Projects Delivered

Frailty and multi-morbidity are terms used to describe people at risk of worsening health, increasing disability and death. These are often older people who have multiple health problems and frequently present to health and social care services at a point of crisis. However, identifying these vulnerable people earlier may allow extra support and assessment to prevent such crises. There are multiple ways of identifying multi-morbid people, but our current record systems for primary care (GP practices) and secondary care (hospitals) are not well connected. In this project, we aim to bring data together data from GP and hospital records to provide a combined view of patients’ health. We will provide reports of multimorbidity that may be used to test new approaches to the care of these patients. No individual level patient data will be shared as part of this project.

‘Atrial fibrillation’ is the term used to describe an irregular heartbeat, a common condition that often requires treatment with blood-thinning medication (‘anticoagulation’) to reduce the risk of stroke. Until recently, most patients were treated with blood-thinning medication called warfarin. However, patients taking warfarin need regular blood tests to monitor the drug levels and can require dose changes following these blood tests.

However, new drugs called ‘Direct Oral Anticoagulants’ (DOACs) have recently been developed. In patients with atrial fibrillation and normal kidney function, these drugs are as safe and effective as warfarin, but without the need for any blood tests or dose changes, making them much more acceptable to patients. Few studies have looked at whether these drugs are safe and effective in patients with either very bad or very good kidney function. This is important because these extreme levels of kidney function can be quite common – perhaps affecting ~1 in 5 patients – and also because DOACs are mostly removed from the body by the kidneys. Therefore, it is easy to appreciate that abnormal kidney function might impact on the amount of drug left in your body.

Here, we will use a large dataset containing a range of reliable and accurate data collected as part of patient care to improve our understanding of the safety and effectiveness of DOACs, compared to warfarin or no anticoagulation treatment, in patients with atrial fibrillation and abnormal kidney function."

There have been reports of rare and specific blood clots after vaccination with Covid-19 vaccines. There is a need to determine this risk for individuals as early as possible. This study will determine if the risk can be identified during a hospital admission.

Where people live in households or neighbourhoods is closely associated with a range of socio-economic and other factors. Many such factors are key to answering questions and providing solutions in the advanced care setting. For example, from one’s address, we can infer whether someone is a care home resident (type of residence), or lives in an affluent or deprived area, or one with high or low air pollution (environmental factors). In principle, GP registration address recorded in the Community Health Index (CHI) would allow us to accurately identify where someone lives (beyond existing uses of address postcode which is less fine grained). Utilising the Unique Property Reference Number (UPRN) created by the Ordnance Survey (OS), we can develop a more granular picture of where people live utilising a coded system that removes the need for addresses, reducing identifiability of data for research and innovation.

Compared to babies born vaginally, babies born by planned Caesarean section are at a higher risk of developing breathing difficulties, and of requiring NNU admission. This risk decreases as the pregnancy progresses; for this reason, most planned Caesarean births are scheduled from 39 weeks’ onwards. However, 10-15% of women scheduled for planned Caesarean require delivery before 39 weeks’, known as “early term” (37 to 38+6 weeks). National guidelines released in 2010 recommended that these women are offered ACS, to reduce the likelihood of their babies developing breathing problems and of requiring NNU admission.

However, the risk of breathing difficulties in babies born from 37 weeks’ onwards is small, and the evidence to support the benefits of ACS before planned Caesarean is limited. Approximately 101 babies need to be exposed to ACS to prevent one case of respiratory distress syndrome. Additionally, evidence has emerged suggesting ACS exposure near the end of a pregnancy may be harmful for babies, increasing risk of low blood sugars in newborns, and associated with increased risk of mental and behavioural disorders in childhood. This has impacted upon ACS prescribing, although current practice (and associated trends) is unknown.

Unfortunately, some older people develop frailty due to worsening health and weakened health reserves. Specialist care can improve outcomes for frail older adults, but this may be difficult to prioritise in busy hospitals. Despite this, many markers of frailty such walking difficulties and memory problems are routinely noted in hospital records. These can be grouped into a summary score called a frailty index, to help identify patients at risk. In this study, we will test the value of a frailty index score recently implemented in the Royal Infirmary of Edinburgh. We will do this by seeing if it has identified people at risk of deteriorating health, hospital readmission or death. We will also see if adding further information about patients’ health conditions, medications and blood results could improve the frailty index further. We aim to maximise the value of information already collected in hospitals to prioritise good care for older people.

Delirium is a sudden-onset serious disturbance in mental abilities that affects 1 in 4 older hospitalised patients. It is highly distressing for patients and carers.

The cause of delirium is unknown but delirium is associated with poor health events such as a higher risk of dying, staying long in hospital or future mental health decline. This suggests that delirium may be a marker of brain health and dementia risk. However, there are no large-scale studies which have explored possible clinical indicators of delirium and their relationship with poor health events. Clinical indicators include blood tests or body measurements such as blood pressure and oxygen levels. 

This project will identify clinical markers that are important in people with delirium and how these are related to poor health events. Research in this area will contribute to our knowledge of delirium and may improve how it is identified and managed in hospitals.

Public Health Scotland have identified 8 cases of hepatitis in children in Central Scotland, with no known
cause. This project is looking to understand whether this is more widespread than these known cases to
inform policy decisions.