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NMAHP Research Unit ebulletin Mar/Apr 2015
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From SIP to swallow after head and neck cancer:

Developing a practical intervention package


Emma KingPersistent swallowing difficulties can have a profound effect on a person’s quality of life after head and neck cancer. Our SIP (Swallowing Intervention Package) study aims to find out how swallowing exercises can best be used to make a difference. In the first phase, the unit’s Emma King is running focus groups and consensus workshops with patients, carers and healthcare professionals such as speech and language therapists. This means the intervention that is developed will directly reflect the insights and knowledge of people with the most practical experience.

A growing number of head and neck cancer survivors face long-term swallowing difficulties. This is because the incidence of the disease is increasing, it is being treated more intensively (with combinations of surgery, chemotherapy and radiotherapy), and more people are surviving. Swallowing difficulties can have a profound effect on how easily or well people are able to eat and drink. In addition to the social and psychological consequences, they can become dependent on a feeding tube, and are at risk of food or fluid going into the airway instead of the stomach. 

Some evidence suggests that swallowing exercises offered by speech and language therapists can improve outcomes in people with head and neck cancer who are being treated with chemo-radiotherapy. However, it is not clear what should be offered, when and for how long, or how realistic this is. 

Before joining Principal Investigator Professor Mary Wells on the SIP project, research fellow Emma King was working on a study which is developing an alternative to human blood donation for people who need transfusions. As well as supporting work in the laboratory to generate red blood cells using stem cell technology, Emma interviewed people who are dependent on or who have had transfusions to find out how they would feel about this option. Emma says, “For research to be of practical use, it needs to bring together social science and science & technology, as well as patients and a variety of staff groups. In the SIP study, for example, there would be no point in developing a swallowing intervention without being sure that it makes sense to and is do-able for patients and staff.”

The second phase of SIP will be a feasibility study, with a view to developing a proposal for a clinical trial of the package. As the feasibility study will investigate the extent to which SIP is actually used by patients and staff as intended, and the impact it has on swallowing and quality of life, both qualitative and quantitative research methods will be needed. 

You can follow the SIP study on facebook and twitter.

Wells M, MacAulay F, Patterson J, Hulbert-Williams N, Dougall N, McGarva J, Niblock P, Slaven E & Boa S.  Improving quality of life and swallowing function in patients with head and neck cancer: Development and feasibility of a Swallowing Intervention Package (SIP). (Chief Scientist Office, Scotland, 2014-2016).
David Fitzpatrick

The unit’s David Fitzpatrick tells participants at the clinical academic summit how he manages the demands of being a paramedic in the Scottish Ambulance Service with doing research aimed at improving the quality and safety of prehospital emergency care.


An NMAHP ‘clinical academic’ is a nurse, midwife or allied health professional who is striving to improve patient care by developing as both a clinician and a researcher. As the NMAHP Research Unit plays a key role in supporting this way of working, we recently hosted a summit attended by clinical academics and senior leaders from the Scottish Government, NHS and universities. The participants reflected on the impact clinical academics have already had on the quality of services and how they have managed to do it. In light of this experience, they then considered how clinical academic roles can be shaped and supported more effectively in future to the benefit of patients.
 
The high level summit was organised by Gaylor Hoskins, a nurse who is a clinical academic research fellow in the unit. She says that participants were clear that the strategic focus must be on person centred care. This means that, although they were enthusiastic for a clinical academic route to be interweaved with the post registration career development framework for NMAHPs, the emphasis should not be on ‘roles’, but how evidence is integrated into practice. 

Gaylor explains, “As health professionals the provision of effective, safe, patient-centred healthcare is at the heart of everything we do. In recent years evidence based practice has become our mantra. However, knowledge should not only inform practice but be informed by practice. In addition to training, the ability to use evidence requires a career structure that allows us time to question what we do and to investigate ways of providing the best possible care.” 

The key ideas and actions agreed during structured workshops at the summit will form the basis of a strategic nursing, midwifery and allied health professions’ education and career framework. Gaylor says, “With hard work, appropriate leadership and support for the development of a critical mass of high quality clinical NMAHP researchers, we hope to make a significant and demonstrable difference to the lives of the people of Scotland.”  

The Clinical Academic Research Careers Summit was held on 4 February 2015 at the Stirling Court Hotel, University of Stirling. Speakers presented a variety of international, UK and Scottish perspectives. They included Professor Tracey Bucknall from Deakin University in Melbourne, Australia, Sue Latter who is Professor of Nursing at the University of Southampton, and NMAHP Research Unit director Professor Brian Williams with independent consultant Jennifer Waterton. Facilitators were leaders from the Royal College of Nursing, the Scottish Government and the NHS. Gillian Knowles, Dr Jacqui Morris, Professor Michael Brown, Professor Mary Renfrew and the unit’s David Fitzpatrick (pictured) also gave presentations based on their experience of combining clinical and academic roles.

Open access to Jim Coyne:

Unit welcomes Carnegie Centenary Visiting Professor


Jim CoyneJim Coyne has joined the unit for four months as a Carnegie Centenary Visiting Professor. This prestigious award scheme recognises the benefits to the Scottish university community when scholars of high distinction have the opportunity to share their unique knowledge, experience and perspectives. For Jim, the trip is about strengthening existing collaborations, developing new joint projects, writing papers and taking part in everything from ‘Skeptic in the Pub’ talks to formal lectures. His mission is to promote open access - he is an Academic Editor of PLOS one and looking to recruit more editors from Stirling - and raise the quality of scientific writing and critique. This means “giving away” tools that will enable professional and lay people to recognise and address what he sees as the “crisis of integrity” in science literature.
 
Jim’s association with Andrew Carnegie’s philanthropy goes back half a century. In high school he lived with his mother, sister and chronically ill brother in estate housing on welfare, and lacked the resources to go to college. The Carnegie Institute of Technology offered a generous package (full tuition scholarship, job, loan) that made it possible. With his acceptance letter arriving almost 50 years to the day before he came to Scotland for the visiting professorship, Jim says “it’s nice to be working over here as payback for the aid the American foundation gave me a long time ago.”

Given this background, it is perhaps not surprising that Jim has a strong social conscience. He increasingly identifies himself as on “the militant wing” of promoting open access publishing and restoring scientific integrity. Greater scepticism towards interventions and publishers that are incentivised by profit and protectionism has led him to a deliberately confrontational strategy. While conceding that not many academics will choose to take such a radical stance, he is suspicious of the way that civility is used to contain conflict, and believes it is essential to disrupt the status quo in order to bring about change. He stresses that this is “not just about a few bad apples turning out fraudulent science, but about the lack of trustworthiness and the social, political and institutional forces that distort the reporting of science.” 

Jim sees blogging, twitter and planned ebooks as one solution, as they offer “unfettered, instant communication that lends itself to testing out ideas and receiving ready feedback”. His vision is that “everything not terribly flawed” will be published transparently, with open access and no more pay walls, and continue to be peer-reviewed in indexed post-publication commentary.

While in Scotland, Jim continues to add to his over 350 publications and to blog twice monthly about bad science at PLOS Mind the Brain and Science Based Medicine. For notification of his engagements, follow him on twitter @coyneoftherealm. In the next ebulletin, we will hear why Jim, a clinical health psychologist, is so keen to raise awareness among policy makers, clinicians and patients of undeclared conflicts of interest.

Implementing an implementation science interest group:

Why, what, who and how?


The burgeoning research field of ‘implementation science’ is, on the face of it, highly relevant to anyone who wants their research to be useful and used. But what exactly is ‘implementation science’? What assumptions lie behind it? And how is it different from improvement science or evaluation or any other applied research we are already doing? To try to answer these questions, the unit started a Stirling Implementation Science Interest Group. Rather than looking for consensus and agreed definitions, the group works at a conceptual level. This means it deliberately brings in diverse perspectives and encourages critical discussion to open up different ways of thinking about why and how we do research. 

When PhD student Avril Nicoll had the idea for a cross-disciplinary reading group, she saw it as an implementation project. She explains, “We used a version of Normalisation Process Theory at the first session to help us think through whether this was a group worth having and, if so, how we would make it happen. This included asking ourselves questions like: How is it different from anything we are already doing? How much involvement can we realistically sustain? Could the group make our jobs easier in any way? How will we judge its value? We agreed that making it an interest rather than a reading group would give us flexibility to be creative, and that having a coordinator for a set number of sessions would help keep the focus and momentum.”

The group takes place approximately every 6 weeks for 1 hour. A volunteer chooses and summarises an article, including why they thought it would be a good vehicle for discussion. Strategies to help with critique have included mind maps, models and a critical reading template. As well as discussing papers (such as this), and reports (such as this) the group has reviewed a website, debated a blogpost, and considered how models (such as this) might help explain implementation scenarios. Notes relating to each meeting are saved on Google Drive, and members also share news of relevant papers and events.

As expected, participation is fluid, but has included people at all levels of a research career (some pictured at the most recent session). They have come from the School of Education, Health Psychology, and St Andrews University School of Management as well as the School of Health Sciences (including the Institute of Social Marketing and NMAHP RU). Disciplinary backgrounds are even more diverse, covering anthropology, information sciences, science and technology studies, physiotherapy, speech and language therapy, sociology, psychology, education, nursing, pharmacy and statistics.

As members agreed the group is continuing to generate new ideas and understanding in an enjoyable way, Helen Frost is coordinating a further set of 6 sessions. Helen joined the unit in December 2015 as a research fellow working with the Scottish Improvement Science Collaborating Centre (SISCC) in Dundee. She is a physiotherapist by background and has a long-term interest in implementing evidence-based practice. There will be more on Helen’s work in future ebulletins.
Brian WilliamsThe Nursing, Midwifery and Allied Health Professions Research Unit is based at the University of Stirling and Glasgow Caledonian University. Led by Director Brian Williams, unit staff work with practitioners, researchers and NHS patients and carers to produce research that can inform and improve healthcare. A key aim of the unit is to contribute to the development of researchers across the nursing, midwifery and allied health professions. Contact us for more information.
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