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 deliver two new programmes – a Postgraduate Certificate in Sleep Medicine and a Graduate Diploma in Respiratory Science. Commissioning of these programmes forms part of the response to a review of NHS England diagnostic services, which highlighted significant deficits in the current workforce.
Sleep medicine is a specialised area of healthcare that focuses on sleep disturbances and disorders. The Postgraduate Certificate in Sleep Medicine is the first programme to focus solely on this important area of healthcare. It has been designed to enable advanced, integrated sleep science training to be delivered to a wide range of existing healthcare professionals, including doctors, nurses, allied health professionals, and healthcare scientists. This will allow the rapid expansion of sleep science services to reduce waiting times and address delays in diagnosis and treatment.
The Graduate Diploma in Respiratory Science has been developed as an accelerated (12-month) training pathway for graduates in related disciplines, such as Sports Science or Biomedical Science. To-date such graduates would need to undertake a three-year Practitioner Training Programme (PTP) to become qualified healthcare scientists. This new programme combines clinical and professional modules from the PTP with work-based training to provide a fast, quality-assured scheme for upskilling trainees to Practitioner level. This is essential for meeting workforce demands in respiratory physiology, which have been further impacted by the Covid-19 pandemic.
Dr Karina Stewart, Associate Head of the School of Applied Sciences (Subject Lead for Healthcare Science), Dr Adrian Kendrick (Senior Lecturer in Respiratory and Sleep Physiology) and Dr Kathryn Yuill (Senior Lecturer in Physiology) led on submission of the tender response.
Dr Stewart commented:
“We are delighted with this outcome. The programmes will be an important addition to our portfolio of healthcare science training currently offered at UWE Bristol, which includes a degree apprenticeship (Level 6) Respiratory and Sleep Physiology PTP.”
The Health Education England contract is for three years in the first instance. Delivery of the Postgraduate Certificate in Sleep Medicine starts from October 2023, and delivery of the Graduate Diploma in Respiratory Science will begin in September 2024.
Bringing together researchers working in the fields of long-term conditions, palliative and supportive care, and emergency care, to inform knowledge mobilisation across the lifespan.
Connecting experts from mental health sciences; children and young people; emergency and critical care; public health and wellbeing; health, ethics and society and evaluative research.
The Education and Childhood Research Group encompasses four strands of research Equity in education; Pedagogy; Childhood, children and young people; and Sustainability in education.
The Psychological Sciences Research Group conducts applied research that has a positive influence on people and places; at home, in the workplace, and in the wider social environment.
The Social Science Research Group is a multidisciplinary, applied research grouping that is dedicated to facilitate a better understanding of the complex social world that we live in.
Dr Natasha Bradley, Research Fellow in Realist Evaluation, Centre for Health & Clinical Research
Background
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?’.
Aims
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.
Methods
Literature synthesis
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.
Findings
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.
Next Steps
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.
Formerly known as BRIDGE, the Education & Childhood Research Group (ECRG), is a large, diverse research group made up of researchers, associates and doctoral researchers.
The research group has four main strands:
Equity in Education
Strand Leaders: Prof Richard Waller and Malcolm Richards
Members of this inter-disciplinary community share a common interest in researching the inequities that persist in societies through critical enquiry. We engage with our local-global students, teachers, and community, to collaborate on exciting research, knowledge co-production, and impactful outcomes. Members of this inter-disciplinary community share a common interest in researching the inequities that persist in societies through critical enquiry. We engage with our local-global students, teachers, and community, to collaborate on exciting research, knowledge co-production, and impactful outcomes.
Pedagogy
Strand Leaders: Dr Benjamin Knight and Mandy Lee
Pedagogy is a broadly interpreted and broadly applied umbrella concept covering many aspects of education and overlapping with a wide range associated educational and social concepts. In the Education and Childhood Research Group (ECRG), the Pedagogy research strand specifies a focus on classroom teaching and learning. The strand has two key elements. The first investigates interpretations of what it means to ‘learn’, what learning looks like, contexts in which it occurs and factors which influence it for individuals and groups. The second element investigates teaching and instruction with a view to developing insights about the most useful ways of organising and configuring teaching in the interest of learning. Research within this strand is predicated on the belief that we have much more to learn about learning and teaching, and that novel insights and new theories are there to be uncovered. Seeking effective and innovative approaches to teaching, appropriate for the 21st century, is a central aim of this research strand.
The Childhood, Children and Young People
Strand Leaders: Dr Sarah Chicken and Dr Tim Clark
This strand focuses on research into children and young people’s experiences, rights, voices, perspectives, and related policy and practice. The strand is underpinned by a construction of children and young people as agentic meaning makers who are experts in their own worlds and there is a privileging of research with, rather than on this often overlooked group. The strand aims to showcase work in this area and provoke critical discussion about research with children.
Sustainability in Education
Strand Leaders: Dr Verity Jones and Dr Tessa Podpadec
Research on sustainable development creates knowledge and influences practices to shape sustainable futures. The strand members’ research incorporates sustainable development questions about diverse local, national and global contexts. For example: how can society approach responsible and ethical consumption? and, What is the role and function of education in this? UWE Bristol recognises the Sustainable Development Goals (SDGs). The core purpose of this research strand is advancing knowledge in economic, social and environmental dimensions to solve sustainability challenges, create opportunities and shape our communities across the region and beyond as set out in the UWE Bristol Strategy 2030.
Group Leader and Associate Professor of Education Policy in Critical Education, Dr Alpesh Maisuria, commented on the group:
“The forerunner to ECRG was BRIDGE, which was hugely successful and delivered excellent REF results. With being appointed successor and alongside the university’s move to Colleges and School structure, I wanted to evolve the Research Group to more closely align with the College. I also wanted to reflect the new staff expertise that had come into School.
The research group was large and I felt would benefit from a Distributed Leadership model, and so I implemented a structure that included Strands of research, each with Co-Leaders to establish the research themes.
It was also important for me that ECRG has a role in developing future research leaders in the School, and strand leadership is an opportunity for colleagues to gain experience in a high profile role to steer our research ambitions and excellence.”
A UWE Bristol and University of Bristol spin-out, tech start-up Milbotix Ltd, has announced an investment round to complete the development of SmartSocks™, which track signs of stress and agitation in people with neurocognitive diseases such as Alzheimer’s disease and other dementias.
Award-winning start-up Milbotix, which is backed by Alzheimer’s Society, seeks angel investment to complete the development of SmartSocks™ and match grants worth over £1/2 million. The investment will enable Milbotix to help millions of people living with dementia.
Angel investor Dean was inspired to invest in Milbotix after witnessing that his late mother, who had dementia, was becoming increasingly agitated and upset.
“Smart socks would have picked up when Mum was becoming agitated and would have helped in the early days of her illness by enabling Dad to deploy the distraction techniques we used to calm her. They would also have helped the hard-pressed care home staff to target their care to her needs and alerted them to her distress when she was alone in her room, enabling them to respond more quickly and help relieve her anxiety.”
Alzheimer’s Society, the UK’s leading dementia charity, says there will be 1.6 million people with dementia in the UK by 2040, with one person developing dementia every three minutes. Dementia is thought to cost the UK £34.7 billion a year.
Agitation and aggression in dementia are often caused by unmanaged pain and anxiety. The SmartSocks™ contain comfortable sensors that measure the wearer’s sweat, pulse, temperature, and motion. They work in conjunction with patent-pending artificial intelligence software and a mobile app that alerts carers to signs of distress.
Natasha Howard-Murray, Senior Innovator at Alzheimer’s Society commented “By taking the form of an everyday item, these smart socks are less stigmatising and invasive than current products and will be easier to use in care settings, helping carers to feel less overwhelmed with multiple tasks.”
Commenting on Dean’s investment, founders Dr Zeke Steer and Jacqui Arnold said “We are seeking passionate, impact-oriented investors like Dean to help us revolutionise how dementia care is delivered. Please get in touch if you would like to support the development of the SmartSocks™ product line.”
About Milbotix Milbotix Ltd is headquartered near Oxford, UK, with offices in Bristol. The company is a spin-out from the University of Bristol and the University of the West of England. Founded by robotics and AI expert Dr Zeke Steer and dementia specialist Jacqui Arnold, Milbotix’s mission is to improve the lives of people with dementia and other conditions that make it difficult for them to communicate distress. Milbotix is partnered with Alzheimer’s Society through their Accelerator Programme.
The Story Behind SmartSocks™ Dr Steer was working as a software engineer in the defence industry when his great-grandmother, Kath, began showing signs of dementia. A gentle person with a passion for jazz music, she became prone to bouts of agitation and aggression after her diagnosis. Realising that technologies like artificial intelligence could revolutionise dementia care, Dr Steer quit his job and completed a PhD at the Bristol Robotics Laboratory so that he could find a way to help people like Kath.
During his PhD research, he spent some time volunteering with Bristol-based charity St Monica Trust. “I came to see that my great grandmother’s symptoms weren’t an isolated case, and that distressed behaviours are very common,” he explained. “Current alternatives to the SmartSocks™ are worn on the wrist, which presents problems with the devices being removed and causing distress. The SmartSocks™ are comfortable and familiar and exploit the high density of sweat glands on the soles of the feet to more accurately recognise when the wearer is stressed.”
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.
Bristol Business School
BBS has one research centre and six research groups:
The Applied Marketing Research Group (AMRG) exists to foster working relationships with external organisations with the aim of collaborating in areas of marketing and customer engagement.
A forum for world-leading inter-disciplinary research in the areas of corporate governance, asset pricing, market efficiency, corporate disclosure and accountability.
The Human Resources, Work and Employment Research Group takes on a reconstructive ‘both-and’ approach to human resources and employment studies research.
The Innovation, Operations Management and Supply Research Group is formed around the core disciplines of innovation, operations management and supply chain management.
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.
Mock courtrooms in the Bristol Law School
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.
Providing a forum for research activity in the field of environmental, sustainability and natural resources law. Members are drawn from across the University as well as externally.
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.
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:
The background
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.
This is a game-changing proposition that targets an unmet yet critical healthcare challenge
Insights from Focus Group
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.
Where next?
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
