Research Directorate & Strategy
Research at a glance:
- Research Strategy
- Research Directorate
- Current Research
- Current Projects
- Research Network
- Resources
- Research Programmes
Research Strategy
The NRTC is committed to expanding the evidence base in respiratory disease management and has developed a strategy with four main aims:
- To investigate the effects of training on knowledge, practice and patient outcomes
- To evaluate methods and delivery of training
- To investigate methods of improving the diagnosis and management of patients with respiratory and allergic diseases
- To investigate methods of care delivery.
More specifically, we want to investigate how the organisation and delivery of training in respiratory disease management can:
- Impact on patients health
- Improve delivery of care
- Raise awareness of respiratory disease.
To support these aims, we are expanding our existing work in asthma and
allergy (see current projects) to include a cluster randomised controlled
trial of the effects of asthma training for health professionals on patient
outcomes, a project looking at the quality indicators used for respiratory
disease in the new General Medical Services (GMS) contract and a study
looking at improving diagnosis rates in occupational lung disease.
Details of these projects will follow later.
As with other chronic diseases morbidity from respiratory disease and
the resulting burden of care to the NHS remains unacceptably high despite
the existence and availability of proven effective treatments. Whilst
more scientific research and evidence-based guidelines are available to
health professionals than ever before patients continue to suffer from
impaired quality of life.
It is widely accepted that scientific research underpins effective treatment and patient management but without the necessary skills or knowledge to interpret scientific research data health professionals are unable to make effective clinical decisions.
The National Respiratory Training Centre, research strategy aims to produce and promote the use of research evidence on how the organisation and delivery of training in respiratory disease management can:
- Impact on patients health
- Improve delivery of care
- Raise awareness of respiratory disease
- Provide health professionals with the opportunity to develop skills needed to locate, read and understand published evidence.
There are two courses, a one day workshop in Reading & Understanding Research Papers and a degree level module in Evidence-Based Practice. These encourage health professionals to develop their critical appraisal skills and to encourage the performance of evidence-based decision-making in day to day clinical practice. The degree level course also provides instruction on basic audit and research.
Our research activities and teaching programmes inform and support each other. Gaps in the evidence in respiratory disease are identified by NRTC staff and Trainers and the findings from our research will inform the educational materials and teaching on NRTC courses. We are encouraging our network of external Trainers to develop research awareness and expertise and to become involved in generating and participating in research activity where appropriate.
Research Directorate
The NRTC currently has three other full time research staff involved in delivering one internally funded and five externally funded research projects. The Research Directorate is led by Dr Samantha Walker, a nurse with 15 years experience in research and a PhD in allergy and immunology. She has published widely in national and international journals, and holds an honorary senior lecturer position at the University of Edinburgh.
Our two researchers are funded by a mixture of internal and external grants (Current Projects): Jane Upton has a background in health services research and a PhD in Dysfunctional Breathing in Asthma; Jane Coomber has a first degree and an MSc in medical sociology and this is her first research post. Both are enthusiastic members of the research team.
Links with external academic partners are being strengthened by a number of honorary research appointments and by opportunistic and timely collaboration with local (Centre for Health Services Studies, Warwick Business School and Department of Primary Care, University of Warwick) and national (Imperial College, London; University of Manchester; University of Edinburgh; University of Aberdeen; St. Georges Hospital Medical School, London; London School of Hygiene and Tropical Medicine) university departments. In addition the NRTC is developing formal and informal research networks within the broad sphere of respiratory research.
Dr Samantha Walker RGN, PhD - Director of Research, email: s.walker@educationforhealth.org.uk
Dr Jane Upton BSc (Hons), MSc, PhD - Research Project Manager, email:
j.upton@educationforhealth.org.uk
Jane Coomber RGN, MSc - Researcher, email: j.coomber@educationforhealth.org.uk
Kim Esslemont - Research Administrator & PA to Director of Research,
email: k.esslemont@educationforhealth.org.uk
Current Research
The aims of the Centre’s research programme are being delivered in the context of three disease areas; allergy, asthma and COPD. Our research involves a broad range of methodologies and entails multidisciplinary working. To develop a sustainable programme of research the NRTC is developing:
- Research expertise in a broad range of research methodologies
- A respiratory research network to facilitate the performance of primary care research
- Research infrastructure to support research activity
- Internal research development and training for academic staff
- Methods of integrating research findings into teaching and training activities.
Our plans for primary care research are being underpinned by the development of a national respiratory research network which was launched at the end of 2002. We are also developing research network links with GPs and practice nurses in local Primary Care Trusts. Nationally, the NRTC contributes to the development of a joint primary care research network through involvement with other respiratory charities and organisations such as the Medical Research Council (MRC) and the GP Airways Group (GPIAG). All our research adheres to NHS Research Governance Guidelines, overseen by external academic partners.
Current Projects
Title: The effectiveness of structured asthma-training on symptoms
and quality of life in patients with asthma: clustered randomised controlled
trial in primary care
Project schedule: May 2005 to April 2008
Activity:
This study will evaluate the effect of providing asthma training to primary care nurses on patient outcomes. It will include primary care practices where nurses have not received specialist asthma training, randomised to either the intervention or control group. The intervention group will attend the NRTC asthma diploma level module. The control group will receive the BTS/SIGN asthma guidelines; these nurses will be given asthma training on completion of the study follow-up period. Please contact Jane Upton to obtain further details regarding this study.
Contact Person: Jane Upton email: j.upton@educationforhealth.org.uk
Title: Validation of the mini and standardised versions of the
Paediatric Asthma Quality of Life Questionnaire (PAQLQ)
Project schedule: October 2004 to June 2006
Activity:
This validation study will compare the original PAQLQ with two shorter versions of the questionnaire, the mini and standardised versions. This 9-week, observational study will assess 50 children at baseline and after 1, 5 and 9 weeks. Shorter versions of the questionnaire will hopefully encourage increased use within clinical practice. They will be an excellent resource for patients and health professionals, helping them to focus consultations on the needs of the child
Contact Person: Annie Wing email: a.wing@educationforhealth.org.uk
Title: The impact of hayfever on exam results in adolescents:
case control study
Project schedule: June 2003 to December 2004
Activity:
This is a multi-centre case control study involving schools in the West Midlands area. The study will investigate the effects of summer hayfever on GSCE exam performance using mock January exams as a baseline. If positive, this study will inform governmental strategy on the timing of school exams in the future.
Contact Person: Samantha Walker email: s.walker@educationforhealth.org.uk
Title: The link between self-reported asthma and rhinitis in primary care
Project schedule: June 2003 to October 2003
Activity:
This is a survey of 7½ thousand patients in primary care with self-reported asthma and the co-existence of rhinitis.
Results:
76% of patients with asthma reported having symptoms of rhinitis in the absence of a cold. Symptoms varied between seasonal and perennial sufferers: sneezing,, runny nose and itchy eyes/nose/palate were more commonly reported in the seasonal group (all p≤0.001) but nasal blockage more commonly reported in the perennial group (p=0.000). 49% of patients reported that their nasal symptoms made their asthma worse.
Publications:
S.M. Walker, A. Sheikh and A. Hardy. Self-reported rhinitis is a significant problem for patients with asthma: results from a national (UK) survey. Am J Crit Care Med 2004; 169(7):A822.
Contact Person: Samantha Walker email: s.walker@educationforhealth.org.uk
Title: Establishing patterns for asthma patient adherence to preventer inhaler
therapy in clinical practice
Project schedule: March 2003 to September 2005
Activity:
This study is looking at the relationship between satisfaction with asthma treatment and adherence to treatment using quantitative (validated questionnaires) in a group of patients on inhaled preventer asthma therapy.
Contact Person: Jane Coomber email: j.coomber@educationforhealth.org.uk
Title: Patients’ attitudes towards asthma inhaler devices and self-reported
adherence to asthma therapy
Project schedule: March 2003 to March 2005
Activity:
This is a survey of the influences on patients’ use of asthma inhaler devices and their adherence to treatment. It involves the development and dissemination of a questionnaire to 500 asthmatic patients recruited by 100 NRTC-trained practice nurses. Results will help to inform training needs for nurses involved in asthma care.
Link to Poster (not yet available)
Contact Person: Jane Coomber email: j.coomber@educationforhealth.org.uk
Title: Assessment of key influences on asthma inhaler device selection
in trained asthma practice nurses
Project schedule: March 2003 to March 2004
Activity:
This is a survey of the influences on nurses’ selection of inhaler devices in primary care. It involves the development and dissemination of a questionnaire to 1500 NRTC-trained practice nurses. Results will help to inform training needs for nurses involved in asthma care.
[research area: improve delivery of care]
Results:
44 key influences on device technique were identified by asthma nurse experts, incorporated into a questionnaire and sent to 1500 asthma-trained nurses who were asked to rank each influence in terms of importance. Response rate to the questionnaire was 38%. Highest scoring influences were the patient’s preference, age and lifestyle, asthma training and ease of use of inhaler device. Nurses reported the importance of selecting inhaler devices for patients carefully in order to maximise adherence to treatment.
Publications:
- Connell S., Fletcher M., Karbal B., Morrison K., Walker S. Assessment of key influences on asthma inhaler device selection in trained asthma practice nurses. Eur Resp J 2003; 22(45):P3205.
- A. Hardy, M. Fletcher, B. Karbal, K. Morrison, S. Walker. Influences on asthma inhaler device selection in trained asthma nurses. Thorax 2003; 58(III):P16.
- A. Hardy, M. Fletcher, B. Karbal, K. Morrison, S. Walker. Improving adherence: nurses perceptions of patients inhaler needs. Am J Crit Care Med 2004; 169(7):A327.
- Fletcher MJ, Hardy AJ, Karbal B, Morrison K, Walker SM. Effects of asthma training on inhaler device selection and utilisation in general practice. Eur Resp J 2004;24(48):P1687.
Contact Person: Jane Coomber email: j.coomber@educationforhealth.org.uk
Title: The effectiveness of structured allergy-training on quality
of life in patients with perennial rhinitis: parallel group randomised
controlled trial in primary care
Project schedule: May 2002 to December 2004
Activity:
A randomised controlled trial evaluating the impact of allergy training on quality of life in patients with perennial rhinitis. The study will also assess effects on delivery of allergy care in general practice.
Results:
Patients with perennial rhinitis who had access to an allergy-trained
health professional (intervention group) reported significant improvements
in health-related quality of life from baseline(p=0.009) which were not
observed in those who received a written leaflet on rhinitis management
(control group; p=0.74). The difference in quality of life between
baseline and 6 months post-training was greater in the intervention group
compared to the control group (intervention vs control p=0.08).
Link
to Poster (pdf)
Publications:
- Khan-Wasti S, Sheikh A, Fletcher M, Walker SM. Quality of life in patients with perennial rhinitis. Eur Resp J 2004;24(48):P626.
Contact Person: Samantha Walker email: s.walker@educationforhealth.org.uk
Research Network
Are you a potential researcher?
The National Respiratory Training Centre (NRTC) is developing a national network of respiratory health care professionals to support a research programme designed to expand the evidence base for respiratory disease management in primary care. The aim of the research is to raise awareness of the morbidity associated with respiratory disease, improve patient care and enable more successful patient self-management. The following information explains what is involved and how you can take part.
What is involved?
Members of the NRTC Research Network will be invited to take part in a selection of activities within a structured programme of research projects. Participation in any of the research activities is by choice, however, it is hoped that most members will contribute to at least one research project each year. The level of contribution might range from completing a one-page questionnaire to recruiting and monitoring patients for a trial of an educational intervention.
Members will be required to attend a short course on practical research skills including guidelines for Good Clinical Practice (GCP) in research before taking part in any project. Training will be offered to successful applicants in response to project demand.
Members of the NRTC Research Network will experience the processes of high quality research and learn how data are collected, analysed and interpreted. Members may also have the opportunity to take part in disseminating new research findings, so helping to improve the daily practice of patient care. The expertise of the team at the NRTC is also available for guidance on your own research into respiratory disease management.
Who are we looking for?
We are looking for a multi-disciplinary team of enthusiastic, motivated, community-based health professionals with a respiratory interest. We do not need you to have any research experience (although we will give you training in simple research principles), just a desire to help put primary care research on the map in terms of developing and promoting excellence in health care delivery.
Although we are currently developing the NRTC Research Network in the UK only, there may be opportunities in the future to develop international research collaborations and we would be delighted to hear from interested practitioners from overseas.
Who can join?
We are interested in hearing from anyone working in primary care with an interest in respiratory disease. We are particularly keen to develop a truly national membership and seek representation from inner city practitioners as well as those working in remote, rural areas around the country. Applications will be considered on the basis of geographical location and level of interest! Successful applicants who join the network and complete at least one project on our behalf will be registered on our database of ‘NRTC Researchers’ and will be invited to participate in future projects as they develop.
No previous research experience is required.
What are the benefits?
As a member of the NRTC Research Network you will automatically qualify for:
- Access to education on research
- Access to expert advice on research design
- Experience of high quality research at a level of your choice
- Discount voucher for subscription to Airways Extra – a professional subscription scheme for health professionals run jointly by the NRTC and the Asthma UK which includes four editions of The Airways Journal (an amalgamation of Asthma UK's’ Asthma Journal and the NRTC Bulletin)
- Free pocket book on understanding and interpreting medical research papers and applying the results to practice (Simply Evidence-based Practice)
- Use of the title ‘NRTC Researcher’ (following successful completion of one project) as evidence of research involvement and professional development.
Members of the NRTC Research Network will receive invitations to contribute to research projects, in which full details will be given for each project.
How can I join the NRTC Research Network?
If you would like to join, seek support from your colleagues, please print out the application form (pdf) or obtain one by contacting the NRTC on 01926 838976. Please fax this form back on 01926 493224.
For further information please contact:Dr Samantha Walker, Director of Research on 01926 838975, email: s.walker@educationforhealth.org.uk
Jane Coomber, Researcher on 01926 836999, email: j.coomber@educationforhealth.org.uk
Resources
Simply Evidence-based Medicine
Simply Evidence-based Medicine is one in the series of NRTC pocket books. It describes how research evidence can be integrated into everyday clinical practice to improve patient care.
Review by Dr Aziz Sheikh Professor of Primary Care R&D:
“Simply Evidence-based Medicine, describes how research evidence
may be integrated into everyday clinical practice to improve patient care.
It is a very readable introduction to Evidence-Based Medicine, highlighting
its potentials to enhance the quality of routine clinical care. The liberal
use of flowcharts, graphs and tables, ensure that the most important messages
are conveyed in an easily accessible manner. I recommend it wholeheartedly!”
To order your copies (£4.90) including p&p please contact the
National Respiratory Training Centre on 01926 493313 or email: enquiries@educationforhealth.org.uk
Research Programmes
Reading and Understanding Research Papers - One Day Short Course
In the eighteenth century smallpox was a killer disease, as widespread as cancer or heart disease in the 20th century. But medical practice was revolutionised and lives were saved when Edward Jenner's research, based on careful case studies and clinical observation, resulted in the vaccination procedure still used worldwide today.
This interactive short course will enable you to interpret new research as it becomes available to inform your clinical, management and prescribing decisions. The programme focuses on a variety of published research papers (randomised controlled trial, systematic review, and a qualitative research paper) and allows time for analytical discussion and feedback.
For more information, or to book your place please contact the Module Administrator; Cheryl Warner on 01926 836998 or email: c.warner@educationforhealth.org.uk
Evidence-based Practice
Degree Module - Open University 30 Points Level 3
This six month degree level distance learning module will give you an in depth knowledge about the principles of finding, understanding, using and presenting information from research papers. It uses examples from many different areas of medicine/nursing including drug treatment, stroke, asthma, myocardial infarction, home-based support for older patients, multiple sclerosis and HIV and is suitable for both specialists and generalists.
The aims of the module are to:
1. promote the use of evidence-based practice principles to inform and
improve clinical practice
2. equip students with the skills and confidence to relate research findings
to individual practice
3. guide you through the principles of audit, conducting a research study,
presenting data and getting published.
Format and Assessment
The module is delivered by distance learning, with one day face to face
study day which takes place one month into the six month study period.
Assessment is via written case studies.
For more information, or to book your place please contact the Module
Administrator; Cheryl Warner on 01926 836998 or email: c.warner@educationforhealth.org.uk
