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Projects

Study Title Study Lead Health & Social Care
Partner Organisations
Lay summary
Does total joint arthroplasty of the hip and knee reduce the risk for serious cardiovascular events in patients with moderate-severe osteoarthritis? Mr Edward Davis The Royal Orthopaedic
Hospital NHS Foundation Trust; Dudley Group of
Hospitals NHS Foundation Trust
It has been observed that patients with arthritis who have a hip or knee joint replacement seem to have less heart disease than similar patients who do not have hip or knee joint replacement. It is unclear whether this is because subtly healthier patients are selected to have joint replacement or because joint replacement improves their general health. This study will analyse records of arthritis patients who had hip or knee joint replacement compared to arthritis patients of the same age and sex who did not. It will try to work out if joint replacement really did result in fewer of them having heart disease after surgery.
Changing case Order to Optimise patterns of Performance in mammography Screening (CO-OPS): study protocol for a randomized controlled trial. Dr Sian Taylor-Philips, Warwick Medical School UK wide – Breast Screening Centres In breast cancer screening, mammograms (x-ray images) are taken of women's breasts and examined for signs of cancer. In the NHS Breast Screening Programme each woman's mammograms are examined separately by two radiologists, who each indicate if there should be recall for further tests. This is a highly skilled but repetitive activity where radiologists examine batches of 30-50 women's mammograms in each session. A decrease of performance has been observed over time in similar repetitive visual tasks, such as searching a radar screen for enemy aircraft. The current practice is for both radiologists to examine each batch of mammograms in the same order as one another, so their performance decrease would occur when looking at the same women's mammograms. We plan to run an experiment to test whether the two radiologists examining batches in a different order to one another increases the number of cancers detected. The idea is to make sure that optimal performance for the first and second radiologist happen when examining different women's mammograms, to improve overall cancer detection rates.
Fluorouracil plasma monitoring: the My5-FU assay for guiding dose adjustment in patients receiving fluorouracil chemotherapy by continuous infusion. Dr Paul Sutcliffe, Warwick Medical School NICE This project investigated the diagnostic accuracy and cost effectiveness of My5FU -a blood test aimed at ensuring that people are receiving the right amounts of chemotherapy agents for colon and other cancers
Accurate diagnosis of latent Tuberculosis in children, in people who are immunocompromised or at risk from immunosuppression, and recent arrivals from countries with a high incidence of Tuberculosis: systematic review and economic evaluation. Dr Paul Sutcliffe, Warwick Medical School NICE We looked at ways to diagnose latent TB (inactive TB ) in different populations using a single blood test and a tuberculin skin test. We looked at 3 groups – children, those who have a low immunity, and recent arrival to our country from high incidence areas. We found that different tests were cost- effective for different population subgroups.
Estimation of undiagnosed and untreated atrial fibrillation in UK primary care Prof Tom Marshall, University of
Birmingham
UK wide primary care settings AF is the most common cause of irregular heart rhythm, becoming more common with age. People with AF may not have any symptoms, but sometimes develop blood clots in the upper chambers of their heart, which may break off and lodge in the brain causing stroke. As a result people with AF are at much higher risk of stroke than others of similar age and sex. The chances of a person with AF having a stroke are greatly reduced if they take anticoagulant drugs, which reduce the tendency of blood to clot. It is therefore important that GPs identify people with AF and that they offer anticoagulant drugs to them to reduce their chances of developing strokes. This analysis will look at a large dataset of electronic patient records from over 500 general practices. It will determine whether the number of people with diagnosed AF is consistent with what we would expect and determine what proportion of these patients are indeed being prescribed anticoagulant drugs.
A randomised controlled trial evaluating the effectiveness and cost-effectiveness of ‘Families for Health’, a family-based childhood obesity treatment intervention. Dr Wendy Robertson, Warwick Medical School Coventry City Council,
Warwickshire City Council, Wolverhampton City Council
The prevalence of childhood obesity in the UK is high, and the NHS needs programmes which are effective in helping children who are already obese or overweight. A new programme called ‘Families for Health’ has been developed at the University of Warwick to help families reduce obesity in children aged 6 to 11. This is a group-based programme, 10 weeks long, involving children and their parents. In addition to a focus on healthy eating and activity, it is designed to help parents develop their parenting skills to support lifestyle changes within the family. This study is a randomised controlled trial comparing Families for Health with the ‘usual care’ across in Coventry, Warwickshire and Wolverhampton. 120 families will be randomly allocated to the two treatment arms. The aims of the research are to find out if the ‘Families for Health’ programme manages to reduce the degree of overweight (BMI z-score) and to estimate whether the programme is value for money.​
Non-Invasive prenatal testing (NIPT) for T21, 18 and 13, an Evidence Review for the UK National Screening Committee Dr Sian Taylor-Philips, Warwick Medical School UK National Screening
Committee; University
Hospital Coventry and
Warwickshire NHS Trust
This is a review for the uk national screening committee bringing together the research evidence about whether to offer pregnant women noninvasive prenatal tests (NIPT) for Down's syndrome, Edwards syndrome and Patau syndrome. Currently women are offered the combined test in the first 12 weeks of pregnancy. We will examine the evidence to advise whether NIPT testing should be offered in addition to the combined test.
NIHR Clinical Trials Fellowship “Randomised Controlled Trials and alternatives for evaluating diagnostic tests” Dr Sian Taylor-Philips,Warwick Medical School   This is a training secondment funded by the national institute for health research for Sian Taylor-Phillips. She will be working with Birmingham university learning about the best methods of evaluating medical tests.
Systematic Reviews to Underpin the Development of a Blood Test for Cancer. Dr Sian Taylor-Phillips, Warwick Medical School University Hospital Coventry and Warwickshire NHS Trust This project brings together the results of many studies investigating different blood tests to detect cancer. It's ultimate aim is to combine them into one blood test to detect cancer.
Lighten Up Plus Prof Kate Jolly, University of
Birmingham
Birmingham City Council Many people who lose weight regain the weight after they finish their weight loss programme. Local authorities fund 12-week weight loss programmes free to people who are overweight, often from commercial providers. When one asks people who have successfully maintained their weight loss they frequently mention regular self-weighing, so that they can control their food intake and exercise levels if they start to gain a few pounds. In collaboration with Birmingham City Council, Birmingham Community Health Care NHS Trust and Flo Simple Telehealth we designed a programme to help people maintain weight loss using text messages. After completing a 12-week weight loss programme 380 people were allocated by chance to ‘usual care’ which included a leaflet of hints and tips to keep weight off and a follow-up telephone call after 3 months; or the text programme. People allocated to the text programme received a weekly text asking them their weight and responding with simple supportive messages. People were asked to self-report their weight after 3 months and are being weighed after 9 months follow-up.
Systematic Review: Parent only interventions for childhood overweight or obesity (Cochrane Review) Dr Rebecca Johnson, University of Warwick (Systematic reviews) All over the world more children are becoming overweight and obese. These children are more likely to suffer from health problems. A recent review of parent only interventions for the treatment of childhood obesity suggest that parent-only interventions appear to be as effective. However, more information is needed about what works best for treating this problem. The purpose of this review is to investigate the effectiveness of diet, physical activity and behavioural interventions focusing on ‘parents only’ designed to treat overweight and obesity in children aged 5-11 years.
Diet, physical activity and behavioural interventions for the treatment of overweight or obesity in adolescents aged 12 to 17 years (Cochrane Review) Dr Lena Alkhudairy, Warwick Medical School (Systematic reviews) Obesity in children and adolescents has reached worryingly high levels globally, and can be associated with short and long term health consequences. As tackling obesity remains a public health priority, it is important to understand the effectiveness of different treatment approaches. The purpose of this review is investigate effectiveness of lifestyle interventions (diet, physical activity and behavioural approaches) for the treatment of overweight and obesity in children aged 12-17 years. This study showed that providing dietary advice on consumption of fruit and vegetables has some favourable effects on blood pressure (systolic blood pressure (SBP): mean difference (MD) -3.0 mmHg (95% confidence interval (CI) -4.92 to -1.09), diastolic blood pressure (DBP): MD -0.90 mmHg (95% CI -2.03 to 0.24)) and low-density lipoprotein (LDL) cholesterol but analyses were based on only two trials.
The experiences of the smoking carers of children in a Paediatric Intensive Care Unit: A qualitative study protocol Prof Kate Jolly, University of
Birmingham
Birmingham Children’s
Hospital NHS Foundation Trust
We know that secondhand smoke (from parents or carers or other adults) worsens asthma and other lung diseases in children. When children are admitted to Paediatric Intensive Care for lung problems, there is an opportunity to get parents and carers to think about reducing their children's exposure to secondhand smoke. However there are a number of possible difficulties with raising this subject at a sensitive time. This project will investigate the views of carers and of health service staff in relation to raising the subject of secondhand smoke while a child is in Paediatric Intensive Care. We will also investigate the potential of a new test to determine whether children have been exposed to secondhand smoke.
Warwick (Cochrane) Preventive Heart Group Dr Karen Rees,
University of Warwick
(Systematic reviews) See individual lay summaries below.
Vitamin C supplementation for the primary prevention of cardiovascular disease. Dr Karen Rees,
University of Warwick
(Systematic reviews) This review is not yet published in full the aim is to determine the effectiveness of vitamin C supplementation as a single supplement for the primary prevention of cardiovascular disease (CVD).
Omega 6 fatty acids for the primary prevention of cardiovascular disease. Dr Karen Rees,
University of Warwick
(Systematic reviews) This review is not yet published in full the aim is to: determine the effectiveness of increasing omega 6 fatty acid intake in place of saturated or monounsaturated fats or carbohydrates for the primary prevention of CVD; and to determine the effectiveness of decreasing omega 6 fatty acids in place of carbohydrates or protein (or both) for the primary prevention of CVD.
Yoga for the primary prevention of cardiovascular disease Dr Karen Rees,
University of Warwick
(Systematic reviews) Yoga has been found to cause reductions in diastolic blood pressure (mean difference (MD) -2.90 mmHg, 95% confidence interval (CI) -4.52 to -1.28), which was stable on sensitivity analysis. Reductions also occurred in triglycerides (MD -0.27 mmol/l, 95% CI -0.44 to -0.11) and high-density lipoprotein (HDL) cholesterol (MD 0.08 mmol/l, 95% CI 0.02 to 0.14).
Fixed-dose combination therapy for the prevention of cardiovascular disease Dr Karen Rees,
University of Warwick
(Systematic reviews) Compared with placebo, single drug active component, or usual care, the effects of fixed-dose combination therapy on all-cause mortality or CVD events are uncertain; only few trials report these outcomes and the included trials were primarily designed to observe changes in CVD risk factor levels rather than clinical events. Reductions in blood pressure and lipid parameters are generally lower than those previously projected, though substantial heterogeneity of results exists. Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo, single drug active component, or usual care but may be associated with improved adherence to a multidrug regimen. Ongoing trials of fixed-dose combination therapy will likely inform key outcomes.
Tai chi for primary prevention of cardiovascular
disease
Dr Karen Rees,
University of Warwick
(Systematic reviews) There are currently no long-term trials examining tai chi for the primary prevention of CVD. Due to the limited evidence available currently no conclusions can be drawn as to the effectiveness of tai chi on CVD risk factors. There was some suggestion of beneficial effects of tai chi on CVD risk factors but this was not consistent across all studies.
Vitamin K for the primary prevention of
cardiovascular disease
Dr Karen Rees,
University of Warwick
(Systematic reviews) This review is not yet published in full. The aim is to determine the effectiveness of vitamin K supplementation as a single ingredient for the primary prevention of CVD.
Startwell a service evaluation of nutritional and
physical activity training for early years staff
Prof Kate Jolly
University of
Birmingham
Birmingham City Council and Birmingham Community Health Care NHS Trust Obesity is becoming an increasing problem in children. This is thought to be due to a range of causes which include diets that are high in sugars and other unhealthy foods and drinks, larger portion sizes and children taking less physical activity. Many children attend nurseries and pre-schools and these are an important influence on the children’s eating behaviours and physical activity levels. Birmingham City Council and Birmingham Community Health Care NHS Trust have developed a training programme for staff who work in nurseries. This teaches them about how they can make the nursery a healthier environment. We are doing a study to see what effect this training has on the activities provided by the nurseries. We have asked all nursery staff attending the training to complete a questionnaire about the food and drinks offered, opportunities for active play, how the staff act as role models to the children for healthy behaviours. This questionnaire will be repeated one year after the training programme was delivered.
Various public health projects Jenny Sheppard & Mark Sheldon, Worcestershire County Council Worcestershire Country
Council
 
The barriers and facilitators to the implementation of NICE clinical guidelines in UK practice. Elective orthopaedics using total hip replacement for the treatment of end stage arthritis. Ms Amy Grove, Warwick Medical School University Hospitals Coventry and Warwick Evidence based practice is aimed at reducing variation within the NHS. It ensures that the most clinically and cost-effective procedures are used to treat patients. This research explores decision-making for hip replacement
by orthopaedic surgeons, to identify potential barriers and facilitators to the implementation of evidence based guidance in practice. The research will include an initial meta-ethnographic review, followed by ethnographic case studies (interviews, observations and document analysis) of two orthopaedic centres in NHS hospitals. The
findings will inform the design of an intervention aimed at improving uptake and understanding of evidence by orthopaedic surgeons in the NHS.
Newborn Blood Spot Screening for Tyrosinaemia type 1
in the UK
Dr Sian Taylor-Phillips, Warwick Medical School UK National Screening Committee  
Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene Peter Auguste NICE To evaluate the benefits and costs of ataluren within its marketing authorisation for treating Duchenne muscular dystrophy, resulting from a nonsense mutation in the dystrophin gene for national commissioning by NHS England.
The LISA-TRACKER anti-tumour necrosis factor (anti-TNF) assay kits, used for monitoring anti-TNF drugs and antibodies in people with inflammatory bowel disease Mrs Karoline Freeman, Warwick Medical School NICE The LISA-TRACKER ELISA kits are manufactured by Theradiag and distributed in the UK by Alpha Laboratories UK Ltd. The Medical Technologies Advisory Committee identified the LISA-TRACKER ELISA kits as potentially suitable for evaluation by the Diagnostics Assessment Programme on the basis of a briefing note. The final scope was informed by discussions at the scoping workshop held on 29 September 2014 and at the assessment subgroup meeting held on the 13 October. The following alternative technologies which were identified as similar to the LISA-TRACKER ELISA kits have been included in the final scope: TNFα-Blocker ELISA kits (Immundiagnostik), and Promonitor ELISA kits (Proteomika).
LDK378 for previously treated anaplastic-lymphoma-kinase-positive non-small-cell lung cancer Dr Emma Loveman   To appraise the clinical and cost effectiveness of ceritinib within its marketing authorisation for previously treated anaplastic lymphoma kinase-positive non-small-cell lung cancer.
Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) intervention Rod Taylor (PenCLAHRC) PenCLAHRC, CLAHRC West Midlands and CLAHRC East Midlands Cardiac rehabilitation (CR) has been shown to significantly reduce the risk of hospitalisation and improve health-related quality of life. NICE recommends offering CR for patients with Heart Failure (HF), but few UK centres have a specific rehabilitation programme for HF.
The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) intervention is a home-based self-help CR manual to improve health-related quality of life. The manual includes an exercise programme; management of stress/anxiety; HF symptom monitoring; and understanding and taking medications. The study team includes academics from three CLAHRCs: South West (who are leading the study), West Midlands Theme 3 (Prevention and Detection) and East Midlands. The researchers are conducting a trial to assess the clinical- and cost-effectiveness of the intervention in addition to usual care for patients with systolic HF. Outcomes after 12 months will be compared with a control group receiving usual care to measure disease specific health-related quality of life, as well as survival, hospitalisation, psychological well-being and patient safety.
The findings will provide valuable information for clinicians, policy makers, patients and their caregivers about the role of self-directed rehabilitation interventions and has the potential to positively impact on the current poor provision and uptake of rehabilitation services for people with HF.
A review of the cross-sectional associations of explanatory variables with overweight and obesity for minority ethnic groups in the UK Ms Marie Murphy, Warwick Medical School    
A mixed methods review/synthesis of the perceptions and beliefs related to weight status / obesity for minority ethnic groups in the UK Ms Marie Murphy, Warwick Medical School    
Risk scoring systems which combine the FIT result for colorectal cancer screening: a systematic review Ms Jennifer Cooper, Warwick Medical School    
Lifestyle Risk Factors and Colorectal Cancer Screening: FIT Pilot Analysis and Development of a Risk-Adjusted Prediction Model Ms Jennifer Cooper, Warwick Medical School Study being carried out at Midlands Bowel Cancer Screening Centre at Rugby hospital which comes under UHCW. Other site is Royal Surrey for the Southern Bowel Cancer Screening Centre  
The feasibility and accuracy of using routinely recorded data from electronic GP records in a risk prediction model combining the FOBT for colorectal cancer screening Ms Jennifer Cooper, Warwick Medical School University of Birmingham  
Risk-Adjusted Colorectal Cancer Screening Using the FIT: Development of a Risk Prediction Model using Routine Data Ms Jennifer Cooper, Warwick Medical School Advisers for the project- Queen Mary University (Sue Moss, Stephen Halloran for this project)  
Universal antenatal culture-based
screening for maternal Group B Streptococcus (GBS) carriage to prevent early-onset GBS disease: An external rapid review and routine data analysis
Dr Sian Taylor-Phillips, Warwick Medical School UK National Screening Committee This review is to provide evidence for the UK National Screening Committee's policy recommendation on group B streptococcus screening
Risk and protective factors for the
transition of Group B Streptococcus (GBS) from maternal carriage to neonatal early-onset GBS disease
Dr Sian Taylor-Phillips, Warwick Medical School UK National Screening Committee This review is to provide evidence for the UK National Screening Committee's policy recommendation on group B streptococcus screening
Adverse events in women and children who have received intrapartum antibiotic prophylaxis treatment Dr Sian Taylor-Phillips, Warwick Medical School UK National Screening Committee This review is to provide evidence for the UK National Screening Committee's policy recommendation on group B streptococcus screening
Accuracy and timeliness of real-time
polymerase chain reaction tests for Group B Streptococcus maternal colonisation in pregnant women in labour compared to antenatal culture
Mrs Farah Seedat Cochrane Pregnancy and Childbirth Group This review on the diagnostic accruacy of real-time PCR and antenatal culture to diagnose group B streptococcus maternal carriage has been registered with the Cochrane Pregnancy & Childbirth Group. The protocol has been submitted for the Group to review.
International comparisons of policy-making systems and processes for population health screening: A systematic review Mrs Farah Seedat UK National Screening Committee This review explored the policy-making processes for health screening across different countries and was given as oral and written evidence to the Parliamentary House of Common's Science and Technology Committtee as well as the DH three yearly review of the National Screening Committee.
Health Checks Dr Chris Stinton, Warwick Medical School Public Health Coventry, Public Health Warwickshire, Punlic Health Dudley Cardiovascular diseases are the second leading causes of death in England. In 2009, the NHS introduced ‘Health Checks’, a cardiovascular disease risk assessment, awareness, and management programme that targets the top seven causes of preventable deaths. The programme is subject to concerns regarding the heterogeneity of designs through which the programme is delivered, its uptake, and the evidence relating to its effects on outcomes. Public Health England (2014) has outlined research priorities for the NHS Health Check programme including the identification of (1) the most effective communication and delivery methods for engaging people with the greatest need, (2) the models of delivery of the different components of the programme that are most effective, and (3) the performance of the current model.
Systematic review of interventions health professionals views of prescribing anti-coagulations for atrial fibrillation - qualitative Prof Kate Jolly, University of Birmingham    
Systematic review of interventions to improve health professionals prescribing anti-coagulations for atrial fibrillation - quantitative Prof Kate Jolly, University of Birmingham    
Evaluation of the Eat Well Move More child weight management service Dr Rebecca Johnson Solihull Metropolitan Borough Council  
Transatlantic knowledge mobilisation in public health: lessons for best practice Dr Rebecca Johnson    
Evaluation of the Coventry GP Alliance: best care, anywhere Prof Aileen Clarke University of Warwick, University of Birmingham, Coventry University his project, funded by the Prime Minister’s Challenge Fund, evaluates the impacts of initiatives introduced within Coventry and Rugby CCG to provide integrated patient care on staff and the wider health and social care system. The final evaluation report has been recently published (Nov-16) and can be downloaded here