Projects Delivered

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.

More than one third of patients seeking urgent hospital treatment in Scotland do so because of breathing
difficulties. Research tends to focus on diseases (e.g. asthma) rather than symptoms like breathlessness.
The patient journey across different parts of the health service has not been well studied.

In this project, we will study patients that attended the Royal Infirmary of Edinburgh’s Emergency Department
with breathlessness and investigate what happened next. We will look to better understand the patterns of
referrals, tests, appointments, and other outcomes that follow a hospital attendance. We will try to
understand the effect of the COVID-19 pandemic on this group of patients. Our analysis will use techniques
that help predict how likely it is that a patient will follow a particular treatment pathway. The purpose of this
work is to guide improvements in these pathways in the future, for example by reducing unnecessary delays
to treatment or testing.

Heart disease is common and a heart attack is the leading cause of death or disability in older patients. In our research so far, we have shown that older patients receive fewer recommended treatments for a heart attack compared to younger patients, despite being at higher risk of future heart problems and therefore potentially having the most to gain from therapy. Multiple health problems and the risks of complications make it more difficult for clinicians to choose the best treatment for many older patients.

We want to learn the reasons behind treatment differences between younger and older patients and use this information to develop tools, personalised for each patient, which can aid decision making in this increasingly common patient group. This will help patients and their families make informed decisions about their care and doctors to identify patients who will benefit from treatments, regardless of age.

New medicines are in development that may reduce the risk of cancer recurrence and improve survival after treatment for early breast cancer. The UK regulators and NHS Scotland need strong evidence on the value of new treatments prior to approving medicines as standard care paid for by the NHS.

While clinical trials can provide much of this evidence, there is also a need to provide evidence on the current ‘real-world’ patient population, standard treatments and current outcomes.

The project will generate real world evidence on the current early breast cancer patient pathway. Analysis takes place within the NHS by NHS staff, with only a summary report that does not contain individual patient data being released for the purposes of NHS Health Technology Assessment.

The project output will enable NHS decision makers to make better informed reimbursement decisions on future medicines to ensure the NHS is providing high value care to the patients it serves.