Poster slide show - PRIME Annual Meeting 2020

A poster slide show of PRIME work packages
and research posters will play during the break

To improve the diagnosis and treatment of acute infections and optimise antibiotic use to address the issue of increasing
antimicrobial resistance.
Aim:
• RCGP Research Paper of the Year for the PACE study (CRP testing reduced antibiotic prescribing in patients with COPD)
• NIHR Advanced Fellowship awarded to Harry Ahmed to investigate relationships between infection, antibiotic use and serious bleeding in anticoagulant
medication users.
• Ser Cymru Grant awarded for the ‘COPE’ study in collaboration with Cardiff Metropolitan University: a longitudinal mixed methods study of attitudes,
beliefs and behaviour in response to the coronavirus pandemic.
• Leigh Sanyaolu (Academic Fellow) shortlisted for an NIHR Doctoral Research Fellowship aimed at generating new knowledge around the benefits and
harms of prophylactic antibiotics for recurrent UTIs.
• MISSOURI: Application submitted to the BHF for a big-data study looking at the risk of heart attack and stroke after a urinary tract infection.
• Increasing portfolio of work investigating Pharmacy-led treatment of common infections – awaiting outcome of NIHR HS&DR application.
• Missing link study – studying immune markers and the urinary microbiome in patients with urinary tract infection
Key activities/highlights over the past year:

Aims
• To increase our portfolio of work and generate new and novel insights into the
epidemiology of infections, building on collaborations with Oxford, PHE, and the SAIL
databank.
• To successfully secure major external funding for trials and observational studies that
lead to significant practice change in our approach to antibiotic prescribing.
• To increase our critical mass and support early career researchers to develop into
independent researchers in infections.
Focus
To increase understanding of the epidemiology of infections and improve antibiotic
prescribing
Current focus and plans for forthcoming year:

We deliver research in collaboration with
NHS organisations and academic partners
from Wales and across the UK
Our core interests:
• Clinical and cost effectiveness of:
• Alternative care pathways to reduce
ambulance conveyance to the Emergency
Department
• Risk prediction tools in primary care
• New treatments in the prehospital care
context
• Adoption and implementation of new technology
and working practices in pre-hospital care
• Including patients and service users in planning
and delivering research
• Use of anonymised linked routine data in research
Key activities/highlights this year:
Completed the HEAR study of the health and wellbeing of asylum
seekers and refugees in Wales (Public Health Wales), and secured
funding for the follow-on study HEAR 2 (RfPPB)
Secured funding for definitive trial of paramedic administered
anaesthetic block on scene for suspected hip fracture RAPID2 (HTA)
Gained funding and started evaluation of 999 Triage models for
COVID19 (UKRI Rolling Call)

• Deliver our active programme of research on:
- How best to respond to 999 callers with sustained high needs, through the STRETCHED and INFORM studies
- Impact of paramedics working in primary and community care settings, through the ARRIVE and PARE studies
- Feasibility of undertaking a definitive trial of Take Home Naloxone in emergency settings (TIME)
- Use and impact of the Pre-Hospital 12-lead electrocardiogram (PHECG2)
- Triage of COVID-19 patients in ambulance services (TRIM)
- Effectiveness of interpretation services for asylum seekers and refugees (HEAR2)
- Costs and effects of pre-hospital analgesia for suspected hip fracture (RAPID2)
• In collaboration with NHS and academic partners, develop and submit new proposals for research to
address the needs of healthcare providers and patients
• Disseminate research findings and engage with policy makers, providers and the public to make an
impact
Aims/plans for forthcoming year:

We investigate how communities, organisations (statutory, nonstatutory, 3rd sector), and practitioners can work together with
people to coproduce seamless care that can be accessed in the right place, at the right time, and in the right way.
Aim/what we address:
• Continued development and implementation of the Family Resilience Assessment Instrument and Tool with all health visitors across Wales, using the FRAIT
Community of Practice and looking forward to identifying innovative ways of furthering this research programme using digital technology, as well as the potential
to expand this work internationally, e.g. with colleagues in India.
• Implementation and development of the Community Nursing Research Strategy.
• Final reports on the Social Prescribing Services provided by Mind Cymru and the British Red Cross; and ongoing evaluation of the Social Services and Well-being
(Wales) Act 2014.
• Using consensus methodologies including on studies including identifying learning needs of social prescribers, mapping to explore the complexities of managing
children’s care, research priorities for social prescribing, quality indicators for health visiting practice and factors for multi-agency working.
• Ongoing capacity building including KESS studentships, building research capacity in the third sector and supporting primary care
• Working with industry on the health element of the BEACON’s project, to develop new products to improve recycling and prevent landfill.

1. Investigate ways to improve equity of access to health and social care, and health
education e.g. in rural settings, location of services, removing barriers, vulnerable
groups such as people with learning disabilities, and tackling health inequalities
2. Tackle workforce development so that efficient, effective, timely care can be
available that is good value for money. This may involve examining the redistribution
of tasks to the most appropriate providers, with associated factors such as up-
skilling/training, supervision, remuneration, workload, safety, and a work culture of
feeling valued.
3. Continue to implement and develop the Community Nursing and Social Care
Research Strategies for Primary Care in Wales

People should have the opportunity to make informed decisions about their care and treatment, in partnership with
their healthcare professionals. Treatment and care should take into account individual needs and preferences
Integrating shared decision making into the Value Based Healthcare Agenda in Wales
• We work closely with Public Health Wales , Improvement Cymru, HEIW, and Welsh Government colleagues to develop and deliver shared decision making training
to NHS clinicians across Wales. This training will help support the delivery of the Value Based Healthcare approach in Wales.
Improving delivery of person-centred healthcare through research
• Working with Patient Safety WP to explore patients’ experiences of healthcare during the COVID-19 pandemic and patient-reported safety incidents,
• Working with the Infections WP to develop research on uptake of influenza vaccine amongst care home staff, uptake of a potential COVID-19 vaccine amongst
members of the public, and shared decision aids for women with recurrent urinary tract infections.
• Ongoing research in relation to development and validation of diagnostic and decision making aid for men with lower urinary tract symptoms, exercise self-
management support for people with multiple sclerosis, and lifestyle support for people with Huntington’s Disease.
PhD Successes
• Dr Amber Jordan has recently successfully defended her PhD in viva. Her PhD was on supporting adolescents to become more involved in shared decision making
regarding their health.
Policy & International Collaborations
• Natalie Joseph-Williams has led an international group to develop guidelines for the implementation of Patient Decision Aids in routine clinical practice, and is Chair
Chair of the SDM in Rare Diseases White Paper Group. Adrian Edwards is academic lead on the NICE SDM Guideline committee.
Email: wood@cardiff.ac.uk / josephnj1@cardiff.ac.uk

• Collaborate with the Patient Safety Work Package, led by Dr Andrew Carson-Stevens, to explore the nature of patient-reported safety concerns
experienced in healthcare settings during the coronavirus pandemic and to develop a taxonomy of patient-reported safety incidents and inform safer
person-centred work strategies / workflows
• Deliver and embed Shared Decision Making training to healthcare professionals across Wales as part of the NHS Value Based Healthcare programme.
• Understand and evaluate the role of Patient Reported Outcome Measures (PROMs) in informing and measuring shared decision making in routine
clinical practice. Continue to work with Welsh Government / Public Health Wales to embed this as part of the NHS Value Based Healthcare programme in
Wales
• Support completion of ongoing research programmes and PhDs in WP5, and increase capacity by securing new research grants, PhD / Post Doctoral
Fellowships addressing our goal of supporting improving person-centred healthcare services
• Develop and evaluate new models and training resources for implementation of person-centred resources across new areas e.g. care homes, dentistry
• Further contribute to the advancement of healthcare policy / guidelines in the field of person-centred care by: 1) informing NICE SDM Guideline
development; 2) delivering a White Paper on SDM in Rare Disease to Government; 3) publishing international standards / guidance for the integration of
Patient Decision Aids into routine clinical settings

An estimated 23,000 people in Wales require palliative care at any one time. Non-palliative care specialists (GPs,
community nurses, and paramedics) play an important role in supporting and delivering end-of-life care.
• Completion of the NIHR-funded CARiAD feasibility RCT on the intervention of teaching lay
carers to give as-needed subcutaneous medication for breakthrough symptoms in people
wishing to be at home when they die. As part of the COVID-19 pandemic response, the Welsh
Government End of Life Board requested our team to draft policy for the CARiAD package to
be implemented rapidly.
The NIHR fast-tracked publication in support of this work, and WG approved the new all-
Wales policy in March 2020. Implementation is progressing at pace. Many groups in England
also expressed interest.
• We were commissioned to look at the scope of provision of all bereavement services in
Wales using NICE guidelines. A key consideration from the results is the development of a
national framework for bereavement care, to facilitate increased prioritisation of
bereavement support at organisational and regional level, and equity and access across
Wales.

• An ESRC funded mixed methods study is exploring bereavement
during the COVID-19 pandemic. The study aims to identify
implications for the delivery of end-of-life care and bereavement
support during and beyond the pandemic and to ensure prompt
translation into practice.
In parallel we are conducting analysis of bereavement
experiences from the COPE Cymru 3-month survey led by Cardiff
Metropolitan University.
• We are conducting an online survey exploring experiences of
providing palliative and end of life care within Community
Pharmacy.
This work will assist the Royal Pharmaceutical Society and Marie
Curie towards the development of UK ‘Daffodil Standards’ for
Community Pharmacy with the aim to improve current practice.
Key activities/highlights over the past year (continued):

1. Management of common symptoms in the last months/weeks/days of life, and
service models to support this, e.g. the role of nurse prescribers, medicines
management, including de-prescribing
2. Lay caregiver support: Anticipatory education on preparing for a home death, role-
extension (e.g. carer-administration of as-needed injectable medication), and
evidence-based bereavement support
3. Improving awareness, societal expectations, knowledge and acceptance of death
and dying.

Screening, prevention & early diagnosis (SPED) has continued to build on its strengths in cancer and other health priorities.
Focus has been aimed at developing strategies to prevent obesity related disease and reduce harm from tobacco, increasing
public awareness, and improve equitable uptake of cancer screening.
• Developing and evaluating community-based strategies for encouraging earlier cancer diagnosis and integrated prevention across tumour sites.
• Addressing the (adverse) social gradient in cancer, including completion of the ABACus3 trial of a targeted cancer awareness intervention for adults living in
deprived communities (see images below)
• Increased national and international collaborations seeking to accelerate early diagnosis for cancer.
• With our sister centre, the Wales Cancer Research Centre, we have been developing our international collaborations in Vietnam, Australia and the US through an
NIH grant and associated work.

• The WICKED study team created and began delivering workshops to General Practice staff across Wales to expedite cancer
diagnosis to improve cancer outcomes as part of the ThinkCancer! Feasibility Study.
• Recruitment in the NIHR funded Cancer: Life Affirming Survivorship support in Primary care (CLASP) Programme hit its
target of 2,500 patients recruited throughout England and Wales.
• Work is ongoing on an NIHR HSDR-funded realist evidence synthesis with co-design aiming to explain how primary care can
promote physical activity and physical function for people with long-term conditions.
• The Cancer Research Wales funded Diagnostic Journeys in Prostate Cancer (DJiP) study is now well underway, with patient
interviews and HCP focus groups in progress.
• UKRI COVID-19 Rapid Response population study and associated Lancet Oncology commentary about the anticipated
of COVID-19 on missed cancer referrals, reduced cancer screening and later stage diagnosis.

1. Involve patients, health professionals, and members of the public in developing,
evaluating and implementing person-centred interventions that address health
inequality in cancer screening, prevention and early diagnosis
2. Develop and test new measures and tools to improve cancer screening, prevention,
and early diagnosis behaviour across a range of cancer types
3. Underpin our research with state-of-the-art behavioural science and sociological
theory and methods
4. Deliver these aims whilst ensuring all our programmes of work are completed on
time, and new grant applications in this field are in the pipeline

Poor oral health is closely linked with social and economic disadvantage. In the UK, 49% of children have developed dental caries by age
five, and dental extractions under general anaesthetic are a leading cause of hospital admission in children aged 5-9 years. A programme of
major reform in how dental services are commissioned in Wales is underway.
• Exploring how technology can be employed to improve oral health in disadvantaged adolescents.
• We have received funding to provide evidence to support the current reforms to how primary dental care is commissioned in Wales.
• The international applicability of our work has been recognised by the award of a prize from the International Association for Dental Research.
• The PRIDA study - working with Public Health Wales and the office of the Chief Dental Officer we are exploring how a shared decision aid can be used to agree an
appropriate interval to attend the dentist.
• With colleagues in the Cardiff University School of Mathematics, we have won funding from Health and Care Research Wales to determine how a more efficient
and cost effective preventive approach can be adopted in primary dental care in Wales – the OPTIMISE study
• The NIHR funded BRIGHT clinical trial (in collaboration with the Universities of Dundee, Leeds, Sheffield and York) has completed all baseline examinations, and
year two examinations in the schools recruited in 2017/18 are underway.
• The objective of this work is to determine the clinical and cost effectiveness of SMS messages in encouraging behaviours conducive to good oral health in
adolescents living in disadvantaged communities.

1. Developing, evaluating, and implementing value-based models of preventing dental
decay including the use of operational research
2. Co-production in the delivery of dental services – sharded decision making in
relation to the appropriate use of dental services
3. School based clinical trial to determine the potential of SMS messaging to improve
oral hygiene and prevent dental caries
4. An epidemiological study to ascertain the impact of oral health improvement
programmes and the oral health of young adults in Wales.
Aims/plans for forthcoming year/s:

Wales School for Social Prescribing Research
The Wales School for Social Prescribing Research is a virtual all-Wales school, which aims to build a
world-leading critical evidence base for social prescribing in Wales, using a translational research model
to ensure findings have high-impact in academia, practice, policy and education.
• Evaluation: Developing the social prescribing evaluation methodology, reporting standards, glossary of terms, training
materials & small-large-scale evaluations of social prescribing projects.
• Social value: Projects exploring social value and social return on investment for social prescribing interventions.
• Education: Social prescribing workforce development and training, social prescribing in higher education settings
• Well-being: Philosophical conceptualisations of well-being, developing tools to measure social well-being
Our themes

1. Identify principles of good practice in social prescribing research, evaluation and monitoring.
2. Develop the evaluation methodology using a multi-stage approach (realist review, consensus
methods and Alpha and Beta testing) for use in social prescribing practice and research.
3. Engage with Wales Social Prescribing Research Network members to provide advice and consultancy
through regular evaluation forums and 2-3 social prescribing evaluations.
4. Work with members of the public to develop research ideas and disseminate findings.
5. Apply for grant funding to further research programmes within our four themes.
6. Continue to raise research awareness and capacity for social prescribing across sectors.
7. Develop social prescribing education work through the HEFCW funded social prescribing in higher
education project with Wrexham Glyndwr University & University of South Wales.
Wales School for Social Prescribing Research

Public involvement and engagement in primary and emergency care
research: the story from PRIME Centre Wales
Bridie Angela Evans1, John Gallanders2, Lesley Griffiths2, Robert Harris-Mayes2, Mari James2, Sian Jones2, Natalie
Joseph-Williams3, Mary Nettle2, Martin Rolph2, Helen Snooks1, Carolyn Wallace4, Adrian Edwards3,
and on behalf of the SUPER group and PRIME Centre Wales1
1 Swansea University; 2 SUPER; 3 Cardiff University; 4 University of South Wales
Background
International policy promotes involvement of patients and public
members in research to benefit patient care and health outcomes.
90% of health service encounters are in primary and emergency care.
Research into these services is coordinated in Wales by PRIME Centre
Wales.
Our aim is to ensure PRIME research is relevant to service users, carers,
the public and policy makers by incorporating comprehensive patient
and public involvement in every phase of our work.
This poster summarises our approach to public involvement and
engagement.

PRIME’s approach to public involvement and engagement
PRIME has policies and processes to enable and promote successful public involvement and engagement
across research activities. This ensures public perspectives and patient experiences are integrated
throughout research development, implementation and dissemination and in managing and delivering
PRIME strategy over a 10 year timescale.
A public/patient group called SUPER is a
key resource providing wide-ranging
perspectives via email and face-to-face
discussion. SUPER is Service Users for
Primary and Emergency care Research.
We collect information on
processes and experiences
to assess value and impact,
to guide ongoing involvement
and engagement. We follow
best practice and strive for
continuous improvement.
We involve public contributors
in developing, undertaking and
reporting our research. Research
leaders welcome public views. A
funded post provides leadership
and support to staff and to
public and patient contributors
to facilitate collaborations.

PRIME’s stable and well-resourced structure has allowed
us to embed diverse approaches to public involvement
and engagement across research. During the COVID-19
pandemic, we have adapted to online meetings and virtual
communication to ensure public contributors remain
involved in research.
PRIME researchers and public contributors are motivated
to work together. They have committed to collaborations,
developed knowledge and skills and also sustained
relationships.
Central is the public/patient group SUPER. This innovative
model offers experience-based expertise to add value to
the research cycle from earliest generation of research to
rapid dissemination of findings.
Effective public involvement and engagement enhances
relevance and quality of primary and emergency care
research to benefit patients and the general population.
We incorporate
online and in-
person methods to
ensure public
perspectives can
effectively
contribute to all
stages of research.
.
For more information:
Dr Bridie Evans, PRIME PPI Lead b.a.evans@swansea.ac.uk
See our paper at https://doi.org/10.23889/ijpds.v5i3.1363

Torrens-Burton A1, Goss S2, Holland-Hart D2, Longo M2, Sivell S2, Farnell D3, Sutton E4, Nelson A2, Byrne A2, Seddon K5 , Selman L4, Harrop E2
(and on behalf of the study steering group)
1. PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
2. Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
3. School of Dentistry, Cardiff University, Cardiff, UK
4. Population Health Sciences, University of Bristol, Bristol, UK.
5. Wales Cancer Research Centre RP
METHOD (from WP1)
An online survey was developed including both open and closed questions on bereavement experiences and
bereavement service use (see QR code or www.covidbereavement.com). Recruitment is UK wide via social media,
also bereavement and community organizations. We currently have approx.500 participants. We would like to
increase participation from men and people from minority ethnic groups. The survey will close on the 26th
December 2020.
BACKGROUND
There have been c.60,000 excess deaths in the UK since mid-March, with an additional c.300,000 people bereaved. Covid-19 is having an impact on the grief experiences of people
bereaved during the pandemic as well as bringing significant challenges to the bereavement services which support them. This study, funded by the UKRI/ESRC, aims to investigate the
grief experiences, support needs and use of bereavement support by people bereaved during the Covid-19 pandemic. This will provide crucial evidence of the needs and experiences of
this group, and how bereavement services are responding. This will inform end-of-life care processes and bereavement support, helping to mitigate a significant mental health burden in
the future.
Participants also showed
high levels of grief as
measured by the Adult
Attitude to
Grief questionnaire.
Future analyses will
determine factors
associated with
participant grief and
resilience over time.
For more
information
please contact
Dr Emily Harrop:
harrope@cardiff
.ac.uk
There are three study work packages (WP):
WP1: Longitudinal survey at three time-points of UK residents bereaved during Covid-19
WP2: Qualitative interviews with survey participants
WP3: Mixed methods study of bereavement services providers (survey plus case studies)
“As only 10 of us could go, I asked
neighbours to gather outside the house
as the hearse left for the crematorium.
Hardest part was driving myself, alone,
following the hearse. Then coming
straight home alone after the 'service' to
an empty house….Very hard that friends
and family couldn't come to visit Dad
and support me in his last few weeks.
The District Nurses were like a surrogate
family!”
PRELIMINARY RESULTS
Data from the first 145
participants have been
analysed. The table and
quote provide a
snapshot of some of the
unique grief issues
experienced by people
bereaved during the
pandemic.

CONCLUSION:
The COVID-19 pandemic has highlighted the importance of robust research infrastructures. At the same
time, high-quality research will be vital for resolving this crisis.
The ability to adapt to the current research challenges in ways that preserve the integrity of ongoing research is a
testament to this. These findings mirror many research centres.
Pushing through high waves: the impact of COVID-19 on
ongoing research projects (and researchers)
BACKGROUND:
The COVID-19 outbreak has found most of us in
uncharted territory - a place of uncertainty and
unpredictability we seem destined to remain in
for a while. As a result, science,
worldwide, started to pivot around the
pandemic overnight. The effects of the large-
scale mobilisation of researchers and health
care providers towards the pandemic quickly
extended to research projects (and researchers)
funded before the onset of the pandemic.
AIMS:
To summarise the impact on studies developed
in and supported by the Marie Curie Palliative
Care Research Centre.
METHODS:
The researchers involved in affected studies
helped to identify the research activities
impacted by the pandemic.
RESULTS:
A total of nine studies (two large multi-centre
RCTs, four qualitative studies, two
observational studies, and one PhD) were
affected by the pandemic.
1. Cardiff University, Marie Curie Palliative Care Research Centre, Cardiff, United Kingdom; 2. Velindre Cancer Centre, Cardiff, United Kingdom; 3. Prime Centre Wales.
Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
Longo M.1, Holland-Hart D.1, Goss S.1, Torrens-Burton A. 1,3, Baddeley E. 1, Ferreira Semedo L. 1, Islam I. 1, Mazzaschi F.1, Sivell S.1, Harrop E. 1, Byrne A.1,2, Noble S.1, Nelson A.1
As result of the financial pressure on charity organisations, funding for two studies which had not yet
started was pulled back by the funder.
New resubmission requesting funded (and unfunded) study extensions had to be submitted.
Each study was subject to a thorough risk assessment to assess the impact of COVID-19 on study
participants and secure transfer of confidential data (e.g. consent forms).
Changes to procedures had to be submitted for approval by ethics committees (e.g. PIS, ICF, Remote
consent, adaption of interview structures, changes to study objectives).
SOPs around remote consent taking, data management, and data transfer had to be
developed/amended.
Applications to have Letters of Access renewed had to be submitted to accommodate new study
timelines.
Some of the research staff had to be furloughed. In case of unfunded extensions, some of the projects
will have to be completed without the dedicated researcher.
The pandemic might require some HCPs to move overnight to different areas and roles, possibly
including the research HCPs who have been supporting recruitment to ongoing studies.
Nipped
in the
bud
Recruitment
delays
Risk
assessme
nt
Ethical approval
for protocol
changes
Amendment
s to SOPs
Letters of
Access
Staff
contracts
Changing HCPs
roles
Dr Mirella Longo
Marie Curie Palliative Care Research Centre,
Division of Population Medicine, Cardiff University School of Medicine,
www.cardiff.ac.uk/marie-curie-palliative-care-research-centre @MCPCRCCardiff

Torrens-Burton A1, Jones E2, Ferreira Semedo L3, Jones S4, Nelson A3
1. Prime Centre Wales. Divisionof PopulationMedicine, School of Medicine, Cardiff University, Cardiff, UK
2. National lead for Wales: CommunityHealthcare, Cardiff & Vale University Health Board, Cardiff, UK
3. Marie Curie Palliative Care Research Centre (MCPCRC), Divisionof PopulationMedicine, School of Medicine, Cardiff University, Cardiff, UK;
4. Director, Policy and Public Affairs, Marie Curie, London, UK
For more information
please contact Dr Anna
Torrens-Burton: torrens-
burtona@cardiff.ac.uk
Patients experiencing a life-
threatening illness require palliative
care and access to services to
maximise their quality of life.
Pharmacy plays a key role in terms
of optimising treatment regimens for
patients by reducing harm, increasing
the value of medication use and
improving patients’ and caregivers’
knowledge of medicines.
This can only be achieved by ensuring
timely access to palliative medicines
as well as effective communication
with other healthcare professionals
within palliative care teams.
In the UK, governmental bodies
emphasise the need to engage with
stakeholders and focus on the health
and well-being of patients, families
and the workforce.
Background
To explore the experiences of
pharmacists working in the
community in relation to providing
palliative and end of life care.
In addition, we aim to understand
how their experiences may have
changed during the currentCovid-19
pandemic.
Aim
This project is still in progress but the
findings from the survey will feed
into the development of UK
standards for community pharmacy.
The aim is to improve services for
providing palliative and end of life
care.
This work follows on from the already
developed Daffodil Standards for
GPs.
ImplementationAn online survey was developed
(see QR code below) which has
been sent out to
pharmacists/locum
pharmacists/pre-registration
pharmacists who work in
community pharmacy throughout
the UK.
Recruitment followed a top-down
approach, cascading an email
invite throughout key
organisations, starting with
leadership and working down to
front-line employees.
Methodology

Challenges of recruiting emergency department
patients to a qualitative study: a thematic analysis of
researchers’ experiences Price D, Edwards M, Carson-Stevens A, Cooper A, Davies F, Evans B,
Hibbert P, Hughes T, Rainer T, Siriwardena S. & Edwards A. (2020)
Findings Future recommendations
Complicated or time-consuming electronic health
record systems for identifying patients.
Implementation of ECDS in Emergency Departments will ensure better quality data on
presenting complaints and diagnoses.
Narrow participant eligibility criteria. Broadening eligibility criteria to enable more participants to be invited and thus recruited.
Limited research nurse support. Good contact before research visits to build rapport and ensure understanding of
research; carrying out practical preparations to lessen burden on hospital.
Lack of face-to-face communication between
researchers and eligible patients
Implement face-to-face recruitment methods in research design, allowing patients to give
consent during their ED visit rather than via post at a later date.
This study is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR), project number 15/145/04. The views expressed are those of the
author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Aim: Explore reasons for low patient recruitment in GPs in EDs study & propose recommendations to improve future patient
recruitment for research in similar settings.
Methods of exploring patient recruitment challenges:
Thematic analysis of field notes from research visits to Emergency
Departments & meeting minutes and progress reports.
748
patients
invited
24
patients
interviewe
d

The OPTIMISE Study
Optimising value-based, preventive care delivery in NHS General Dental Services
Christian Bannister1, Anwen Cope2, Anup Karki3, Michael Allen4, Paul Harper1, Ivor Chestnutt2
Background
Expected Outcomes
Tooth decay, gum disease and mouth cancer are preventable
conditions. Dental teams have a considerable role to play in
supporting patients to change their lifestyle or by delivering
preventive treatments. This could reduce the number of patients
who develop these problems and minimise the severity of the
condition. Much of this treatment could be done by dental hygienists
and therapists or dental nurses. Using the skills of other members of
the dental team to their full potential is called ‘skill-mix’.
We believe that increasing the amount of preventive care delivered
by NHS dental practices and using skill-mix to its full potential would
be a more efficient use of NHS resources.
Primary Outcome
• A computerised modelling tool with a web-based interface
where dental practice owners or service planning teams can
input the risk/need profile of their patient population to
generate an optimised skill-mix use matrix within a preventive-
led care model
Secondary Outcomes
• To develop patient pathways (stratified for patient age/oral
health need and risk) to describe care currently delivered in NHS
Wales general dental practice; and evidence-informed care
delivery under a preventive-led model.
• To describe how long commonly performed dental procedures
take in NHS General Dental Practice
• To produce scenarios of skill-mix utilisation based on the
pathways of care developed
Study Design
Study Aims & Objectives
The aim of this project is to develop a computerised online tool
which will show service planners and dental practices the benefits of
changing their ways of working.
• We will describe the treatments adult and child patients
currently get when they see an NHS dentist in Wales using data
that is already routinely collected. We will then look at clinical
guidelines to see what patients should be getting in terms of
preventive care when they go to the dentist. We will talk to
dental professionals and patients to reach a consensus on what
an ideal care-pathway would look like.
• We will work out how long the additional preventive advice and
care would take. We will do this via an online questionnaire
survey, where dental professionals in Wales will be asked to give
estimates of the mean and range of the time taken to undertake
common clinical tasks. We will then ask dental professionals to
comment on the timings we have collected.
• We will put this information together in a web application to
show how preventive care could best be delivered using
currently available resources. We can also show how much we
need to pay dental practices to increase the amount of
preventive care they provide.
Study Aims & Objectives
This study is funded by Health and
Care Research Wales
1 Cardiff School of Mathematics, 2 Cardiff School of Dentistry, 3Public Health Wales, 4Cardiff and Vale University Health Board | Correspondence to: bannister@cf.ac.uk

BACKGROUND: Most non-small cell lung cancer (NSCLC) patients presenting with metastatic disease are unsuitable for curative treatment. Embedding patients’ values and preferences into the treatment
decision-making process may facilitate difficult consultations, reduce aggressive end-of-life treatments, and reflect more closely patients’ goals and motives in their everyday lives. The Cancer Reform Strategy
states that the Clinical Nurse Specialist (CNS) plays a major role in the delivery of information, communication and co-ordination of care to patients with advanced cancer. AIM: Embedded in the PACT study we
aimed to study the CNS’ role along the clinical pathway of patients diagnosed with advanced NSCLC. METHODS: The PACT study was a five-stage, multi-site qualitative study (n=99) using multiple
methodologies to observe how treatment decisions were made along the patient clinical pathway. Here we report on the role of the CNS.
Holistic care: The clinical nurse specialist’s role in advanced lung cancer patients
Longo M.1, Sampson C.1, Sivell S.1, Byrne A.1, Noble S.1, Lester J.2, Jones D.3, Radley L.3, Anagnostou D.1, Nelson A.1
Dr Mirella Longo
Marie Curie Palliative Care Research Centre,
Division of Population Medicine, Cardiff University School of Medicine,
www.cardiff.ac.uk/marie-curie-palliative-care-research-centre @MCPCRCCardiff
1Cardiff University, Marie Curie Palliative Care Research Centre, Cardiff, United Kingdom; 2Velindre Cancer Centre, Cardiff, United Kingdom; 3Cardiff University,
Cardiff, United Kingdom.
Acknowledgments: This study was funded by The Velindre Stepping Stones Appeal. AN, AB, ML, SS and SN’s posts are funded by Marie Curie Cancer
Care core grant funding (grant reference MCCC-FCO-17-C).
RESULTS: Starting from the MDT meetings, the CNSs
would advocate the patient perspective and highlight
relationships, patient’s home context and priorities along
the clinical pathway (Fig 1). However, the absence of the
CNS compromised the quality of that information at MDT.
During patient consultation with oncologist, CNS impact
along all phases of the consultation emerged(Fig. 2).
Clinical nurse specialist: He is spending most of his time in
bed his family have come up to stay with him and his GP has
started him on some MST and I’ve asked the GP to review
again
Chest physician: So his performance status is that at least
two if not anymore three
Oncologist: And then the performance status is two or three
then
Chest physician: Yeah two or three yeah
Clinical nurse specialist: Yeah two to three at the moment.
(Site 3 – MDT 2)
CONCLUSION: ‘Patient-centred care’ necessitates direct patient involvement in clinical
decision making. This, however, strongly depends on how key information such as prognosis are
made available and understood by the patient, and the context in which they were raised and
discussed. Access to dedicated CNSs can be instrumental to ensure the translation of a ‘patient-
centred’ approach.

This study is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR), project number 15/145/04.
The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Michelle Edwards, Alison Cooper, Davies Freya, Andrew Carson-Stevens, Thomas Hughes, Niro Siriwardena, Helen Snooks, Adrian Edwards
Aim: Describe & classify predominant streaming pathways in Emergency
Departments in England and Wales and explain how they operate.
A Classification of Primary Care
Streaming in Emergency Departments
Reception &
Triage
Streaming Reception
Streaming &
Triage ED Triage
Reception
Hospit
al
service
ED
Primar
y care
service
Hospit
al
service
Hospit
al
service
ED ED
Primar
y care
service
Redirection to
community
primary care
service
Front door streaming Streaming inside No streaming
GPwSi
Methods:
- National survey of 77 EDs in England & Wales
- Interviews with 21 ED Clinical Directors
- Case study observations and interviews at 13 EDs
- Stakeholder and PPI consultation
Findings: Streaming pathways in EDs
Conclusions:
- Pathways adapted to local circumstances - department layout,
patient demand, GP skill mix and interests, accessibility of
community primary care services.
- Understanding types of streaming and ensuring consistency of
terminology is important for evaluation, quality improvement,
performance measurement and research

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