Public Health Wales Research and Development 2013/14
The following table contains all research and development projects which concluded in the 2013/14 financial year.
# / Project Title / Lay Summary / Public Health Wales Investigator / Useful Links and Publications1 / SUPERLY Pro-Ex / This is a study of two additional tests to be carried out on cervical screening samples, in order to find out if it might be possible to safely reduce the number of women referred to hospital as a result of having abnormal smears. Taking part in the study will not involve having any extra samples taken or any change of treatment. Women will be invited to take part if they have been referred to colposcopy clinic after having had at least two abnormal smears. If they consent to being included in the study, their most recent smear will be tested with the new test (ProExC) and for human papillomavirus (HPV). The results of these tests will be compared with the results of the biopsies taken in colposcopy as part of routine practice and then with the result of any subsequent smear tests or biopsies taken as part of their normal clinical care over the next two years. / Dr Anne Hauke (Regional Coordinator,
Cervical Screening Wales)
/
Lippiatt,J.A.(2013). Human papillomavirus and biomarker analysis to
predict high-grade cervical disease in women with
persistent low-grade squamous cytological
abnormalities.Ph.D. Thesis. Cardiff University: U.K.
2 / Exploring attitudes to HPV self-sampling among a socially-stratified sample of Welsh women / The introduction of Human Papillomavirus (HPV) self-sampling is being discussed however as yet, no policy has been set. Self-sampling is a method where a woman can collect a sample of her own cells for HPV DNA testing. HPV self-sampling has been shown to have similar specificity and sensitivity to clinician sampling, is more sensitive than cytology and potentially avoids embarrassment and discomfort concerns associated with smear testing. This doctoral research aims to investigate women’s attitudes towards HPV self-sampling by incorporating the theoretical framework of the Extended Health Belief Model (EHBM) and particularly focusing on the concept of self-efficacy. / Dr Anne Hauke (Regional Coordinator,
Cervical Screening Wales)
/
3 / Validation and application of cryptosporidium oral fluid immunoglobulin assays / Options for assessing whether an individuals or groups of people have had recent exposure to the parasite Cryptosporidium, a major cause of gastro-intestinal illness, are limited. For individuals, diagnosis of ensuing illness by testing stool samples for the parasite is usual. However, routine laboratory tests are not very sensitive for detection of the parasite, and not everyone will become sick and seek diagnosis. To study groups of people, blood samples can be tested for antibodies (specifically immunoglobulin G) which develop following infection. However, this is invasive, and not desirable for children who are of special interest as they are at high risk of infection. Newly-published methods for detecting antibodies in oral fluid involve a non-invasive, convenient sample collection process but the assays need further evaluation and validation as indicators of recent infection. If proven successful, the assays will be of great benefit for outbreak investigations and population exposure and risk studies into Cryptosporidium. / Professor Rachel Chalmers (Clinical Scientist, Public Health Wales Health Protection)
/ Annual Report: April 2010 - March 2011 - Reference Laboratory Service for Cryptosporidium
4 / Blood Stream Infections focus on outcomes Phase 1 / Infection is a major concern in British hospitals and it is estimated that there are around 90100,000 cases of Blood Stream Infections (BSI) every year. The death rate from these infections can be very high 10-30% and for certain organisms can reach 50%. Blood stream infections with Methicillin resistant Staphylococcus aureus, Pseudomonas aeruginosa, extended spectrum Blactamase producing E.coli or Klebsiella spp and Candida spp. have been particularly associated with high levels of mortality following infection. A number of factors are thought to play a role in poor outcome, in particular underlying disease and the site and severity of infection. In contrast, timely appropriate use of antibiotics and removal of infected prosthetic materials are thought to be beneficial from small single centre studies. Ward staffing levels are also thought to have a role. All these factors will be examined in more depth in this multicentre study to see what effect they have and how they can be changed to improve patient care and outcome of disease following a BSI. The results of the study will then be fed back into the NHS to modify practice to improve patient care and outcome. / Dr Robin Howe (Consultant Microbiologist, Public Health Wales)
/
5 / Giardia Typing Pilot Study / Up to 200 cases of the gastrointestinal illness giardiasis, caused by the protozoan parasite Giardia duodenalis (syn. lamblia), are reported in Wales each year. Some cases are acquired abroad but outbreaks have occurred here, especially in institutional settings resulting in exclusion and ensuing impact on carers. Clusters of cases are reported in Wales among people who have not been abroad, but it is often unclear what links, if any, there are between them. Current methods of detection rely on microscopical examination of stools to observe the presence of the parasite. However, due to the organism’s invariant morphology, this does not differentiate between “strains” (assemblages). Differentiation of assemblages may assist investigations into case relatedness, and source identification, as has been demonstrated during outbreak investigations abroad. Although two assemblages are found in humans, it is suspected that assemblage A contains more subtypes originating from animals and that assemblage B may be predominantly human in origin, but we do not know what the distribution is in Wales. Assemblage typing could be readily implemented by the national Cryptosporidium Reference Unit (CRU), Public Health Wales Microbiology ABM, where the technological platforms and proven scientific expertise in molecular parasitology are already in place for Cryptosporidium typing. In a one year pilot study, stool samples submitted for routine investigation of gastrointestinal illness in which Giardia is detected, will be blind coded and further tested by assemblage typing. The typing data will be added to patient exposure data which is collected as part of routine investigation and follow-up of cases, and analysed for trends and statistical associations to see if the additional information helps explain sources of infection and links between infections. If it is found to be of help, then Giardia typing can be considered for inclusion as part of Public Health Wales' service delivery. / Professor Rachel Chalmers (Clinical Scientist, Public Health Wales Health Protection)
/ Elwin, K., Fairclough, H., and Chalmers, R.M. (2013) Giardia typing– following in crypto’s footsteps? [Presentation slides]
6 / Point Of carE Testing for urinary tract Infection in primary Care (POETIC) (Stage 1 and Stage 2) / Fifteen percent of community antibiotic prescriptions are for uncomplicated urinary tract infections (UTI’s). Most women presenting with UTI symptoms are prescribed an antibiotic agent. However, 34%-60% of patients treated with an antibiotic do not have a microbiologically proven UTI and 25% of those with a positive culture are not prescribed antibiotics. This is important in terms of improving outcomes for women with symptoms of UTI. Unnecessary use of antibiotics contributes to the development of resistant bacteria, an important and increasing public health threat. One approach to improving the management of women with symptomatic UTI is to use technologies that incorporate near patient culture techniques. One such technology is the Flexicult system, which is a novel point of care test. This POCT uses specific chromatogenic agar to identify bacteria, and can be impregnated with antibiotics of choice to identify any antibiotic resistant bacteria. The results of this test are available to the Clinician within 24 hours, enabling a
more accurate diagnosis and better decisions about treatment regime. Timely identification of a bacterial pathogen, and its antibiotic resistance profile, in urine samples from women presenting with symptomatic UTI in primary care, could help reduce the overall use of antibiotics and help ensure that the most appropriate antibiotic is used for women who are likely to benefit from antibiotic treatment (avoiding the use of antibiotics where no bacterial infection is identified, and ensuring the narrowest spectrum antibiotic to which the infecting bacteria is sensitive to).This will not only improve the care of patients presenting with symptomatic UTI, it will
also help reduce the selective pressure that comes from widespread unnecessary antibiotic use which is an important contributory mechanism in the development of antimicrobial resistance.
The two stages described here will allow us to:
1. Assess the feasibility of integrating such a test into general practices as well as the acceptability for both prescribers and patients.
2. Assess the variation in current management that could be changed by utilising a new POCT.
Both of these are required before a full scale implementation RCT of the test can be undertaken. / Dr Robin Howe (Consultant Microbiologist, Public Health Wales)
/
7 / Laboratory Evaluation and Development of Rapid Diagnostic Tests for Urinary Tract Infection / Around 80% of all antibiotics in the UK are prescribed in primary care. With the development of antibiotic resistance and few new antibiotics, the need for change is paramount. Point of care tests are considered to be a useful tool in helping GPs to make a decision as to whether to prescribe antibiotics or not. Though many point of care tests (POCTs) have been developed many are not used as they are not feasible for practical use in settings like GP surgeries. This is because they are often to complex, expensive or timely.
This project focuses on the development of a potential new point of care test to guide GPs in prescribing antibiotics to patients with suspected urinary tract infection (UTI) or acute cough. The test uses a new technology called chromatic sensing. If successful this test would be inexpensive, easy to use without the need for reagents or laboratory equipment and produce results within minutes.
Chromatic sensing uses current information technology such as laptop computers and mobile phone systems to
capture and analyse images of samples. Images of urine (for UTI) or sputum (for acute cough) are analysed according to the red, blue and green (RBG) wavelengths of the image of the sample. The RBG signals are translated into effective signal strength, dominating wavelength and signal spread synonymous with the parameters of colour science. We hope to determine a difference between bacterial positive and bacterial negative urine and sputum samples according
to these parameters.
The aim of this study is to explore whether chromatic sensing can distinguish between bacterial positive or negative urine and/or sputum samples and be helpful in guiding clinicians in their decision to prescribe antibiotics. The primary objectives are to refine and optimise the setup for taking images of urine and sputum samples using either laptop and webcam system or a mobile phone and to determine whether chromatic sensing can distinguish between bacterial culture positive or negative urine and/or sputum samples. / Dr Robin Howe (Consultant Microbiologist, Public Health Wales)
8 / Investigating long-term health effects of Cryptosporidium occurring in the twelve months following acute infection: an outbreak follow-up study / The study will follow-up a group of people who were part of an outbreak of cryptosporidiosis occurring in the North of England and Scotland during May 2012. We will approach potential participants, seek informed consent, and ask them to complete a health related questionnaire at 3 months and again at 12 months after they were diagnosed with Cryptosporidium infection. Environmental Health Officers routinely conduct 'exposure' questionnaires with cases of Cryptosporidium at the time of their diagnosis. We will link data from exposure and follow-up study questionnaires.
The outbreak follow-up study aims:
-Toinvestigate those health sequelae of Cryptosporidium infection which occur after the acute infection has resolved (postacute health sequelae).
-To investigate whether people who have had Cryptosporidium infection are at an increased risk of Developing symptoms consistent with post-infectious irritable bowel syndrome. / Dr Rhianwen Stiff (Specialty Registrar, Public Health Wales)
9 / Validation of Matrix Assisted Laser Desorption/Ionisation-Time of Flight (MALDI-TOF) for identification of Neisseria Gonorrhea / The purpose of this project is to determine which identification system is the most sensitive and specific for the identification of cultured N. Gonorrhoea from clinical specimens and also to determine which method will provide results within the time and budget constraints of the laboratory. The study also aims to evaluate the antibiotic susceptibility to Cephalosporins and Macrolides within these bacteria.
As new technology is being developed and entering clinical laboratories, it is important to determine if this technology will be of benefit to the Cardiff laboratory and not implemented because it is new. Also it is important to determine a method that will provide the laboratory with reproducible results in a timely manner, as well as providing the clinician with a confirmed positive or negative result which will ultimately help with treatment efficacy. / Paula Brookes (Operational Manager- Bacteriology Public Health Wales Cardiff)
10 / Using the All Wales Clinical Governance Practice Self Assessment Tool for general medical practices – assessing the opinions of health care professionals / Clinical governance is a framework for the improvement of patient care through commitment to high standards, reflective practice, risk management and personal and team development. The Clinical Governance Practice Self Assessment Tool (CGPSAT) for general medical practices is about monitoring outcomes, identifying errors, reviewing activity and continually learning and developing. It is about sharing knowledge and experience, both good and bad. This study proposes to develop a questionnaire-based evaluation tool that can be used by Public Health Wales to determine what benefits(or not) have been derived by health care professionals who have completed the CGPSAT. If Public Health Wales decide that the service tool develop as part of this study is fit for purpose they will adopt it and provide feedback to the researcher based on the responses they receive from the questionnaire. If the questionnaire is not adopted they will provide feedback as to why. The researcher will review the feedback and information receive from Public Health Wales to review the service evaluation tool and identify any further improvement that are required or can otherwise be made. / Dr Paul Myres (Professional Lead, Primary Medical Care Advisory Team, Public Health Wales)
11 / Barriers to Uptake of Smoking Cessation Services in Pregnant Women in Cwm Taf (BASICS) / The study aims to identify ways to improve the support for pregnant women who wish to give up smoking in the region served by the Cwm Taf Health Board, South Wales. A questionnaire will be used to ascertain the views of recently pregnant mothers on the opportunities available to give up smoking during pregnancy. / Mrs Angela Jones (Consultant in Public Health, Public Health Wales)
/ Cancer Annual Report Cwm Taf Health Board October 2013
12 / (APP-cohol awareness)- supporting people to drink less alcohol using a smart phone app and scratch card recorder / Project objectives are to:
a)identify appropriate target ‘user’ groups
b)determine how best to direct the target users to the app and scratch card
c)determine what health messages should be used to support behaviour change by the users
d)determine whether and to what extent the app and scratch card can effect behaviour change and reduce alcohol consumption. / Dr Sarah Jones (Consultant in Environmental Health Protection, Public Health Wales) /
13 / Intervention Now To Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT) / The overall aims are to identify and evaluate the effectiveness of interventions for preventing repeat unintended pregnancies amongst adolescents, and to investigate the barriers and facilitators for their implementation and uptake. Whilst these overall aims are broad, the focus will be on the implementation of interventions; specific research objectives are to determine:
- What factors characterise subgroups who are at greater risk of repeat unintended pregnancies (i.e. what are the predictors of repeat unintended pregnancy)?
- Which (elements of) interventions appear to be effective, how do they work, in what setting, and for whom (conversely, why are they ineffective, why don’t they work)?
- What are the barriers and facilitators to the acceptability, uptake, and implementation of interventions?
- What is the relative cost-effectiveness of interventions?
/ Rhiannon Whitaker1*, M. Hendry1, A. Booth2, B. Carter3, J. Charles1, N. Craine4, R.T. Edwards1, M.Lyons4, J.Noyes1, D.Pasterfield1, J.Rycroft-Malone1, N. Williams1 (1. Bangor University LEAD INVESTIGATOR, 2. University of Sheffield, 3. Cardiff University, 4. Public Health Wales) (2014)Intervention Now To Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, qualitative and realist synthesis of implementation factors and user engagement.BMJ Open. 4(4)
Whitaker R, Hendry M, Aslam R, Booth A, Carter B, Charles JM, et al.Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement. Health Technol Assess 2016;20(16)
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