NMAHP Research Unit ebulletin Nov/Dec 2016
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Unit welcomes new Director:

Professor Margaret Maxwell sets sights on international stage

Margaret MaxwellFresh from her appointment as Unit Director, Margaret Maxwell has set out her ambitions, with the top priority to see the international reputation and profile of the Unit as a whole catch up with the excellence of its work. A career-long researcher, Margaret's first post following her Sociology degree was in NHS information and healthcare data. With that first post focusing on diverse areas such as cancer, mental health, and resource allocation, Margaret “got the bug for different methods for different research questions, and an interest in the way the NHS worked.” She then moved into primary care research where she valued her research being “grounded in a setting where patients were walking through the door." This led to her interests in the work carried out by primary care nurses and other health professionals, as well as in the physical, mental and social needs of patients. Her new role will combine her passion for health services, primary care and mental health research with the leadership skills honed over the years in leading research teams and as deputy director within NMAHP-RU. Margaret is looking forward to shaping the next stage in the Unit’s history with the support of “a great bunch of colleagues who all want to see the Unit succeed.”
Christine Hazelton

Christine's three year vision:

Improving interventions for stroke-related visual impairment

Frustrated by the lack of treatment options for patients with stroke-related visual impairment, optometrist Christine Hazelton set out to address this gap in services. Her Stroke Association funded PhD explored scanning training, which helps people make best use of their remaining vision through quicker, larger and less repetitive eye movements. She has now embarked on a new three year Research Fellowship with the Unit - funded by Glasgow Caledonian University - to investigate the effectiveness and feasibility of different scanning training methods. Christine says of her new role, “I will keep building the evidence base for effective rehabilitation using a mix of research methods. In particular I hope to identify what makes scanning training work by comparing computer-based interventions with those provided by clinicians. I also want to understand the perspectives of all involved, and explore the most appropriate outcome measures to use in future trials of scanning training interventions.”

Qualitative research suggests that the impact of visual impairment on the daily life of stroke survivors is extremely broad, as it limits practical abilities, leads to loss of social role and activities, and has a profound emotional effect. Unfortunately, people with stroke-related visual impairment have, in the past, had few treatment options compared to those whose vision loss was caused by an ocular condition, such as glaucoma or diabetic retinopathy. Christine says, “Research that directly gathers and analyses the opinions of stroke survivors, carers and clinicians is very rare in this field, but is so important when developing interventions, to ensure they have an effect on the daily lives of the stroke survivors, rather than just on their eye movements or other visual skills.”

In addition to developing the Unit’s stroke rehabilitation ‘vision’ workstream, Christine will support the work of the Stroke & Long Term Neurological Conditions Research Group and the School of Health & Life Sciences at Glasgow Caledonian University. This will include organising activities, such as the annual World Stroke Day event, and mentoring and teaching research students.  

Beyond the university, Christine will continue to provide a range of learning opportunities for both stroke and vision clinicians from the NHS, social care and charity backgrounds. Previously this has included hands-on workshops via a Scottish Government Stroke Improvement Fund grant in 2014, and a presentation at the Scottish Parliament's first joint meeting of the Cross-Party Groups on Visual Impairment, Deafness, and Heart Disease and Stroke. Earlier this month Christine also presented at the Scottish Stroke Vision and Hearing Network conference (pictured). Speaking mainly to occupational therapists and low vision specialists, she detailed the range of management options available for post-stroke visual impairment, and offered tips on choosing the most appropriate tools for individual patients.

Worldwide response to RELEASE project:

Aphasia datasets ready for re-analysis

Louise WilliamsAphasia is an impairment of language that affects a third of stroke survivors. Speech and language therapy helps, and now the RELEASE study aims to find out what it is about individual people with aphasia and the type of intervention they receive that is most likely to lead to recovery of language. Rather than looking for people to take part, RELEASE (REhabilitation and recovery of peopLE with Aphasia after StrokE) called for datasets which could be re-analysed. The Unit’s Dr Louise Williams explains, “Running randomised controlled trials and longitudinal studies is expensive, time-consuming, and generates lots of data which can’t all be used at the time. We wanted to get the most out of pre-existing data from trials involving people with aphasia to help us answer important questions about how aphasia changes over time and what makes intervention effective. We’ve received datasets from all over the world - Australia, Brazil, Canada, China, Croatia, Cyprus, Egypt, Finland, France, Germany, Iran, Italy, Japan, the Netherlands, Norway, Portugal, South Korea, Spain, Sweden, Turkey, the UK and the USA!”

The first datasets for RELEASE came via the Collaboration of Aphasia Trialists. This network of leading aphasia investigators is committed to improving the lives of people with aphasia through better aphasia research, international consensus, and data sharing. A systematic search of the literature was also conducted to find datasets which, if still available, might be eligible. Louise says, “From screening the 5276 records found through the systematic search, we identified 874 potentially eligible datasets, and have been inviting these researchers to join RELEASE. To date we have received 76 different datasets contributing 4597 anonymised individual patients’ data from 22 countries, an amazing response.”

The RELEASE team will be working from their statistical analysis plan to conduct secondary analyses of the pooled, anonymised individual data over the next year. Louise presented the RELEASE project at the UK Stroke Forum on November 29th 2016 and will also be presenting at the International Aphasia Rehabilitation Conference on 14th December. To stay updated with progress you can follow RELEASE on twitter and by contacting

Aphasia impacts on the ability to speak, understand speech, read and write. There are 367,000 people in the UK living with aphasia, and each year over 50,000 people are newly affected.
Attending the ACTIVE webinar

Getting ACTIVE with webinars:

Involving people in reviews and improving postnatal care

Applied healthcare researchers are always looking for ways to share their knowledge and experience with a wider audience, and developments in technology are opening up new opportunities. Alex Pollock, Pauline Campbell and Helen Cheyne recently dipped their toes into the world of webinars, where a live presentation followed by question and answer session is delivered over the internet for up to an hour. Participants can register from around the globe, and just need a computer with a speaker to see and hear the presentation. If webinars are recorded and made available online, over time they can reach even more people. Alex and Pauline’s webinar explored how to involve consumers in Cochrane reviews, while Helen’s for the Royal College of Midwives explained how the PRAM project can help plan high quality, cost-effective postnatal services.

Cochrane is a worldwide independent network of people who seek to improve healthcare decisions, and Alex and Pauline are experienced Cochrane reviewers. Cochrane reviews bring together research findings on a topic in a systematic and unbiased way in order to inform choices and decisions about healthcare. Cochrane Learning Live is a series of monthly webinars providing opportunities for learning and knowledge exchange for everyone from beginners to experts. Alex and Pauline were invited to discuss the ACTIVE (Authors and Consumers Together Impacting on eVidencE) project.

Having experienced for themselves the value of handing over control and decision making about stroke research priorities to people who had had a stroke and their carers, they decided to do the same for a systematic review of effectiveness of physiotherapy interventions. Alex says, “Although I was initially anxious when our consumer group disagreed with our plan for categorising papers, they came up with a very practical new way of describing physiotherapy interventions which had a huge impact right the way through to what the final review looked like. Our success with this project made us eager to understand how other people were involving patients, carers, healthcare professionals and policy makers in their systematic reviews in a meaningful way, and so the ACTIVE project was born.” 

In the webinar Alex and Pauline explained how ACTIVE is progressing towards the goal of providing evidence based information and materials on how to plan, describe and involve people in reviews in different ways. They are keen to hear from anyone who has involved consumers in reviews so that this work can be as comprehensive as possible. The ACTIVE webinar recording and accompanying materials can be accessed for free from here

Like Alex and Pauline, Helen is an advocate for involving the right people in research, including decision makers, midwives, other maternity professionals, managers and service users. With her co-presenter John Bowers, she introduced webinar attendees to the Post Natal Resource Allocation Model study. PRAM involved using a series of workshops and modelling of data to develop a computer-based tool which can be used to consider which design of postnatal care would be both efficient and provided at the right time in the right place for the local context. 

Helen says, “In the last 10-15 years, postnatal care has been seen as a service that has had less priority and resources, and is an easy target for cuts. This is unsatisfactory for women and demoralising for midwives. Quality and cost both matter, and both can be achieved. I hope PRAM will put postnatal care back in the spotlight, so that it gets the priority and explicit decision making that it deserves.” 
Siti and her family on graduation day

Celebrating Siti's graduation

Family and colleagues mark the end of the beginning

The weather was chilly, but there was a warm welcome for Siti Roshaidai Binti Mohd Arifin and her family when they travelled from Malaysia to Stirling to celebrate Siti’s graduation. At a gathering in the Unit after the ceremony, PhD supervisors Helen Cheyne and Margaret Maxwell congratulated Siti on the amazing feat of completing her PhD within 3 years and on achieving her first post-doctoral grant. Siti moved to Stirling with her husband and son while she worked on her thesis ‘Perspectives of postnatal depression in Malaysia: Exploring experiences of women and healthcare practitioners’, which meant Hafiy completed his first year of primary school in Scotland. Siti is now lecturing in an assistant professor post in Malaysia at Kulliyyah of Nursing, International Islamic University. She said, “Studying for a PhD was not only my ambition but my mom’s too. So having her at my graduation was a way of showing my unlimited love and appreciation to her for bringing me to this level. It also meant I could mark ‘the end’ of my PhD journey, not just with my supervisors and colleagues, but with my other half Fairol and son Hafiy who supported me all the way.”
Panel on the role of context

Margaret Maxwell, Carina Hibberd, Glenn Robert and Eddie Duncan taking questions from the floor


Context is everything:

From common sense to action

When new interventions are introduced to improve health or healthcare services, common sense tells us that context makes a difference to what happens next. Well-known contextual factors include motivation, leadership, culture, vision, attitudes, pressures and stability. They combine in a dynamic, fluid process to make interventions more or less likely to succeed in different ways in different places. Our recent SISCC capacity and capability building seminar brought clinicians, managers, quality improvement practitioners and researchers together to reflect on the role of context and how we can take it into account when designing studies. As the Unit’s SISCC (Scottish Improvement Science Collaborating Centre) Research Fellow, Emma Coles organised the day. She said, “The seminar series aims to link people from academic and practice communities so we can exchange knowledge, learn together and form new networks. The real mix of people attending confirmed that context matters to all of us. The challenge now is to use this developing knowledge to design improvement or research projects that are more sensitive to context.”

Unit Director Margaret Maxwell opened the day with an overview of why context is important, stressing in particular that any interventions developed through research can only be ‘scalable’ if we understand how they might act in different contexts. Glenn Robert, Chair in Healthcare Quality & Innovation from King’s College London, agreed that we need to get away from studies that describe and list contextual factors to ones that understand how they interrelate. He argued for an ‘action oriented stance’ that equips frontline practitioners to understand what they can do to change the context, recommending the MUSIQ model as a practical example. 

Juliet MacArthur, a leading clinical academic in Lothian, explained that she is now applying learning about context from her PhD study of a leadership programme to embed compassionate care across thirty three wards. This includes taking a slow, measured and appreciative approach, building in a ‘pause’ if necessary for NHS Winter pressures, and recognising the value of skilled facilitation. Joanne Matthews from Healthcare Improvement Scotland gave her perspective on the shifting patient safety context since the Scottish programme began in 2008. She drew attention to the crucial role of relationships, the adaptation needed for different contexts such as care homes following the integration of health and social care, a national focus on outcomes, and the need to collate and update records of improvement work.

The Unit’s Carina Hibberd shared her learning from a number of research projects in collaboration with NHS staff, where aspects of context that were crucial to implementation of the intervention could not have been anticipated. She emphasised that any researcher becomes part of the context just by being there, and needs to decide how to handle that. Data collection methods shouldn’t clash with the intervention approach, and researchers have to be ‘strict’ with themselves about limiting what data they will collect. Colleague Eddie Duncan also reported on an NHS study, where the analysis led to the development of a pivot model to show how context and mechanisms interact in a cumulative way to tip the outcome. He hopes this will lead to ‘multi-criteria decision making’ to help intervention support teams recognise when they need to get involved. 

Having discussed their contextual knowledge gaps and problems in groups, attendees had the chance to put questions to four of the speakers at the end of the day. Margaret, Carina, Glenn and Eddie reinforced both the importance of context and the challenge of acting on this knowledge. Suggestions that everyone could act on included: valuing staff and their potential to change their contexts, creating opportunities for people to learn in situ rather than out of context, and fostering the few staff who want to pursue research careers while supporting the rest to ask ‘why’, gather meaningful data, and reflect on outcomes.

Scottish NMAHP Research Awards:

Plans underway for 2017/18

Gaylor HoskinsScotland's Chief Nursing Officer recently made the difficult decision to postpone the Scottish NMAHP Research Awards until 2017/18. On behalf of the CNO and the award judging panel, the Unit's Gaylor Hoskins (pictured) explained, “Our aim in creating the awards was to ensure that they would become the most prestigious research awards in Scotland for researchers from nursing, midwifery and the allied health professions. We had hoped to build on the success of the inaugural event in 2015, but, following a disappointing response to the call for nominations, felt it would be unfair to the applicants to go ahead at this time. We know there are many very deserving NMAHP researchers in Scotland, and the awards are an ideal platform for sharing expertise, celebrating success, and inspiring future researchers. We will therefore be doing all we can to encourage applications in 2017/18, with the support of Higher Education Institutions, the NHS, individual nurses, midwives and allied health professionals, and research communities across Scotland.” To discuss any aspect of the Scottish NMAHP Research Awards, contact Gaylor directly.
Margaret MaxwellThe Nursing, Midwifery and Allied Health Professions Research Unit is based at the University of Stirling and Glasgow Caledonian University. Led by Director Margaret Maxwell, 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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