clahrc east midlands research study portfolio

#CLAHRCour project portfolio

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Dear Colleagues

I know that for many people the term Healthcare Research conjures up images of men in white coats testing drugs but the research we are doing at CLAHRC East Midlands is very far from that. We are concentrating on how we can improve the health of the region through better ways of delivering care, by helping the NHS target the time, people and money it has in the most useful and effective way possible. Our focus is very much on long term conditions that people can develop and have for some time with complications developing over many years.

Our priorities have been developed through close collaboration with all our partners and a rigorous analysis of the health needs of the area. We know what challenges face the NHS in the East Midlands and the work we are undertaking will help meet them. We have also take account of the fact that our region has some of the highest densities of Black and Minority Ethnic communities in England with South Asian communities being particularly well represented. Many, if not all of these communities, experience above average levels of diabetes, stroke, heart disease and mental health challenges and our work will help reduce these health inequalities.This short report spells out in plain English four core thing that are the mainstay of our research programme:

• What we are doing• Why we are doing it• What the benefits will be• Who we are working with

Because of the extraordinary combination of experience, skills and knowledge within CLAHRC East Midlands we are uniquely placed to meet and help overcome the challenges the NHS faces in our region. It is still very early in the lifetime of this CLAHRC but I am confident that we will deliver on our commitments to the benefit of all – to enable people to live healthier for longer.

Professor Kamlesh KhuntiDirector CLAHRC East Midlands

“Supporting our leading researchers is so important

and these NIHR CLAHRCs will link the NHS,

universities, and other relevant organisations

providing care for patients in what will be

ground-breaking work to improve the lives of

thousands of patients across the country.”

Professor Dame Sally C. Davies

Chief Medical Officer and Chief Scientific

Advisor at the Department of Health

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A SOLID FOUNDATIONCLAHRC East Midlands is building on the strengths of the two previous

CLAHRCs whose activities and outcomes have been praised by the NIHR. The

experiences of both Leicestershire, Northamptonshire and Rutland (CLAHRC-

LNR) and Nottinghamshire, Derbyshire and Lincolnshire (CLAHRC-NDL) will

contribute a wealth of expertise in the area of prevention and management

of chronic disease, public and mental health, and implementation and

improvement science. During the five years that the two CLAHRCs existed

they produced a substantial level of high quality studies, delivered over 100

research and implementation projects, recruited over 30,000 participants,

attracted over £20 million of external research grant funding, published

over 300 papers in peer reviewed journals and supported over 30 PhDs.

CLAHRC-EM Launch

The launch of the National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM) got off to a flying start in February 2014. More than 150 delegates from across the region took the opportunity to hear how the £28 million project will target local health priorities to drive forward improvement and innovation.

Professor Mike Cooke CBE, Chair of NIHR CLAHRC EM, said “The East Midlands hosts some of the best health researchers in the world and the region has an enviable track record of success and achievement. CLAHRC EM will enable us to build on their skills, experience and dedication to deliver projects that match what the NHS is telling us is important to them. However, the key element will be transforming good research outcomes into practical improved health outcomes on the ground. The turnout at our launch demonstrates the enthusiasm for our ambitions and the support we have from all our partners.”

GETTING INVOLVEDAs the very name Collaboration for Leadership in Applied Health Research and Care (CLAHRC) implies, working closely with all our partners, including patients and the public, is the keystone of how CLAHRC East Midlands operates. We want as many organisations and individuals to become involved in our activities as possible. Their positive contribution will provide valuable insights and energy that will improve what we do and how we do it.

By emphasising the word ‘Collaboration’ in our title, we want to develop a network of people and teams across the East Midlands, and further afield, who will enthusiastically engage with us. We want them to contribute and share their ideas, knowledge and skills so that our goals of delivering world class research that can transform the health and lives of people in the East Midlands are achieved. We are already working with industry partners, improving knowledge and skills in the NHS through our PhD programme, generating real public involvement in our studies especially with Black and Minority Ethnic Communities and encouraging NHS staff to become involved in our programme of activities. Together these and other initiatives form a backbone of involvement that we will build on over the coming years.

OUR PARTNERSNIHR INFRASTRUCTURE

• 5 x NIHR BRUs• NIHR PCRN• NIHR Disease Specific

Research Networks• NIHR Health Technology

Cooperative in Mental Health

• NIHR Research Design Service LOCAL COMMUNITY PATIENTS & PUBLIC

• Patients and the public• Patient representative groups• Third sector organisations INDUSTRY

• Qbtech• Baxter Healthcare Ltd• Novo Nordisk• MSD Ltd• PRIMIS• Sanofi• InHealth WORLD CLASS ALLIANCE

• UK Centre for Tobacco Control Studies

• MRC UK Centre for Musculo-skeletal Ageing

• National Centre for Sport and Exercise Medicine

• Institute of Mental Health

NHS & CARE PROVIDERS

• 16 NHS Trusts, 19 NHS Clinical Commissioning Groups and 2 Local Area Teams

• 10 Upper Tier Local Authorities• EM Leadership Academy• Strategic Clinical Networks:

- Mental Health, Dementia and Neurological Conditions

- Respiratory - Cardiovascular (including

cardiac, stroke, renal and diabetes)

- Maternity, Children and Young People

ACADEMIC & EDUCATION

• 5 x Universities: - Leicester - Nottingham - Loughborough - Lincoln - Coventry

• Health Education East Midlands EAST MIDLANDS ACADEMIC HEALTH SCIENCE NETWORK

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Study Lead: Dr Tom Yates

Reader in Physical Activity, Sedentary Behaviour and Health, and a key researcher within the Diabetes Research CentreUniversity of Leicester

Preventing Chronic Disease Theme: Carol Akroyd carol.akroyd@uhl-tr.nhs.uk

Why are we doing it: Type 2 diabetes, where the body can no longer control the amount of sugar in the blood, is an increasing health problem affecting over two million people in England alone. It has many serious consequences, including heart problems, reduced quality of life and early death. People from a BME background, are known to be at an increased risk of developing type 2 diabetes. However, despite this increased risk, there has been little attempt to develop and evaluate diabetes prevention programmes that have been specifically designed for these communities within the UK.

What the benefits will be: This study will ensure that the Let’s Prevent programme is suitable for multi-ethnic communities and will also develop a resource pack to aid implementation of the programme. We believe our study will lead to a best practice approach for reducing the risk of type 2 diabetes. The East Midlands has some areas with very high prevalence of diabetes, and it is predicted to continue to grow. Improving people’s knowledge of diabetes risk and reducing prevalence will have substantial impacts on individual patient’s health, improved quality of life and reduced NHS costs.

Who we are working with: We will be working with GP practices across the East Midlands, in particular those with a large multi ethnic population.

What we are doing: We want to help GP practices with a high BME population deliver a programme that will reduce the risk of developing diabetes. The pathway will find people who are at high risk of type 2 diabetes and provide a lifestyle education programme based on helping people to eat a healthy diet and do more exercise. We will ensure the programme is suitable for BME populations before it is taken into GP practices.

REDUCING THE RISK OF DIABETES IN BLACK MINORITY ETHNIC POPULATIONS

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EDUCATION FROM AND TO THE HEARTWhat we are doing: Despite heart disease being a major cause of death in England many people do not know what are the risk factors that cause it. We will develop a pragmatic structured education programme for people at high risk of heart disease to support a healthy lifestyle and improve taking prescribed medicines. A trial will then be conducted to see whether the programme can reduce the risk of heart disease.

Study Leads: Professor Kamlesh Khunti

Professor of Primary Care Diabetes & Vascular Medicine. University of Leicester

Professor Stephen Rodgers

General Practitioner and Honorary Senior lecturerUniversity of Leicester

Preventing Chronic Disease Theme: Carol Akroyd carol.akroyd@uhl-tr.nhs.uk

Why are we doing it: Many deaths from heart disease could be avoided by people changing their lifestyle habits. Risk factors include high blood cholesterol, high blood pressure, being overweight, not exercising enough, eating high fat foods, high salt foods, not eating fruit and vegetables, smoking and drinking too much alcohol. Also, many people do not take the medicines that they have been prescribed for risk factors such as raised blood pressure and cholesterol. It has been shown that people need information about their own risk factors and to be given the appropriate support to help them make lifestyle changes.

What the benefits will be: The East Midlands experiences high rates of cardiovascular disease (CVD) and the large Black and Minority Ethnic communities in the region have higher than average rates. Developing and implementing an educational programme for people who are already at risk of CVD, will reduce the existing and future risks of CVD, improve patients health and reduce NHS costs.

Who we are working with: This project has been developed in collaboration with a number of partners across the academic and health communities including:

• Nene CCG • Leicestershire County CCGs • Corby CCG • East Midlands Academic Health Science Network (EMAHSN) University of

Leicester

CVD PREVEN

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PRACTICE EARLY WARNING SYSTEMS:FLAG AND SAVE LIVES

Chief Investigator: Professor Kamlesh Khunti

Professor of Primary Care Diabetes & Vascular Medicine. University of Leicester

Managing Chronic Disease Theme: Pam de Chazal pam.dechazal@uhl-tr.nhs.uk

Why are we doing it: People with T2DM and MA, are at a high risk of heart and kidney disease and early identification can mean earlier treatment, better outcomes and improved long term health. However there is currently no routine way for GPs and practice nurses to review all the risk factors that they need to consider. The new software will bring these factors together and alert the healthcare professional that the patient has a high risk of heart and kidney disease. The healthcare professional can then target the many risk factors involved in order to improve heart and kidney outcomes.

What the benefits will be: The study aims to show that patients cared for by practices receiving additional training and using the computerised ‘prompting’ system will have better health outcomes. If this is the case, the evidence will be used to recommend that all GP surgeries are provided with this training and information to improve patient outcomes, including, quality of life and decrease costs by reducing the number of medications and hospital visits.

Who we are working with: This project has been developed in collaboration with a number of partners across the health community including:

• Leicester City CCG • Leicestershire County CCGs • Nottingham City CCG • PRIMIS • East Midlands Academic Health Science Network (EMAHSN) • Health Education East Midlands (HEEM) • 24 GP practices from Leicester and Nottingham

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What we are doing: The study aims to develop and test a method of reducing heart and kidney complications in people with type 2 diabetes (T2DM) (where people have raised blood sugar levels), and microalbuminuria (MA), (a moderate increase in the level of albumin in urine and an indicator of kidney disease). If successful this will reduce mortality and symptoms, decrease in-patient costs and improve quality of life. The study will install a customised software package on practice databases which will flag patients with T2DM and MA to the GP/ practice nurse. Control practices will not have the software installed and will be used to compare the results.

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Principal Investigator: Professor Melanie Davies

Professor of Diabetes MedicineUniversity of Leicester

Managing Chronic Disease Theme: Pam de Chazal pam.dechazal@uhl-tr.nhs.uk

Why are we doing it: Diabetes is a highly prevalent, long term condition, making it one of the NHS’s biggest and most expensive challenges, accounting for approximately 10% of the total NHS expenditure. Diabetes affects 3.7 million people in the UK and a recent study concluded a third of the UK population could be at risk of diabetes. Diabetes cost the NHS £17,000 per minute in 2011 mainly due to complications that are largely avoidable through better care. Urgent action is vital to meet this challenge and deliver care as close to home as possible.

What the benefits will be: The new way of caring for people in Leicester, Leicestershire and Rutland has the potential to reduce the demands on out-patient clinics, deliver care in the community and save NHS resources. If we can confirm that it is producing the benefits that are anticipated we can support and inform other NHS organisations planning similar programmes This will lead to improved patient outcomes, save NHS resources and match up with the NHS Quality, Innovation, Productivity and Prevention(QIPP) priorities.

Who we are working with:

• Community care – Leicestershire Partnership NHS Trust who provide integrated mental health, learning disability, and community health services across Leicester, Leicestershire and Rutland (LLR).

• Primary care - the three Clinical Commissioning Groups (CCGs) that cover LLR which are Leicester City CCG, West Leicestershire CCG, and East Leicestershire and Rutland CCG.

• Acute care - University Hospitals of Leicester.

What we are doing: To see whether redesigning diabetes services to support greater collaboration between community, primary and acute care will improve outcomes for patients. The results of the evaluation will be used to support policy makers and other stakeholders in implementing the programme locally and nationally. It will assess how good the service redesign is in reducing blood sugar and other health indicators in people with type 1 or type 2 diabetes, how overall care improved and whether the skills of practice staff benefited.

DEVELOPING INTEGRATED DIABETES SERVICES TRAN

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Principal Investigator: Professor Sally Singh

Professor of Pulmonary and Cardiac Rehabilitation. University Hospitals of Leicester NHS Trust

Managing Chronic Disease Theme: Pam de Chazal pam.dechazal@uhl-tr.nhs.uk

Why are we doing it: COPD is the third leading cause of death worldwide, and is associated with considerable disability, poor quality of life and high use of healthcare. Managing the day to day symptoms of the disease can be complex and requires a broad range of knowledge, skills and behaviour, including exercise, breathing control, relaxation, chest clearance and medications. SPACE FOR COPD is a supported self-management programme, which provides people with an opportunity to learn these important skills. This study will work on delivering self-management support to small groups of patients within the community. This will ensure that care can be delivered closer to home, and will particularly focus on using group support to enhance the impact of the programme.

What the benefits will be: If SPACE for COPD can be shown to work it can be rolled out across the East Midlands and further afield. It will provide more choice for patients as to how they can be supported in the management of their condition, leading to improvements in patient care, and has the potential to reduce healthcare utilisation with associated cost savings.

Who we are working with: We will be working closely with GP practices in Leicester City, Leicestershire and Rutland and others across the East Midlands.

IMPROVING HEALTH;A WEIGHT OFF THEIR CHESTWhat we are doing: We will evaluate the effectiveness of delivering a Chronic Obstructive Pulmonary Disease (COPD) self-management programme to small groups of people based in the community. The programme has been shown to work when a member of the research team delivered the programme to patients on a one-to-one basis. We now need to find out if a healthcare professional based in the community can deliver the programme to small groups and achieve the same improvements shown in the one-to-one sessions.

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IMPROVING ADHD DIAGNOSIS FOR CHILDREN AND YOUNG PEOPLEWhat we are doing: This study will find out whether:

• Using the results of an objective test of activity and attention (QbTest) leads to an earlier correct diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD)

• The QbTest leads to better treatment and improved patient outcomes for ADHD• The QbTest is clinically and financially viable in the NHS.

Principal Investigator: Professor Chris Hollis

Professor of Child & Adolescent Psychiatry. University of Nottingham

Enhancing Mental Health Theme: Jayne Simpson jayne.simpson@nottshc.nhs.uk

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AWhy are we doing it: ADHD is a neuro-developmental disorder that affects 3-5 in 100 children. The symptoms of ADHD include poor attention, hyper- activity and impulsivity. There has been a rapid growth in diagnosis over the last 30 years with the number of children recognised and treated for ADHD in the UK increasing almost 10 fold from the early 1980s, with spending on drugs for ADHD increasing seven fold between 1998 and 2005. Despite this growing demand, clinical methods for assessing and treating ADHD have hardly changed over the past 30 years. Current ‘best clinical practice’ relies on lengthy clinical interviews and observations or questionnaires. However, in real-world NHS practice it is generally not possible to provide this to all referrals with the result that patients often have to wait a long time until a diagnosis of ADHD is confirmed.

What the benefits will be: Objective measures of activity and attention have the potential to shorten assessment time, increase diagnostic accuracy, reduce delays in treatment, and improve treatment response. QbTest uses a computerised measure of attention and impulsivity with a motion tracking system that records the amount of movement the patient makes when performing the task. QbTest is the only test of its type that measures the physical movement of the patient, which may be important in distinguishing ADHD from other conditions. There is some evidence to suggest that QbTest can reduce diagnostic uncertainty by improving the accuracy of diagnosis and reducing the time to start treatment for ADHD.

Who we are working with: We are working alongside Community Paediatric and Child and Mental Health Service teams across the East Midlands and England. We are inviting young people (aged 6-18 years), and their parents/carers, who have been referred for an assessment of ADHD to participate in the trial...

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HELPING URGENT CARE USERS COPE WITH DISTRESS ABOUT PHYSICAL COMPLAINTS

Principal Investigator: Professor Richard Morriss

Professor of Psychiatry & Community Mental Health. University of Nottingham

Enhancing Mental Health Theme: Jayne Simpson jayne.simpson@nottshc.nhs.uk

Why are we doing it: Six percent of the population have excessive anxiety about their health and this may cost the NHS in England £3 billion per year in unnecessary costs. Despite much of this money being spent on unplanned or urgent care and in-patient admission, there is little evidence of patient benefit. In previous research, patients with health anxiety were reluctant to accept face-to-face talking treatment from mental health services. Providing therapy remotely might be more acceptable to patients with health anxiety.

What the benefits will be: Reducing the use of urgent and emergency care by people who don’t need it is a Government priority. Providing therapy to people with health anxiety remotely might be more acceptable. It is also more cost effective and can be better supervised as it can be delivered by a smaller group of local experts who will be highly familiar with the needs of these patients.

Who we are working with: We will be working with primary and secondary health care providers of unscheduled care across the East Midlands covering Nottinghamshire, Derbyshire, Lincolnshire, Leicestershire, Northamptonshire and Rutland. This will include:

• Accident & Emergency departments • GP practices and GP out of hours services • Mental health services delivering psychological treatment

We will be recruiting participants of any age or background over the age of 18 years who meet the study criteria. We will work with NIHR MindTech to develop the internet and video technology.

What we are doing: Many people regularly visit Accident & Emergency departments, walk in centres or make an urgent same day appointment with their GP – unscheduled care. We want to understand their needs better and to find out whether Cognitive Behavioural Therapy (CBT), also known as talking therapy, over the phone, or via video calling, will improve their physical and emotional health. We will find out if talking therapy given remotely is clinically or cost effective compared to usual care. We will also find the best way of delivering this treatment by talking with service users, health professionals, other experts and researchers.

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NOVEL WAYS OF SUPPORTING MENTAL WELL-BEING OF YOUNG PEOPLE

Principal Investigator: Dr Kapil Sayal

Professor of Child and Adolescent Psychiatry. University of Nottingham

Enhancing Mental Health Theme: Jayne Simpson jayne.simpson@nottshc.nhs.uk

Why are we doing it: Self-harm is one of the five leading causes of hospital admissions. Re-admissions due to self-harm occur frequently within 30 days. Unfortunately, at the moment, if individuals who self-harm do go to hospital, there is considerable variability in whether they are seen by a specialist in this area and what help they get offered. There are strong links between depression and self-harm and tackling depression could reduce the risk of repeated self-harm and suicide. Improving access to psychological therapies (IAPT) services that provide the majority of psychological treatment for depression may not offer support designed to help people who have a high risk of self-harm and/or suicide. It has been found that delivering talking therapy by phone or video calling can help people stay in therapy.

What the benefits will be: The remotely delivered problem solving CBT has the potential in reducing symptoms of depression and future acts of self-harm. If it is clinically effective and cost effective, then it will be rolled out across the East Midlands and embedded into current clinical practice. This will improve health outcomes, quality of life and reduce use of NHS resources.

Who we are working with: For the first phase of the study we will be working conducted within Mental Health Liaison Teams within Derbyshire Healthcare NHS Foundation Trust. If this pilot study is successful in engaging and retaining adolescent and young adults in the remotely delivered problem solving behaviour therapy, then we will roll out the study across mental health trusts within East Midlands.

What we are doing: This study aims to see whether a Problem Solving based Cognitive Behavioural Therapy (CBT), a type of talking therapy is acceptable and practical in helping adolescents and young adults with depression and who have self-harmed. This therapy will be delivered remotely, via video calling or telephone. We want to find ways to get adolescents and young adults (aged 16-30) involved in, and to stay with, talking therapy delivered by phone or video calling and to find out whether delivering therapy this way is clinically effective and cost effective in comparison to usual care. We also want to work with clinicians, commissioners and service users to find out what would stop this form of therapy succeeding and what would help it.

E-DASH

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Why are we doing it: Maintaining health and independence is a priority for many older people living in the community. A focus on wellbeing and health promotion for older people aims to prevent, reduce or delay the need for NHS or social care.At the moment people may miss out on support or services because they fall between the gaps where services are not ‘joined up’ or coordinated. For support in the community, the third sector (charities, voluntary and community organisations as well as social enterprises) could play an important role in addressing lifestyle health factors, but these are frequently not coordinated with other parts of the system, for example the NHS, social care and other agencies.

What the benefits will be: This research will lead to improved delivery of health and social care through coproduction of a ‘menu of what works’ guide in prevention and health promotion. We will have stakeholder events about six months before the end of the study followed by targeted activities to support the use of the research findings in regional services.

Who we are working with: Early contacts have been made with: • Age UK Nottinghamshire, Derbyshire and Leicestershire • Nottingham City CCG • Northamptonshire County Council • Rushcliffe CVS • East Midlands Later Life Forum • Derbyshire County Council • The EASY-Care Foundation

Study Lead Professor John Gladman

Professor of the Medicine of Older People. University of Nottingham

Caring for Older People and StrokeSurvivors Theme (COPSS): Yvonne R Simpson yvonne.simpson@nottingham.ac.uk

What we are doing: Will a standardised needs assessment of older people help to facilitate integrated care and support, where third sector organisations are involved in delivery alongside NHS and social care?We think that a crucial factor at the heart of integration is the way patients’ needs are assessed. We will ask whether a structured assessment is a useful way of integrating third sector organisations, through signposting or referral to services and confidentially sharing information. An overlooked potential benefit of service integration is that the information from individual assessments could provide an overview of the needs of the population and improve planning decisions and commissioning.

SUPPORTING OLDER PEOPLE’S RESILIENCE THROUGH ASSESSING NEEDS AND OUTCOMES

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EVIDENCE BASED IN-HOSPITAL STROKE REHABILITATION What we are doing: We are exploring the delivery of evidence based stroke rehabilitation in four stroke units in the East Midlands. We will examine the activities stroke survivors are engaged in and how much time they spend practising activities of daily living. We will also seek the opinions of healthcare professionals and service users in order to find out what works well in rehabilitation practice and identify areas for improvement. The information we gather will be used to facilitate the delivery of evidence base stroke rehabilitation.

Principal Investigator: Professor Marion Walker Professor in Stroke Rehabilitation. University of Nottingham

Caring for Older People and StrokeSurvivors Theme (COPSS): Yvonne R Simpson yvonne.simpson@nottingham.ac.uk

Why are we doing it: In the UK around 150,000 people have a stroke each year, with people over 65 years old most at risk. Having a stroke can leave many patients with long lasting disabilities. There is robust research evidence showing that early and appropriately delivered stroke rehabilitation leads to better outcomes for stroke patients. However, the provision of in-hospital rehabilitation in the UK is variable, occurs much less than in other European countries, and is not always evidence based. This project aims to understand why these differences occur in order to facilitate improvements in the delivery of evidence based stroke rehabilitation.

What the benefits will be: What we find in our study will improve our understanding of the delivery of specialist rehabilitation early after stroke and offer insights into the factors that facilitate or obstruct evidence based practice. In partnership with key stakeholders we will develop interventions to target specific problems we identify and we will work together to improve local service provision. If successful, our programme could be rolled out on a regional and national basis within the framework of Academic Health Science Networks and/or Local Education Training Boards.

Who we are working with: We will focus on the delivery of rehabilitation in four stroke units in East Midlands. We intend to work with colleagues from:

• Royal Derby Hospital Stroke Unit • University Hospitals of Leicester • Lincoln County Hospital • Northampton General Hospital

In addition, we will work with the Nottingham Stroke Research Consumer Group to involve stroke patients and their carers in shaping the study.

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Why are we doing it: Hypoglycaemia in people with diabetes is relatively common and can have significant health implications, as well as implications for driving which can affect employment. The care pathway being evaluated has been developed and implemented in Leicester City to provide education and support to people who experience hypoglycaemia and will be fully tested in two new sites.

What the benefits will be: It is hoped that this intervention will be successful in preventing the number of repeat call outs for hypoglycaemia. The study will also assess whether factors such as fear of hypoglycaemia, quality of life and knowledge of DVLA driving regulations are improved by the pathway. Reducing the number of ambulance call outs for hypoglycaemia would result in significant cost saving to the NHS in addition to the patient benefits. The study will collect data in order to establish the financial costs and benefit of the intervention.

Who we are working with: We will focus on the implementation and evaluation of the pathway in two areas; Lincolnshire and Northamptonshire. We intend to work with colleagues from: • East Midlands Ambulance Service• Diabetes Specialist Nurse teams throughout

Lincolnshire and Northamptonshire• University of Lincoln• East Midlands Ambulance Service research team• East Midlands Academic Health Science Network• Health Education East Midlands

Chief Investigator: Professor Kamlesh Khunti

Professor of Primary Care Diabetes & Vascular Medicine. University of Leicester

Caring for Older People and StrokeSurvivors Theme (COPSS): Yvonne R Simpson yvonne.simpson@nottingham.ac.uk

What we are doing: The study will implement and evaluate an enhanced care pathway for people with diabetes who require an ambulance call out to treat hypoglycaemia (low blood sugar level). The intervention consists of an information booklet aimed at raising awareness of hypoglycaemia followed by a phone call from a diabetes specialist nurse to discuss the causes and management of hypoglycaemia. The nurse may also request that medications are changed to prevent future episodes.

ENHANCED CARE PATHWAY FOR PEOPLE RECEIVING AN AMBULANCE CALL OUT FOR HYPOGLYCAEMIA

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What we are doing: We will be working with schools in the East Midlands to develop, implement and evaluate a programme that provides opportunities to break up sedentary time and, in turn, increase physical activity for year 5 students (aged 9-10 years). We will support teachers to use flexible adaptive components of the intervention within different contexts and settings rather than prescribing a standard ‘one size fits all’ approach.

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Study Lead :Dr Lauren Sherar

Senior Lecturer, Physical Activity and Public Health.Loughborough University

Preventing Chronic Disease Theme: Carol Akroyd carol.akroyd@uhl-tr.nhs.uk

Why are we doing it: It is generally believed that too much sitting is detrimental to children’s health. Young children today are increasingly driven to school and learning often means sitting at a desk for long periods at schools. To date few school based interventions have focused on reducing sedentary behaviour throughout the whole day. It is likely to be challenging for teachers to change their teaching methods to provide opportunities to students to break up sedentary time and incorporate more physical activity throughout the day. A natural and flexible approach to accommodate the different settings, teaching methods, curriculum subjects and physical environment is required for sustainable implementation. Most importantly, school teachers and support staff need to be empowered to implement their own interventions which will be appropriate to their school contexts and students.

What the benefits will be: Reducing sedentary time and increasing physical activity during the school day will hopefully produce positive changes in the health and wellbeing of students and lead to behaviour change that will be sustained into adulthood. In addition, this work will hopefully engage and mobilize a range of stakeholders to create feasible and sustainable changes to policy and practice which will lead to a decrease in the time pupils spend sitting in UK schools.

Who we are working with: • Primary schools across the East Midlands • Loughborough University • Leicester Diabetes Centre • Leicester University • British Heart Foundation National Centre – Physical Activity and Health• Nottingham University• Deakin University, Australia• National Centre for Sport and Exercise Medicine in the East Midlands• Health Education East Midlands

A SCHOOL BASED PROGRAMME TO REDUCE SEDENTARY TIME IN PRIMARY SCHOOL STUDENTS

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The projects this theme will undertake are still very much in the formative stage. However they will undertake rigorous research to increase the knowledge base and to advance the theories and methods for translating and spreading evidence-based innovations into routine clinical practice. This will be achieved by evaluating the range of implementation, improvement and translation strategies used by CLAHRC East Midlands study teams.Transferable lessons will be identified and shared with collaborators, partner organisations, other healthcare leaders and the health and implementation research communities. The theme will also have a support function, advising study teams on appropriate implementation and knowledge translation strategies.

IMPLEMENTING EVIDENCE AND IMPROVEMENT (IEI)

IEI Theme Lead: Professor Justin Waring

IEI Deputy Theme Lead: Graeme Martin

IEI Theme Manager and Capacity Development Lead: Emma Rowley

Hosted by Nottinghamshire Healthcare

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@CLAHRC_EM www.clahrc-em.nihr.ac.uk