interest in what would become known as ‘health literacy’ was sparked by Jo’s early research work. Exploring ways to engage with patients led to a realisation that individuals can’t take control in decisions about their own health if they don't have access to easily understandable information.

According to the World Health Organisation...

'Health literacy is defined as ‘the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health’.

“A person's health literacy level influences their knowledge and their accurate risk perception” explained Jo. “This has an effect on patients being able to take medications, and to know when and where to seek help – whether it’s phoning 111, going to their GP or straight to A&E, which has a major impact on the use of healthcare services. There’s also reduced uptake of things like voluntary screening in people with low health literacy… and this has a big influence on health outcomes, quality of life and mortality.”

Health literacy affects patients' ability to navigate their way through an increasingly complex care system – whether it’s simply adopting a healthy lifestyle, reading the words on a pill bottle or giving their informed consent for a major operation.

Jo pointed to a frequent mismatch between health systems and the skills of the patients and families they’re meant to serve.  She reported the case of one patient with a chest X-ray appointment at Manchester Royal Infirmary, too embarrassed to ask for help finding the right department that was signed ‘radiology’ and not ‘X-ray’. The result was a missed appointment - with a significant time cost to the NHS and inefficient use of resources, as well as obvious inconvenience to all parties.


Health literacy is a far from isolated problem.

Jo’s own assessment has revealed that health information is too complex for 43% of people aged between 16 and 65 to understand. And if that information includes numbers – like dosage instructions on a bottle of medicine – that rises to over 60% of the population. That’s more than 20 million people of working age who may not be able to understand and use information they need to look after their health. So what can we do about it?

“We can design more interventions: these can be as broad as changing the law, or just changing the way healthcare professionals talk in their one-to-one encounters with patients. And in parallel we need to improve the health literacy of our adult population.”

Jo illustrated the successful results of a ‘teach-back’ initiative in Stoke-on-Trent. Instead of patients being asked “do you understand everything?” at the end of a consultation, clinicians now invite the patient to explain in their own words what’s been discussed. This helps quickly pinpoint any areas of potential misunderstanding.

Other initiatives range from community-based sharing of health information on social networks to broadening young children’s vocabulary through role-playing games like ‘going to the dentist’ and ‘healthy eating’.

“Remember that health literacy isn’t just about printed information” concluded Jo. “We also have to think about interactions between professionals and patients, the built environment… and so much more.” 
Stay tuned for more findings from our seminar speakers - and news on other regional healthcare-focused events.

Dr Jo Protheroe

Jo Protheroe joined the Research Institute for Primary Care and Health Sciences as a Senior Lecturer in General Practice in 2011. After graduating in 1991, Jo worked for the NHS for 7 years before being awarded a Fellowship by the Wellcome Trust in 1998. After completing her PhD at the University of Manchester, Jo was awarded a Post-Doctoral fellowship from the RC-UK scheme to fund research into development of interventions to support shared decision making in disadvantaged groups.

Jo continues as a GP in inner-city Manchester. Her research interests include decision aids/decision analysis; facilitating decision-making in general practice with a focus on disadvantaged groups; patients participation and health literacy.