̽��ֱ�� of Cambridge - Jonathan Mant

Young at heart

cjb250 — Wed, 13 Mar 2019 14:03:28 +0000

Improvements in public health, education and medicine mean that our lives are much longer than at any point in human history. Thanks to studies of volunteers from the eastern region, we may be able to spend these extra years living independently and in good health.

Academy of Medical Sciences announces 2018 Fellowships

cjb250 — Thu, 10 May 2018 10:22:09 +0000

̽��ֱ��new Fellows have been elected for their outstanding contributions to biomedical and health science, leading research discoveries, and translating developments into benefits for patients and the wider society.

This year's elected Fellows have expertise that spans sleep research, infectious and tropical diseases, diabetes medicine, parasite biology and ultrasound research and technology among many other fields.

Professor Sir Robert Lechler PMedSci, President of the Academy of Medical Sciences said: “ ̽��ֱ��Academy simply could not tackle major health and policy challenges without our dynamic and diligent brain trust of Fellows. I extend my warmest congratulations to all who are joining us this year, each of whom has earnt this prestige by advancing their own field of biomedical science.

“Later this year the Academy will celebrate 20 years of supporting the translation of biomedical and health research into benefits for society. As we celebrate this special anniversary we stand at a crossroads of both enormous health challenges and great opportunity for medical sciences. So I am delighted to see the remarkable breadth and depth of the expertise within our 48 new Fellows. We look forward to these experts joining us in addressing the health challenges we face head on and exploiting opportunities to improve health in the UK and internationally.”

̽��ֱ��Cambridge researchers among the new Fellows are:

Professor Simon Baron-Cohen FBA, Autism Research Centre
Professor Simon Griffin, Department of Public Health and Primary Care
Professor James Huntington, Cambridge Institute for Medical Research
Professor Peter Hutchinson, Department of Clinical Neurosciences
Professor Jonathan Mant, Department of Public Health and Primary Care
Professor Lalita Ramakrishnan, Department of Medicine
Professor David Rowitch, Department of Paediatrics
Professor Nicole Soranzo, Department of Haematology

̽��ֱ��new Fellows will be formally admitted to the Academy at a ceremony on 27 June 2018.

Eight Cambridge academics are among 48 of the UK’s world leading researchers who have been elected to join the prestigious Fellowship of the Academy of Medical Sciences.

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Stroke survivors and caregivers feel abandoned by health services, study finds

cjb250 — Wed, 21 Feb 2018 19:00:14 +0000

̽��ֱ��study, by researchers at the ̽��ֱ�� of Cambridge, suggests that primary care and community health care interventions which focus on improving active follow-up and information provision to patients and caregivers, especially in the first year after stroke, could help improve patient self-management and increase stroke-specific health literacy.

Globally, stroke is the second leading cause of death. Stroke-related disability burden is on the rise with a 12% increase worldwide since 1990, and contributes to the large economic burden of stroke due to healthcare use, informal care and the loss of productivity. ̽��ֱ��annual cost of stroke, including health care cost, medicines and missed days of work, is estimated at $33 billion in the USA and £8.9 billion in the UK.

Primary care could play an important role in the care of stroke survivors and their caregivers, supporting access to community services and facilitating transfer back to specialist services when new problems emerge. It could also help provide training, and identify and address health needs of caregivers. However, the feeling of abandonment that people with stroke experience following hospital discharge suggests this role is not being fulfilled.

To better understand the possible reasons behind this feeling of abandonment, a team at Cambridge’s Department of Public Health and Primary Care carried out a systematic review of qualitative evidence in the field. In total, they analysed 51 studies (encompassing 566 stroke survivors and 593 caregivers). Their results are published today in the journal PLOS ONE.

̽��ֱ��analysis found an unaddressed need for continued support in a quarter of studies. Survivors and caregivers felt frustrated and dissatisfied with a lack of proactive follow-up either from primary care, the hospital, or allied healthcare professionals. This led to feelings of dissatisfaction, uncertainty, that a stroke survivor was “forgotten and written off” and that their general practice did not care about them.

Lack of support for caregivers was reported in more than one in five studies (22%), even though they felt healthcare professionals assumed that they would provide the majority of care needed. They felt ill prepared and pressured to “become experts” in caring for stroke survivors. In addition, both survivors and caregivers felt emotional support was lacking, even though they are at risk of anxiety and depression.

Long waiting times for assessment and rehabilitation and little or no help from social services left survivors feeling “left in the lurch”. Caregivers felt that access to rehabilitation was not provided early enough, causing survivors to “go backwards”.

More than two out of five (41%) of studies highlighted gaps in information provision. Opportunities for support could be missed due to the lack of knowledge of what services were available. ̽��ֱ��lack of information about local services and how to find them was confusing and prevented access. Many caregivers and survivors had to find out information by themselves from the internet, friends and other caregivers. When information was provided, it was often inconsistent and covered only some services.

A quarter (23%) of the studies highlighted inadequate information on stroke, its consequences, and recovery. Information presented too early after stroke disempowered stroke survivors and caregivers, leading to feelings of confusion, fear and powerlessness. Survivors and caregivers wanted specific information on the significance of post-stroke symptoms and how to manage them. Lack of information led to unrealistic expectations of “getting back to normal”, leading to disappointment and tensions between the survivor and caregiver.

Ineffective communication between survivors, caregivers and healthcare services as well as within healthcare services resulted in feelings of frustration and having “to battle the system”. Gaps in the transfer of knowledge within the healthcare system and the use of medical jargon sometimes caused confusion and were construed as indifference to survivors’ needs.

“Patients and caregivers would benefit from active follow up and information provision about stroke that is tailored to their specific needs, which change over time,” says Professor Jonathan Mant, who led the study. “People take active efforts to find information for themselves, but navigating and appraising it can be challenging. What is needed is trustworthy information written in an accessible language and format, which could support better self-management.”

̽��ֱ��study found that that many stroke survivors and caregivers felt marginalised due to the misalignment between how healthcare access in primary care is organised and survivors’ and caregivers’ competencies. For example, individuals felt that in order to access services they needed an awareness of what services are available, plus the ability to communicate effectively with healthcare professionals. This situation can be compounded by cognitive, speech and language problems that can further affect a patient’s ability to negotiate healthcare access.

“Stroke survivors and their caregivers can feel abandoned because they struggle to access the appropriate health services, leading to marginalisation,” says Dr Lisa Lim, one of the study authors. “This arises because of a number of factors, including lack of continuity of care, limited and delayed access to community services, and inadequate information about stroke, recovery and healthcare services.

“We need mechanisms to encourage better communication and collaboration between generalist services, which tend to provide the longer term care after stroke, and specialist services, which provide the care in the immediate phase post-stroke.”

̽��ֱ��researchers argue that providing support from healthcare professionals within the first year after stroke would increase patients’ ability to self-manage their chronic condition. This can be achieved by providing timely and targeted information about stroke, available resources, and by regular follow-ups to foster supporting long-term relationships with healthcare professionals.

“Giving the right information at the right time will help stroke survivors and their caregivers become more self-reliant over time and better able to self-manage living with stroke,” adds Dr Lim.

̽��ֱ��team identified two key areas of improvement to address patients’ and caregivers’ marginalisation: increasing stroke-specific health literacy by targeted and timely information provision, and improving continuity of care and providing better access to community healthcare services.

Reference
Pindus, DM et al. Stroke survivors’ and informal caregivers’ experiences of primary care and community healthcare services - a systematic review and meta-ethnography. PLOS ONE; 21 Feb 2018; DOI: 10.1371/journal.pone.0192533

A systematic review of studies focused on stroke survivors’ and carers’ experiences of primary care and community healthcare services has found that they feel abandoned because they have become marginalised by services and do not have the knowledge or skills to re-engage.

Stroke survivors and their caregivers can feel abandoned because they struggle to access the appropriate health services, leading to marginalisation

Lisa Lim

Kate Whitley (Wellcome Images)

Blood pressure measurement - close-up

Researcher profile: Dr Lisa Lim

As well as being a researcher in the Department of Public Health and Primary Care, Dr Lisa Lim is also a GP. Her experience with patients helps inform her work.

“My research is with stroke survivors, looking at how we can improve things for them after stroke as well as preventing further strokes,” she says. “We know that stroke survivors and their carers often struggle after they have been discharged from specialist services and their needs are not always identified or addressed by healthcare services; this is what we want to change. This is a problem I see in my clinical practice and I know how important it is to these patients.”

Working in collaboration with researchers at the ̽��ֱ�� of Leicester, Dr Lim and the team at Improving Primary Care after Stroke (IPCAS) have spent the past two years developing and piloting a primary care intervention for stroke survivors. ̽��ֱ��intervention is now ready to be trialled and they are currently recruiting GP practices and patients.

Dr Lim says she hopes her work will demonstrate how important it is that we continue to invest in primary care research and how primary care can help people to live well with a chronic problem like stroke – “It can make a massive difference to peoples’ lives,” she says.

“It may not be considered by some to be the most glamorous research,” she adds. “We will not be ‘curing’ stroke, but what we are trying to do is make a big impact on the day-to-day lives of people affected by stroke.”

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Graduate, get a job … make a difference #7

ta385 — Tue, 19 Sep 2017 10:00:00 +0000

Gwilym Thomas (Trinity Hall), MB, Medicine (2015)

I graduated from Cambridge’s Medicine course in 2015 and I’m now working as a second year GP trainee, having already completed two years of post-qualification foundation training.

I’m currently based in A&E at the West Suffolk Hospital where my focus is on providing timely care and deciding whether someone can then return home or needs to be admitted for on-going treatment.

Junior doctors like me rotate jobs every four to six months so there is constant variety. Prior to A&E, I was working on a Care of the Elderly ward. I hope to be a GP within two to three years and during that time continue my involvement with Primary Care research.

My Motivation

I’m inspired by the positive impact I can make on the lives of patients and their families as part of a multidisciplinary team. I get particular satisfaction from taking a holistic approach, one of the tenets of GP training.

When I started at Cambridge, General Practice was near the bottom of my list of career options. I felt it might be repetitive and lacking in intellectual rigour, but actual experience completely changed my mind. In primary care I had such enthusiastic GP tutors and saw how embracing not just the biological but also psychological and social aspects of a patient’s problem could lead to better outcomes.

On the flipside, the biggest challenges I face are the long hours, difficult decisions and emotional challenges inherent in the job, alongside the wider issues in the NHS and social care.

What Cambridge did for me

̽��ֱ��Cambridge medical course is founded on core science which is later developed during clinical training, which seemed to match my learning style. In unfamiliar situations I can often problem-solve from first principles due to this sound scientific basis. It has also made me familiar with critically appraising evidence and that helps my clinical decision-making.

I discovered the world of primary care research, almost by accident, through Student Selected Components (SSC). Professor Jonathan Mant was my supervisor on my first Primary Care related SSC, which took me to the interface between stroke rehab in the hospital and community. Later, he encouraged me to submit an abstract to the Society for Academic Primary Care (SAPC) regional conference, and presenting there made me very enthusiastic about academic Primary Care. Professor Martin Roland, Dr Charlotte Paddison and Dr Katie Saunders supervised me on my second SSC in the Primary Care Unit. They gave me a lot of support to present again at SAPC, locally and nationally, and to publish the paper with which I won a Royal College of General Practitioners research prize in 2016.

My time at Cambridge proved so many of my preconceptions about primary care wrong. I soon learnt that GPs must use their clinical and diagnostic skills to make diagnoses, or deal with uncertainty, with fewer resources than available in hospital. I found there are also opportunities to develop specialist interests. My clinical placements were in various specialties and locations which helped me learn to integrate rapidly into a team and give me an insight into my eventual career plans. I also received really effective teaching in communication skills, which I continue to develop as a GP trainee.

During my 4th and 5th years, I spent several weeks with the practice team at Nene Valley Medical Practice in Peterborough, and that longitudinal placement really inspired and helped me to become a GP. During my elective in Scotland I received a lot of support and great advice from the anaesthetic department at Lorn and Islands Hospital in Oban. ̽��ֱ��short time I spent at the small, two-GP, Easdale Medical Practice, on the Isle of Seil also inspired me a great deal. Since graduating, the GPs at both Guildhall and Barrow Surgery in Bury St Edmunds, and the Grove Surgery in Thetford have been really supportive, friendly and knowledgeable. West Suffolk Hospital has been a good place to train as a junior doctor.

Applying to Cambridge

I grew up in Shepshed, a village in Leicestershire, and went to school in Loughborough. I was fortunate in having university-educated parents and in attending a school where Oxbridge applications were encouraged. But during my teenage years I had a lot of time out of school due to illness – I was diagnosed with Crohn's disease. I had to restart my GCSE year and, prior to returning, my head teacher advised me that either medicine or Oxbridge might be a realistic goal but, concerned for my health and welfare, they told me it might be best not to aim for both. I doubt they know how much that drove me to prove them wrong!

Crohn’s made the rest of school and the start of university a battle but I was open on my application about my illness and the potential for things to go wrong. I spoke to the ̽��ֱ��’s Disability Resource Centre team at an open day and my College also made me aware of all the support available if I needed it, which fortunately I rarely did. I did, however, receive targeted financial support via a Disabled Student's Allowance which made a huge difference to my confidence when I started at Cambridge. I have been in remission for some time now but being in some situations as both a patient and relative does, I think, help me approach things more holistically as a doctor.

It is really important with a medical degree to consider the course structure. While the traditional model at Cambridge suited me, it may not match everyone’s learning style. As for choosing a college, I didn't know where to start so decided to visit a shortlist on open day. I settled on Trinity Hall, where I felt most at home, a decision I’ve never regretted.

Cambridge graduates enter a wide range of careers but making a difference tops their career wish lists. In this series, inspiring graduates from the last three years describe Cambridge, their current work and their determination to give back.

My time at Cambridge proved so many of my preconceptions about primary care wrong.

Gwilym Thomas, MB, Medicine (2015)

Find out more

For more information about studying Medicine at Cambridge.

Find out more about General Practice as a career.

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Stroke survivors face ‘invisible impairments’ to return to work

cjb250 — Wed, 06 Apr 2016 18:30:53 +0000

Each year, 110,000 people in England alone suffer a stroke, a quarter of whom are of working age. ̽��ֱ��UK’s stroke strategy highlights the importance for people who have had a stroke of returning to work: being unemployed is associated with physical and mental health problems, while working has positive effects on the health of people with chronic conditions. A recent study estimated the cost of stroke care in the UK to be £9 billion a year, of which almost a third (30%) is due to loss of income and productivity.

To explore the experiences of people who have returned to work after a stroke, researchers analysed the archives of TalkStroke, a UK-based online forum hosted by the Stroke Association, across a seven year period (2004-2011). It is believed to be the first study to utilise data from such forums to study barriers to staying in work after stroke.

̽��ֱ��researchers searched more than 20,000 posts for the phrases “return to work” and “back at work” and identified 60 people who had posted about the issue during the seven year period. Almost all of those who managed to return to work still experienced a range of residual invisible impairments, including memory and concentration problems and fatigue.

On the online forums, some commenters described the problems with looking ‘normal’, but not feeling the same way and how this led to a lack understanding among co-workers, but also to their own sense of feeling a fraud.

Having a supportive employer helped people ease themselves back into work and enabled survivors to make adjustments, including a gradual return to work, reduced hours and working from home. But when employers were unsupportive, survivors found this particularly distressing and stressful; some posters even reported being bullied by colleagues.

Some commenters gave specific advice to others, such as recommending speaking to their GP, but awareness was low of what do and where to seek advice if stroke-related problems persisted long-term.

“Although a stroke survivor may look like they have recovered, they can be still be affected by invisible impairments that make work difficult,” says Dr Anna De Simoni, a lecturer in Primary Care Research at QMUL and visiting researcher at the Department of Public Health and Primary Care, ̽��ֱ�� of Cambridge.

“Conversations in the internet forums suggest we need to raise awareness of the support available to individuals, but also more widely amongst primary care professionals and employers of how they can best accommodate and support their staff.”

Perhaps surprisingly, the forums also highlighted that GPs themselves did not always understand the impairments and could often do more to support their patients. One man, aged 61 at the time of his stroke, reported that his GP was unwilling to extend his sick leave as he said the man could sit at a desk and move all his limbs and so was fit to work, yet the man suffered impairments such as walking and communication problems, limb spasms and fatigue.

In a sister paper, also in BMJ Open, the authors report how TalkStroke proved to be a powerful tool for providing advice and support for survivors and their carers. ̽��ֱ��study found that 95% of information and support requests by patients with stroke and their families in the online forum were answered in replies.

̽��ֱ��main reasons for taking part in online discussions were requests and offers of information and support, and sharing own experiences of stroke. Most information needs were around physical impairments, understanding the cause of stroke and the potential for recovery.

Professor Jonathan Mant from the Cambridge Primary Care Unit says: “Almost all requests of information and support on the forums receive an answer. In a time when GP surgeries are full and patients are waiting weeks for community appointments, these online forums can provide a way for stroke survivors and their carers to receive helpful advice and support.”

̽��ֱ��researchers were funded by the National Institute for Health Research and the Evelyn Trust.

Kate Pieroudis, Manager of the Back to Work Project at the Stroke Association said: “Employers can have a vital part to play in helping stroke survivors get back into the workplace and on the road to recovery. Stroke is incredibly complex and affects every person differently. In some cases, the long-term effects of the condition, such as communication problems or memory loss, may only become apparent in a work environment.

“With the right support, many stroke survivors can and do go back to work successfully. Planning with employers is essential so they understand how a stroke has affected an individual, and can put necessary support and adjustments in place. ̽��ֱ��Stroke Association provides information and practical advice on work and stroke to both employers and stroke survivors.”

̽��ֱ��Stroke Association’s ‘Complete Guide to Stroke for Employers’ can be downloaded here.

Reference
Balasooriya-Smeekens, C et al. Barriers and facilitators to staying in work after stroke: insight from an online forum. BMJ Open; 6 April 2016; DOI 10.1136/bmjopen-2015-009974

De Simoni, A. et al. Stroke survivors and their families receive information and support on an individual basis from an online forum: descriptive analysis of a population of 2,348 patients and qualitative study of a sample of participants. BMJ Open; 6 April 2016; DOI 10.1136/bmjopen-2015-010501

‘Invisible impairments’ can make it difficult for stroke survivors to maintain a job, according to a study from the ̽��ֱ�� of Cambridge and Queen Mary ̽��ֱ�� of London (QMUL). ̽��ֱ��findings, published today in the journal BMJ Open, suggest that more needs to be done to make survivors, their GPs and employers aware of the difficulties that they may face.

Although a stroke survivor may look like they have recovered, they can be still be affected by invisible impairments that make work difficult

Anna De Simoni

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