5 4 Newborn babies and elderly patients have been at the forefront of research at BH in recent months. The CHARMER study has closed after enrolling 1,330 patients at BH aged from 65 to 103 on elderly care wards Juniper and Walnut. The study, which also took place at 24 hospitals with nearly 30,000 patients and is the largest of its kind, looked at whether elderly patients benefit from a reduction in the number of medicines they take. The study was led at BH by consultant geriatrician Clifford Lisk who is passionate about appropriate prescribing in older adults and teaches extensively on the subject. He said: “Us geriatricians look at our patients’ medications all the time but this study is trying to embed those working practices into anyone caring for an elderly patient. From getting an extensive list of medications, including nonprescription such as painkillers or even eye drops, we can build a complete picture to see if potentially the medications might even be causing harm.” DiVO is a maternity study which has been testing the standard of care ophthalmoscope for congenital cataract screening in newborns compared to a neocam. Natasha Ford, the senior research midwife who led on the study for BH, said it hadn’t been hard to recruit to the study as parents were reassured that they were getting both treatments, and it was non-invasive and nearly 900 babies had taken part. The standard care ophthalmoscope can sometimes provide an unclear result for babies from Black, Asian and minority ethnic backgrounds which can potentially lead to unnecessary referrals and worry for parents, or worse it could be missed entirely. By taking a picture, it delivers a better view of the pupil in black and white. Despite not finding a single cataract in the study group at BH, which wasn’t unexpected as the condition is very rare, it is hoped that once all the results are back from across the country, it will provide meaningful statistical analysis to work out whether the neocam should become the new standard of care. Natasha said it was exciting to work in maternity research. She said: “We even get patients approaching us to codesign studies to help services improve. It’s a fascinating area to be in.” Youngest and oldest patients contributing to research A big part of the role is debunking myths “ There is no doubt this study has brought medicine management to the fore “ “ “ Clifford Lisk, consultant geriatrician The community diabetes team out and about in Enfield To tackle disparities in diabetes care the Enfield community diabetes team at North Mid have teamed up with other community services and clinicians. As part of a project to reduce health inequalities, the team are helping people with type 2 diabetes to ‘live well’ through community outreach work and collaboration with primary care colleagues, the council and the local voluntary sector. And they are already seeing results, as fewer patients living with diabetes have visited ED since the project began in April last year. Diabetes specialist nurses (DSNs), dietitians and health and wellbeing coaches in the team visit community events and spaces such as libraries, supermarkets and places of worship to offer blood sugar screening, which helps identify those at risk of developing diabetes. Individuals whose screening test indicates they may have or are at risk of diabetes are then given advice about the long term condition. Closing the gap in diabetes care Health and wellbeing coach Sarah Azouri, who lives with diabetes herself, explained the importance of these one-to-one conversations: “We help people understand the risks, symptoms and causes of diabetes. A big part of the role is debunking myths or discussing cultural or familial beliefs that prevent them from getting help. I often get told by patients that they aren’t taking their prescribed medication because their family says it causes side effects or isn’t needed. “The more we break the stigma, the more trust we gain from different populations and the better their health outcomes are going to be.” Rebecca Crowe, diabetes dietitian, said: “A lot of patients can struggle with the amount of misinformation about diabetes. With our outreach work, we can take the time to explain things like safe portion-sizes so they can apply the learning to their everyday eating habits.” Once they have a better understanding of diabetes and how it can be treated, at-risk individuals are advised to Natasha Ford, senior research midwife, with the neocam device book a blood test with their GP surgery. The team can also help by contacting the surgery on their behalf. As well as outreach work, collaborating with local community services and some GP practices is key to the team’s project. Angelina Bulatova, DSN, said: “We meet with healthcare professionals, such as practice nurses, pharmacists and GPs in the community every month. We discuss patients with diabetes at risk of hospitalisation due to high glucose levels and identify the best treatment. We support these clinicians to care for patients in the community which reduces hospital admissions.” Over 70% of patients who are reviewed at these interventions have shown improved blood glucose levels after treatment. If more complex medical care is required, they are referred to the community diabetes clinic at North Mid. Nneka Agabi, DSN lead and manager of the service, said: “Respecting patients’ cultural backgrounds and their personal journey with diabetes is essential for fostering meaningful engagement. Projects like this shine a light on overlooked aspects of care and encourage innovative approaches to help patients who need it most. By addressing gaps in diabetes care, we can create a more inclusive, responsive, and effective service.” The next step for the project is to create more accessible content through educational videos that can be translated into different languages. “Although we were in the standard care cohort there is no doubt this study has brought medicine management to the fore and people are realising just how important it is, especially when you consider over half of patients who took part in the study had dementia. Results should be available within six months to a year’s time but we are already working much more closely with our pharmacy colleagues.” Clifford predicts the results will show the value of pharmacists taking a more active role at board rounds. “This is the kind of study that gets people’s attention and could have a profound effect on our practice. If we can get a grip on over prescribing this could be good news for everybody.”
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