The Screen and Treat with Aspirin to Reduce Pre-eclampsia (STARshiP) study is led by researchers from Saint Mary’s Managed Clinical Service, part of Manchester University NHS Foundation Trust (MFT), in collaboration with The University of Manchester and the Nottingham Clinical Trials Unit at the University of Nottingham.

With the study of 200,000 women and their babies, STARshiP represents one of the largest endeavours in pregnancy screening research.

Funded by the National Institute for Health and Care Research (NIHR) and sponsored by The University of Manchester, the trial aims to transform antenatal care of the condition.

Pre-eclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from 20 weeks) or soon after their baby is delivered.

Early signs of pre-eclampsia include having high blood pressure and protein in the urine.

Though the condition occurs in up to 8% of pregnancies, there are currently few ways to predict which patients may be at risk.

With the aim of improving the detection of women at higher risk of developing the condition and offering aspirin as a preventative treatment, the STARshiP study will quantify the benefit of the screening, offered by the researchers at the same time as the early pregnancy scan.

Key features of the STARshiP study include:

• Combined Screening Technique using the Fetal Medicine Foundation Test: The STARshiP study will implement a new screening method for pre-eclampsia which includes additional measurements taken during the first trimester ultrasound scan and a blood test to measure placental hormones.
• Aspirin Treatment to reduce the risk of pre-eclampsia: Pregnant people identified as high-risk through the new screening process will receive aspirin treatment as per the current NHS standard care. Aspirin is a safe, cost-effective treatment which has been shown to reduce the incidence and severity of pre-eclampsia.
• Efficient Trial Design: The STARshiP study is designed in a way that the screening test will be rolled-out across participating maternity hospitals, with all participating hospitals having implemented the screening test by the end of the study. This type of research study is called a ‘stepped wedge clinical trial’ and is an efficient way of conducting a clinical trial, resulting in everyone having the opportunity to try implementing the test during the study.

The STARshiP study will span across 18 maternity hospitals in the North of England and East Midlands regions. At MFT it will be rolled out by Saint Mary’s Managed Clinical Service (MCS), across its three sites: Saint Mary’s Hospital, North 91ֱ�� General Hospital and Wythenshawe Hospital.

Professor Jenny Myers and Dr Lucy Higgins are joint chief investigator of the STARshiP trial.

Professor Myers, Clinical Professor at The University of Manchester and Consultant Obstetrician, Maternal and Fetal Health Research Centre, Saint Mary’s Hospital, said: "The immense promise this trial has in demonstrating the impact of a more effective screening test for pre-eclampsia and reducing the burden of this devastating pregnancy complication is more relevant than ever.”

Dr Higgins, Senior Clinical Lecturer at The University of Manchester and Honorary Consultant Obstetrician, Maternal and Fetal Health Research Centre, Saint Mary’s Hospital, said: "By integrating improved early screening, we aspire to mitigate the risks associated with this condition and improve maternal and fetal outcomes."

Marcus Green, CEO of Action for Pre-eclampsia (APEC) said: “Women need to know if they are at risk of pre-eclampsia both so they can be prepared and to ensure clinicians target the right care to them. This study will hopefully help find one more piece in the pre-eclampsia jigsaw and we will be fully supporting the trial.”

Dr Jane Harvey, a representative from the Patient and Public Involvement Group (PPI) said: "I never thought I was at risk of pre-eclampsia, when it happened it was terrifying. It is absolutely fantastic that this new test could potentially prevent this life-changing disease from affecting the lives of so many families."

Jane Daniels, Professor of Clinical Trials at the Nottingham Clinical Trials Unit at the University of Nottingham, said: “NCTU are excited to be coordinating another large screening study in pregnancy. Although these studies take time, we hope that the results will ensure the best method of identifying at-risk pregnancies, is available for everyone.”

has been awarded an OBE for his services to public health, to epidemiology and to adult social care, particularly during Covid-19, has been awarded an OBE for his for services to the advancement of the science of radiation protection, Professor Paul Klapper has been awarded an OBE for services to viral diagnostic testing, and Professor Paul Howarth has been awarded a CBE for his significant contribution and service to the nuclear industry and to UK research and development (R&D).

The list celebrates individuals who have had an immeasurable impact on the lives of people across the country - such as by creating innovative solutions or driving real change in public life.

Ian Hall is a Professor of Mathematical Epidemiology and Statistics at The University of Manchester. He is a long-standing member of SPI-M (the pandemic disease modelling advisory group) and played a critical role in the operations of this group during the swine flu and Covid-19 pandemics.

During the Covid-19 pandemic he was academic chair of the SAGE working group of Social Care and participated in the SAGE Environmental Modelling Group as well as attending SAGE itself. He was also involved in a number of research projects, including the national core study on transmission () and Project TRACK to understand and control the risks on public transport. He also helped analyse data from a new heat map, providing a national picture of the spread over time.

Since the pandemic, Professor Hall has continued working with UKHSA through an honorary contract, notably with Health Equity Division on vaccination strategies in prison and homeless settings.

His other research interests include the impact of diseases on vulnerable populations and the study of vector-borne infectious diseases and environmental infections, such as Legionnaires Disease.

Richard Wakeford is an Honorary Professor in Epidemiology in the Centre for Occupational and Environmental Health (COEH), having been Professor in Epidemiology at the Centre before retiring at the end of 2019. He specialises in the epidemiology of exposure to ionising radiation, particularly as related to radiological protection.

Professor Wakeford is a member of various committees, including the UN Scientific Committee on the Effects of Atomic Radiation and the International Commission on Radiological Protection. He was a member of the Scientific Advisory Group for Emergencies (SAGE) following the Fukushima nuclear accident in Japan, and for 25 years was Editor-in-Chief of the Journal of Radiological Protection.

Richard completed his PhD in high energy physics at the University of Liverpool in 1978 and worked for British Nuclear Fuels Ltd (BNFL) for nearly 30 years. It was the many challenges faced at BNFL where he developed his skills in radiation epidemiology and radiological protection. He was privileged to work with Sir Richard Doll during this time. After taking early retirement from BNFL, Richard joined the University, initially through an association with Dalton Nuclear Institute and then joining COEH.

Paul Klapper is Professor of Clinical Virology at The University of Manchester. He began his career in virology in 1976 working as a laboratory technician at Booth Hall Children’s Hospital. He completed his PhD while working at 91ֱ�� Royal Infirmary on the diagnosis of herpes simplex encephalitis - a topic he continued to work on for over 20 years and led to the development of a reliable molecular diagnostic test for the condition. He also helped establish independent quality assurance testing in the infancy of viral molecular diagnostic testing. 

Throughout his career, Professor Klapper has been at the forefront of several key developments of viral diagnostic testing. Notably, he worked with the Greater 91ֱ�� Hepatitis C testing strategy, developing community-based testing methods to aid control of the HCV pandemic. In 1981, he became an NHS Clinical Scientist, working in both 91ֱ�� and Leeds as a Consultant Clinical Scientist. Ten years later, in 1991 became a Fellow of the Royal College of Pathology. 

On retiring from the NHS in 2012, Professor Klapper joined The University of Manchester as a Professor of Clinical Virology.  Early in 2020, he volunteered to help with establishment of large scale Covid-19 testing and became the clinical lead for the Alderley Park testing facility. He also served as a Clinical Advisor for testing with the Department of Health.

 Professor Klapper continues to conduct vital research in blood-borne virus infection and in congenital human cytomegalovirus infection.

Paul Howarth is Professor of Nuclear Technology at The University of Manchester and Chief Executive of National Nuclear Laboratory. 

Professor Howarth has had a distinguished career working in and for the nuclear sector, building a reputation as one of the leading figures in the UK nuclear sector and around the global industry. After completing his degree in Physics and Astrophysics and PhD in Nuclear Physics, he started his career working on the European Fusion Programme. Early in his career he was awarded a prestigious Royal Society Fellowship to work in Japan on their nuclear programme. On returning to the UK he continued to work on nuclear fission leading the UK’s advanced reactor programme while working at British Nuclear Fuels, co-founding the at the University  and working closely with UK Government on building the case for new nuclear build.

Professor Howarth was appointed CEO for the National Nuclear Laboratory (NNL) in 2011 following its creation as a public corporation, having been instrumental in its establishment from British Nuclear Fuels Limited (BNFL). During his tenure as CEO, NNL has been transformed into a successful business and a true national laboratory, delivering profits to reinvest into nuclear science and technology and critical support to nuclear organisations in the public and private sectors. 

The birthday honours are awarded by the King following recommendations by the prime minister, senior government ministers, or members of the public.

The awards recognise active community champions, innovative social entrepreneurs, pioneering scientists, passionate health workers and dedicated volunteers who have made significant achievements in public life or committed themselves to serving and helping Britain.

To see the full Birthday Honours List 2024, visit: https://www.gov.uk/government/publications/the-kings-birthday-honours-list-2024  

Some differences in practice and performance of locum and permanent GPs were found, however the researchers suggest they are likely to be shaped by the organisational setting and systems within which they work.

The results of the study -  the largest ever carried out on temporary doctors, was published in BMC Medicine today (20/03/2024), and should allay concerns over the competency of temporary doctors in general practice.

The researchers found no evidence that emergency admission numbers occurring within seven days of a consultation were different when seen by a locum or a permanent GP.

Hospital admissions for conditions often managed in primary care such as Chronic Obstructive Pulmonary Disease (COPD), Asthma, Diabetes mellitus, Epilepsy, Hypertension, Heart failure, Stroke and transient ischemic attack (TIA), Peripheral arterial disease (PAD) and Hypothyroidism also did not differ after seven days. 

And eight out of the 11 prescribing safety indicators used by the researchers  in the study showed no differences between locum and permanent GPs.

Differences for the remaining three were small and two which showed locums to be prescribing more safely were not clinically meaningful.

The research team examined around 3.5 million patient electronic health records from the  CPRD GOLD database with linkage to Hospital Episode Statistics.

They analysed 37 million recorded consultations from a representative sample of the primary care population of England from 1st April 2010 to 31st March 2022.

However, there were some differences in practice found by the researchers: patients who had a consultation with a locum GP were 12% less likely to return to practice for another consultation when compared to patients who had a consultation with a permanent GP.

Those patients, suggest the researchers, could have opted to wait to see a permanent GP out of preference. Some practices may assign more straightforward cases, which wouldn’t require another consultation, to locums.

A consultation with a locum was 21% more likely to lead to a prescription for an antibiotic and 8% more likely to lead to a prescription for strong opioid painkillers. That may indicate locums are likely to be less aware of or compliant with practice prescribing guidelines, potentially explaining the difference.

Locum GPs were also markedly less likely to both order tests (20% less) and refer patients (15% less) to other services such as hospital outpatient clinics than permanent GPs.

That, suggest the researchers may be down to practices setting  constraints on such decisions by locums, requiring them to be reviewed or approved by another GP in the practice.

Lead author said: “Staff shortages in the global health sector are considered to be one of the most significant health issues of our time.

“That is why locums are a key component of the medical workforce in the NHS. However, evidence on differences in quality and safety between locum and permanent doctors is limited.

“There have been some past high profile examples of poor quality care by locum doctors, though the same could likely be said for permanent doctors.

“Indeed our qualitative research suggests that some patients actually welcome the opportunity to see a locum GP because they get a fresh perspective on their condition."

91ֱ�� co-author added: “Despite  public concerns, the clinical practice and performance of locum GPs did not appear to be systematically different from that of permanent GPs in our study.

"Greater attention to the quality of induction, supervision, communication, and practice management may help address some of the differences we did find.

“We believe future research should focus on understanding how organisations can make best use of locums as part of their wider medical workforce and how locum doctors can be enabled to practice and perform effectively as members of the clinical team.”

The paper, ‘Comparing the clinical practice and prescribing safety of locum and permanent doctors: observational study of primary care consultations in England’, is available .

Modelling vascular flow is crucial for understanding and treating vascular diseases, but traditional methods are labour and computationally intensive. The new research, published in the Interface, evaluates state-of-the-art methods that accelerate the simulation process while retaining the level of accuracy required for such crucial applications.

The researchers, led by The University of Manchester, found that Reduced Order Modelling (ROM) - a technique for reducing the computational complexity - can be used selectively to accurately accelerate various types of vascular flow modelling problems.

They also found that Machine Learning methods can be used to overcome limitations in ROM techniques or to provide entirely new simulation techniques that can tackle a wide array of vascular flow modelling problems.

The findings have the capacity to revolutionise the vascular medical field.

The review also highlights the significance of these accelerated simulation methods for in-silico trials, which are virtual simulations integral to the development and regulatory approval of new medical devices. Using these simulation acceleration techniques, in-silico trials can be conducted with unprecedented speed and accuracy, reducing reliance on conventional clinical trials that are often expensive and time consuming. 

The research also advocates for a concerted effort to establish a benchmarking framework for simulation acceleration methods. This initiative would establish standardised metrics for evaluating precision and speed-up across different simulation approaches, encouraging transparency and comparability in this rapidly advancing field.

One in 11 people over the age of 65 have in the UK, and more than 75% of people over 75 have hearing problems. This means hearing loss commonly occurs alongside dementia.

However, tests for dementia which assess memory, attention and language often include spoken questions that rely on hearing. People with hearing loss score worse in these tests, which could lead to a false diagnosis of dementia.

The new test developed and validated in the study could accurately diagnose dementia in people with hearing problems. It is an adapted version of a standard test – the – which is commonly used to diagnose dementia and mild cognitive impairment (a condition in which a person has minor problems with their mental abilities, such as memory or thinking).

Previously, other researchers have tried removing spoken questions from this test to accommodate hearing loss. However, this approach made the test less accurate.

In this study, the research team instead replaced 3 spoken questions from the MoCA test with written ones. One question assessed attention and the other 2 questions assessed language.

The team evaluated the revised test in a study of 256 people. It was found to be accurate and reliable in people with and without hearing loss.

This is the first fully validated and reliable cognitive test for people with hearing problems and is now .

Researchers say this meets an international need for a reliable test to identify cognitive impairment among people with hearing loss. The test is also being translated and validated in Arabic, Greek, German and Portuguese, and other languages will follow. The standard test is already available in more than 100 languages.

The study was led by Piers Dawes, Professor of Audiology at the University of Queensland in Australia and The University of Manchester, supported by the It was funded by the and involved researchers based across the world, including in the UK, Australia, Canada, Cyprus, France, Greece and Ireland.

As reported in , Professor Piers Dawes, co-lead for 91ֱ�� BRC’s Hearing Health project investigating the prevalence of hearing loss in people with dementia, said: “To maximise quality of life and ensure people get access to appropriate help, it is vital that cognitive difficulties are reliably differentiated from hearing difficulties. For example, a person may struggle with communication and functioning in daily life. Clinicians and family members may incorrectly assume that the person’s difficulties are due to dementia, when in fact they are due to treatable hearing loss.

“Conversely, cognitive impairment may contribute to a person’s difficulties with communication. The hearing loss version of the MoCA test offers the potential to help differentiate cognitive from hearing difficulties.”

Among the study participants, who were aged 60 years or more and recruited from 7 sites across England, Ireland and Australia:

• 159 people had hearing loss and took the revised test only; 83 of this group were known to have dementia.
• 97 people (with no hearing problems) took both the revised and the original versions of the test; 30 people in this group were known to have dementia.

The researchers found the new test was:

• accurate; it identified people with dementia and hearing problems with only small differences between the adapted and original versions of the test.
• reliable; 28 people (10 with normal cognition and 18 with dementia) were retested between 2 and 4 weeks after their initial test and scored similar results.

The test closely matches the standard MoCA test for identifying dementia. It asks similar questions, takes a similar length of time to complete and assesses the same cognitive areas.

People who had spent more than 12 years in education tended to score higher than those who had not. This effect is also found for the standard MoCA test. Adding 2 points to the scores of people who had spent 12 years or less in education (the adaptation made for the standard test) increased its reliability.

While the test could accurately diagnose dementia in people with hearing problems, researchers have identified areas for further investigatio

• To date, this test has been assessed only in people who developed hearing problems – it may not be an effective test in people who were born with hearing loss
• Another . Research is needed to develop a test for people with visual problems.

The , and the , can be found online.

The results of this study were published in the

UK-Med is the only UK based emergency medical team (EMT) to be approved by the World Health Organization. It is also the only UK based medical charity to partner as an EMT with the UK government during overseas humanitarian disaster. If requested, UK-Med can quickly deploy a full field hospital in support of a WHO or UK government response to the quake in Morocco.

“For now, its vital important that we conduct a rapid assessment of the humanitarian health needs to determine how best we can support the people impacted by this devastating earthquake,” adds Mr Godfrey.

UK-Med launch Morocco emergency appeal

To support UK-Med’s work in Morocco, public donations are encouraged at 

Tom Godfrey says, “Please give generously to support our appeal.  We rely on the support of the public to fund our life-saving work.  It costs hundreds of thousands of pounds to deploy a full field hospital with dozens of specialist NHS staff. We’re a small nimble medical aid charity, and your donation will help us to save lives.”

UK-Med has more than thirty years’ experience responding to humanitarian emergencies, including the war in Ukraine and the earthquake in Turkey and Syria, by providing rapid medical care for affected communities.

With a roster of nearly 1,000 NHS and international doctors, nurses, paramedics, logisticians and other allied non-health professionals who are highly skilled in emergency work, UK-Med provides an on-call system for global health relief.

In the last year alone, UK-Med has deployed more than 400 personnel, provided treatment for 35,000 patients around the world, and has trained 11,000 local medical staff.

For interviews contact Ian Woolverton, Media Manager, on +44 (0) 7377 547362. For other inquiries, email comms@uk-med.org or call 0161 275 7873. Follow UK-Med on social media for the latest updates (, , and ).

Dr Jen O’Brien and Dr Jennifer Silverthorne are among the new fellows named in the Advance HE National Teaching Fellowship Scheme, which recognises individuals who have made a tremendous impact on student outcomes and the teaching profession in higher education. 

Dr O’Brien is a Senior Lecturer in Human Geography, as well as the University’s Academic Lead for Sustainability Teaching and Learning. She is an Inaugural Fellow of the 91ֱ�� Institute of Teaching and Learning and leads the ‘Informed and Inspired’ Challenge for Sustainable Futures. A Development Geographer by training, Jen is interested in the intersection between innovative pedagogy and independent field or applied research aiming to inspire and equip learners to ethically address challenges of sustainability, inequality and social justice to make a difference. She directs the University Living Lab, which links applied research needed by organisations with students who can undertake it for their assessment to effect change.

Jen leads 91ֱ��’s ‘Creating a Sustainable World’ course, which is run through the University College for Interdisciplinary Learning (UCIL). The first of its kind in the world, the course - which is available to undergraduates and postgraduates from across the University - uses the UN’s Sustainable Development Goals (SDGs) to equip them with the skills to make positive social change and reflect critically about sustainability. It has been recognised by the Times Higher Education University Impact Rankings, which ranks 91ֱ�� first in the UK and Europe and second in the world for its contribution to the SDGs.

Dr Jennifer Silverthorne is a Reader in Clinical Pharmacy in the Division of Pharmacy and Optometry who leads a team of clinical academics, senior NHS pharmacists and placement tutors providing clinical education. Her commitment to inclusive practice in the classroom, programme design and assessment has changed the University’s approach to Pharmacy teaching and influenced the practice of colleagues. Her reach into the sector through work with professional, statutory and regulatory bodies has transformed Pharmacy education to deliver a highly skilled, reflective and progressive workforce fit for the future.

“I’d like to congratulate Catherine, her team, Jen and Jennifer for their well-deserved awards,” said Professor April McMahon, the University’s Vice-President for Teaching, Learning and Students. “Being acknowledged in this way is a huge achievement, and it recognises their dedication to teaching, and to our colleagues and students.

“I’d also like to thank them for their overall outstanding contribution to the teaching and learning provision at our University. I am sure they will continue to drive forward even more positive change in the future.”

An independent panel of senior higher education leaders, representing the four UK nations, assures the quality of the National Teaching Fellowship Scheme and Collaborative Award for Teaching Excellence and recommends winners.

"Every year as we select the NTFS and CATE winners, we are in awe of these extraordinary and gifted people who are teaching with such professionalism, passion and commitment in higher education - this year was no different,” said Professor Becky Huxley-Binns, Pro-Vice-Chancellor for Education at the University of Hull, and Chair, UK Teaching Excellence Awards Advisory Panel 2023. 

“These awards are incredibly important in recognising and celebrating these people and in sharing 'what works' so that colleagues can build on their expertise too and students can enjoy the benefits of great practice in teaching and learning.”

The awards ceremony will take place in Birmingham on Thursday 28^th September. 

The CRF, which was a cornerstone of the government’s ‘Levelling Up’ agenda, was established to address regional inequalities through investment in place-based initiatives.

However, the findings of a new study suggest that the current method for CRF allocation runs the risk of widening existing inequalities rather than ‘levelling up’.

Academics from the NIHR Applied Research Collaboration Greater 91ֱ�� (ARC-GM), the University of Manchester and Health Equity North (HEN) examined the allocation of the first round of the CRF across English regions, and whether more economically deprived regions are getting a proportionate share of the pot.

They found that:

• Nationally, there was no significant correlation between regional economic resilience and funding allocations.
• All regions in the North of England received less than their expected share of the flagship ‘levelling up’ fund.
• The least resilient region in England – the North East – received £13.4 million less.
• By contrast, the South West was awarded £9.9 million more than their expected share.

To support CRF allocation, the government developed a way to measure economic resilience, which covered productivity, skills, unemployment, population density, and household income. These were selected to identify places with poor economic performance, which would be less able to resist and recover from shocks.

The CRF allocation process involved multiple stages, with the economic resilience index being used at the outset to identify 100 priority places. There are more than 10 steps from the identification of priority places to CRF bid approval, with the final decision made by the Secretary of State for the Department of Levelling up, Housing and Communities.

The analysis by HEN and ARC-GM used the UK government’s methodology to construct a regional economic resilience index to generate a ‘fair share’ funding allocation and compared these to the actual allocation.

The average resilience score in England was 46.0, ranging from 28.5 in the North East to 65.6 in London. (See Table 1 below for full regional breakdown)

Dr Luke Munford, Co-Academic Director at Health Equity North, and Senior Lecturer in Health Economics at the University of Manchester, said: “There are deep-rooted, persistent regional inequalities in health and wealth across England. People in the North live shorter lives and have higher rates of bad health, disability and economic inactivity. These inequalities have widened during recent decades and will continue to do so without effective policies put in place by government.

“While investment like the Community Renewal Fund is very welcome, the methodology for distribution of the funding doesn’t add up and has the potential to further widen the North-South divide.

“Despite committing to targeting people and places most in need, our research shows the imbalance that remains when it comes to investing in areas that face worse inequalities.

“To mitigate this risk, there needs to be allocation of funding at a regional level, based on an objective measure of need and involving local leaders in decision making.”

Christine Camacho, ARC-GM PhD Fellow and Public health registrar, said: “The ‘levelling up’ agenda offers an opportunity to address the longstanding inequalities in England, but our findings clearly show that there was no significant correlation between regional economic resilience and CRF funding allocations.

“A transparent approach for the distribution of funding to regions based on need is essential. Economic resilience is only one part of the story. A multidimensional index of community resilience could be used to assess place-based disparities.”

Table 1. Regional economic resilience index (ERI) scores, actual and expected Community Renewal Fund (CRF) allocations for English regions

The lecture can be streamed live on from 6pm on Tuesday 16 May, where it will also be available afterwards for those unable to watch it live.

The analysis found that ‘persistent high turnover’, defined by the researchers as when more than 10% of GPs changed in a practice in at least 3 consecutive years - was not uncommon.

Persistent high turnover affected 2,309 of English practices (over 28%) at least once between 2009 and 2019.

The practices were associated with:

• 1.8 more emergency hospital attendances per 100 patients.
• 5.2% fewer people seeing their preferred doctor.
• 10.6% fewer people reporting obtaining an appointment on the same day.
• 1.3% more people having lower overall satisfaction with their practice.

Practices with ’persistent high turnover’ also tended to be larger, located in more deprived areas and had a higher health burden from serious chronic conditions.

The highest levels of ‘persistent high turnover’ were in Cumbria and the North East, South Central and the West Midlands.

The differences, say the team, could be explained by different levels of social deprivation, unequal distribution of the GP workforce, and different pressures on the healthcare system.

Published in the journal BMJ Quality and Safety today (24/01/23), the researchers studied an average of 7,526 practices each year from 2007 to 2019.

The researchers observed a worrying increase in the practices affected in a year, from 2.7% in 2009 (high turnover in 2007, 2008 and 2009) to 6.3% in 2019 (high turnover in 2017, 2018 and 2019).

The project has been funded by the Health Foundation as part of its Efficiency Research Programme.

Co-author Rosa Parisi said: “This study is a wakeup call for primary care and for the first time gives us clarity on one of the major problems affecting it.

“Thanks to this work, it is now possible to identify an association between high turnover and both patients’ health outcomes and the service they receive.

“We think high GP turnover is likely to affect continuity of care, and that might explain why  avoidable emergency attendances are more likely to happen. Indeed we know from previous studies that continuity of care is deeply important to patients.

“And the link between high turnover and deprivation may be explained by the challenges GPs face in those areas in managing patients with more complex health needs with no additional resources.”

The study also involved two discussion groups with a total of four GPs who welcomed the findings and recognised the need for research in this area.

They highlighted workload pressure, limited opportunities and contribution to decision making and the management of their practice, particularly salaried GPs, with lack of funding and investment from the government.

Co-author Professor Evan Kontopantelis said: “This study shows practices with persistent high GP turnover need more support from local and national authorities.

“There is a desperate need for policies to maximise retention of GPs and personal and professional support, targeting areas which influence job satisfaction and work-life balance.

“In addition, the current funding formulae do not fully take account of the demands associated with practising in a deprived areas - and this too needs to be addressed.

“We already know that socioeconomic deprivation impacts GP work found that in highly deprived areas, GP work typically extends beyond the management of the illness but that they are not resourced to perform those additional tasks.”

The  paper Predictors and population health outcomes of persistent high GP turnover in English general practices: a retrospective observational study is available here

“In my very different clinical roles I’ve always sought to enact the same values of UK-Med - excellence, determination, collaboration, compassion and learning,” Sir John added. “My one constant is that a service organisation is the people who work for it. The staff’s fulfilment and contentment determine the efficiency and efficacy of any organisation, so that will be my key focus during my tenure.”

Tony, who grew up in Failsworth and originally studied medicine at The University of Manchester, has no plans to actually retire - although he’s looking forward to a slightly slower pace of life. Included in his plans are long walks with his wife of forty years, Caroline, and playing his guitar, on which he recently recorded an LP; a present gifted by Caroline for his seventieth birthday. 

Alongside his ambassadorial role he’ll continue working with the WHO, with whom he helped set up the Emergency Medical Teams Initiative, setting standards within the field. He’s also helping set up the Faculty of Remote Rural and Humanitarian Healthcare, based at the Royal College of Surgeons in Edinburgh. 

“To me it’s like the final piece in the jigsaw of making this work like any other branch of medicine. It will give you a professional home, with set standards, where there’ll eventually be examinations so you can show people you’ve trained in this work specifically.”

The findings, published in The British Journal of General Practice, show that missed opportunities for early diagnosis of the potentially debilitating condition are relatively common in general practice.

Doctors already know that delays in the diagnosis and initiation of treatment are associated with deterioration in patients’ quality of life.

GPs are most often the first point of contact for people with the condition, rather than dermatologists.

Patients who are later diagnosed with psoriasis, find the researchers, are twice as likely to be prescribed steroid or antifungal creams than people without psoriasis, which may mask the signs and symptoms of psoriasis and contribute to a further delay in diagnosis.

The research team includes members of the Global Psoriasis Atlas (GPA, a collaboration between three leading international organisations in world dermatology: International Federation of Psoriasis Associations (IFPA); International League of Dermatological Societies (ILDS); and International Psoriasis Council (IPC).

“We already know that early diagnosis of psoriasis can improve the effectiveness of treatment for psoriasis, so these findings are pertinent,” said lead author Maha Abo-Tabik, a PhD research student at The University of Manchester.

“The World Health Organization, for example, has highlighted how many people suffer needlessly from psoriasis due to missed or delayed diagnosis.

“That is why we think it is essential to design additional dermatology training for primary care professionals to improve their diagnostic skills for psoriasis.”

The researchers carried out extensive analysis of electronic health records from more than 700 general practices between 2010 and 2017 across the UK, comparing clinical diagnoses and treatments between people with and without psoriasis.

17,320 psoriasis cases and 99,320 controls were used from the Clinical Practice Research Datalink Gold database.

They repeated the analysis with 11,442 cases and 65,840 controls extracted from a second database called Clinical Practice Research Datalink Aurum – with similar results.

Patients with psoriasis were up to eight-times more likely than those without psoriasis to be diagnosed with pityriasis rosea - a minor skin condition -at six months before the diagnosis of psoriasis, they found.

They were twice as likely to be diagnosed with eczema or tinea corporis – a fungal skin infection - one year before diagnosis.

They were also more likely to report symptoms of psoriasis such as dry skin, rash, skin texture changes and itching than controls up to five years before diagnosis.

And they were prescribed topical corticosteroids or topical antifungals in the year before diagnosis twice as often as those without psoriasis.

GPA Director, Chris Griffiths is Emeritus Professor of Dermatology at The University of Manchester, Head of the Dermatology Theme at the NIHR 91ֱ�� Biomedical Research Centre and Honorary Consultant Dermatologist at Salford Royal, part of Northern Care Alliance NHS Foundation Trust.

He added: “Psoriasis is long-term disease affecting around 3% of people in the UK, which substantially affects their quality of life and is linked with other serious medical conditions such as arthritis, heart disease and depression.

“The findings from this study suggest the diagnosis of psoriasis may be missed or delayed by up to five years for some individuals hence leading to a potentially detrimental delay in establishing an appropriate treatment regimen.

“It is crucial that diagnosis and treatment start as soon as possible, if patients are to reduce the risk of life-long impairment.”

A copy of the paper Mapping opportunities for the earlier diagnosis of psoriasis in primary care settings in the UK is available

The findings, published in the Journal of Health Economics and funded by the National Institute of Health and Care Research, are the first to show evidence of income-related inequalities in access to timely and appropriate emergency care in England.

Using national data on patients arriving by ambulance at all major English A&E departments during 2016/17, the researchers compared waiting times, treatments, and health outcomes for patients.

They found that patients from more deprived areas waited longer to receive treatment, and received less complex treatment than those from more affluent areas, even when presenting with the same health conditions and at the same hospital.

Though the inequalities in waits were small for an individual patient (2.2% increase in waiting time for the start of treatment), the differences were systematic and represent a substantial amount of delay at the population level.

Patients from deprived areas were also less likely to be admitted to hospital (2% less) and less likely to be referred on for follow-up care (7% less).

Previous research has found patients from more deprived areas also wait longer for planned operations such as knee replacements despite having the same level of need for treatment, but this is the first study to look at waiting times for emergency care.

The observed inequalities were present even when A&E departments were less crowded, indicating that inequalities aren’t concentrated in periods when staff are under greater time pressure. It is possible, say the researchers,  that unconscious bias is the reason that lower priority is given to patients from deprived areas.

Waiting times are likely to be more important in an A&E setting, where the severity of conditions may have very serious health consequences for patients, and prioritisation decisions must be made quickly. This pressure may also lead to higher fear of litigation, which could subconsciously affect how doctors interact with some patients.

, Patients from the most deprived areas, who are more likely to have underlying health conditions, accounted for more than twice as many attendances as those from the least deprived areas, and were equally or more severe on arrival, despite being younger on average.

But inequalities in timely and appropriate care in A&E may also exacerbate these existing health inequalities, with patients from the most deprived areas almost 6% more likely to attend A&E again within 7 days and almost 5% more likely to die within 30 days, compared to the least deprived.

Lead author Dr Alex Turner from The University of Manchester said: “Our results suggest the NHS principle of “equal access for equal need” is not being upheld in English Emergency Departments.

“Adding to evidence from previous studies that patients from more deprived areas wait longer for planned operations, we find these patients also wait longer for care in A&E where extended waits are more likely to have severe consequences for health”

“And though the magnitudes of inequalities are smaller in an A&E setting than in planned care, we also found patients from deprived areas were substantially more likely to choose to leave without treatment while waiting in A&E.

“Not only do patients from more deprived areas receive less timely care, they also receive different care, with physicians less likely to provide these patients with complex care within the A&E and less likely to refer them for subsequent care.”

Co-author Dr Ruth Watkinson added: “We find evidence that suggests patient-staff interactions, and particularly unconscious bias towards patients from deprived areas, may contribute to unfair inequalities in A&E. Policies designed to improve these interactions should be prioritised.

“Inequalities in mortality following A&E attendance suggest the healthcare system may be exacerbating already-entrenched inequalities.

“Addressing this is especially important given reducing health inequalities is a key priority for the NHS.”

‘Smart pumps’-  which automatically calculate the dose and rate of different drugs before they are pumped into a vein  - prevent potentially fatal errors by stopping the administration of the wrong rate.

But according to the study published in BMJ Open Quality, though the technology probably saved the lives of 110 people in two Trusts over a year, it has largely failed to be adopted by hospitals.

Though many IV pumps used in hospitals have a smart capability, most trusts do not utilise the functionality because they are difficult to configure and maintain.

Smart pumps are usually configured by a pharmacist and checked by a consultant or senior nurse. Conventional pumps, however, are set by ward staff who calculate and input infusion rates themselves - increasing the risk of drug errors.

The risks are illustrated by previous work from the 91ֱ�� team, who demonstrated that 1 in 10 IV drug administrations are associated with an error, and up to 1 in 10 of those were associated with harm.

In the BMJ Open Quality study, almost 1.5 million IV infusions were administered over one year (644 052 patient bed days), but only 45% (745,170) of these were administered with smart pumps capability enabled.

There were 6,067 infusions that exceeded the dose limits of the pumps. Subject matter experts were asked to rate severity of all adverse events on a scale of 0-no harm to 10-death and they found 89% of these events were unlikely to cause patients any harm.

However, smart pumps prevented 668 moderate to severe harm administration errors (a rate of 0.9/1000 IV administrations) and included blood thinning medication, drugs affecting heart rhythm and drugs used to stop epileptic seizures.

Of 17.9/1000 intercepted drug administration errors, the most common drugs to trigger an alert were antibiotics (2,979 alerts in 134,821 infusions) but there was a relatively low potential for harm from these infusions (1.01/1000 administrations). 

The highest incidence of potentially harmful adverse events was for parenteral anticoagulants (24.16 per 1000 administrations which risks severe bleeding. There have been reports of these events in the NHS recently.

Drugs with greatest potential for harm with an adverse event were parenteral anticoagulants at 24.16/1000 administrations, antiarrhythmics at 21.8/1000 administrations and antiepileptics at 20.86/1000 administrations. 

Some alerts were triggered because the pumps were programmed with limits that did not reflect practice in the clinic, which suggested routine practice might contribute to patient harm.

In another paper published in the journal Drug Safety at the same time, the research team collaborated with academics, patient advocacy groups and senior clinicians to develop and publish guidelines to support organisations in their adoption of smart pumps, so they are used to their full potential across the NHS and infuse drugs at standardised concentrations.

A symposium of 36 clinical and academic medication safety experts proposed strategic recommendations to support the implementation of medication administration technology to improve medication safety.

Both papers were the result of collaborations the University of Manchester, pump manufacturers Becton-Dickinson - who funded the study- and the NHS who shared their data with the team.

Lead author is a researcher at The University of Manchester based in the division of pharmacy and optometry and a practising pharmacist.

He said: “Intravenous infusion errors leading to fatalities are extremely  rare event; the vast majority of IV infusions are safe.

“But avoidable harm associated with medication is a persistent problem in health systems and the use of preprogramed infusion devices can mitigate and reducing their incidence

“Configuration of these pumps is often poorly implemented – with little consistency between hospitals.

“Even though smart pumps have been available for around 20 years and are routinely used in the USA - we only 20 to 30 trusts use them in some way, and even fewer to their full capability. Within a few years, all IV pumps will have smart functionality, so it makes sense for hospitals to make full use of them.”

He added: “Variation in the manner in which medicines are prepared and used within complex modern healthcare systems exacerbates these challenges, so a strategic human-centred approach is needed to support their implementation.

“Smart functionality has a role in intravenous medication safety, but only as part of a programme of interventions to standardise intravenous medication practice.

“They aren’t a panacea but like a seat belt in a car in that they can avoid catastrophic injuries to patients.”

Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety is available

The impact of drug error reduction software on preventing harmful adverse drug events in England: a retrospective database study is available

Andrew Doig, a professor of biochemistry, says today’s lockdown quarantines used to tackle Covid-19 mirror methods used as long as 500 years ago to combat the Black Death in Croatia, France and Italy.

Other measures that saved lives during the Covid-19 pandemic - including vaccines, drug discovery and germ theory, he adds, have changed little in broad terms from at least a century ago.

The book – ‘This Mortal Coil. A History of Death’ - published by Bloomsbury this month - charts the untold history over 10,000 years of what killed us - and what kept us alive.

Professor Doig said: “Many of the measures used to combat infectious disease today, such as Covid-19, would be very recognisable to people living 100 or even 500 years ago.

“From quarantine and drug discovery to vaccination and hand washing, not much has  changed fundamentally in 100 years, it’s just that we’re just better at applying this knowledge.

“Vaccination was invented 200 years ago, drug discovery in the 1900s, and the importance of cleanliness to stop the spread of deadly microbes was first shown in the Victorian era.”

Even though its cause remained a mystery, the Black Death -  a deadly pandemic in Europe from 1346 to 1353 - lead to the creation of a system used in Southern Europe called quarantine.

Quarantine emerged from the authorities’ legally enforceable 40-day isolation period designed to stop infectious diseases from spreading. The word itself is derived from the Italian word for forty.

In 1843, American professor Oliver Wendell Holmes urged obstetricians and midwives to purify their instruments and routinely wash their hands to stop them infecting new mothers.

In 1796, an English doctor called Edward Jenner extracted some pus from the blisters on a milkmaid’s hand which he injected into eight-year-old James Phipps, the son of his gardener, giving him a mild case of cowpox. When James was later deliberately infected with smallpox, he was unharmed.

Jenner published his findings and named his procedure ‘vaccination’, after the Latin word for cow: vacca. Within ten years of his discovery, the smallpox vaccine had travelled the world.

In the late 19th century scientists showed that infectious disease is caused by transmission of microorganisms, not by foul air, promoting the importance of sanitation .

And in 1907 German Paul Ehrlich began a search for a magic bullet, a chemical that might kill disease-causing microbes, but not human cells.

Derived from his earlier work staining different cells with dyes, Ehrlich modified promising chemicals to increase their activity against target cells, while reducing their toxicity.

Initially testing on mice, Ehrlich used the approach to develop a drug based on a compound called Atoxyl to treat African sleeping sickness and later syphilis.

Professor Doig added: “Causes of death have changed hugely over the centuries: 10,000 years ago the most common cause of death was likely have been violence and in the Middle Ages it was famine, plague and childbirth.

“In the 19th Century people died from infectious diseases such as smallpox, typhoid and measles; all of these are now thankfully rare.

“That is why my book pays tribute to the pioneers from as long as 500 years ago who made possible the knowledge which has undoubtedly saved lives during the Covid-19 pandemic.”

Published in Cardiovascular Research, the findings – based on big data and a unique kidney tissue resource funded by – suggest that tackling obesity could have a powerful impact on kidney health.¹

Using data from around 300,000 participants in the – one of the world’s largest biomedical databases and previous genome-wide association studies – the scientific team extracted information on the two most common measures of obesity, body mass index (BMI) and waist circumference (WC), and different measures of kidney function.

Most of the previous studies have been unable to explain if the relationship between obesity and renal disease was little more than an association.

However, through a technique called Mendelian Randomisation – which groups people according to a genetic code randomly assigned at birth and removes any bias – they found that increasing values of genetically predicted BMI and WC were causally associated with the measures of kidney function.

The team were able to show that the causal effect of obesity on the kidney is only partly mediated by high blood pressure and type 2 diabetes.

Through analysis of 467 kidney tissue samples, the study also uncovered the signatures of obesity on the human kidney – groups of genes and pathways that may potentially explain the effects of obesity on the kidney.

First author, Dr Xiaoguang Xu from The University of Manchester, said: “Obesity and kidney disease are common complex disorders with an increasing clinical and economic impact on healthcare around the globe.

“Our evidence substantiates the value of weight loss as a strategy of preventing or reversing a decline in kidney health, as well as decreasing the risk of renal disease.

“So, we hope our findings will help to stimulate further research and drive the development of public health policies to improve kidney health and prevent kidney disease through encouraging weight loss.”

Principal Investigator Professor Maciej Tomaszewski from The University of Manchester is also a Consultant Physician based at 91ֱ�� Royal Infirmary, part of MFT.

He said: “Chronic kidney disease affects more than 10 per cent of adults worldwide and is predicted to become a global threat to public health. With the use of Mendelian Randomisation, we were able to demonstrate a potentially causal effect excessive weight has on kidney health and the risk of chronic kidney disease and several other kidney disorders.

“Through the analysis of one of the largest collection of the human kidney samples, we have uncovered the specific renal pathways associated with body mass index/waist circumference – they are the most likely biological connections between obesity and kidney health and disease.”

Dr Aisling McMahon, Executive director: research, innovation and policy at Kidney Research UK said: “Studies like this from the University of Manchester, are adding to a growing body of evidence suggesting that obesity is a direct cause of kidney disease.

“Three million people in the UK are already living with kidney disease. With levels of obesity on the increase, this figure could be set to rise rapidly. The 91ֱ�� team’s findings demonstrate the need to promote healthy lifestyles in order to improve kidney health. Once someone becomes a kidney patient, they are a kidney patient for life because there is no cure. As the UK’s largest kidney disease research charity, finding new and transformative treatments and ways to prevent kidney disease are our core priorities. This means that our endeavours to help prevent people developing kidney disease are just as critical as finding new ways to treat it.”

1.  Xu X, Eales JM, Jiang X, Sanderson S, Drzal M, Saluja S, Scannali D, Williams B, Morris AP, Guzik TJ, Charchar FJ, Holmes MV, and Tomaszewski M. Contributions of obesity to kidney health and disease: insights from Mendelian randomization and the human kidney transcriptomics. Cardiovascular Research. 2022. doi:10.1093/cvr/cvab357.

91ֱ�� is available  

Dry Eye Disease (DED) is the most common ocular surface disorder, affecting approximately 350 million people worldwide and causing persistent eye irritation, blurred vision, pain and decreased quality of life. DED is characterised by a loss of homeostasis of the eye’s tear film and a vicious cycle of corneal epithelial damage and inflammation.

The newly-published study evaluated Link_TSG6 in two validated mouse models of DED: an autoimmune model where NOD.B10.H2 mice spontaneously develop dry eye disease, and the desiccating stress model that mimics DED caused by environmental factors. Results from the study showed that topically administered Link_TSG6 (e.g., twice a day for 7 days) dose-dependently reduced corneal epithelial defects and suppressed inflammatory markers while increasing tear production and conjunctival goblet cell density. At the highest Link_TSG6 dose, no corneal lesions remained in approximately 50% of treated eyes. In addition, Link_TSG6 was significantly more effective than Restasis^â, the market leading treatment, at reducing corneal epithelial erosions and reducing inflammation.
 

“There is a desperate need for treatments that rapidly and significantly improve the signs and symptoms of Dry Eye Disease,” said Dr Joo Youn Oh from Seoul National University College of Medicine, a corresponding author of the paper. “The present findings support the viability of Link_TSG6 as a promising drug candidate that both suppresses inflammation and promotes repair of the cornea – critical steps in overcoming the pathophysiology of Dry Eye Disease."

The study showed that Link_TSG6 suppresses the levels of inflammatory cytokines on the ocular surface and inhibits the infiltration of Th1 and Th17 immune cells into the lacrimal glands and lymph nodes, indicative of the protein's multiple anti-inflammatory effects.

Professor Tony Day, a co-corresponding author, from the Wellcome Centre for Cell-Matrix Research, University of Manchester, said: "Link_TSG6 is a biological drug that harnesses the protective effects of TSG-6, a protein that is made in our bodies in response to inflammation and injury.  It is extremely rewarding to obtain such compelling preclinical data with our novel treatment approach for Dry Eye Disease. We hope to further progress this work by advancing Link_TSG6 towards human clinical trials. It is our ambition to see Link_TSG6 approved and available to patients with DED."

Caroline Milner, a Founder of Link Biologics, said: “The publishing of this research is a major accomplishment in our journey towards finding an effective treatment for Dry Eye Disease, which could improve the lives of millions around the world.  The team is working diligently to build on these findings and secure additional funding to reach our next milestone."

The full paper "The Link module of human TSG-6 (Link_TSG6) promotes wound healing, suppresses inflammation and improves glandular function in mouse models of Dry Eye Disease" is available

At a national level, the use of locums was low and stable between 2017 and 2020 though some practices and areas used significantly more locums than others.

The proportion of locum GPs, compared to other GPs in rural practices was 25% greater than in urban locations.

Practices that were single handed- where a lone GP works- used locums at a rate 4.6 times higher that of practices employing more permanent GPs.

Practices rated as inadequate by the Care Quality Commission used locums at a rate 2.1 times higher than practices rated as outstanding.

The findings, say the team, are likely to reflect the difficulties many practices have in recruiting doctors and sheds light on the challenges facing primary care.

Locum GPs also tend to be male and younger, with an average age of 42, and more likely to have qualified outside of the UK when compared to other GPs.

The analysis, funded by the National Institute for Health Research (NIHR), used data from NHS Digital on almost 34,000 doctors and found:

• Locums made up on average 3.15% of the GP workforce in December 2017 and 3.31% September 2020, figures adjusted for full time equivalent
• Around 65% of the locums were UK qualified and around 54% were male
• Around 74% of the locums were used to cover long term absences or vacancies
• Locums were concentrated in parts of the North West, Greater London, West Midlands, Essex and the Isle of Wight.

Locum GPs are defined as doctors who provide cover for permanent staff including maternity/paternity leave, sick leave, annual leave, suspended doctors or vacancies.

Lead author Dr Christos Grigoroglou from The University of Manchester said: “Locum GPs have an important role in the delivery of primary care services, particularly in the delivery of out-of-hours care and in helping to address short-term workforce shortages.

“Despite expectations that locum GP numbers are rising we found that locum use in primary care has remained stable over time though their use seems to vary substantially across different practice types and areas of the country.”

 He added: “In recent years, the NHS has suffered from insufficient long term workforce planning, prolonged shortfalls in funding, and a high number of doctors leaving the profession early which have contributed to the current workforce crisis.

 “Before we conducted this study, research on the extent of GP locum use in general practice and the composition of the GP locum workforce was sparse.

“So identifying the drivers behind variation in locum use in English primary care provides useful context for those involved in workforce planning, especially in areas with high GP turnover.”

 Dr Thomas Allen from The University of Manchester said: “Accurate monitoring of the GP workforce may help policy-makers and commissioners to understand current challenges in primary care, including capacity and composition of the GP workforce and inform future workforce planning.”

&�Բ�����;“We suggest that relatively high and sustained levels of locum use may be an indicator of wider problems which are affecting recruitment and retention.”

“Practices in rural areas and those with inadequate CQC inspection ratings may face substantial challenges in recruiting and retaining permanent GPs, and this study highlights this.”

 Professor Kieran Walshe from The University of Manchester said: “Accurate monitoring of the GP workforce may help policy-makers and commissioners to understand current challenges in primary care, including capacity and composition of the GP workforce and inform workforce planning.

“This can be particularly useful to meet local health care needs with sufficient resources for training and deployment of GPs which will help ensure that the targets set out in the NHS long-term plan are met.”

The research*, published in the , involved searching electronic health records to uncover how many people in prisons have been affected by a potential problem related to their prescribed medication.

The research was funded by Greater 91ֱ�� Mental Health NHS Foundation Trust (GMMH) Research Capability Funding and the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and The Northern Care Alliance NHS Foundation Trust.

Researchers worked with prison pharmacists who conducted searches of the electronic healthcare records of two large prisons to identify how often people were affected by 13 ‘Prescribing Safety Indicators’ (PSIs). For example, prescribing of antipsychotic medication without carrying out the essential physical health tests to monitor weight, blood sugar and cholesterol.

To develop the PSIs researchers looked at published studies and worked with prison healthcare staff to identify the common situations where potentially hazardous prescribing can occur.

Dr Richard Keers works with the GM PSTRC, and is a Clinical Lecturer in Pharmacy at The University of Manchester. He also co-leads the Suicide, Risk and Safety Research Unit based at GMMH where this work originated, and said: “Our research has shown that Prescribing Safety Indicators can be successfully implemented into prison electronic health records, and that they provide a significant opportunity to measure and improve medication safety for people in prisons as we have already seen in primary care.”

The results of the study revealed that more patients were affected by some PSIs than others. Understanding how the searches could be used more widely in prisons was also investigated with researchers interviewing 20 prison health care staff to explore this topic.

The staff they spoke to said that having people who can take on the leadership of the searches and working together as a team to respond to them was important.

Prof Darren Ashcroft, Director of the NIHR Greater 91ֱ�� PSTRC, said: “Our next step is to use these results to launch a new study. We are now working with a prison health care provider to test the introduction of the electronic health record searches and a way for staff to work together to respond to them across a large group of prisons nationally. This will take place over the next 18-24 months to see how effective this is at improving medication safety.”

* Implementing prescribing safety indicators in prisons: a mixed methods study

Researchers analysed a new de-identified database that pulls together healthcare information from general practices across Greater 91ֱ�� to identify trends around self-harm by sex, age group, ethnicity and deprivation. They found a potentially concerning treatment gap for self-harm among men and people living in the most deprived areas.

The study’s* findings were published in today. The investigation was funded by the UK Research and Innovation (UKRI) and the National Institute of Health Research (NIHR) COVID-19 rapid response call. It was also supported by additional funding and researchers from the NIHR Greater 91ֱ�� Patient Safety Translational Research Centre (GM PSTRC) - a partnership between The Northern Care Alliance NHS Foundation Trust (NCA) and The University of Manchester.

Dr Sarah Steeg, Presidential Fellow in mental health epidemiology at The University of Manchester, who worked with researchers from the GM PSTRC on this study, said: “We believe the fact the number of people accessing healthcare for self-harm didn’t return to pre-pandemic levels by May 2021 is unlikely to be because these people aren’t harming themselves. It is more likely to be because people aren’t seeking help or aren’t seeking help in the same way as they did before the pandemic.”

There has been research that’s looked at self-harm during the first wave of the pandemic. However, despite further waves of COVID-19 and ongoing national and regional restrictions that affected Greater 91ֱ�� into the autumn/winter of 2020 and the spring of 2021, little was known about how many people were visiting their GP after harming themselves during that time.

Dr Steeg, continued: “The findings of our study are concerning as the deepening health inequalities we observed during the first wave of the pandemic, in 2020, didn’t recover by the spring of 2021. This could reflect a hesitance to seek help from health services in the way people did before the pandemic.”

Researchers believe the potential treatment gap among men is particularly concerning due to the increased risk of suicide for men if they have harmed themselves.

This is the first study to be published that used the Greater 91ֱ�� Care Record, which brings together healthcare and social care information. It meant researchers could examine the number of times self-harm was recorded across primary care (for example, general practices) every month until May 2021.

Professor Niels Peek, lead of the Safety Informatics theme at the GM PSTRC, who was also part of the team that created the Greater 91ֱ�� Care Record, said: “This is an important milestone for the Integrated Care System in Greater 91ֱ��. It tells us that we can use data from the Greater 91ֱ�� Care Record to accurately assess the impact of the pandemic on the 91ֱ�� population.”

* Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: time series analysis of electronic healthcare records for 2.8 million patients in the Greater 91ֱ�� Care Record

https://www.sciencedirect.com/science/article/pii/S2589537021004557

But did you know that monitoring a person’s body clock (or circadian rhythm) could help diagnose and treat asthma?

New research supported by Asthma UK, a charity which provides health advice and a helpline to people with asthma as well as funding research into the condition, has revealed that asthma is “highly rhythmic”, meaning it is impacted by a person’s body clock.

It means the symptoms an asthma patient might have such as coughing, wheezing or shortness of breath, could be more intense at different times of day and this insight could revolutionise the way doctors treat the 5.4 million people in the UK who have asthma and help to prevent life-threatening asthma attacks.

The study carried out by Dr Hannah Durrington, a Clinician Scientist at The University of Manchester and a Consultant in Respiratory Medicine at , part of , explored why people with asthma experience worse symptoms at night and in the early hours of the morning.

The results showed that tests used to diagnose asthma should take time of day into account, for example peak flow measurements (a quick test to measure air flow out of the lungs) are lower at 4am than at 4pm, and this is the case for other asthma tests.

Doctors assess the severity of asthma in a patient (particularly eosinophilic asthma, which is associated with high levels of a white blood cell called eosinophils) by measuring the levels of eosinophils in blood or sputum (phlegm).

Dr Durrington, who is also a researcher at the , revealed that these levels naturally change over the course of a day, so if doctors timed appointments around these variations, they would get a much more accurate picture of a person’s asthma.

Her research could help the medical profession determine whether there is an optimum time of day to use inhalers and take other asthma medication, so it has the best chance of keeping symptoms under control.

Dr Durrington said: “Asthma can have a huge impact on people, leaving them coughing, wheezing, gasping for breath and putting them at risk of having a life-threatening asthma attack. It is really exciting to think my research could play a part in making things better for people with asthma, helping doctors assess if patient’s symptoms are at their worst depending on the time of day and identifying exactly when people should take their inhalers to keep them well.”

Dr Erika Kennington, Head of Research at Asthma UK, which funded the study, said: “There is still so much we don’t know about asthma, and studies like these are a vital step in understanding the disease and ultimately leading to us finding a cure for this dreadful illness that causes the deaths of three people every day in the UK. But despite the fact that 5.4 million people in the UK have asthma, only two per cent of all medical research funding in the UK is spent on research into respiratory diseases."

A parent-led intervention that supports the social development of babies displaying early signs of autism has significantly reduced the likelihood of an autism diagnosis being made in early childhood, according University of Manchester scientists, part of an international research team led by CliniKids at the Telethon Kids Institute in Australia.

In a study published in , the team led by Professor Andrew Whitehouse (the University of Western Australia) and including Professor Jonathan Green, Dr Ming Wai Wan and Dr Carol Taylor from the University of Manchester, found that a clinician diagnosis of autism at age three was only a third as likely in children who received the pre-emptive intervention (iBASIS-VIPP) compared to those who received treatment as usual — the first time such an improvement has been demonstrated worldwide.

The study builds on previous work by the team led by Jonathan Green at The University of Manchester in originally developing and testing the iBASIS-VIPP intervention in a trial in the UK.

Professor Green said: “These findings are the first evidence that a pre-emptive intervention during infancy could lead to such a significant improvement in children’s social development that they then fell below the threshold for a clinical diagnosis of autism.

“Many therapies for autism have tried previously to replace developmental differences with more ‘typical’ behaviours. In contrast, iBASIS-VIPP works with each child’s unique differences and create a social environment around the child that helps them learn in a way that was best for them.

“The therapy uses video-feedback to help parents understand and appreciate the unique abilities of their baby, and to use these strengths as a foundation for future development.

“By doing so, this therapy was able to support their later social engagement and other autistic-related behaviours such as sensory behaviours and repetitiveness, to the point that they were less likely meet the ‘deficit-focused’ diagnostic criteria for autism. This is the first evidence that a pre-emptive intervention during infancy could lead to such a significant improvement.

“The children falling below the diagnostic threshold still had developmental difficulties, but by working with each child’s unique differences, rather than trying to counter them, the therapy has effectively supported their development through the early childhood years.”

Professor Green added: “With this therapy we are providing support before a diagnosis is given – and parents overwhelmingly want this. The finding is consistent with previous findings which increases our confidence in the reality of the results. This evidence could have a massive impact on clinical practice and public health – not that many clinical trials have such potential.”

The four-year randomised clinical trial enrolled babies aged 9-14 months to investigate the impacts of iBASIS-VIPP. All babies had shown early behavioural signs of autism. Over a period of five months, half received the video intervention, while a control group received current best practice treatment.

Eighty-nine children completed an assessment at the start of the study, at the end of the therapy period, and when they were two and three years of age. Identification, assessments and interventions took place in Perth as a collaboration between Telethon Kids and the Child Development Service, which is part of the Child and Adolescent Health Service, and in Melbourne at La Trobe University, led by Associate Professor Kristelle Hudry.

Professor Whitehouse said given the high prevalence of autism worldwide, the implications of the findings were enormous. In Australia, about 2 per cent of all children have an autism diagnosis.

“Autism is not typically diagnosed until three years of age, however, interventions commencing during the first two years of life, when the first signs of development difference are observed and the brain is rapidly developing, may lead to even greater impact on developmental outcomes in later childhood,” Professor Whitehouse said.

“This is a genuine landmark moment for child health research. Our aim is to understand each child’s strengths and challenges so that we can better support and nurture the unique abilities they bring to this world.

“This is an important step forward in what we hope is an opportunity to develop new clinical models that use very early intervention in babies showing early behavioural signs of autism.”

Professor Whitehouse said follow-up of study participants in later childhood, when the behaviours for autism may be more apparent, would be critical to determining the longer-term significance of the video intervention.

Collaborating institutions included La Trobe University, The University of Western Australia, the Western Australian Child and Adolescent Health Service, Griffith University, the University of South Australia, The University of Manchester UK, Evelina London Children's Hospital, Guys and St Thomas’ NHS Foundation Trust UK.

The full paper, Effect of pre-emptive intervention on developmental outcomes for infants showing early signs of autism: A randomized clinical trial of outcomes to diagnosis can be read here.

The study of 140 people with chronic obstructive pulmonary disease (COPD) measured self-reported exposure to mould using a questionnaire.

They were four times more likely to visit a GP for chest problems (at least four times in the previous year) if they vacuumed their home more often than once a week.

The patients were also over three times more likely to visit a GP for chest problems (at least four times in the previous year) if they did not ask visitors to remove shoes when entering their home.

In addition, current or previous occupational contact with agricultural resources also increased the risk by more than three times.

According to the peer-reviewed study ‘Impact of self-reported environmental mould exposure on COPD outcomes,’ published in Pulmonology, the findings are likely to be associated with Aspergillus, a mould found in decaying vegetation, compost, air conditioning and damp walls and ceilings.

Lead author Dr Chris Kosmidis, a Senior Lecturer at The University of Manchester and Honorary Consultant in Infectious Diseases at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust, said: “It must be stressed that most people will be unaffected by mould, but this research demonstrates quite clearly that people with COPD will have an increased risk of ill-health if exposed.”

Aspergillus can also lead to a debilitating, but rare condition called chronic pulmonary aspergillosis (CPA) which causes shortness of breath, fatigue, coughing (including coughing up blood) and weight loss.

Participants in the study were twice as likely to have CPA if they lived within one mile of a farm or agricultural area.

COPD is the most common condition associated with CPA in the UK, and around 3,600 people are estimated to have the illness in the country.

The  is helping to reduce disease progression and symptoms for people with respiratory conditions by working towards earlier diagnosis and a more targeted approach.

Dr Kosmidis, who is also a 91ֱ�� BRC researcher said: “We’re not able to generalise about the specific risk to COPD patients exposed to mould from this relatively small sample.

“However, it would be fair to conclude that activities which bring COPD patients into contact with mould may increase the risk of flaring and hospitalisation.

“Mould is present in homes and outdoors, but certain activities may increase the amount.

“As it is well known that admission to hospital carried a higher risk of death for COPD patients, it is clear that preventing those flares is an important goal of clinical staff.”

Preventative measures could include:

• ventilating the home often
• opening a window during and after vacuuming
• good maintenance of the vacuum cleaner
• avoiding dust from being carried into the home, for example by taking off shoes on entering
• taking care of visible mould in the home

The British Lung Foundation estimates that 1.2 million people are currently living with diagnosed COPD, making it the second most common lung disease in the UK, after asthma.

The number of people who have had a diagnosis of COPD increased by 27 per cent in the last decade, from under 1,600 to nearly 2,000 per 100,000.

Of the 140 patients who took part in this study, 60 had CPA as well as COPD and 39 were active cigarette smokers.

The participants were recruited at the , 91ֱ�� University NHS Foundation Trust, and through the ,  and .

The paper Impact of self-reported environmental mould exposure on COPD outcomes, published in Pulmonology, is available 

Dr Wendy Thompson, a dental researcher from The University of Manchester, says users also reported turning to antibiotics when unable to access urgent dental services.

The findings ring true with by Dr Thompson, who discovered that dentists increased dental antibiotic prescribing by 25% in England during the COVID-19 crisis when dental services were less accessible.

“While antibiotics do not cure toothache, it is surprising that so many of the social media users had experienced taking antibiotics for toothache,” said Dr Thompson.

The study was carried out with undergraduate Rachel Emmott , now a foundation dentist.

Internationally, dentists are estimated to be responsible for 10% of all antibiotics prescribed to humans.

Studies in the United Kingdom and United States have shown up to 80% of dental antibiotic use is unnecessary, fueling antibiotic resistance.

Some users in the study, published in the International journal of pharmacy practice, reported having to wait up to a week in severe pain before access to professional treatment was available.

But conversely, the desire to avoid a dental appointment was also expressed as a reason for seeking antibiotics, often underpinned by fear of dental treatment or its cost.

People are known to regularly seek antibiotics for toothache from non-dental professionals, including general practitioners and in emergency departments. Self-medication by people with toothache is also reported.

The study examined 144 posts on Twitter and Facebook over two years, based on the search terms antibiotic, dentist, and tooth-ache.

According to the researchers, because the search criteria was tightly defined the number of entries was higher than expected, indicating that the phenomenon is likely to be common.

Dr Thompson said: “A general belief that antibiotics are an appropriate and necessary treatment for toothache exists.

“Some people believe antibiotics are always the appropriate treatment for toothache and are frustrated or disappointed when they are not prescribed.

“In this sample of social media users, the misplaced belief that antibiotics are an appropriate treatment for toothache was widespread.

“Users attributed their behaviour to poor access to professional dental care, but also avoiding dental appointments because of anxiety and the perceived affordability of dentistry.

“And a range of strategies to cope with the severe impact toothache was having on people’s quality of life were identified, from prayer to antibiotics.”

More than half of all the posts portrayed an element of physical pain of varying severity, including ‘agony’, ‘excruciating’, and ‘unbearable.

A feeling of inability to cope and issues needing to be overcome to continue daily activities was evident, including the inability to drive, lost productivity and missed social events.

She added: “Managing this behaviour through addressing people’s expectations and desire for antibiotics to cope with toothache should be part of our strategy in tackling antibiotic resistance.

“That means appropriate access to professional dental care for those with acute toothache, including for people with fear of dentistry and people on low incomes, should be integral to health services reviews of dentistry.

“Furthermore, the time is now ripe for these important issues for dentistry to be included in the government’s next UK 5-year national action plan on tackling antibiotic resistance.”

'Antibiotics for toothache: A social media review’ is piblished in the International journal of pharmacy practice

is a spin-out company from the Catalan Institute of Nanoscience and Nanotechnology () and the Catalan Institution for Research and Advanced Studies (), partners of - and supported by - the European Commission’s programme.

INBRAIN’s work involves the decoding of brain signals by implanting innovative, flexible nanoscale graphene electrodes, developed in conjunction with researchers at 91ֱ��’s Nanomedicine Lab and the  (NGI).

These signals may then be used to produce a therapeutic, personalised response for patients with epilepsy, Parkinson’s and other neurological disorders.

This new investment is co-led by Barcelona-based venture capitalists Asabys Partners and Alta Life Sciences, joined by: Vsquared Ventures, a deep tech-focused early-stage venture capitalist based in Munich; TruVenturo GmbH, Germany’s most successful internet company builders; and CDTI, the Spanish Ministry of Science and Innovation.

Fruits of long collaboration

Kostas Kostarelos, Professor of Nanomedicine at The University of Manchester , the NGI and co-founder of INBRAIN Neuroelectronics, said: ‘’This investment for INBRAIN is a testament that graphene-based technologies and the properties of 2D materials have a unique set of propositions to offer for clinical medicine and the management of neurological disorders.

“This did not happen suddenly, though, or by a stroke of good luck in the lab,” he added. “It is the culmination of many years of persistent and consistent work between at least three research institutions, one of which is the Nanomedicine Lab in 91ֱ��, the other two in Barcelona, all working closely and cooperatively under the critically important funding of the Graphene Flagship project.”

The Graphene Flagship is the European Commission’s €1bn research funding spearhead and a key partner of ICN2, ICREA and Graphene@91ֱ��, with a mission is to accelerate advanced 2D materials research and commercialisation.

High costs of brain disease

The high incidence of brain-related diseases worldwide and their huge annual cost - around £700bn in Europe alone, according to a 2010 study by the European Brain Council - call for greater investments in basic research in this field, with the aim of developing new and more efficient therapeutic and diagnostic tools.

Existing brain interfaces are based on metals such as platinum and iridium, which significantly restrict miniaturisation and signal resolution, and are therefore responsible for considerable side effects.

As a consequence, there is a 50% rejection rate of these implants in candidate patients. INBRAIN Neuroelectronics has a disruptive technology proposition, based on the novel material graphene, that overcomes the current limitations of metal-based neural interfaces.

Graphene electrodes allow miniaturisation to nanoscale, with the potential to reach single-neuron resolution. The extraordinary properties of graphene - which is light, biocompatible, flexible and extremely conductive - are harnessed in much smaller devices, which are safer to implant and can be programmed, upgraded and recharged wirelessly.

Driven by artificial intelligence, the implant can learn from the brain of the specific patient and trigger adaptive responses to deliver a personalised neurological therapy. In addition, the use of big data management will permit remote monitoring of the device and data processing.

Better patient outcomes

Carolina Aguilar, founder and CEO of INBRAIN (pictured centre with team, above), said: “Patients with chronic conditions are alone with their diseases, at most they see their physician 1-4 times per year for a follow-up. With less invasive and more intelligent neuroelectronic therapies, we aim to provide safer and real-time adaptive therapies to empower them and improve the outcomes that matter to them.

“This way patients can better deal with their condition between follow-up visits, by getting the right therapy and support when they need it.”

The technology has already been validated in vitro and in vivo, with extensive biocompatibility and toxicity tests mainly performed in 91ֱ�� using preclinical models. This significant investment will be dedicated to bring the technology to human patients, with the execution of multiple clinical trials in collaboration with key neurosurgical and neurological groups in Europe, including various NHS hospitals.

 is one of The University of Manchester’s  - examples of pioneering discoveries, interdisciplinary collaboration and cross-sector partnerships that are tackling some of the biggest questions facing the planet. #ResearchBeacons

The University of Manchester has announced today a groundbreaking gene therapy partnership to ease the lifelong suffering of people with Hunter syndrome.

The University has agreed to a worldwide license and collaborative research funding agreement with ., a leading clinical-stage gene therapy company with a mission to free people from a lifetime of genetic disease, based in Cambridge, Massachusetts, USA.

The significant partnership agreement is for the clinical development of an investigational lentiviral gene therapy for mucopolysaccharidosis type II (MPS II), or Hunter syndrome, a rare and deadly lysosomal disorder that primarily affects young boys.

Hunter syndrome, which affects an estimated , causes devastating complications throughout the body and brain, including severe cardiac and respiratory dysfunction, skeletal malformations and hearing impairment. Children with severe cases of Hunter syndrome typically show early symptoms in their toddler years and begin to regress developmentally around age six, losing basic motor skills and cognitive function.

The current standard of care is weekly enzyme replacement therapy (ERT), which can delay some complications but does not halt overall progression of the disease and has not been demonstrated to address cognitive issues. Even with ERT, people with Hunter syndrome face life-limiting symptoms and a significantly reduced life span.

The University of Manchester will sponsor the investigator-led Phase 1-2 clinical trial for Hunter syndrome which is expected to begin in 2021. The Hunter syndrome program was developed by Brian Bigger, a professor of cell and gene therapy at The University of Manchester. Professor Bigger has published preclinical data demonstrating that the introduction of the transgene with an optimised, proprietary tag has the ability to correct peripheral disease and normalise brain pathology.

Primary investigators for the clinical trial will be; Professor Robert Wynn, Consultant Paediatric Hematologist at the and Dr. Simon Jones, Consultant Paediatric Physician for inherited metabolic diseases at the Willink Unit, and the .

“We feel an enormous urgency to bring forward a treatment that may halt this deadly disease in its tracks, before symptoms emerge and before children lose their physical and cognitive skills,” said Professor Bigger. “We are delighted to be working with AVROBIO on this program. Both of our teams have deep experience running international clinical trials in other lysosomal disorders. AVROBIO also has a leading gene therapy platform, plato®, which is designed to optimise the consistency, predictability and efficacy of its gene therapies and to enable efficient scaling for worldwide commercialization. By working together, we believe we can greatly accelerate development of this important program.”

The investigational gene therapy, which will be called AVR-RD-05, involves ex vivo transduction of the patient’s own hematopoietic stem cells with a therapeutic transgene designed to express functional enzyme the patient needs to maintain cellular health, coupled to a proprietary protein tag that is designed to improve stability of the enzyme in the bloodstream and facilitate uptake by tissues from head to toe. When reinfused into the patient, the gene-modified stem cells are expected to engraft in the bone marrow and produce generations of daughter cells, each carrying the transgene. Those daughter cells are then expected to differentiate into macrophages, microglia and other components of the immune system and circulate throughout the body and central nervous system, potentially enabling widespread distribution of functional enzyme.

Geoff MacKay, AVROBIO’s president and CEO said: “The lentiviral gene therapy approach is well suited to treat a progressive and pervasive disease such as Hunter syndrome, which affects organs throughout the body and severely impairs cognitive function. If we treat children early, before their symptoms arise, we hope to prevent the tragic complications that rob these young children of their futures.

“We believe our deep experience with investigational gene therapies for lysosomal disorders will enable us to efficiently move the program through clinical development in collaboration with Professor Brian Bigger, who has done tremendous work to develop and optimize this investigational gene therapy. We’re proud to add this program to our leading lysosomal disorder pipeline and excited about its potential to change the lives of patients and families living with Hunter syndrome.”

The University of Manchester’s technology transfer office, The and AVROBIO have negotiated the exclusive, worldwide license to the technology. Under the terms of the license, AVROBIO will pay The University of Manchester an upfront cash payment and additional payments based on the achievement of development and regulatory milestones. The company will pay The University a mid-single digit percentage royalty on annual net sales of licensed products. Additionally, under the collaborative research funding agreement, AVROBIO will cover budgeted clinical trial costs.

Andrew Wilkinson, CEO of the University’s technology transfer company, The University of Manchester Innovation Factory said: “We are delighted that AVROBIO will be working with teams from The University of Manchester and The University of Manchester Foundation Trust to develop a therapy for this debilitating genetic disease. AVROBIO’s strategic focus on bringing new personalised gene therapies to the world along with their technical and commercial expertise in this area make them an excellent partner for the investigational Hunter syndrome gene therapy programme.”

Up to a third of older adults with hearing loss in England could be undetected and untreated, according to a new study by University of Manchester researchers.

The study, published in , might mean millions of people are not seeing ear specialists or given hearing aids when their hearing has considerably deteriorated.

Women, older people, with fewer qualifications and living in more deprived areas were the at higher risk of not recognising their hearing had deteriorated and thus were less likely to seek help, found the researchers.

The findings reveal many hearing loss cases remain undiagnosed in primary care, since people very often cannot recognise their hearing has been affected, and highlight gaps in the continuity of hearing care pathways.

, who led the study, said untreated hearing difficulty can have a negative impact on mental and physical health, and despite that, hearing loss among older people is underdiagnosed and undertreated.

The team examined patterns of health pathways among older adults in England, using hearing data of 8,529 participants aged 50-89 years old from the English Longitudinal 91ֱ�� of Ageing (ELSA).

The researchers said that as the survey is representative of the English older population, the findings provide a good representation for England as a whole.

Although participants had objectively been identified as having hearing loss, they did not self-identify their own difficulties correctly and reported themselves as having normal hearing.

Action on Hearing Loss estimates thar hearing loss affects over 12 million people in the UK and costs the UK economy around £25 billion a year in productivity and unemployment.

There is no accurate figure for England because of the absence of a screening programme.

By 2035, it is estimated that there will be more than 15 million people with hearing loss in the UK – a fifth of the population.

Diagnosis of hearing loss starts in primary care, where traditionally, people with hearing difficulties present to their GP to seek advice and investigation.

Ms Tsimpida, who is based at the University’s Institute for Health Policy and Organisation (IHPO) said: “ It is crucial that those with hearing loss are detected in a timely way, referred to ear specialists and given access to hearing aids. The early identification of hearing difficulties in primary care may be the key to tackling this major public health issue.

“However, more research is needed to understand why so many people are undiagnosed, though we feel making hearing loss part of a routine primary care examination among older adults would be beneficial.”

The study was carried out during Ms Tsimpida’s NIHR 91ֱ�� Biomedical Research Centre PhD Studentship, co-authored by her supervisors Dr Maria Panagioti, Professor Evangelos Kontopantelis and Professor Darren Ashcroft.

She added: “This lack of self awareness of hearing loss is a problem for many people”.

Clinical research often relies on a self-report measure of hearing loss. Our study showed that self-report measurement of hearing loss had limited accuracy and was not sufficiently sensitive to detect hearing loss.

“These findings may inform public health policies relevant to selection of appropriate and validated tools for detecting hearing problems among middle-aged and older adults.”

“The study also provides novel insights into the clinical practice and reinforces the importance of an effective and sustainable hearing loss screening strategy in primary care.”

A , led by researchers at Greater 91ֱ�� Mental Health NHS Foundation Trust, the University of Manchester and the National Institute for Health Research (NIHR), has found that young women are most vulnerable to postpartum mental illness.

The term ‘postpartum’ refers to the period following childbirth. Whilst childbirth is a leading cause of mental illness in women, up until now, how it affects women at different ages has been unknown.

This is the first study of its kind to compare rates of mental illness during postpartum periods and non-postpartum periods in women of different ages. The study examined UK general practice data from almost 2.7 million women in the UK. Postpartum periods were matched on age and general practice to non-postpartum periods and Cox regression models were then used to compare new mental illness between postpartum and non-postpartum periods.

The results showed strong evidence that the effect of giving birth on mental illness was age-dependent for depression, anxiety and affective psychosis, with the effect being far greater in young women.

In 15-19 year olds, depression was over seven times more likely to occur in postpartum periods than non-postpartum periods. 15-19 year olds were also 50% more likely to develop anxiety in postpartum periods than non-postpartum periods.

Childbirth also had over twice the effect on affective psychosis in women aged 15-24 compared to women overall.

These findings will aid the understanding of postpartum mental illness. This will inform the development of targeted support and allow clinicians to provide accurate information to women and their families.

Dr Eleanor Swift, ST4 Doctor in General Adult Psychiatry at Greater 91ֱ�� Mental Health NHS Foundation Trust, and NIHR Academic Clinical Fellow said:

“This study adds  new evidence that the effect of childbirth on mental illness is highly age-dependent. Young women are affected to the greatest extent, particularly for depression and anxiety.

“This is important because postpartum mental illnesses has been repeatedly linked to poorer outcomes for mother and child and these risks make planning parenthood more daunting for women.

“We hope that having a better understanding of which women are most at risk of postpartum mental illness can help provide clearer information and target treatments to the right groups of women to reduce health inequalities.”

Placebo pain-relief is reproducible in patients with chronic pain compared to healthy volunteers according to a unique University of Manchester study.

In a research first, patients with high levels of psychological distress such as depression and anxiety experienced pain relief in a placebo experiment with inert cream they thought might help them.

And that, say the research team, could encourage clinicians to think about using alternative strategies other than pain medication. It could also, they say, manage pain better and reduce dependence on pain medication which can have unwanted side-effects.

Pain is experienced as a result of particular brain processes in the brain which are sometimes not fine-tuned as well as they might be. Placebo is a powerful way of positively harnessing the brains ability to take control of how we feel pain.

The study, funded by Versus Arthritis is published in Pain – the world’s leading journal in the field.

The cream was applied to the forearm of 60 osteoarthritis and 79 fibromyalgia patients as well as and 98 Healthy Individuals.

The placebo group was told this may or may not be a local anaesthetic cream, while the control group was told the cream was inactive.

They were then given laser pain and asked to rank the intensity of the pain before, during and after cream application, along with expectation of pain relief and anxiety.

The procedure was repeated after two weeks and the results were found to be the same.

The findings complement the team’s work on enhancing natural pain control, using ‘Alpha brain-wave entrainment’, a light therapy which tunes the brain to a particular frequency of 10 cycles per second – known as alpha frequency.

Alpha brain-wave entrainment was previously shown by the team to be associated with the expectation of pain relief in health volunteers and patients with chronic pain.

Professor Anthony Jones from The University of Manchester is the Director of the Human Pain Research Group (HPRG), which is based at Salford Royal NHS Foundation Trust, part of the Northern Care Alliance NHS Group.

He said “Chronic pain carries a huge socioeconomic burden and substantially impacts the quality of life of affected individuals.

“It is often difficult to treat- and many of these patients have to live with its effects - and resultant impacts on their mental health- day in day out.

“But this study shows for the first time that people with osteoarthritis and fibromyalgia can modulate their responses to experimental pain as efficiently as healthy individuals.

"There might be a way to treat these patients - and that’s exciting.”

Dr Manoj Sivan is an Associate Professor in the Leeds Institute of Rheumatology and Musculoskeletal Medicine at the University of Leeds and honorary senior lecturer at The University of Manchester.

He said: “What was previously considered to be a nuisance variable has now been shown to have substantial potential to improve patient outcomes in chronic pain.

“Understanding the neural mechanisms of placebo response enables us to tap in to this more to modulate pain perception and enhance the analgesic effect of other novel step-change treatments, such as our Smart Neurotherapies Platform.”

He added: “With the current crisis of overuse of opioids a concern for all clinicians, this research strengthens the evidence for using non-drug approaches to manage chronic pain and encourages an important cultural change in managing our patients”

Dr Andrea Power, Honorary Research Associate at the University of Manchester said: “Pain normally increases negative emotions, which in turn increases the subjective experience of pain.

“Conversely, analgesic administration induces the expectation of reduced unpleasant symptoms, which reduces anxiety and, consequently, actual symptoms of unpleasantness.

“That is why chronic pain patients have psychological co-morbidities such as anxiety, depression, pain catastrophizing and cognitive impairments.

“For this reason, the role of expectancy and anxiety in modulation of pain by placebo has a role in treating these patients.”

Val Derbyshire, who has Osteo Arthritis and Fibromyalgia and works with the Salford Fibromyalgia Support Group

She said: “Currently people are offered different treatments - including opioids- with varying levels of success. Some people despair of ever finding resolution for their pain, and will try almost anything however weird and wonderful it may seem, whilst others are suggestible to any option offered.

“Anything which can reduce the use of Opioids and the concomitant side effects has to be welcomed. Placebo has been shown to work for many individuals without any harmful side effects. Therefore I believe that it could be used more widely in the treatment of chronic widespread pain.”

The abstract is available  

Ambulance workers who took part in a University of Manchester led study have told of the complex challenges they face in responding to suicide without adequate training and support.

The qualitative interview study by experts at 91ֱ�� and Keele University, funded by the National Institute for Health Research is published in the journal Frontiers in Psychology.

The ambulance workers told the research team that as first responders to the scene of a death by suicide:

• they are exposed to many distressing suicides during their working lives, including the suicide of colleagues, and all had been personally bereaved by suicide;
• they are often faced with managing distressed friends and relatives of the deceased with little professional training in how to respond to those bereaved by suicide;
• there is little acknowledgement in the workplace that suicides may be traumatic, opportunities for staff debriefing are rare, and staff are reluctant to access work-based support services due to potential stigmatisation.

Though limited by a relatively small sample of 9 people from one English ambulance service in 2014, its themes, say the researchers, may be relevant in other parts of the UK and beyond.

“We know ambulance staff are exposed to suicide related incidents on almost a daily basis. However, we fail to identify, acknowledge and address their unmet needs dealing with this issue, despite our awareness that exposure to suicide, is a known risk factor for further suicide,” said Dr Sharon McDonnell, Honorary Research Fellow at The University of Manchester, Managing Director of Suicide Bereavement UK and PI of the study.

“All participants in the study reported losing at least one colleague to suicide. This finding alone highlights the urgency of future research, exploring the magnitude of this problem.”

She added: “Ambulance staff reported feeling helpless, hopeless, ill-equipped and unsupported in the workplace, when exposed to suicide. This issue was especially pertinent when they encountered intense grief reactions from those bereaved by suicide. The urgency of providing high quality care, support and training to assist and empower staff to manage these profoundly distressing circumstances cannot be underestimated.”

Full paper available at: 

Patients recovering from COVID-19 could suffer significant long-term effects, according to research into the experiences of people hospitalised by previous coronavirus outbreaks.

Researchers at the universities of Leeds, 91ֱ�� and Hull have for the first time collated evidence on physical, psychological and social impacts among patients who fell victim to Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) – two previous viral infection outbreaks similar to the current COVID-19 pandemic.

These previous outbreaks resulted in respiratory and exercise capacity problems in the first six months after hospitalisation, mental health problems including post-traumatic stress disorder, anxiety and depression in up to a third of survivors at six months and beyond. Quality of life for one third of survivors was impaired even 12 months after discharge from hospital.

Publishing their findings in the Journal of Rehabilitation Medicine, the researchers warn that rehabilitation clinicians and services should anticipate similar health problems in survivors of COVID-19.

Dr Manoj Sivan, an Associate Clinical Professor and Consultant in Rehabilitation Medicine at the University of , was lead clinician on this research.

He said: “COVID-19 is a new illness and the acute phase has already been devastating for people in many countries across the globe.

“While we have all rightly been busy creating capacity in acute service and saving lives, we must not forget those being discharged from the hospitals. We don’t really know the long-term health problems these survivors face in the recovery phase of this pandemic.

“We do though have the two previous coronavirus outbreaks to learn from. This research gives us a rough idea of the rehabilitation needs in the first year after discharge. This allows us to prepare and plan services to meet their needs and work towards the best possible care for these patients in the community.”

Co-author Dr Stephen Halpin, Senior Research Fellow and Consultant in Rehabilitation Medicine at Leeds is, like Dr Sivan, also a member of the University of Manchester’s Division of Neuroscience and Experimental Psychology.

He said: “This highlights the importance of developing strong follow-up multidisciplinary rehabilitation services and has directly informed our management of COVID-19 patients in Leeds.”

Co-author Dr Abayomi Salawu is Honorary Senior Lecturer at Hull York Medical School and Consultant in Rehabilitation Medicine at Hull University Teaching Hospitals NHS Trust.

He said: “Considering the novel nature of COVID-19, we can only guess what the impact in the medium to long term on the survivors will be. However, we do know that patients who required ICU input for more than two weeks are likely to have ongoing rehabilitation needs irrespective of the diagnosis.

“This work has enabled us to develop a unique comprehensive follow-up and rehabilitation pathway. This has been designed despite current prevailing circumstances that have had significant impact on what services can be provided by the rehabilitation therapy teams in the community.

“It is anticipated that when we subsequently do a service evaluation of this follow-up pathway that we have created across Yorkshire for patients with COVID-19, we will be able to add more evidence to the expanding knowledge base in managing it.”

The authors identified almost 1,200 previous international studies into the harmful long-term clinical outcomes for survivors of SARS and MERS coronavirus infections after hospitalisation or intensive care unit admission. They carried out a systematic review of 28 of those studies – the majority of which related to SARS cases; 23 were included in their meta-analysis.

The researchers cautioned: “At this stage it is not possible to conclude whether the long-term outcomes identified in SARS and MERS patients will also occur in COVID-19 survivors.

“However, as SARS and MERS belong to the same family of virus as COVID-19, and the clinical features are looking identical, including severe respiratory distress and intensive care admission in severe cases, the long-term picture is likely to be similar with COVID-19.

“Rehabilitation clinicians and services should plan ahead for timely follow-up, screening and interventions to enable best possible recovery and quality of life for these individuals.”

Acute multidisciplinary rehabilitation while in hospital, post-acute rehabilitation in rehabilitation or respiratory units once discharged from hospital, and long-term rehabilitation interventions in the community are all recommended to optimise physical, psychological and functional recovery for those recovering from coronavirus.

Ideal multidisciplinary rehabilitation teams must include physiotherapists, occupational therapists, psychologists, speech and language therapists, dietitians, and physicians in rehabilitation medicine – with links to acute respiratory and intensive care teams and relevant community rehabilitation teams.

The authors also recommend that further research should be carried out into COVID-19 survivors, focusing on capturing lung function abnormalities, exercise capacity, psychological and cognitive impairments and, ultimately, quality of life.

The paper, “", is published in the Journal of Rehabilitation Medicine (DOI: 10.2340/16501977-2694).

COVID19 is hitting the North hardest with its effects likely to last longest in the region particularly in deprived urban areas according to University of Manchester and Newcastle experts.

Analysis released today by the Northern Health Science Alliance, in collaboration with the NIHR Applied Research Collaborations (ARCs) in the North East & North Cumbria and Greater 91ֱ��, show the impacts of the virus are already hitting hard; on death rates from the illness, death rates from all causes and on job losses.

The team analysed data from the Office for National Statistics to map figures for the last six weeks on COVID19 deaths, deaths from all causes, and unemployment figures, to build up a picture of how the virus is affecting different parts of England.

The figures show deprived urban areas in the North of England are being hit with high rates of COVID deaths, higher death rates from all causes and particularly suffering from greater rates of increases in unemployment.

Researchers looked at the average England COVID mortality rate (36.6 per 100,000 people) and the average all-cause mortality rate (161 per 100,000 people) from March 1 to April 17 and the average increase in rate of people claiming unemployment benefits (1.9 percentage points) from March 12 to April 9. They then mapped across the main trainlines in England to see how different urban and rural centres performed compared to the national average in all three metrics.

Main centres in the North including 91ֱ��, Liverpool, Newcastle and Durham are above the English average in all three areas whereas Slough is the only place outside of the North to be red in all areas.

Unemployment rates were added into the map as these have a proven link to and are a strong indicator of future health inequalities. The unemployment rate rose from 4.2% to 6.7% in Greater 91ֱ��, compared to a rise from 2.2% to 2.9% in the South East.

Professor Clare Bambra of Newcastle University said: “These maps show the stark regional inequalities in the impacts of the pandemic across the country. The Northern hotspots should be prioritised as COVID testing roles out and new NHS investment and public health investment should target those areas most effected. To avoid a parallel mental health pandemic, economic and social measures to ‘level’ up the regions need to be implemented as soon as possible”

Dr Luke Munford of the University of Manchester said: “This visualisation shows that COVID-19 is impacting parts of the country in different ways, and there appears to be a North/South divide emerging.

“The unemployment data, particularly, is a cause for concern – pre-COVID-19 unemployment rates in the North were already above the English average, and they are increasing much faster than they are in the south. Given the well-known link between unemployment rates and mental health and suicides, these data would suggest that action needs to be taken in the North.”

Hannah Davies, Health Inequalities lead for the NHSA, said: “The impact of the disease on areas already suffering from greater health inequalities will leave a long, devastating impact across the North of England, and particularly in urban areas if action is not taken by government now.

“As the Government looks to its levelling up agenda it must pay close attention to where it can support the health and wealth of the region and support local authorities, the NHS, and metro mayors to make decisions based on the needs of their population.”

The NHSA is a partnership established by the leading Universities and NHS Hospital Trusts in the North of England to improve the health and wealth of the region by creating an internationally recognised life science and healthcare system. It links ten universities and ten research-intensive NHS Teaching Trusts with four Academic Health Science Networks (AHSNs covering a population of over 16 million).

The organisation brings together health research collaborations across the region, draws in international investment to the North and acts as a voice for its health research system.

World-leading 91ֱ�� researchers are working towards developing a test for COVID-19 that could be used at home like a domestic pregnancy test.

This prototype test is based on the fact sugars coat all human cells and could be used in the fight to detect infectious agents like coronavirus.

This new screening new approach can help identify the COVID-19 virus - not by its genetic code, which can mutate, but by using its reliance on chains of sugars on human cells, which are constant.

Sugars coat all cells in the human body and they are the first layer a bacteria or virus encounters. Professor Rob Field and his team are interested in how to use the sugars to identify and even block a virus from penetrating the cell – and so preventing further infection.

The simple-to-use testing device has the potential to be used in 'hotspot' communities like frontline NHS staff allowing doctors and nurses to easily test at home to see if they have COVID-19 symptoms or not before going to work.

Communities associated with a building or geographical location which require increased safeguarding such as, hospitals, care homes or workplaces, can quickly test visitors.

Professor Field and his team at The University of Manchester are now working at pace with spin-out company to get their new test ready and officially validated ready for the autumn. An autumn launch this year is key, as the application of this screening kit can support diagnoses of 'flu vs coronavirus', given the typical trend of flu season which can initially present similar symptoms.

The tester would be very useful to ensure people with seasonal flu aren't confused with people having suspected COVID-19 and the consequences of having to self-isolate and create a new round of disruption to society and the economy.

Prof Field said: “Our existing prototype product for influenza can detect the virus in less than 20 minutes and could be adapted to identify other pathogens such as coronavirus.

“Respiratory viruses invade the body through cells in the airways and lungs. These cells are covered in a coat of sugar chains, known as glycans, which are used for normal function of human tissues. Viruses can utilise these glycans as part of the infection process.”

This process can also be used in reverse to identify the virus in saliva or nasal fluids, said Professor Field, a world expert in glycoscience at the (MIB) - and his specialist company has developed this diagnostic technique that uses an artificial glycan receptor to capture a virus.

Professor Field added: “Right now, everybody is talking about a vaccine for coronavirus but vaccine development, validation, safety-testing, manufacture, regulatory approval and deployment is a time-consuming process.

“A low-cost, easy to use screening test that can be performed at the point of care would be an ideal way to limit initial disease transmission in the community and at points of entry to hospitals, or at national borders, for instance.

“Current COVID-19 tests are largely based on PCR (polymerase chain reaction) that requires a laboratory setting for analysis and relies on prior knowledge of the viral genetic code. This code can change as the virus evolves, potentially limiting the effectiveness of the test.

“The Iceni Diagnostics approach uses glycan recognition, which is unaffected by seasonal variation in the genetic code, and can be offered as a handheld home or field-based test.”

Professor Field and his dedicated team have already developed a series of prototype products that can specifically detect pathogens such as Norovirus and different strains of influenza in less than 20 minutes. The team based at MIB will be working with Iceni Diagnostics to further develop these tests in the coming months.

The hand-held device currently under development uses lateral flow – like a home pregnancy test – to give a simple yes/no answer. It requires no refrigeration and no training, meaning the test is usable in any location, by any person, in order to detect flu or other pathogens.

“The current Iceni Diagnostics products detect a single virus. However, the next generation of diagnostics will enable the detection and discrimination of a series of pathogens that give rise to similar symptoms.

“This would enable, for example, a distinction between flu and COVID-19 in a single sample which increases the versatility and robustness of the diagnosis. Additionally, the way the virus interacts with its glycan receptor makes it seasonally consistent, so, even if the virus genetic code mutates, it will still be detected – meaning the Iceni Diagnostics’ test should remain effective in the longer term.”

Professor Field says that the device under development holds huge promise for changing the way we manage global disease: “This new approach, which is based on host-pathogen glycan recognition could potentially result in a more universal detection technique, crucial in early diagnostics of outbreaks.”

The University of Manchester has a growing list of scientists and academics who are either working on aspects of the COVID-19 outbreak or can make a valuable contribution to the national discourse. Please checkout our p. 

Our people are also  and with partners from across society to understand coronavirus (COVID-19) and its wide-ranging impacts on our lives.  to support the University’s response to coronavirus or visit the University’s  to lend a helping hand.

The University of Manchester is repurposing specialised equipment across its campus to help produce safety equipment for NHS workers battling COVID-19 in an attempt to help reduce the critical demand across the region.

In a combined effort with other universities, including Salford and MMU, The University is utilising 3D printing capabilities to design and make headbands for protective facemasks worn by frontline NHS medical staff in hospitals.

With nearly 50 printers across the University it is aimed that around 500 additional mask headbands can be produced per week. The face shield is being laser cut by regional commercial suppliers and assembled at .

Professor Brian Derby is coordinating the 3D printing response at The University of Manchester, he said: “3D printing has allowed the Greater 91ֱ��-based team to progress rapidly from concept, to prototypes, which allowed infection control teams to validate the design and enable the production of PPE acceptable for use in the regions hospitals.”

A team of experimental officers and technical staff who can operate the 3D printers have volunteered to work on site to help with the surge in demand. Measured steps are being taken in an effort to reduce staff travel to minimise risk. NHS staff will collect the masks from the University campus on a daily basis to help resupply their essential stock of PPE.

The University of Manchester is assisting the NHS by mobilising its staff, laboratory space and equipment as part of a collective effort to combat the COVID-19 pandemic in a fast moving and rapidly changing situation.

The University of Manchester has established a COVID-19 research rapid response group through which scientists are working with NHS colleagues from 91ֱ�� University NHS Foundation Trust and the , supported by , and utilising our experimental and translational research expertise through the NHIR 91ֱ��  and .

Much sought after personal protective equipment (PPE) is also being donated by the University in the midst of a global shortage. Some high-spec or environmentally controlled laboratories including biomedical labs and graphene cleanroom labs, require users to wear PPE including; goggles, gloves and facemasks.

A stock of PPE including 47,660 pairs of nitrile gloves and 200 pairs of protective goggles has now been donated to local health practices to help safeguard doctors and nurses with further stock to be audited and offered.

Elsewhere the which is based at The University of Manchester and with national links to industry and academia has put out to link industry partners with NHS colleagues in order to help industry understand and solve problems faced by the nation’s medical staff in a rapidly changing environment caused by the COVID-19 pandemic.

At The University of Manchester, our people are working together and with partners from across society to understand coronavirus (COVID-19) and its wide-ranging impacts on our lives. to support the University’s response to coronavirus or visit the University’s  to lend a helping hand.

More than 450 medical and social care students across 91ֱ�� have stepped forward in less than a week to support NHS workers while they tackle the COVID-19 pandemic.

Called the 91ֱ�� National Health Supporters, the students are providing help to NHS workers so they can get on with the day job – including support for collecting groceries, babysitting children, pet walking and manning the receptions at GP surgeries.

The idea originated from Saif Khan, a fourth year medical student at The University of Manchester, after he noticed local health care professionals voicing concerns on social media about how they would balance home life with work commitments in the coming weeks.

After posting his idea on Facebook, Saif was inundated with offers of help from fellow students from The University of Manchester. The idea snowballed with students returning to the city from other universities during lockdown also offering to get involved.

The team has the correct procedures in place for safeguarding and Saif helped facilitate its expansion across the UK as other students in other parts of the country launch similar initiatives. As well as coordinating the 91ֱ�� National Health Supporters, he currently oversees part of the initiative nationally.

Saif said: “Within just a few days we have created a movement across the country of students who have NHS workers’ backs. We’re here to help them so they can focus on the day job.

“We’re in a unique position - unlike final year students we can’t be fast-tracked into junior doctor level posts, but we all have DBS checks and first aid training to help NHS workers with babysitting and working in GP surgeries on reception.”

Saif has now returned to his family home in London where he is coordinating the huge volunteering response from his living room. He added: “The medical teachers and mentors on my course are amongst the most inspiring I’ve met. It really is a privilege to be able to give something back to the NHS community in 91ֱ��.”

The 91ֱ�� National Health Supporters services are being promoted in hospitals across Greater 91ֱ�� and are keen to take more volunteers.

Professor Felicity Stewart, Director of Undergraduate Medical Studies at The University of Manchester, said: “We are very proud of our students and their generous contribution to the crucial work in our city on combatting the COVID-19 pandemic.”

Rachael Middleton is a fourth year medical student at The University of Manchester. She is supporting by spending time with the nine-year-old son of a GP in South 91ֱ�� while he’s at work. She said: “The primary school has closed, so I’ve been helping him with his homework. He is a very sweet little boy and I’m really happy to do this. Everyone I know from my year wants to help – it comes with our profession.”

If you are a student who would like to get involved or a NHS worker who would like support, get in touch with the 91ֱ�� National Health Supporters through the national website . 

At The University of Manchester, our people are working together and with partners from across society to understand coronavirus (COVID-19) and its wide-ranging impacts on our lives. to support the University’s response to coronavirus or visit the University’s  to lend a helping hand.

A group of scientists and clinicians from the UK, the Netherlands, Italy and the USA have worked together and made an important discovery that explains an often fatal organ defect that affects unborn babies and children.

Finding mutations of a key gene that controls how the urinary bladder grows before birth could be key to developing future treatments for this rare but devastating disease.

Research published today in the demonstrates why babies can have massively distended bladders that don't empty. This results in a back-up of urine that causes the kidneys to stop working.

Professor Adrian Woolf, a co-author of the paper and a kidney disease researcher in the and University of Manchester, said “Sadly most of the affected babies are terminated before birth due to the poor outlook. Although this condition is not common, it is one of the many hundreds of rare diseases that together affect one in seven of all of us. These diseases urgently need more research.”

Dr Esther Creemers, co-author at the Amsterdam UMC Research Centre said: “The gene at fault is called Myocardin and we show, for the first time, that it is essential for normal formation of muscle in the wall of the human bladder. When this goes wrong, the quality of the muscle is poor, and so the bladder can’t empty.

“We found several families who carry critical changes in this gene” said Professor Bill Newman, from the . “The bladder disease is much worse in boys than in girls, but some affected people are also born with abnormal hearts, probably because the gene also control the growth of muscle in the heart or the large blood vessels nearby.”

The newly published research is important in terms of developing genetic counselling but also helps understand the mechanism of a congenital rare but fatal disease. This opens the way to consider more futuristic treatments such as gene therapy, and a similar strategy is being used to treat other serious inherited diseases in other organs.

Oldham based doctor, has developed a new blood test which could help local rheumatoid arthritis patients to better manage their illness by keeping to their medication regimes.

Methotrexate is the most commonly prescribed drug for the 400,000 people in the UK suffering from this autoimmune disease. However, around 40% of rheumatoid arthritis (RA) patients do not take the drug as prescribed and, currently, clinical staff have no way of knowing whether a patient is taking their medication as advised.

Thirty eight year old, Dr Bluett practises at the borough’s which provides care for patients in orthopaedics, rheumatology and chronic pain. He is also a researcher for the and a Clinical Senior Lecturer at The University of Manchester.

The new test, developed, refined and assessed over 4 years, measures the methotrexate levels in a patient’s blood over the previous seven days. The final research results from 138 RA patients showed that the test has a 95% sensitivity in detecting whether someone took their methotrexate in the preceding week.

The initial evaluation of the blood test’s effectiveness was carried out in the with 20 patients from the North West.

“Patients may not take their methotrexate as prescribed for several reasons” said Dr Bluett, who splits his time equally between clinical practice and academic research at The University of Manchester. “Methotrexate is a weekly treatment, taken over a long period and can have side effects. Non-adherence means the drug won’t work as effectively and risks a patient’s condition worsening.

“Our new marker will enable doctors to start supportive conversations with patients about the difficulties they may be experiencing with the medication and how to resolve them.”

Dr Bluett was appointed as a consultant at the specialist musculoskeletal service, on New Radcliffe Street, in April 2018. The service, commissioned by NHS Oldham Clinical Commissioning Group, receives nearly 15,000 new referrals a year, mainly from local GPs and provides long term support for nearly 1,500 people with rheumatoid arthritis.

Dr Bluett’s  was published this month in the world’s leading rheumatology journal: the Annals of the Rheumatic Diseases.

“We need to see whether RA patients’ adherence improves when they receive feedback on their methotrexate levels. So, the next step will be a feasibility study to assess how we can gauge this in a clinical trial.

“I hope this further work validates our approach which could then, after appropriate regulatory approval, be incorporated into routine clinical practice. I want to ensure the best outcomes for RA patients” concluded Dr Bluett.

The Medical Research Council  funded 91ֱ�� Molecular Pathology Innovation Centre part funded the work.

Women who develop diabetes in pregnancy but are not diagnosed are much more likely to experience stillbirth than women without the condition, according to new research.

The study, led by the University of Leeds and the University of Manchester, found that the risk of stillbirth was over four-times higher in women who developed signs of gestational diabetes but were not diagnosed.

However, with appropriate screening and diagnosis that increased risk of stillbirth disappeared.

Funded by the charities Action Medical Research, Cure Kids, Sands and Tommy’s, the study compared the symptoms and care of 291 women who experienced a stillbirth to 733 similar women who did not experience a stillbirth across 41 maternity units in England.

Researchers found that across all women with high blood sugar, measured after a period of fasting, they had on average twice the risk of stillbirth than women without the condition.

The increased risk was likely to be caused by the missed diagnoses and lack of subsequent care experienced by many of the women, although the results show an association only, and cannot provide certainty about cause and effect.

The new research was published in BJOG: An International Journal of Obstetrics and Gynaecology.

Dr Tomasina Stacey, who led the study at the University of Leeds and now works at the University of Huddersfield, said: "There's good news and there's bad news. The good news is that women with gestational diabetes have no increase in stillbirth risk if national guidelines are followed for screening, diagnosis and management. The bad news is that the guidelines are not always followed and some women therefore experience avoidably higher risk."

According to recent figures, approximately 5% of women in the UK experience gestational diabetes during pregnancy.

The National Institute for Care Excellence (NICE) recommends that all women at a higher risk of gestational diabetes should receive blood screening for the condition: this includes women with a raised body mass index (a BMI of over 30), or from South Asian or Black Caribbean ethnic groups.

Only 74.3% of the participating women with a raised BMI and 74.7% of the participating women from South Asian or Black Caribbean ethnic groups received screening.

On average, women at higher risk of gestational diabetes who were not screened according to the NICE guidelines also experienced higher risks of stillbirth.

Co-author Professor Alexander Heazell, from the University of Manchester and Clinical Director of Tommy’s Stillbirth Research Centre, said: “It's not clear why some women missed out on being screened or diagnosed for gestational diabetes, but this needs to be improved.

“Gestational diabetes can cause serious complications in pregnancy. It's important that we detect every woman with symptoms so she can receive the appropriate care and support.”

In 2015, the NICE raised the threshold for diagnosing gestational diabetes to a fasting plasma glucose concentration – where blood sugar is measured after fasting – of greater than 5.6mmol/L. In the United States the threshold is 5.1mmol/L, and there is considerable debate worldwide about the appropriate level for diagnosis.

The present study found little evidence to support one threshold over another, instead finding that the risk of stillbirth increased steadily with increasing glucose concentration.

Dr Stacey, who also works at Calderdale and Huddersfield NHS Foundation Trust, added: "There's no blood sugar level where the risk suddenly jumps. The choice of the right threshold for diagnosis is therefore more about pragmatism and finding the right balance of risk to resource, and avoiding over-medicalisation. Our study shows that the current NICE guidelines can be effective, but only if they are followed."

According to recent figures from MBBRACE-UK, around four in every thousand pregnancies in the UK result in stillbirth.

Commenting on the research, Mr Edward Morris, Vice President of Clinical Quality at the Royal College of Obstetricians and Gynaecologists, said: “Women with gestational diabetes are more likely to have a stillbirth, but with adequate monitoring, care and treatment, this risk can be managed so that women can maximise their chances of having a healthy pregnancy and birth.

“Maternity units should follow NICE clinical guidance to ensure women are diagnosed and supported to avoid complications and ensure the best possible outcomes.”

The study is unique for separating the harmful biological effects of raised glucose from the benefits of diagnosis, which typically leads to better care and management of the condition.

Co-author Dr Peter Tennant, from the University of Leeds and the Alan Turing Institute, explained why this is so important. He said: "There's a lot of debate about the true impact of gestational diabetes, and whether it's worth spending so much time and money on screening, diagnosis, and care for these mothers. But most women with diabetes currently receive good care, and this really seems to help.

“Only when you look at women who aren't appropriately screened or diagnosed, does the full impact of gestational diabetes become clear."

The research project came out of a Stillbirth Summit in 2011, and was created with the help of more than 550 parents and members of the public. It was designed by and for parents, to try to maximise the positive impact it could have on society.

The paper is titled ‘Gestational diabetes and the risk of late stillbirth: a case-control study from England, UK’ and will be available online

More information on gestational diabetes - including symptoms, treatment, and management – can be found on the .

Despite the suffering caused by bipolar disorder – also known as manic depression, a significant minority of patients actually want to keep it because of the creative highs it gives them, according to new research from University of Manchester psychologists.

In the online survey of 103 people, 26 of them would want to keep their Bipolar Disorder - in which they experience deep depression but at other times euphoria.

TV personality Stephen Fry’s own experiences were highlighted in his 2006 documentary ‘’.

Of the people he interviewed with the condition, most, he said, would not ‘ to remove their Bipolar Disorder

Like Fry’s documentary, The 91ֱ�� study showed that people who see bipolar disorder as part of their personal identity, were less likely to want to fully recover from it.

Yet, unlike the observations of Fry, the majority of respondents in the 91ֱ�� study (77 of them) did want their disorder removed permanently.

The 91ֱ�� study also showed a more subtle range of views – people with the condition reported a wide variety of both positive and negative views of their condition.

The study is published in the Journal of Affective Disorders

The study was carried out by Dr Warren Mansell, a Reader in Clinical Psychology from the University of Manchester and Siri Folstad, who was one of Dr Mansell’s undergraduate students.

The results, says Dr Mansell, could have an important impact on designing services for people with the diagnosis.

He said: “Though many people with Bipolar Disorder are severely affected by it, like Fry, a significant minority of them do not want it to go away as they see it as part of their makeup.

“And knowing there is such a difference in attitude towards bipolar disorder is helpful when selecting the best treatment.

“If these patients were to find a way of getting high moods without the bipolar disorder, they would.

“But nevertheless, it may be a lot more helpful for clinicians to help them by tackling recognised problems such as anxiety and depression - rather than trying to work on the high moods.”

The respondents with bipolar disorder were asked if they would want to permanently remove their bipolar disorder with a ‘button press’, reflecting Fry’s comments.

They were then asked the same question about a reversible button press - one in which they could switch the disorder on and off as and when they wanted.

And they were also asked to explain the reasons for their decision.

Siri Folstad said: “All of this points to a mental health provision that embraces this individuality of views and prioritises discussion of them to provide the most relevant help.

“This is not how they are typically delivered - usually the ‘facts’ about bipolar disorder are presented as applying to everyone with the diagnosis and with certainty.

“It is possible that this diagnostic label creates unnecessary stereotyping.”

The Button Question’: A is published in the Journal of Affective Disorders

University students who are Lesbian, Gay and Bisexual (LGB) are at higher risk of self-harm and attempting suicide than their heterosexual counterparts, finds new research.

The study also shows that low self-esteem may explain the increased risk of self-harm in LGB students. Low self-esteem may result in LGB students who have faced discrimination or have struggled to accept or share their sexuality with others.

The study was carried out by a team at The University of Manchester, Leeds Beckett University, Lancaster University and Edith Cowan University in Australia, and is published in Archives of Suicide Research today.

Of the LGB students who completed an online questionnaire, 65% had carried out non suicidal self-harm over their lifetime compared to 41% of heterosexual students.

Self-harm typically includes behaviour such as cutting, hair pulling, scratching, burning or non-lethal overdoses.

And 35% of LGB students had attempted suicide in their lifetime compared to 14% of non-LGB students.

The study was completed by of 707 students with an average age of 23 from two English Universities of which 119 self-identified as LGB.

The study does not tell us, however, whether being at University increased the risk of self-harm in LGB people.

And it is not possible to compare the student sample with prevalence rates for non-suicidal self-injury and suicide attempts across the population as a whole.

Dr Taylor said: “Surprisingly, there is little data on the psychological mechanisms that might explain the association between being lesbian, gay or bisexual, and self-harm in UK students. This data highlights how low self-esteem may leave some LGB students more at risk.

“Interestingly, anxiety and depressive symptoms did not appear to be important once self-esteem was taken into account.

He added: “So prevention and intervention efforts directed at these psychological mediators by Universities may help to reduce risks in this population.

“Universities are already doing a lot of good things in this area such as counselling and psychological support which is targeted at LGB people.

“And tackling discrimination and improving acceptance of LGB people through public policy and media campaigns may be helpful in reducing any impact on self-esteem.”

Dr Elizabeth McDermott of Lancaster University said: “Young people’s mental health is a national concern and this study confirms that lesbian, gay or bisexual young people have elevated rates of suicidality and self-harm compared with heterosexual youth. We know much less about how LGB young people seek help for their mental health problems, or what type of support would be effective.”

The paper Psychological correlates of self-harm within gay, lesbian and bisexual UK University students, is published in Archives of Suicide Research.

A hypothesis which has been the standard way of explaining how the body develops Alzheimer’s Disease for almost 30 years is flawed, according to a University of Manchester biologist.

The ‘Amyloid Cascade’ argues that a series of stages, starting from the deposition of a starch-like protein called amyloid and ending with dementia, should be reassessed.

Prof Andrew Doig’s review of 120 scientific papers finds that the stages were not linked together in a cascade and the progression to dementia was not linear.

His review is published in the Journal of Alzheimer’s Disease.

“It’s wrong to use a series of waterfalls as an analogy for how dementia develops, as water cannot flow uphill”, said Prof Doig.

“My review shows the system is actually cyclical and does not flow one way – but is a series of feedback loops. Progress in recent years shows some of the elements go back and forth- both upstream and downstream.

”Most research has been at the top of the cascade. But we need to consider other drug targets too.”

According to the cascade, enzymes cut the amyloid into fragments which form plaques that damage cells.

Calcium rises in cells, followed by inflammation and then oxidative stress - an imbalance between certain molecules containing oxygen and antioxidants - and then cell death which causes dementia.

However, according to the research reviewed by Prof Doig, inflammation can either lead to enhanced amyloid deposition or oxidative stress.

Prof Doig added: “The fact that this process is cyclical has important implications as we’re missing opportunities for drug discovery.

“So for example, we need to take a closer look at inflammation and oxidative stress and their relation to amyloid plaques. If we use the Amyloid Cascade hypothesis, that would be less likely to happen.”

“Over the 26 years since the cascade was first described, hundreds of drugs based on this hypothesis have been trialled in people but none of them have worked.

“But if you realise the cyclical nature of this, then combinations of therapies could have a part to play.”

Positive Feedback Loops in Alzheimer’s Disease – The Alzheimer’s Feedback Hypothesis is published in the 

A study by a team of clinicians and scientists from 91ֱ�� University NHS Foundation Trust and The University of Manchester, published in the latest issue of the , shows how deaths from a serious blood stream infection caused by the yeast Candida can be avoided. The study using a biomarker found in patients’ blood (b-1-3-D-glucan) also shows a reduction in inappropriate prescriptions of expensive antifungal drugs.

Diagnosis of Candida blood stream infection is difficult leading to over-use of lifesaving but expensive anti-fungal drugs. Antifungal stewardship aims to ensure that only patients with fungal infections are given antifungal drugs. Current challenges include limited availability of diagnostic tests, long laboratory turnaround times, lack of antifungal stewardship expertise and insufficient evidence identifying effective stewardship interventions. Severe fungal infections, including sepsis caused by Candida, are increasingly found in patients in intensive care and is associated with a high mortality rate. The best outcomes for patients are seen when antifungal drugs are started early.

The Infectious Diseases and Intensive Care Units in collaboration with the NHS Mycology Reference Centre at Wythenshawe Hospital in 91ֱ�� have been developing an antifungal stewardship program over the past 8 years. Key targets of the program are to improve patient outcome while reducing unnecessary use of antifungal drugs by:

• Updating and implementing concise antifungal guidelines based on a European guidance
• Involving and educating clinical champions
• Improving access to timely diagnostic testing

The main difference in the 91ֱ�� study was a patient centred approach focused on improving outcomes compared with most antifungal stewardship programs which are dedicated to managing severe fungal infections and reducing the use of expensive antifungal agents.

The standard diagnostic test for sepsis caused by Candida is blood culture but this has a low sensitivity. There is a perception that available biomarker tests may not be useful forcing clinicians to rely on their clinical experience and judgment. This results in an overuse of antifungal drugs in many intensive care units. The 91ֱ�� antifungal stewardship program successfully reduced the mortality due to Candida infection by 58%. At the same time the number of inappropriate prescriptions of antifungal drugs by 90%. The paper concludes that testing for a blood biomarker (β-1-3-D-glucan) allows safe stopping of antifungal drugs in patients in intensive care units at risk of serious fungal infection.

Doctor Riina Rautemaa-Richardson, clinical senior lecturer and researcher at the University of Manchester and Consultant at the 91ֱ�� University Foundation Trust said: “It is possible to save lives and money with the help of fungal diagnostic tests.”

Doctor Timothy Felton, an Intensive Care Consultant and University of Manchester honorary lecturer, added: “As an intensive care doctor, I often worry if my patient has a severe fungal infection. Using a fungal diagnostic test allows me to start and stop antifungal drugs with more confidence.”

Mental health patients are at much greater risk of dying from unnatural causes following their first discharge from inpatient care than the rest of the population, according to new research.

In the most comprehensive study of this topic ever carried out, The University of Manchester team say though danger to patients is still relatively low, community services and GPs must be aware of the critical period in the first few weeks of discharge - when they are most at risk.

Though the report drew on data derived the entire population of Denmark, its results are relevant to the UK, which has a similar population and health system, say authors Professor Roger Webb and PhD student Florian Walter.

According to the team, the most common threat to life among patients after discharge is fatal poisoning compared to accidents among the general population.

The research was funded by Medical Research Council, European Research Council in partnership with Centre for Integrated Register-based Research and National Centre for Register-based Research at Aarhus University. It is published in the Journal of Clinical Psychiatry today.

The analysis compared over 1.6 million Danes with a subset of 47,000 people who were discharged from their first inpatient stay between 1982 and 1996.

Utilising national administrative datasets, the research team were able to track the group of patients, who averaged age 25 when they were discharged until they died or 31 December 2011.

They looked at method of suicide, types of accidental death, types of fatal poisoning and death by homicide.

Though there is a strong association between hospital discharge and unnatural death, there is no evidence of a causal link between the two, say the researchers.

According to the research, suicide was 32 times more likely after discharge: 171.7 people in every 100,000 died after leaving hospital, compared to 5.3 in every 100,000 for the general population

Intentional self-poisoning was 41 times more likely: 57.1 people in every 100,000 died after hospital discharge, compared to 1.3 in every 100,000 for the general population

And death from fatal psychotropic drugs poisoning , irrespective of intent was over 90 times more likely: 25.6 people in every 100,000 after hospital discharge, compared to 0.2 in every 100,000 for the general population.

Professor Webb said: “When we look at detailed causes of death, each one is markedly raised whether that’s traffic accidents or poisoning.

“So it’s clear this group of people is more vulnerable to dying from a variety of different unnatural causes after discharge, although the risks for each of these causes are nonetheless relatively low in absolute terms.

”However, it’s important to point out hospital is not a cause of unnatural death as these patients are a young cohort already from high risk groups; therefore the risk of dying could be even higher without hospitalisation.”

Florian Walter said: “This is the first study to look at the full range unnatural causes of death among mental health patients after discharge from hospital ever carried out.

“The Danish system is ideal for this sort of research because Danes are given a unique identification number which provides data that are entered into several national registers.”

A previous study by Walter, published in JAMA Psychiatry in 2017, found that patients are most at risk in the first month after discharge.

He added: “The overarching message is that transition from hospital to community is riskier for these people, especially during the first few weeks after discharge.

“Therefore mental health services need to develop broad strategies that include enhanced post-discharge surveillance. These strategies must account for the fact that discharged patients have higher risks of dying unnaturally in lots of different ways.

“We also think better liaison between inpatient and community services is important so that services can be more vigilant about patients taking their medication correctly at the doses prescribed.”

The paper: a national cohort study is published in the Journal of Clinical Psychiatry.

A University of Manchester research team has received a prestigious Royal College of General Practitioners award for their work on adolescent self-harm.

 Their 2017 study, uncovered a steep rise in reported self-harm in teenage girls.

The award gives recognition to an individual or group of researchers who have undertaken and published an exceptional piece of research relating to general practice or primary care.

The trend in 13 to 16-year-old girls from 2011 to 2014 was not seen in boys or other age groups.

The study was published in the British Medical Journal and funded by the National Institute for Health Research

It used anonymised patient records collected from 674 GP surgeries through the Clinical Practice Research Data Link.

The research team consisted of academics from the University of Manchester, including researchers from the NIHR Greater 91ֱ�� Patient Safety Translational Research Centre, the Centre for Health Informatics and the 91ֱ�� Academic Health Science Centre, alongside Professor Carolyn Chew-Graham, Professor of General Practice with Keel University.

Children and teenagers who self-harmed were nine times more likely to die unnaturally than unaffected young people with an especially marked increased risk of suicide and acute alcohol/drug poisoning death.

The study also highlighted a social divide, with the highest rates of harm and lowest referral rates being observed in the most deprived areas.

Dr Cathy Morgan, who was the first author on the paper, said: “We are delighted to receive this prestigious award to further highlight this important area of work. Self-harm is the biggest risk factor for subsequent suicide. Our findings prompt the urgent call for medical, social and public health services to come together to understand and address these worrying trends and ensure vulnerable young people get the help and support they need.”

The research team have donated the prize money to , a 91ֱ�� based charity supporting young people with their emotional wellbeing and mental health.

Further analysis suggested the intervention might prevent five stillbirths for every 10,000 babies born. The effects were too small to prove that the care package had been beneficial, however. The team say further research will be needed.

91ֱ�� lead Professor Jane Norman, Director of the Edinburgh Tommy’s Centre at the University of Edinburgh, said: “The study was designed to detect an effect of 30 per cent or greater. The results suggest that if there is a beneficial effect, it is much smaller than this. It is not possible to say with certainty that the intervention has any effect on reducing rates of stillbirth.

“The research adds further evidence to suggest that being aware of baby movements may help to marginally reduce risks of stillbirth, but it is unlikely that this strategy alone will be reliable for monitoring the wellbeing of babies in the womb. Other interventions will likely be needed to reduce stillbirth rates worldwide.”

In the group that received the care package, more women were induced early and there were higher rates of caesarean section deliveries, the study found.

Researchers say an economic analysis of these data will help policy makers assess whether this approach might fit into a stillbirth reduction strategy.

Professor Alexander Heazell, co-investigator on the study, said: “There are a number of other ongoing fetal movement awareness studies. Results from the AFFIRM trial should be analysed in conjunction with those studies before recommendations can be made on wider implementation of this approach.”

An estimated 2.6 million babies are stillborn each year around the world. In the UK, around 1 in 200 pregnancies end in stillbirth, around 9 babies every day.

Up to a half of women whose pregnancy ends in stillbirth report reduced movements of their babies in the womb in the previous week.

Jane Brewin, Chief Executive of Tommy’s, said: “We know that reduced baby movements is associated with the placenta not working so well and the baby’s health being compromised. The advice for mums-to-be remains the same – if your baby’s movements change please consult your midwife or local maternity unit immediately.”

The study, published in The Lancet, was initiated and funded by the Scottish Government’s Chief Scientist Office. It was also funded by Tommy’s, the baby charity, and Sands, the Stillbirth and Neonatal Death Charity.

Dr Clea Harmer, Chief Executive at Sands (stillbirth and neonatal death charity), said: “Women’s awareness of their baby’s movements remains a key part of public health information during pregnancy. At least 1 in 3 of the parents Sands supports tells us that their baby’s movements had slowed down or changed in the womb before they died. Getting the message out that women need to report any concerns straightaway remains vital to routine antenatal care.”

The human body clock could have a significant impact on the way doctors are able to diagnose and treat asthma, according to new research.

91ֱ�� leader Dr Hannah Durrington from The University of Manchester says the work has important implications on clinical practice in asthma and other inflammatory conditions.

The study of over 300 severe asthmatics found their sputum samples were more than twice as likely to have more inflammatory cells - or eosinophils - in morning clinics than in the afternoon.

Levels of eosinophils - a biomarker in sputum - are used to guide treatment in severe asthma patients.

The study was funded by Asthma UK, the JP Moulton Charitable Trust, the North West Lung Charity and also the NIHR 91ֱ�� Biomedical Research Centre.

It is published in the American Journal of Respiratory and Critical Care Medicine.

Doctor and patients have long known that asthma symptoms are at their worst in the small hours of the morning.

But previous research has shown that the worsening symptoms are biological in cause, rather than a result of lying down.

Dr Samantha Walker, Director of Research and Policy at said: “This is an exciting preliminary study that reveals how powerful the body clock can be. If doctors and nurses know that the time of day can affect someone’s asthma they will be able to diagnose and treat them more effectively.

“Around 5.4million people in the UK have asthma and it can have a huge impact on their life, leaving them gasping for breath and at risk of a potentially fatal asthma attack. But asthma is a chronic condition with complex causes and triggers that can differ from patient to patient. More research into better ways of diagnosing asthma is urgently needed to develop better tests and to help develop more targeted treatments. For more information on how Asthma UK is supporting research and to get involved visit .”

Dr Durrington said: “These research results are really exciting but at an early stage – our aim was to understand a bit more about how the body clock affects the biochemistry of a person with asthma.

“But we are pleased because our work should help with the accurate diagnosis and treatment of asthma in the future.

“We feel it may also have important implications on other lung conditions, as well as outside respiratory medicine.

“Based on our results, different clinical decisions could be made depending on whether the patient is allocated a morning or afternoon appointment.

“And it also points towards opportunities for more personalised treatment for asthma care in the future.

“In the same way that measuring glucose levels in diabetes allows adjustment of insulin dosing, we may see asthmatics monitoring their biomarker chemicals during the day, to help inform optimum treatment times.”

The University of Manchester is home to the largest biological timing . Dr Durrington also provides an asthma clinic at Wythenshawe Hospital, 91ֱ�� University NHS Foundation Trust (MFT).

The paper, '' is published in the American Journal of Respiratory and Critical Care Medicine. DOI: 10.1164/rccm.201807-1289LE