̽��ֱ�� of Cambridge - Mary Dixon-Woods

A very healthy relationship: the ̽��ֱ�� and the NHS

cjb250 — Mon, 03 Jul 2023 15:40:21 +0000

As the NHS celebrates its 75th anniversary, we look at how the close relationship between the ̽��ֱ�� and the hospitals on its doorstep is driving major improvements in how we care for patients.

Cambridge institute publishes ethical framework for asymptomatic COVID-19 student testing in HE institutions

cjb250 — Thu, 25 Feb 2021 13:40:09 +0000

̽��ֱ��use of asymptomatic COVID-19 testing is accelerating in a range of UK settings, including in higher education institutions. ̽��ֱ�� ̽��ֱ�� of Cambridge introduced a weekly asymptomatic testing programme for students in College accommodation in October 2020 as part of its efforts to reduce the spread of COVID-19. ̽��ֱ��programme, based on laboratory PCR tests facilitated by the national lighthouse laboratory network, involves pooling swabs from students in their households. If the pool tests positive, individual tests are performed for each participating student to investigate further.

Researchers at THIS Institute consulted students and staff at the ̽��ֱ�� on ethical issues relating to its student testing programme. Their views, combined with expert legal and ethical analysis, resulted in a new ethical framework aimed at helping higher education institutions make complex decisions about student testing programmes.

̽��ֱ��framework offers recommendations in nine areas:

Design and operation of the programme
Goals of the programme
Properties of the test
Enabling isolation
Choices regarding participation
Benefits, harms and opportunity costs
Responsibilities
Privacy, confidentiality and data protection
Communication

Professor Mary Dixon-Woods, Director of THIS Institute, said: “Higher education institutions must be certain that they can deliver asymptomatic COVID-19 testing programmes for students that are responsive to new evidence, policy and guidance, pandemic conditions, and views of their students and staff. This new ethical framework is intended to help leaders to think through whether asymptomatic COVID-19 testing is the right option for their institution, and to support good organisational decision-making around implementing testing programmes.”

Dr Caitriona Cox, NIHR Academic Clinical Fellow at THIS Institute and project lead, said: “ ̽��ֱ��framework and checklist are freely available and will hopefully act as valuable and timely resources for higher education institutions seeking ethically sound ways to keep people safe and support public health efforts.”

Supported by the Wellcome Trust, Dr Cox and colleagues consulted over 200 students and staff from the ̽��ֱ�� of Cambridge. Participants took part via an online questionnaire or interview. ̽��ֱ��consultation, conducted through Thiscovery, THIS Institute’s online research platform, gathered views about the asymptomatic COVID-19 testing programme. ̽��ֱ��consultation findings were integrated with ethical and legal analysis and expert discussion to produce an ethical framework and checklist.

̽��ֱ��framework, checklist and further information about the work is available on the THIS Institute website.

̽��ֱ��Healthcare Improvement Studies (THIS) Institute has today published an ethical framework for higher education institutions considering running asymptomatic COVID-19 testing programmes for their students.

Higher education institutions must be certain that they can deliver asymptomatic COVID-19 testing programmes for students that are responsive to new evidence, policy and guidance, pandemic conditions, and views of their students and staff

Mary Dixon-Woods

Nordin Ćatić

Testing kit

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Cambridge Science Festival returns for milestone 25th year

Anonymous — Fri, 25 Jan 2019 15:48:27 +0000

Celebrating its 25th year, the Festival runs for two weeks from 11-24 March and explores the theme of ‘discoveries’. An impressive line-up of acclaimed scientists includes microscopist Professor Dame Pratibha Gai, Astronomer Royal Professor Lord Martin Rees, 2018 Nobel prize winner Sir Gregory Winter, geneticist Dr Giles Yeo, statistician Professor David Spiegelhalter, engineer Dr Hugh Hunt, marine biologist and author Helen Scales, THIS Institute Director Professor Mary Dixon-Woods, futurist Mark Stevenson, and science presenter Steve Mould.

̽��ֱ��full programme is teeming with events ranging from debates, talks, exhibitions, workshops and interactive activities to films, comedy and performances, held in lecture theatres, museums, cafes and galleries around Cambridge. There are events for all ages and most are free.
With so many events on offer, audiences will be spoilt for choice. Some of the biggest events in week one include:

Is technology making us miserable? (11 March). Virtually every interaction we have is mediated through technology. Despite being ‘always-on’, are we any better off? Are we better connected? Or is technology making us miserable?
Putting radioactivity in perspective (12 March). Following a renewal of electricity generated by nuclear power, Professors Ian Farnan and Gerry Thomas, Imperial College London, discuss radioactivity in the natural world and the outcomes of decades of study on the health effects of radiation. Could these research outcomes reset attitudes towards radiation and the risks?
̽��ֱ��universe of black holes (13 March). Christopher Reynolds, Plumian Professor of Astronomy, describes how future research into black holes may yet again change our view of reality.
̽��ֱ��long-term perspective of climate change (14 March). Professors Ulf Büntgen, Mike Hulme, Christine Lane, Hans W Linderholm, Clive Oppenheimer, Baskar Vira, and Paul J Krusic discuss how we investigate past climate and the challenges we face in applying this to the policy-making process.
Catalytic activation of renewable resources to make polymers and fuels (15 March). Professor Charlotte Williams, ̽��ֱ�� of Oxford, discusses the development of catalysts able to transform carbon dioxide into methanol, a process which may deliver more sustainable liquid transport fuels in the future.
Does the mother ever reject the fetus? (15 March). Professor Ashley Moffett discusses fetal rejection and explores new discoveries that show that there are multiple mechanisms to ensure there is a peaceful environment in the uterus, where the placenta is allowed to grow and develop to support the fetus.

Top picks for the second week include:

Cambridge gravity lecture: Sir Gregory Winter (18 March). Sir Gregory is a molecular biologist and 2018 Nobel Laureate best known for his work on developing technologies to make therapeutic monoclonal antibodies. His research has led to antibody therapies for cancer, rheumatoid arthritis and multiple sclerosis.
Discoveries leading to new treatments for dementia (18 March). Professor of Clinical Neurosciences and Associate Director of the UK Dementia Research Institute, Giovanna Mallucci discusses how new research leading to insights into dementia and degenerative brain diseases may lead to new treatments.
Improving quality and safety in healthcare (19 March). THIS Institute Director Professor Mary Dixon-Woods looks at the challenges to improving quality and safety in healthcare and considers why it’s so hard to answer the question: Does quality improvement actually improve quality? With Dr Fiona Godlee, Editor in Chief of ̽��ֱ��BMJ.
Immunology: the future of medicine? (19 March) Professor Clare Bryant and a panel of Cambridge immunologists discuss how understanding disease triggers may enable entirely new approaches to treating and potentially preventing disease.
Polar ocean: the dead end of plastic debris (19 March). An estimated 80% of all the litter in our oceans is plastic, and a significant concentration of plastics debris is found in both polar oceans. ̽��ֱ��impact of this debris on the sensitive polar ecosystem could be profound. Pelagic marine ecologist Dr Clara Manno, British Antarctic Survey, explores the current research and existing situation in the polar regions.
Reluctant futurist (19 March). Old models for healthcare, education, food production, energy supply and government are creaking under the weight of modern challenges. Futurist Mark Stevenson looks at the next 30 years and asks, how can we re-invent ourselves for the future?
Adolescent mental health: resilience after childhood adversity (20 March). Adolescence is characterised by huge physiological changes as well as a rapid rise in mental health disorders. Around 45% of adolescent mental health problems are caused by childhood difficulties but fortunately not all who experience difficulties develop mental health disorders. Dr Anne-Laura van Harmelen discusses mechanisms that may help adolescents with a history of childhood difficulty to become more resilient.
Making algorithms trustworthy (21 March). Increasingly, algorithms are being used to make judgements about sensitive parts of our lives. How do we check how their conclusions were arrived at, and if they are valid and fair? Professor David Spiegelhalter looks at efforts to make algorithms transparent and trustworthy, using systems that make predictions for people with cancer as an example.
On the future: prospects for humanity (22 March). Professor Lord Martin Rees argues that humanity’s prospects on Earth and in space depend on our taking a different approach to planning for tomorrow.

This year’s Cambridge Science Festival also celebrates significant milestones in science, including the 200th anniversary of Cambridge Philosophical Society, Cambridge’s oldest scientific society, and 150 years since the publication of the modern Periodic Table.

Speaking ahead of the Festival, Dr Lucinda Spokes, Festival Manager, said: “We are tremendously proud of this year’s programme due to the variety of events and the calibre of our speakers from a range of institutions and industries.

“Alongside the meatier topics we have an array of events for all ages and interests across both weekends. We have everything from the science of perfumery and how your mood affects your taste, to a science version of 'Would I Lie to You?'

“One of my personal top picks are the open days at the various institutes and departments based at the West Cambridge site on Saturday 23 March. As always, the site is hosting some truly fascinating events, everything from the future of construction and how to make Alexa smarter, to how nanotechnology is opening up new routes in healthcare, and state-of-the-art approaches to low-cost solar energy and high-efficiency lighting solutions.

“A Festival of this magnitude would not be possible without the help from many people; we thank all our scientists, supporters, partners and sponsors, without whom the Festival would not happen. Most of all, we thank the audiences – there are more than 60,000 visits to the Festival events every year. We very much look forward to welcoming everyone from all ages to join us in March to explore the fabulous world of science.”

You can download the full programme here.

Bookings open on Monday 11 February at 11am.

This year’s Festival sponsors and partners are Cambridge ̽��ֱ�� Press, AstraZeneca, MedImmune, Illumina, TTP Group, Science AAAS, Anglia Ruskin ̽��ֱ��, Astex Pharmaceuticals, Cambridge Science Centre, Cambridge Junction, IET, Hills Road 6th Form College, British Science Week, Cambridge ̽��ֱ�� Health Partners, Cambridge Academy for Science and Technology, and Walters Kundert Charitable Trust. Media Partners: BBC Radio Cambridgeshire and Cambridge Independent.

̽��ֱ��2019 Cambridge Science Festival is set to host more than 350 events as it explores a range of issues that affect today’s world, from challenges around climate change policy, improving safety and quality in healthcare, and adolescent mental health, to looking at what the next 25 years holds for us and whether quantum computers can change the world.

We have everything from the science of perfumery and how your mood affects your taste, to a science version of 'Would I Lie to You?'

Dr Lucinda Spokes

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£42m new research institute to boost evidence on improving care in the NHS

cjb250 — Wed, 31 Jan 2018 00:26:59 +0000

̽��ֱ��Healthcare Improvement Studies Institute (THIS Institute), led by the ̽��ֱ�� of Cambridge, is made possible by the largest single grant ever made by the Health Foundation, an independent charity. ̽��ֱ��new institute is founded on the principle that efforts to improve care should always be based on the best quality of evidence. Some of that evidence will be created by NHS patients and staff themselves, using innovative citizen science methods in large-scale research projects.

Director of THIS Institute Professor Mary Dixon-Woods, said: “If you ask people to describe the future of healthcare, they might describe a shiny vision of new treatments and technologies. These kinds of innovations are important. But how healthcare is organised and delivered, including its basic systems and processes, has perhaps just as much impact, and sometimes more, on patient outcomes and experience.”

Dr Jennifer Dixon, Chief Executive of the Health Foundation, said: “ ̽��ֱ��UK population clearly wants a high quality and sustainable NHS into the future. Understanding what works, in which contexts and why, is crucial, as is obtaining that evidence fast so it can be acted on. There couldn’t be a more important time to do this, and that is why the Health Foundation has put its money where its mouth is.”

One way the institute will create the evidence-base is through citizen science. Using methods already used in other areas such as biology and astronomy, THIS Institute is building a digital platform to crowdsource research ideas and collect research data from NHS staff and patients, including their opinions on the right indicators of quality of care and their views on equipment design.

Professor Dixon-Woods, Director, THIS Institute, adds: “Tackling healthcare challenges needs to involve a greater variety of people with diverse experience: the institute is looking for expertise in new places. Some of this expertise will come directly from patients – us, you, me – working alongside healthcare staff and other professionals such as engineers and designers.”

̽��ֱ��institute will be based at the Cambridge Biomedical Campus, alongside Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust and world-leading research institutes. It is made possible by a ten-year grant from the Health Foundation, whose mission is to bring about better health and healthcare for people in the UK.

Press release from ̽��ֱ��Healthcare Improvement Studies Institute.

A new research institute launching today is seeking to create a world-leading asset for the NHS by improving the science behind healthcare organisation and delivery.

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Cambridge awarded £40m to create world-leading health care improvement research institute

cjb250 — Tue, 28 Mar 2017 08:59:33 +0000

This is the charity’s single largest grant to date and will create an institute that is the first of its kind in Europe.

Led by Mary Dixon-Woods, RAND Professor of Health Services Research and Wellcome Trust Investigator at the ̽��ֱ�� of Cambridge, the institute will work closely with a wide range of partners across the UK including RAND Europe and Homerton College, Cambridge. Seeking to strengthen the evidence-base for how to improve health care, it will produce practical, high quality learning about how to improve patient care and will grow capacity in research skills in the NHS, academia and beyond.

̽��ֱ��Health Foundation says it is making this significant investment because it recognises the huge potential for research to shed light on how sustainable and replicable improvements to the quality of patient care can be made in the NHS more quickly.

Dr Jennifer Dixon, chief executive of the Health Foundation, says: “Faster learning and discovery is vital to achieving higher quality health care for patients at a sustainable cost. That is why the Health Foundation is making its biggest single grant to date to help build the field of improvement research.

“ ̽��ֱ�� ̽��ֱ�� of Cambridge and their partners have set out a compelling vision for this ground-breaking improvement research institute – the first of its kind in Europe. This is a significant and exciting step in developing evidence on a massive scale across the NHS about what works to improve patient care. Critically, the institute’s work will include understanding not only which interventions work, but also in which contexts and why.”

Professor Dixon-Woods adds: “ ̽��ֱ��NHS, like health systems around the world, is faced with pressing challenges of quality and safety. Yet the science of how to make improvements has remained under-developed. This funding is a tremendous opportunity to produce new knowledge about how to improve care, experience and outcomes for patients. Together with our partners, the ̽��ֱ�� of Cambridge is hugely excited at the chance to work with NHS staff, patients and carers to identify, design and test improvements.”

̽��ֱ��institute will formally launch within the next year and will be based at the Cambridge Biomedical Campus, alongside Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust and world-leading research institutes.

For more information, please visit the Health Foundation's website.

Adapted from a press release from the Health Foundation.

̽��ֱ�� ̽��ֱ�� of Cambridge is to receive £40 million over ten years from the Health Foundation, an independent charity, to establish and run a new research institute aimed at strengthening the evidence-base for how to improve health care.

This funding is a tremendous opportunity to produce new knowledge about how to improve care, experience and outcomes for patients

Mary Dixon-Woods

Lydia

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Keeping patients safe in hospital

cjb250 — Tue, 15 Nov 2016 09:39:09 +0000

In November 2004, Mary McClinton was admitted to Virginia Mason Medical Center in Seattle, USA, to receive treatment for a brain aneurysm, a potentially serious swelling in a blood vessel. What followed was a tragedy, made worse by the fact that it was entirely preventable.

McClinton was mistakenly injected with the antiseptic chlorhexidine. It happened, the hospital says, because of “confusion over the three identical stainless steel bowls in the procedure room containing clear liquids — chlorhexidine, contrast dye and saline solution”. Doctors tried amputating one of her legs to save her life, but the damage to her organs was too great: McClinton died 19 days later.

Nine years on, an almost identical accident occurred at Doncaster Royal Infirmary in the UK. Here, the patient, ‘Gina’, survived, but only after having her leg amputated.

Professor Mary Dixon-Woods is one of Cambridge’s newest recruits, and she is on a mission: to improve patient safety in the National Health Service and in healthcare worldwide. She has recently taken up the role as RAND Professor of Health Services Research, having moved here from the ̽��ֱ�� of Leicester.

It is, she admits, going to be a challenge. Many different policies and approaches have been tried to date, but few with widespread success, and often with unintended consequences.

Financial incentives are widely used in the NHS and in the USA, but recent evidence suggests that they have little effect. “There’s a danger that they tend to encourage effort substitution – what people often refer to as ‘teaching to the test’,” explains Dixon-Woods. In other words, people focus on the areas that are being incentivised, but neglect other areas. “It’s not even necessarily conscious neglect. People have only a limited amount of time, so it’s inevitable they focus on areas that are measured and rewarded: it’s an economy of attention as much as anything else.”

In 2013, Dixon-Woods and colleagues published a study, funded by the Wellcome Trust, evaluating the use of surgical checklists introduced in hospitals to reduce complications and deaths during surgery. ̽��ֱ��checklists have become the most widely used patient safety intervention in the world and are recommended by the World Health Organization. Yet, the evidence shows that checklists may have little impact, and her research found that in some situations – particularly in low-income countries – they might even make things worse.

“ ̽��ֱ��checklists sometimes introduced new risks. Nurses would use the lists as a box-ticking exercise rather than as a true reflection of events – they would tick the box to say the patient had had their antibiotics when there were no antibiotics in the hospital, for example.” They also reinforced the hierarchies – nurses had to try to get surgeons to do certain tasks, but the surgeons used it as an opportunity to display their power and refuse.

Problems are compounded by a lack of standardisation. Dixon-Woods and her team spend time in hospitals to try to understand which systems are in place and how they are used. Not only does she find differences in approaches between hospitals, but also between units and even between shifts. “Standardisation and harmonisation are two of the most urgent issues we have to tackle. Imagine if you have to learn each new system wherever you go or even whenever a new senior doctor is on the ward. This introduces massive risk.”

One place that has managed to break this pattern is Northern Ireland, which has overcome the problem of poor labelling of lines such as intravenous lines and urinary catheters

Even when an institution manages to make genuine improvements in patient safety, too often these interventions cannot be replicated elsewhere or scaled up, leading to the curse of “worked once”, as she describes it.

One place that has managed to break this pattern is Northern Ireland, which has overcome the problem of poor labelling of lines such as intravenous lines and urinary catheters. A sick patient may have several different lines attached to them; these were not labelled in any consistent way – if at all – so a nurse might use the wrong line or leave a line in place too long, risking infection. Over 18 months, the health service in Northern Ireland came up with a solution. Soon, whether you are in a hospital, a nursing home or a hospice, every line will be labelled the same way.

“I’m interested in how they managed to achieve that and what we can learn that can be used in the next place that wants to standardise their lines.”

Dixon-Woods compares the issue of patient safety to that of climate change, in the sense that it is a “problem of many hands”, with many actors, each making a contribution towards the outcome, and where it is difficult to identify who has responsibility for solving the problem. “Many patient safety issues arise at the level of the system as a whole, but policies treat patient safety as an issue for each individual organisation.”

Nowhere is this more apparent than the issue of ‘alarm fatigue’. Each bed in an intensive care unit typically generates 160 alarms per day, caused by machinery that is not integrated. “You have to assemble all the kit around an intensive care bed manually,” she explains. “It doesn’t come built as one like an aircraft cockpit. This is not a problem a hospital can solve alone. It needs to be solved at the sector level.”

Dixon-Woods has turned to Professor John Clarkson in Cambridge’s Engineering Design Centre to help. Clarkson has been interested in patient safety for over a decade; in 2004, his team published a report for the Chief Medical Officer entitled ‘Design for patient safety – a system-wide design-led approach to tackling patient safety in the NHS’.

We need to look through the eyes of the healthcare providers to see the challenges and to understand where tools and techniques we use in engineering may be of value
John Clarkson

“Fundamentally, my work is about asking how can we make it better and what could possibly go wrong,” explains Clarkson. It is not, he says, just about technology, but about the system and the people within the system. When he trains healthcare professionals, he avoids using words like ‘risk’, which mean different things in medicine and engineering, and instead asks questions to get them thinking about the system.

“We need to look through the eyes of the healthcare providers to see the challenges and to understand where tools and techniques we use in engineering may be of value. I have no doubt that if you were to put a hundred engineers into Addenbrooke’s [Hospital], you could help transform its care.”

There is a difficulty, he concedes: “There’s no formal language of design in healthcare. Do we understand what the need is? Do we understand what the requirements are? Can we think of a range of concepts we might use and then design a solution and test it before we put it in place? We seldom see this in healthcare, and that’s partly driven by culture and lack of training, but partly by lack of time.”

Dixon-Woods agrees that healthcare can learn much from how engineers approach problems. “Medical science tends to prioritise trials and particular types of evidence, whereas engineering does rapid tests. Randomised controlled trials do have a vital role, but on their own they’re not the whole solution. There has to be a way of getting our two sides talking.”

Only then, she says, will we be able to prevent further tragedies such as the death of Mary McClinton.

Healthcare is a complex beast and too often problems arise that can put patients’ health – and in some cases, lives – at risk. A collaboration between the Cambridge Centre for Health Services Research and the Department of Engineering hopes to get to the bottom of what’s going wrong – and to offer new ways of solving the problems.

Standardisation and harmonisation are two of the most urgent issues we have to tackle. Imagine if you have to learn each new system wherever you go or even whenever a new senior doctor is on the ward. This introduces massive risk

Mary Dixon-Woods

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