Dr Natasha Bradley, Research Fellow in Realist Evaluation, Centre for Health & Clinical Research
Virtual wards (VWs) rounds deliver multidisciplinary care to people with fluctuating health conditions such as frailty, within their own homes or usual place of residence. The aim can be to prevent hospital admission and to support self-management. Existing evidence showed there were different types of VWs in operation in the UK, and that results appeared inconsistent.
We used realist methods to provide complementary evidence to existing systematic reviews and randomised controlled trials, by shedding light on the different contexts and mechanisms that enable VWs to work effectively.
This project investigated how and why VWs could work for people with frailty. We carried out a type of literature review called a rapid realist review, asking ‘what works for whom, under what circumstances, how and why?’.
First, we aimed to summarise the different types of VWs for people with frailty. Second, we considered how and why VWs might work by exploring interactions between the context, mechanisms, and outcomes. The knowledge gained in this process could then be applied to help VWs work more effectively.
We searched for academic publications and other online sources of information (‘grey lit’) to gather evidence on VWs for frailty in the UK and ROI. In total, 28 documents were included. We began to extract causal insights and bring them together, informed by rapid realist review methods. In this case, we initially worked with ‘if-then-because’ statements and then gradually synthesized into preliminary context-mechanism-outcome configurations.
Patient and public involvement
To assist us in this process, we had input from people who had lived experience of frailty.
We met with public contributors on two occasions: two people on 28th February 2022, and five people on 15th June 2022. In each meeting, we presented what we thought were important aspects of VWs and invited their discussion. The first conversation helped to refine our initial ideas and the second conversation gave feedback on our findings from the literature synthesis. Alongside these meetings, we also met several times with three clinicians who were experts in frailty VWs.
Two main types of frailty Virtual Ward models were identified: longer-term proactive care to prevent a frailty crisis and short-term acute care for those in-crisis, both intended to reduce acute hospital admissions. Current NHS England policy is directed towards short-term VWs, but longer-term VWs may also be beneficial within a whole system approach to frailty.
Minimum requirements for VWs are common standards agreements, information sharing processes, and an appropriate multidisciplinary team that is able to meet regularly. Pertinent mechanisms include the motivation and capability of the different stakeholders to work together, so that VWs can function as a forum for the integration of care and timely multidisciplinary decision-making.
The patient pathway involves their selection into the VW, comprehensive assessment including medication review, integrated case management, and in some cases proactive or anticipatory care. Important components for patients and caregivers are their communication with the VW and their experience of being at home instead of hospital.
We developed evidence-based theories for how and why different parts of frailty VWs may be important for implementation, for the patient pathway, and for patient and caregiver experience. Our review indicates that existing work has overlooked the potential impact of transfers of care on entering and leaving the VW, and the caregiver’s role in the VW intervention.
The rapid realist review is now complete. Our findings help to explain how and why the contexts of the local healthcare system, the VW team, and the patient are influential to the effectiveness of VWs. A manuscript is under preparation for the peer-reviewed journal ‘Age & Aging’ and we will be submitting our evidence to NHS England for their guidance on VWs for people with frailty.
Innovations in service design for people with frailty remains high-profile in 2023. The insights gained from this review could inform implementation or evaluation of VWs for frailty. A combination of acute and longer-term VWs may be required within a whole system approach. We will be submitting our evidence to NHS England, so that it can have an impact on their guidance for VWs.
Bristol Women’s Voice: International Women’s Day event
Bristol City Hall
International Women’s Day 2023 is being celebrated at a day long event organised by Bristol Women’s Voice. Researchers from UWE Bristol, University of Exeter and the University of Edinburgh will be showcasing their research during this event, as summarised by three local female artists.
This artwork represents a focus group that these institutions conducted to discuss and explore women’s experiences of reproductive events (e.g., menstruation, pregnancy, and menopause) and how they are related to mental health. Dr Kayleigh Easey, a Senior Lecturer at UWE Bristol who led these focus groups alongside Dr Siobhan Mitchell and Dr Kate Ash-Irisarri, explains “We were very fortunate to be joined by three local artists, who have produced some amazing artistic interpretations of the conversations and themes discussed on the day. We can’t wait to share this artwork with members of the public at the IWD event, to help bring awareness and discussion about the impact reproductive events can have on mental health, and what avenues exist to promote positive mental health around this area”.
Some of the outputs to be showcased at this event are from an ongoing GW4 funded grant awarded to the researchers to further investigate an understudied, but pivotal area that can contribute to poor mental health.
This International Women’s Day event is being organised by Bristol’s Women’s Voice, to be held at Bristol’s City Hall from 10am-5pm, involving multiple workshops and interactive displays.
Helen Erswell (Consultant in Health Protection, SW Health Protection, UK Health Security Agency)
Rachel Campbell (Health and Justice Public Health Lead, Office of the Regional Director of Public Health Southwest, NHS England)
Kieran McCartan (Professor in Criminology, UWE Bristol)
On the 07 February 2023, UWE Bristol hosted the third Public Health and Criminal Justice network event. This was a hybrid event with 45 participants attending in person and online. The event was a great success and highlighted the growing recognition that public health, health, and criminal justice need to be working together to understand the causes, consequences, and responses to criminal behaviour. The network is a collaboration between National Health Service England, UK Health Security Agency, and UWE Bristol. The network is a place for people from across the board (we had attendees from health, public health, prison, policing, education, and academic) to discuss these issues, upskill, change the nature of the conversation, and learn new, and hopefully, good, practice.
This event focused on serious and violent offending with several talks focusing on the impact of trauma and trauma informed practice as well as the challenges of risk management. The event happened in the shadow of a report from HMI Probation on the case of Jordan McSweeney and challenges that it poses for the management of medium and high offenders in the community moving forward.
The workshop speakers included:
Dr Anne Eason (Associate Head of Department for Policing, UWE Bristol) who discussed the challenges and the opportunities in managing violent and sexual offenders in the community. In her presentation Anne focused on the reality of working in Probation and the challenges of managing risk, she reflected on the McSweeney case as well as the case of Philip Austin, suggesting that the reality of effective risk management is rooted in working with the individual and recognising their past, triggers and the most effective way of engaging with them.
The next presentation tied directly to the talk by Dr Sarah Senker (Research Associate, UWE Bristol) that focused on the results of a project looking at the role of past trauma in the lives of men who committed sexual offences. The research talked with professionals about how significant they thought that previous trauma was in the lives of people who offend sexually and how you can work in a trauma informed way. Sarah reinforced the person centred, individualise approach that Anne advocated, suggesting that understanding past trauma means that we can better prevent future risk of re-offending.
Following on from Sarah we had two people with lived experience join us and talk about their pathways into, and out of serious and violent offending, They reinforced what both Anne and Sarah had said, but went further by giving concrete examples from their own lives and suggested that the system is not set up in a trauma informed way and that our responses to anti-social and problematic behaviour are retraumatising; they used the example of school exclusion to emphasis this.
This presentation tied to a talk from Dr Duncan Gillard (Enable Trust) who discussed the work that he is involved with to reduce the reality and impact of school exclusions. Duncan highlighted the impact that school exclusions have and that there are more effective ways to respond to prevent anti-social and problematic behaviour before it gets to that point. He went on to discuss a model of therapeutic intervention (the DNA-V model) that looks to do this through a Cognitive Behavioural approach that engages with young people at an individual level. This brought the conversation back to Anne’s points about individualised approaches to risk management and community integration.
The final presentation of the day was from Professor Geraldine Akerman (a practicing psychologist at HMP Grendon) who talked about HMP Grendon, the work that is done there and the challenges, as well as opportunities, that a therapeutic community poses. The presentation neatly tied the day together as it focused not only on treatment and rehabilitation, but also on the role of adverse experiences, trauma, compassion, and rehabilitation. Although Grendon is a specialised unit we can see the impact that approaching the rehabilitation of people convicted of serious violence and sexual offending can have.
The seminar concluded with a Q & A session, which was chaired by Justin Coleman who did a great job of not only managing the questions but linking them together. Justin closed the event by reinforcing in us that serious and violent offending is linked to people’s health, wellbeing, and social context; therefore, in order to reduce and prevent serious offending we need to take a rounded, holistic approach that combines health, wellbeing, trauma informed practice in a compassionate approach that considers the individual and the desistance pathway that they are on.
The next networking event will be held on 21 June 2023, with further details to follow.
In this book, Phil Cole calls for a radical review of what international protection looks like and who is entitled to it. The book brings together different issues of forced displacement in one place to provide a systematic overview.
It draws attention to groups who are often overlooked when it comes to discussions of international protection, such as the internally displaced, those displaced by climate change, disasters, development infrastructure projects and extreme poverty.
The study draws on extensive case studies, such as border practices by European Union states, the United States and its border with Mexico, and the United Kingdom. Cole places the experiences of displaced people at the centre, and argues that they should be key political agents in determining policy in this area.
The Global Migration Network, a research group at UWE Bristol, brings together academics and practitioners interested in migration-related issues. Their aim is to facilitate and contribute to cross-disciplinary research on migration, inform policy and public debate, and engage with users of migration research.
The College of Business and Law is located in the heart of Frenchay campus in a purpose built, ground-breaking building that is home to collaborative spaces, mock courtrooms, state of the art lecture halls and a Bloomsburg trading room.
The College is home to two schools, Bristol Business School (BBS) and Bristol Law School (BLS).
Bristol Business School
BBS is an innovative community full of diverse experts across business management, marketing, economics and accounting and finance. Its courses are accredited by leading professional bodies, such as Chartered Management Institute to the Association of Chartered Certified Accountants and support not only Graduate learners but are also leaders of all fields through many Continual Professional Development courses.
As a prominent university research centre for business, management, and employment, BBS are producing applied research with real-world impact. They are shaping the future of organisations through our active research networks in all of our subject areas, Accounting and Finance, Business Management, Economics and Marketing.
BBS has one research centre and six research groups:
The Sustainable Economies Research Group applies inter-disciplinary approaches to the analysis of complex systems to develop solutions and tools that can better bring forth a sustainable economy.
Bristol Law School
Bristol Law School (BLS) has been a leading provider of legal education for over 40 years. They have a diverse and inclusive learning community benefitting from a growing network of alumni, volunteer opportunities stemming from our Business and Law Clinic and invaluable legal work experience.
Bristol Law School is one of the top-rated ‘post 1992’ law departments in the country, scoring consistently high ratings in the official research assessment exercises. This reflects the fact that legal research provides a central focus for the work of the Law School, and that many staff are engaged in research of national and international significance.
They’ve established connections with professional regulatory bodies, plus regional and national law firms, chambers, and businesses. They’ve also built an extensive global network of partners.
Their world-leading researchers collaborate with national and international organisations on Public International Law, Environment Law and Financial Crime. From environmental law to criminal justice, we’re creating solutions to real-world challenges.
The Global Crime, Justice and Security Research Group provides a forum for research activity in the field of financial crime, criminal justice and procedure, serious organised crime and cyber security.
POST is a bicameral body within the UK Parliament. POST horizon scan for emerging research topics and therefore what is important for UK Parliament to know in terms of science.
Academics considered knowledgeable in these emerging areas are invited to an interview or to share literature on the topic.
POST then produces impartial, non-partisan, and peer-reviewed briefings, designed to make scientific research accessible to the UK Parliament. The briefings come in the form of POSTnotes and POSTbriefs.
Timely and forward thinking, they cover the areas of biology and health, energy and environment, physical sciences and computing, and social sciences.
Dr Jo Barnes, Associate Professor of Clean Air and Dr Daniela Paddeu, Senior Research Fellow, were both invited to be involved in two separate briefings:
“I was very pleased to be invited to contribute via interview to this POSTnote update on Urban Air Quality, as part of the Air Quality Expert Group. It is such an important medium to share our research with ministers and influence policy decisions.”
“It has been a great experience to engage with POST and contribute to their briefing on the future of freight! Definitely rewarding in terms of impact and hopefully it will help ministers and parliamentarians to understand the importance of freight for the future of the UK!”
Find out more about each briefing below:
Urban outdoor air quality
Air pollution is the greatest UK environmental public health threat. It is responsible for 29,000-43,000 UK deaths annually (based on 2019 data) and multiple health effects. Between 2017 and 2025, the total estimated NHS and social care cost will be at least £1.6 billion in England.
Particulate matter (PM), nitrogen dioxide (NO2) and ozone (O3) are the air pollutants of most human health concern in urban areas. No safe lower limit has been identified for these pollutants, which disproportionately affect vulnerable groups.
The impacts of air pollution were highlighted by the 2013 case of Ella Adoo-Kissi-Debrah, in which high levels caused a severe fatal asthma attack. Ella is the first person in the UK to have air pollution listed as an associated cause of death following the 2020 inquest, which highlighted several organisations with responsibility for action on air pollution.
Air quality has been the subject of infringement proceedings by the European Commission against the UK and court cases brought against the Government by the environmental law charity ClientEarth.
The Chief Medical Officer’s 2022 Annual Report focused on air pollution, stating that “we can and should go further to reduce air pollution”.
The freight sector is becoming increasingly reliant on a range of digital technologies to support goods transport, warehousing and logistics. This includes sensors to support inventory management, navigation devices and cloud platforms. Emerging digital technologies are also being explored, including connected and automated vehicles (CAVs), distributed ledger technology and artificial intelligence (AI) tools that can simulate assets and predict maintenance. These technologies could potentially alleviate labour shortages, cut costs, reduce vehicle congestion and enable more transparent supply chains.
Implementing digital technologies to support freight raises several technical and social challenges. Many technologies require better availability of data-sharing infrastructure and sector-wide process standardisation. Furthermore, the development of a legislative framework is still required to guide the introduction of commercial CAVs and enable legal recognition of digital trade documents. The Department for Transport has committed funding to support technologies in freight, including a £7 million Freight Innovation Fund and several funds dedicated to achieving the Government’s net zero greenhouse gas emissions target.
A team led by UWE Bristol has been successfully awarded funding by DARE UK (Data and Analytics Research Environments UK) – a UK Research and Innovation (UKRI) funded programme – to address a key bottleneck in the creation of a coordinated national data research infrastructure for the UK.
Project title: SACRO: Semi-Automated Checking of Research Outputs
Trusted research environments (TREs) play a vital role in enabling researchers to analyse sensitive data – such as health records – for research in the public benefit.
The Five Safes framework is used to protect data confidentiality, including the assurance of ‘Safe Outputs’. In TREs, outputs are typically checked by two expert staff before they are released, which is a significant expense for TRE operators and can cause a bottleneck for researchers.
Meanwhile, the parallel development of TREs and understanding of disclosure risk has created a need to consolidate theory and practice to minimise inconsistent behaviour between different TREs.
Addressing both of these issues, this project seeks to reduce the operating costs of TREs and the time taken to release research results. It will:
Produce a consolidated framework with a rigorous statistical basis that provides guidance for TREs to agree consistent, standard processes to assist in quality assurance.
Design and implement a semi-automated system for checks on common research outputs, with increasing levels of support for other types of output, such as AI (artificial intelligence).
Work with a range of different types of TRE in different sectors (for example, health and socioeconomic data) and organisations (including academia, government and the private sector) to ensure wide applicability.
Work with members of the public to explore what is needed for public trust that any automation is acting as ‘an extra pair of eyes’ – supporting, not supplanting TRE staff and helping them to make easy decisions more rapidly and therefore focus on more complex or nuanced cases.
SACRO is led by UWE Bristol, in collaboration with the University of Oxford, the University of Edinburgh, the University of Dundee, the University of Aberdeen, Durham University, Research Data Scotland, Public Health Scotland, NHS Scotland and Health Data Research UK. The project pulls together expertise from across the country and across research areas. For more information, please contact Principal Investigator: Jim Smith (firstname.lastname@example.org).
Following a competitive tendering process, staff from the College of Health, Science and Society at UWE Bristol have been awarded a Health Education England (HEE) contract to provide a Postgraduate Certificate in Clinical Echocardiography (Echocardiography Training Programme, ETP). The ETP first ran as a pilot in 2020 and subsequently two HEIs were commissioned to deliver training. This recent HEE procurement for additional training provision is in response to urgent workforce needs.
The term echocardiography refers to medical imaging of the heart using sound waves, similar to the ultrasound scans performed during pregnancy. The procedure is routinely used to look at structures within the heart and to assess its functionality, for example following a heart attack or diagnosis of heart failure. It is also used to diagnose conditions such as congenital heart disease or heart valve problems. There is a significant shortfall in cardiac physiology staffing currently, combined with a substantial increase in demand, especially for staff trained to deliver echocardiography services. As an accelerated training option for individuals with existing relevant qualifications, the ETP provides a means to grow the workforce rapidly, thus reducing waiting times for diagnostic and follow-up appointments.
Dr Karina Stewart, Associate Head of the School of Applied Sciences (Subject Lead for Healthcare Science), Mr Duncan Sleeman (Senior Lecturer in Cardiac Physiology) and Dr Kathryn Yuill (Senior Lecturer in Physiology) lead on submission of the tender response. Dr Stewart said that they were delighted with the outcome. She added that the Level 7 ETP would be an important addition to the portfolio of healthcare science training currently offered at UWE, which includes a degree apprenticeship (Level 6) Cardiac Physiology Practitioner Training Programme (PTP). The team were successful in a bid for HEE funding to purchase equipment and software for simulation of cardiac ultrasound in 2021. This will be key to the delivery of training to ETP students, which will be through a combination of on-campus block weeks and online teaching.
The Health Education England contract is for three years in the first instance. Delivery of the Postgraduate Certificate in Clinical Echocardiography will begin in October 2023.
A research centre situated within the Bristol Business School in the College of Business and Law, they specialise in the infrastructure, engineering, construction, operations and facility management sectors.
Dr Muhammad Bilal, of Big-DEAL is working on a ground-breaking and life saving project to utilise AI to revolutionise Heart surgeries by changing how surgeons review and develop their work, in partnership with Bristol University and Bristol Heart Institute. Find out more about his work below:
Over 2 million cardiac surgical procedures are performed yearly around the world to treat people with heart disease. Heart surgery is a challenging procedure that requires a great deal of skill and ability to work in a highly intense clinical environment. A small error during the operation could result in lifelong complications, if not death.
Surgeons’ technical skills play a crucial role in the success of heart surgery. It is therefore essential that these skills be regularly reviewed to ensure that surgeons continue to operate safely and to reduce post-operative complications and patient harm.
Traditionally, expert surgeons review junior surgeons’ performance by either shadowing their operations or reviewing selected extracts of their operation recordings to produce a report that is saved as part of the trainee surgeon’s portfolio. This process is time-consuming, highly subjective, and does not ensure a comprehensive review of the surgeon’s skills, and technical ability.
Currently the UK has only 400 heart surgeons. The pressure of the role, ever increasing demand and the need to constantly develop and review oneself and others work means burn out rates within this field are high.
What has AI got to do with this?
The project team believe that recent advances in AI present fair and scalable methods for solving this challenge, and are partnering with world-renowned cardiac surgeons to create the advancements in heart surgery so desperately needed.
Using IVA-HEART, the AI and advanced data analytics programme as a personal digital assistant, surgeons can rapidly review surgical recordings to assess technical skills, receive timely feedback and learn about the training needs of surgeons. This solution will help reduce the risk of adverse events and poor patient outcomes as well as train the next generation of cardiac surgeons.
What have we done so far?
Dr Muhammad Bilal has been working with the surgeon partners to develop and learn what would work for surgeons in the field. Looking at how to develop the technology to truly support and enable all surgeons to thrive using the technology. The work has been recognised as critical throughout the industry as well as amongst funders. The project is currently at Technolgy Readiness Level 3 (TRL3), this is a pivotal milestone that allows us to submit for validation for minimally invasive mitral valve repair (adult) and aortic correction (paediatric) surgeries.
Some of our Key achievements and milestones
Presented IVA HEART research idea to BHF Program Grant Funding Panel
Awarded VC challenge fund for IVA HEART to kickstart technical feasibility
Participated in MICCAI Surgical Tools Detection Challenge (UWE TeamZERO Ranked 7th and has been invited for joint publication will be submitted in Feb 2023). They presented their approach at the MICCAI 2022 conference in Singapore.
Submitted the manuscript titled: SegCrop: Segmentation-based Dynamic Cropping of Endoscopic Videos to Address Label Leakage in Surgical Tool Detection to IEEE International Symposium on Biomedical Imaging (IEEE ISBI 2023), April 18-21, 2023 · Colombia
Submitted the manuscript titled: Harnessing Secure and Robust AI-XR Surgical Metaverses to Revitalize Interventional Care to IEEE International Conference on Metaverse Computing, Networking and Applications (IEEE MetaCom 2023), June 26-28, 2023 · Kyoto, Japan
Awarded QUBUS digital health accelerator award for market discovery (Queens University, UKRI, Innovate UK, and Kainos LLP). The market discovery research has been completed.
Pitched the idea to NHS innovation lead and other venture capitalists and industry leaders during market discovery
Presented and validated the IVA-HEART project by the UK society for cardiothoracic surgeons on 24th October 2022
Presented and validated by the British and Irish Minimally Invasive Conference (BISMICS) community.
The project is currently at TRL3. The team are planning to validate it for minimally invasive mitral valve repair (adult) and aortic correction (paediatric) surgeries. This will allow them to develop the proof of concept and machine learning capability before moving onto application development.
If you would like to find out more please contact Dr Muhammad Bilal or his team. You can find the links to their UWE profiles below