CaHRU Newsletter (Summer 2018)

CaHRU_logotypeThe latest edition of the CaHRU Newsletter (Summer 2018) was published in July 2018. The newsletter presents the work of the research centre over the previous three months and includes articles from the CaHRU blog covering publications, conferences and funding. The newsletter is written by members of the CaHRU team and produced by Sue Bowler, CaHRU administrator.

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Farewell to international visiting fellow Dr Nadeeka Chandraratne

nadeekapresentationMembers of the CaHRU team had the opportunity to hear firsthand the experiences and achievements of one of our first international visiting fellows from the University of Colombo during her time at the University of Lincoln, and before she travels back to Sri Lanka later this month.

Dr. Nadeeka Chandraratne (pictured) spent the past 18 months here in Lincoln as part of her postdoctoral training in medicine: to acquire and update her knowledge on strengthening primary health care systems, focussing on quality and cost of care and comparing the UK NHS with the Sri Lankan primary care system; and to learn about monitoring and evaluation in primary care.



During her time here she experienced one-to-one support, self-directed learning, participation in CaHRU activities such as seminars and study review meetings, and undertook field visits with the local ambulance service and at a local general practice. She participated and contributed to CaHRU studies, for example the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme developing new quality measures for ambulance services, a study investigating diabetes emergencies in care homes involving ambulance services and a study investigating causes of differential attainment in the GP licensing examination.

nadeekalunchOne study she worked on, an international comparison of multimorbidity policies in Australia, UK and Sri Lanka, was published in the Australian Journal of General Practice. She also had a number of studies from her previous research published in PLoSOne, BMJ Tobacco Control, and Child Abuse and Neglect and has a number of other publications in peer review or near to submission. She also passed her Diploma in the Faculty of Public Health and became a Fellow of the Royal Society of Public Health during her attachment. She particularly valued learning about teamwork and the support she received from all of her colleagues at CaHRU. After an emotional exchange of gifts, the team celebrated Nadeeka’s successful attachment with a meal at the Brayford and wished her well in her future endeavours.

By Prof Niro Siriwardena

[su_document url=”” width=”660″]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

Sleep and Health at the UK Parliamentary Office for Science and Technology

Sleep and healthDr Julie Pattinson and Professor Graham Law from the Community and Health Research Unit (CaHRU) were recently invited and attended the Sleep and Health seminar hosted by the Parliamentary Office of Science and Technology on October 16th 2018. The seminar was held in collaboration with the Nuffield Foundation and invited experts from medicine, research and occupational sectors to highlight the latest research and discuss the implications for policy, with a special session focusing on shift work and sleep.

The Chair’s welcome was delivered by Professor Lord Winston. In the first session Professors from the University of Oxford, including Professor Russell Foster, director of the Sleep and Circadian Neuroscience Institute, presented an Espie_POSToverview of sleep biology and the consequences of sleep disruption. This was followed by Professor John Stradling, Emeritus Professor of Respiratory Medicine, who discussed sleep apnoea as a growing public health problem. Next, Professor Colin Espie, Professor of Sleep Medicine at the Sleep and Circadian Neuroscience Institute, talked about insomnia, highlighting this as a neglected public health problem with scalable evidence-based solutions. Understanding-sleep-and-improving-care-for-people-with-insomnia-He discussed how online programs can address some patients’ needs, profiling online CBT-I options including Sleepio. Dr David Crepaz-Keay, Head of Empowerment and Social Inclusion at the Mental Health Foundation and Senior Mental Health Advisor, Public Health England, gave the final presentation in the first session focusing on sleeping well and translating evidence into public mental health messages.

The second session focused on shift work and sleep, with presenters discussing the health impacts of shift work, and evidence-based interventions to minimise them. Dr Rob Hunter Head of Flight Safety at the British Airline Pilots’ Association represented the aviation sector. Dr Michael Farquhar, Consultant in Sleep Medicine at Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust demonstrated how research can inform best practice, contribute to workplace policies and international regulation.

By Dr Julie Pattinson

Making a positive difference at the EMDoc Annual Conference

This year’s Annual East Midlands Doctoral Network (EMDoc) Annual Conference which took place at Bishop Grosseteste University focussed on the theme of ‘Impact and exchange – making connections beyond the academy’. The event was attended by over 100 doctoral students and it was a great opportunity to see and discuss posters of their work and hear presentations of their studies. It was also an opportunity to showcase CaHRU’s research impact and how this was being developed.

Prof Siriwardena of CaHRU gave the keynote lecture during the afternoon of the conference Niro1on the subject of ‘Making a difference through research’. In the lecture he explained that most researchers are trying to make a difference through their work, but questioned how effective we were at achieving this and what steps we can take to make research more relevant to the wider community. The talk described examples of work from the Community and Health Research Unit which sought to improve health care and outcomes, and what had been learned about doing research that makes a real difference.

The lecture covered definitions of impact, explaining the difference between journal impact factors and real-world impact. Key principles for impactincreasing the likelihood of impact were then presented including researching an important problem affecting many people significantly across a wide area while seeking to implement coherent solutions. A multidisciplinary approach with service user involvement and professional input can help to generate better solutions to problems. This could even be part of the research with patient and public involvement (PPI) and professional collaboration helping to define the problem and coproduce solutions. There were also advantages in working with others to Understanding-sleep-and-improving-care-for-people-with-insomnia-communicate impact in original and interesting ways, being open to generating impact, and trusting others to help or support by relinquishing control.

Finally, the recently developed CaHRU infographics were presented as a way of communicating research and impact in an interesting and engaging way for both the public and professionals.

By Prof Niro Siriwardena

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Placebos and sleep

You may have seen ‘The placebo experiment: can my brain cure my body?‘ recently broadcast on the BBC. This was a fascinating programme in which doctor and broadcaster Dr Michael Mosley, who I met recently at his ‘Great Lives’ lecture at the University of Lincoln, conducted the largest ever trial to investigate the placebo effect in Britain. The effects of placebo on a group of back pain sufferers’ symptoms was extraordinary. Over the past 15 years in CaHRU we have been studying sleep problems and sleeping tablets and so I became interested in the placebo effect of sleeping tablets.

emperor's new drugsA few years ago, in the summer of 2010, I was reading a book during my summer vacation which I bought from a high street bookstore, ‘The emperor’s new drugs: exploding the antidepressant myth’, written by Prof Irving Kirsch, emeritus professor of psychology at the Universities of Plymouth, Hull and Connecticut and associate director of the Programme in Placebo Studies (PIPS) at Harvard, US. I was interested to read it because, as a GP, I saw many patients with depression and I and my colleagues often prescribed antidepressants and were encouraged to do so by guidance of the time. The book was based on Irving’s ground-breaking research into the placebo effect which looked at the Food and Drugs Administration (or FDA, the US drugs regulator) data on antidepressants.

Pharmaceutical companies are required to submit all their experimental data, comparing their drugs with placebo, to the FDA for approval in the United States. Irving and his PhD student Guy Sapirstein used the FDA data in a meta-huedo medinaanalysis published in 1998 to show that for all but the most severely depressed patients the effect of the drugs was only marginally greater than the effect of placebo – the drugs worked but much of their effect was a placebo effect. A further meta-analysis published by Irving and colleagues a decade later in 2008 showed similar findings. I thought we could do the same study with sleeping tablets to see how these drugs compared with placebo. I sent an email to Irving that afternoon while I was on vacation in Devon and to my surprise he emailed back an hour or two later saying he was wondering about the same thing.

We agreed to meet and did so in Lincoln a few months later. The study was duly designed with a study team including Irving, a brilliant statistician Tania Huedo-Medina, and two of my research team at Lincoln, Drs Jo Middlemass and Markos Klonizakis. We obtained a small amount of internal funding from the university to pay for some of the project expenses, downloaded the data from the FDA website, filled four large folders with the information, and began the painstaking and laborious process of extracting the data onto a spreadsheet which Tania had constructed for the purpose. We met a few times at Lincoln to progress the project and had many enjoyable and interesting conversations. A lovely memory of our collaboration was playing the violin together one evening at our home in Lincoln.

bmj_zdrugsSeveral months later the data were analysed and were surprising. There was no evidence from the FDA data that people in these studies slept longer, woke less during the night or had better quality sleep. They did fall asleep slightly more quickly by 22 minutes measured using polysomnography in a sleep lab or 9 minutes subjectively using sleep diaries – and this was over and above similar levels of improvement with placebo, i.e. around half of the effect of sleeping tablets were due to placebo. Our study was published in the BMJ just before Christmas 2012. The paper, ‘Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration‘ has been cited over 160 times since then. I had an opportunity to discuss this with Dr Jeremy Howick, a philosopher and scientist who featured in the BBC programme, and who I met at the Society for Academic Primary Care annual scientific meeting a couple of years ago in Oxford. Irving is continuing his work on the placebo effect with Prof Ted Kaptchuk, director of PIPS.

By Prof Niro Siriwardena