Blog by Lynsey Spillman
I’m a clinical Dietitian working with liver transplant patients. When people have recovered from liver transplant, they often find they gain unwanted weight, and get high blood pressure, diabetes and raised cholesterol. This means they become more at risk of getting cardiovascular disease. My patients have told me they would like help to prevent weight gain and achieve a healthier lifestyle. They want to look after the new liver they have been given.
To know how to best help these patients, we need to find out what they eat, how physically active they are and what influences these behaviours after a liver transplant. This is important to investigate because previous research suggests their behaviour is different to the diet and physical activity behaviours of the general public. Often, for example, we find that they are frightened that exercise might cause them harm. They may experience insatiable hunger after transplant and they may get a taste for the high calorie foods that they needed before their transplant was carried out.
A group of people who have had a liver transplant have been helping me to understand the research questions that are important to them and how to make the research suitable and relevant for people after a liver transplant. I hope that all healthcare professionals working with people who have a liver transplant will be interested in my findings and other researchers who are interested in developing interventions to reduce the risk of cardiovascular disease for these patients.
The findings should be of interest to healthcare professionals and researchers working in other areas, such as kidney transplant or promoting long-term health after other treated medical conditions, like cancer or stroke. Understanding what people eat, how physically active they are and the reasons for this, will help to better focus strategies for improving diet and activity.
About the research environment for clinical dietitians at CUH
In 2013 Professor Christi Deaton started work to improve the research culture and capacity for nurses, midwives and allied health professionals (NMAHPs), including dietitians, at Cambridge University Hospitals. Christi has now established a strategy for developing NMAHP research and established a NMAHP research leadership group. The dietitians became part of this leadership group and have been working with Christi, the Clinical Nursing Research Group (CNRG) at the Primary Care Unit, clinicians and research colleagues from across the Trust to implement the research strategy.
CUH dietitians have always used evidence to inform their practice and engaged with research activities alongside clinical work. Gillian Gatiss, liver transplant dietitian, was a member of one of the first cohorts to be awarded the Health Education England (HEE) and National Institute of Health Research (NIHR) Masters in Clinical Research and two further dietitians have since completed this. Gillian has obtained HEE/NIHR funding to pursue her PhD and started doctoral research within the CNRG in June 2017.
With growing interest and support for dietetic research, the dietitians have now developed their own research strategy, led by myself, hepatology dietitian, and Caroline Heyes, dietetic services manager. Caroline and I presented the plans for implementing the dietitians’ strategy at the 2018 NMAHP Research conference ‘NMAHP research and practice: breaking down barriers’.
The dietitians’ research strategy has been developed around the pyramid shown above, developed using guidance from the British Dietetic Association and the Association of UK University Hospitals. The vision is to have all dietitians at level one and support from the department, Trust and local Universities to enable dietitians to progress up to level four.
My research programme
I had the time and support to develop my research ideas, thanks to my internal research fellowship award from Addenbrooke’s Charitable Trust and the Cambridge Biomedical Research Centre. Professor Simon Griffin and his team at the MRC Epidemiology Unit have been advising me on the methods to use to undertake my own research – invaluable support to help me plan well-designed research.
I plan to undertake 3 linked studies.
• A systematic review of the literature investigating diet and physical activity and their determinants in liver transplant recipients.
• A cohort study will investigate the diet and physical activity behaviours of liver transplant recipients and examine their associations with cardiovascular disease risk, quality of life and behaviour determinants.
• Qualitative semi-structured interviews at 6-12 months post-transplant will be used to explore patients’ experiences of diet.
“Just like The Apprentice”
In July this year I attended the NIHR annual trainee camp. I was put into a group with six other doctoral-level researchers with different professional backgrounds. Just like participants in the BBC’s The Apprentice, we had 24 hours to develop a research idea and write a competitive grant application. We had multiple mini tasks to achieve in this time and had to work strategically to get everything completed. We presented our proposal to a panel of experienced researchers and were joint winners with another team. With this experience I gained friends, future collaborations (with a statistician and psychologist), and skills with presenting, team working and writing grant applications. It was fantastic!
About Lynsey Spillman: Lynsey is a clinical Dietitian at Addenbrooke’s hospital, working with liver transplant patients. Lynsey has been awarded a NIHR Doctoral Research Fellowship and will begin her doctoral research on the diet-related health issues of liver transplant patients in Autumn 2018. She’ll be joining the MRC Epidemiology Unit’s Prevent Group and the Cambridge Biomedical Research Centre’s ‘nutrition, diet and lifestyle’ theme in November.
Media queries: Lucy Lloyd, Communications Manager at the Primary Care Unit
Image: Wikimedia Commons