The Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) is a multidisciplinary national research unit, funded by the Scottish Government Health Directorate Chief Scientist Office (CSO). It has academic bases within Glasgow Caledonian University and the University of Stirling.
Sally Boa, a Speech and Language therapist and a PhD student at the University of Stirling, won the Innovation Award at the Scottish Health Awards 2013, in recognition of her research into goal setting in palliative care.
Palliative care aims to provide a care and support system to help people live actively until death. This is easy to say, but much harder to deliver. Goal setting with patients has been recommended, both within healthcare in general and palliative care in particular, as a mechanism to achieve high quality patient-centred care. However, this seemingly straightforward activity is often difficult and challenging to deliver in practice.
Sally collaborated with Strathcarron Hospice and researchers from both the Scottish Government Nursing Midwifery and Allied Health Professions Research Unit (University of Stirling) and the University of Glasgow to develop and implement a goal-setting intervention in the hospice setting. She expertly combined rigorous academic research with genuine engagement with patients, and partnership with clinicians and managers. This enabled her to collaboratively develop a theory and research-based intervention that was relevant, feasible, effective and implementable.
On hearing of Sally’s shortlisting as an award finalist Marjory MacKay, Director of Nursing at Strathcarron Hospice, commented, “I am delighted to hear that Sally’s work has been nationally recognised. Her research has helped people live until they die. Very few areas of health care can make such a claim. Sally’s work also challenges the public perception of what hospices are. They are not sad, depressing buildings full of people in death’s waiting room but a centre of vibrant, active, humorous, hope-cherishing achievement and care – where sad things also happen. Sally’s research sets a high bar for what true person-centred care can be and can achieve.”
The Scottish Health Awards 2013 is the most prestigious and recognised awards ceremony for healthcare professionals within Scotland.
(Photograph by Chris Watt Photography)
Identifying the most effective upper limb rehabilitation interventions for patients with stroke is a recognised priority for research. Cochrane systematic reviews synthesise evidence from randomised controlled trials and provide the best source of evidence to clinicians making decisions relating to the healthcare interventions. However, there are now at least 11 Cochrane systematic reviews, including over 80 randomised controlled trials, which specifically address interventions aimed at functional recovery of the upper limb. This rapidly growing body of systematic reviews is overwhelming for decision makers, and is failing to effectively facilitate translation of evidence into clinical practice.
Now NMAHP RU has been awarded a CSO project grant of around £84,000 to address the challenges to translating this research evidence into practice by carrying out a Cochrane Overview of interventions to improve upper limb function after stroke. Cochrane Overviews are a relatively new product from the Cochrane Collaboration, and aim to provide a summary of evidence from more than one systematic review. Led by Dr Alex Pollock, this will be the first Cochrane overview carried out by the Cochrane Stroke Group, providing important methodological lessons for future stroke-related overviews.
This Cochrane Overview should improve effectiveness and efficiency in NHS staff implementing evidence-based practice, as all evidence relating to interventions for upper limb problems after stroke will be within one accessible and usable document, allowing NHS staff a quick overview (and an exhaustive list) of Cochrane Intervention reviews relevant to a specific decision. This Cochrane overview should aid decision making and provide clear direction to patients, clinicians and policy makers.
Antidepressant prescribing continues to rise across Scotland, Europe and the US. Known contributing factors are increased long-term prescribing, the use of newer antidepressants and the possible use of higher selective serotonin re-uptake inhibitor (SSRI) doses.
In 2007 the Scottish Government set targets to reduce antidepressant prescribing. Within Scotland the majority of antidepressants are prescribed by general practitioners (GPs) for the treatment of depression but there are currently no formal processes to support GPs to review patients with depression or other common mental health problems. The effect of such reviews is unknown.
The aim of this study was to review general practice patients prescribed the same antidepressant for 2 years or more and evaluate prescribing and management pre and post-review. Four Community Health and Care Partnerships committed to reviewing a proportion of their long-term patients.
78 of 96 practices agreed to participate, representing a population of 388,656 adults. From this population 33,313 (8.6%) were prescribed an antidepressant and 15,689 (47.1%) were defined as long-term users. Amitriptyline was excluded as the majority of prescriptions are for non-mental health use.
2,849 (18.2%) long-term users were reviewed with 1 in 4 (28.5%) having a change in antidepressant therapy: 7.0% stopped, 12.8% reduced dose, 5.3% increased dose and 3.4% changed antidepressant. This resulted in a statistically significant 9.5% reduction in prescribed daily doses and an 8.1% reduction in prescribing costs. 6.3% were referred onwards, half to NHS Mental Health Services.
Pre-review SSRI doses were 10-30% higher than previously reported which supports the suggestion that higher doses are contributing to growth in current antidepressant prescribing.This initiative is currently running as a prescribing indicator in NHSGGC with more than 140 of 270 practices reviewing a proportion of their patients prescribed long-term antidepressants since 2010.
Emma France was invited by Sue Ziebland of the Health Experiences Research Group at the University of Oxford, to present at a workshop on qualitative secondary analysis (QSA) in November.
QSA involves the re-use of qualitative data by someone other than the original researcher. Experts in QSA from across the UK participated in a lively discussion about what does and does not constitute QSA, its challenges and benefits. The findings from the workshop will be used to help explore how QSA can inform health policy and to develop training for National Institute of Health and Clinical Excellence employees involved in evidence
As a result of the workshop Emma has been invited to contribute her experiences of QSA as a case study to the UKDS website.
The effect of mammography pain on repeat participation in breast cancer screening: A systematic review. Breast (e-Pub ahead of print) doi:10.1016/j.breast.2013.03.003.
The frequency and reasons for vaginal examinations in labour. Women and Birth, 26(1), pp. 49-54.
The role of alcohol price in young adult drinking cultures in Scotland. Drugs, Education, Prevention and Policy (e-Pub ahead of print) (10.3109/09687637.2013.765386).
Applying the revenge system to the criminal justice system and jury decision-making [comment on McCullough, M. E., Kurzban, R., & Tabak, B. A.]. Behavioral and Brain Sciences, 36(1), pp. 34-35.