This is a developing list of current projects that the Primary Care Unit is running or collaborating in. To submit a new project, please use this form [STAFF ONLY]

Older or completed projects are not available for view at this time.

RECON – Reducing and preventing Cognitive Impairment in older age groups

Title:	REducing and preventing COgnitive impairment iN older age groups (the RECON Programme)
Project Description:	To develop and test efficient internet-supported healthy behaviour/cognitive exercises to reduce cognitive decline among older age adults.
Project organisation
Start date:	1st January 2017
End date:	31st January 2027
Contact person:	Professor Simon Griffin
Contact Details:	Primary Care Unit Institute of Public Health University Forvie Site, Robinson Way Cambridge Cambs CB2 0SR UK Telephone: (01223) 330307 Fax: 01223 762515 E-mail: profgp@medschl.cam.ac.uk
Collaborative:	Prof Paul Little (Lead) Yardley L Ballard Griffin S Griffiths G Kendrick A Mutrie N Rathod S Robinson L Rossor M Stuart B Yao GL
Further Information, References and Publications
Website : https://www.southampton.ac.uk/medicine/academic_units/projects/recon.page#project_overview

REACH-HFpEF Study – A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers

Title:	A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: the REACH-HFpEF Study
Project Description:	Aim To assess the effectiveness and cost-effectiveness of home-based cardiac rehabilitation programme ‘REACH-HF’ plus usual care (intervention) versus usual care alone (control) in heart failure with preserved ejection fraction (HFpEF) patients and their caregivers.Methods Design: Multicentre parallel two group randomised (1:1 patient allocation) superiority trial with nested process and health economic evaluations and an internal pilot phase.Participants: 520 patients with HFpEF and their caregivers. Setting: 15 sites across England, Scotland, and Wales. Intervention: REACH-HF is a comprehensive home-based cardiac rehabilitation (CR) and self-management programme informed by evidence, theory and service user perspective. It comprises the ‘Heart Failure Manual’, a Relaxation CD, a choice of exercise (walking programme or a chair-based exercise DVD), a ‘Progress Tracker’ tool for patients, and a ‘Family and Friends Resource’ for caregivers. Participating patients and caregivers work through the manual over a 12-week period with facilitation by a trained healthcare professional (e.g. heart failure-specialist nurse or rehabilitation physiotherapist) using both face-to-face support and telephone support. Control: both intervention and control patients will receive usual medical care. Primary outcome: Minnesota Living with Heart Failure Questionnaire score at 12-months.Secondary outcomes: deaths and hospital admissions; blood-borne biomarker; exercise capacity; physical activity levels; psychological well-being; generic quality of life; frailty; selfcare; self-efficacy. Caregivers: burden, generic quality of life, psychological well-being; Collected at baseline (pre-randomisation), and 4 and 12-month post-randomisation. Data analysis Statistics: Main analysis will take an intention-to-treat approach (based on complete data at 6-months). For continuous outcome measures, we will use mixed-effects regression with a random effect of recruiting site and adjusting for baseline outcome score and minimisation variables. Economic evaluation: With-in trial cost-utility analysis over the 12-months. Process evaluation: Case-based mixed methods analysis. Timetable Months 1-6: Setup (approvals, site selection/recruitment, CRF/database development, patient identification); Months 7-36: Recruitment for 18-months (months 7-15: 9-month internal pilot and months 16-24: remaining recruitment completion) and follow-up for 12-months (month 36: end of 12-month follow-up); months 37-42: Analysis, reporting, and dissemination. Expertise Multidisciplinary research team: established track record in the successful delivery of complex intervention pragmatic trials with expertise in cardiology, rehabilitation, clinical trial design, behaviour change, biostatistics, health economics, process evaluation, and patient and public involvement. Impact Given their high unmet need for effective and cost-effective therapies, if positive, the findings of this trial will fundamentally impact the outcomes research of HFpEF patients and their care givers. Results will inform future national and international guideline and provide guidance to health professionals and healthcare commissioners on the need for rehabilitation and how to deliver it efficiently and effectively.
Project organisation
Start date:	1st March 2021
End date:	31th August 2025
Contact person:	Professor Christi Deaton
Contact Details:	Primary Care Unit East Forvie Building Robinson Way Cambridge CB2 0SR UK E-mail: cd513@medschl.cam.ac.uk
Funding information
Funding Organisation:	National Institute for Health Research
Funding Amount:	£2,195,202

Further Information, References and Publications

AI-Skin – Understanding and implementing artificial intelligence technologies to improve skin cancer assessment in primary care settings

Title:	AI-Skin – Understanding and implementing artificial intelligence technologies to improve skin cancer assessment in primary care settings
Project Description:	Skin cancer, including melanoma and the keratocytic carcinomas (basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC), previously known as non-melanoma skin cancers), has one of the highest global incidences of any form of cancer. In the UK in 2016 more than 16,000 people were diagnosed with the deadliest skin cancer, melanoma (Cancer Research UK). Over the last decade the incidence of melanoma has increased by 50% in the UK, and about one in ten melanomas are diagnosed at a late stage. Among the keratinocytic carcinomas, BCC is the most common cancer amongst Caucasian populations. Primary care clinicians have a vital role to play in detecting and managing patients with skin lesions suspected to be skin cancer, as timely diagnosis and treatment can improve patient outcomes, particularly for melanoma. However, detecting skin cancer can be challenging, as common non-malignant skin lesions share features with less common skin cancers. In recent years there has been huge interest in the application of artificial intelligence (AI) to medical diagnosis in general. One key area is cancer detection and diagnosis, and emerging AI technologies and diagnostic aids may soon become available for use in primary care and community settings to aid the triage of suspicious skin lesions (Esteva et al, 2016; Marchetti et al, 2018). We aim to address the following questions: 1. Which AI technologies for detecting possible skin cancer may be ready for evaluation prior to implementation in the primary care setting? 2. What will be the costs and benefits of such implementation to patients and to the NHS?The project will have three main parts: Study 1: a scoping review of the current evidence about AI technologies for detecting possible skin cancer. Study 2: a discrete choice experiment (DCE) with primary care clinicians, aiming to understand the attributes they consider important in AI technologies for detecting possible skin cancer, and the trade-offs between attributes that they are willing to accept. Study 3: a health economic analysis, using routinely available data and relevant research findings (Wilson et al, 2013), aiming to establish the cost and accuracy attributes that are necessary for AI technology to be incorporated safely and cost-effectively into primary care to aid the triage of possible skin cancer.
Project organisation
Start date:	1st April 2020
End date:	31st March 2025
Contact person:	Dr Owain Jones
Contact Details:	Primary Care Unit Strangeways Research Laboratory Worts Causeway Cambridge CB1 8RN UK E-mail: otj24@medschl.cam.ac.uk
Collaborators:	Dr Fiona Walter (University of Cambridge) Professor Steve Morris (University of Cambridge) Professor Jon Emery (University of Melbourne) Professor Anne Spencer (University of Exeter)
Funding information
Funding Organisation:	CRUK Cambridge Centre Clinical Studentship


Further Information, References and Publications
Jones OT, Calanzani N, Saji S, Duffy SW, Emery J, Hamilton W, Singh H, de Wit NJ, Walter FM. Artificial Intelligence Techniques That May Be Applied to Primary Care Data to Facilitate Earlier Diagnosis of Cancer: Systematic Review. Journal of Medical Internet Research. 2021. http://dx.doi.org/10.2196/23483

U-CCODES-AF – Using clinical and consumer devices to enhance screening for atrial fibrillation

Title:	Using clinical and consumer devices to enhance screening for atrial fibrillation
Project Description:	Atrial fibrillation (AF) is an abnormal heart rhythm which increases the risk of stroke when untreated. Consequently, AF screening programmes are now being developed. These involve taking home a handheld clinical device, and checking your heart rhythm twice a day for a fortnight to search for AF. It may be possible to improve this process by using consumer devices such as fitness bands to check for AF in daily life.
Methodology description:	The aim of this project is to establish how clinical and consumer devices can best be used to identify AF. Firstly, we will establish criteria for detecting possible AF from fitness bands. Secondly, we will develop a 30 second test to identify patients who are unlikely to have AF, so they do not have to use a device at home. Thirdly, we will assess different devices for home rhythm monitoring.
Project organisation
Start date:	24th February 2020
End date:	23rd February 2025
Contact person:	Dr Pete Charlton
Contact Details:	Primary Care Unit Strangeways Research Laboratory Worts Causeway Cambridge CB1 8RN UK Telephone: (01223) 331063 E-mail: pc657@medschl.cam.ac.uk
Collaborative:	This project is conducted in collaboration with the Research Centre for Biomedical Engineering at City, University of London
Funding information
Funding Organisation:	British Heart Foundation

Further Information, References and Publications

PRESERVE-HFpEF – A blended lifestyle intervention to preserve lean mass, muscle strength, exercise tolerance and quality of life in multi-morbid older people

Title:	A blended lifestyle intervention to preserve lean mass, muscle strength, exercise tolerance and quality of life in multi-morbid older people
Project Description:	Multi-morbidity, the coexistence of two or more long-term medical conditions, (1) has wide ranging negative impacts on patients’ lives. (2) A James Lind Alliance Priority Setting Partnership involving multi-morbid older adults identified promotion of independence and physical well-being as key priorities. (3) Yet interventions tested are often focused on single underlying disease pathway; and salutogenic approaches that use best practice and support health and well-being by working with the patients’ are missing. This study seeks to test a multi-component intervention in patients with heart failure with preserved ejection fraction (HFpEF), who typify the multi-morbid older adult.
Project organisation
Start date:	1st August 2021
End date:	31th August 2025
Contact person:	Faye Forsyth
Contact Details:	Primary Care Unit East Forvie Building Robinson Way Cambridge CB2 0SR UK E-mail: fc349@cam.ac.uk
Collaborators:	Professor Christi Deaton Professor Jonathan Mant Dr Victoria Keevil
Funding information
Funding Organisation:	Evelyn Trust
Funding Amount:	£23,069

Further Information, References and Publications

STRAT-BCS – Developing a strategy for implementation of risk stratification into bowel cancer screening programmes

Title:	STRAT-BCS – Developing a strategy for implementation of risk stratification into bowel cancer screening programmes
Project Description:	The overall aim of this study is to develop a strategy for implementation of risk stratification within bowel cancer screening programmes. Specific objectives are to: Explore the social and ethical considerations relating to the introduction of risk stratification into CRC screening; Explore views and preferences of individuals concerning the introduction of risk stratification into CRC screening and the acceptability of different strategies; Quantify the relative importance to members of the public of different attributes of risk stratified screening programmes; Quantify the potential impact of incorporating a risk stratified approach on uptake of first invitation to CRC screening; Establish the state-of-the-science and future research and policy requirements for incorporating risk stratification into CRC screening programmes.
Funder information:	National Institute for Health Research Advanced Fellowship
Collaborators:	Professor Simon Griffin (Primary Care Unit) Professor Steve Morris (Primary Care Unit) Dr Mark Kroese (PHG Foundation) Professor Mary Dixon-Woods (THIS Institute) Dr Stephen John (Department of History and Philosophy of Science) Dr Sowmiya Moorthi (PHG Foundation) Dr Chloe Thomas (University of Sheffield) Dr Sophie Whyte (University of Sheffield) Phil Alsop (PPI) Philip Dondi (PPI)
Project organisation
Start date:	1st March 2021
End date:	30th June 2024
Contact person:	Dr Juliet Usher-Smith
Contact Details:	E-mail: jau20@medschl.cam.ac.uk
Further Information, References and Publications

Referrals and Outcomes for Adolescents and Children with Social Workers (COACHES)

Referrals and Outcomes for Adolescents and Children with Social Workers

Title:	Referrals and Outcomes for Adolescents and Children with Social Workers
Project Abbreviation:	COACHES
Project Summary:	A study of mental health referral patterns and outcomes for adolescents and children with social workers.
Project objectives:	Background Many children and young people with social work involvement (CYPwSW) experience mental health difficulties. Yet we know too little about the mental health care they receive from Child and Adolescent Mental Health Services (CAMHS). We do not know which young people get accepted or rejected for treatment. We do not know what treatments lead to positive change for these young people. We also do not know how much these treatments cost. Methods Our team will study anonymised administrative records for young people from two NHS Trusts. What counts as a good result from treatment for young people has various aspects. We will focus on four outcomes in evaluating treatments. These are: i) mental health; ii) education; iii) self-harm, suicidal thoughts, and suicide; iv) general wellbeing. Objectives We will: 1) Examine the profile, needs, and long-term outcomes for CYPwSW accepted or rejected by CAMHS in South London 2) Distinguish forms of CAMHS treatment, and analyse which forms lead to positive outcomes for CYPwSW in South London. We will also examine how factors such as poverty and ethnicity impact how well treatments work. 3) Repeat the analysis in Cambridgeshire and Peterborough, to check our findings. 4) Analyse how much the treatments cost and quantify how much positive outcomes cost. 5) Analyse clinical notes and conduct interviews to understand the experiences and treatment of CYPwSW. 6) Spread word of our findings and recommendations, including holding a Parliamentary Roundtable. Experts by Experience Experts by experience will have a core role across the project. This will include co-leading the qualitative studies and co-organising a Parliamentary Roundtable. Outputs We will publish a report focused on practice implications, and create training for professionals. We will write these together with the Association of Child and Adolescent Mental Health and the British Association of Social Workers. Our study will show the outcomes of routine clinical practice in CAMHS. In doing so we will lay essential ground for future Randomised Control Trials to improve provision for CYPwSW.
Project organisation
Start date:	1st September 2022
End date:	31st August 2026
Contact person:	Professor Robbie Duschinsky
Contact Details:	Primary Care Unit Strangeways Research Laboratory Worts Causeway Cambridge CB1 8RN UK E-mail: rd522@medschl.cam.ac.uk
Project contributors:	Tamsin Ford (co-PI), Rick Hood, Barry Coughlan, Taliah Drayak, Francesca Crozier-Roche, Jack Smith, David Graham, Dustin Hutchinson, Ayla Humphrey, Matt Woolgar, Daisy Kornblum, Rudolf Cardinal, Luke Geoghegan, Tessa Morgan, Yeosun Yoon, Nicole Marshall, Julia Mannes, Dihini Pilimatalawwe
Partner instuitutions:	Kingston University, South London & Maudsley NHS Foundation Trust, Cambridgeshire & Peterborough NHS Foundation Trust, The Care Leaver’s Association, the British Association of Social Workers, & National Children’s Bureau
Funding information
Funding Organisation:	NIHR & Foundations
Funding amount:	£1,321,043

Further Information, References and Publications

https://www.ncb.org.uk/what-we-do/research-evidence/our-research-project...

The ADAPT Trial: Adapting, Disease self-management and Acknowledgement by Psychosocial Targeted interventions

Title:	The ADAPT Trial: Adapting, Disease self-management and Acknowledgement by Psychosocial Targeted interventions
Project Abbreviation:	ADAPT Trial
Project Summary:	Over 5% of the population will develop an autoimmune rheumatic disease at some stage during their lives, with fatigue reported as the most prevalent and life-changing symptom. ADAPT is a randomised controlled trial to investigate the effectiveness of online instructor-led group exercise classes (Pilates or Tai Chi, 50 minutes, twice a week over 8 weeks) on fatigue (primary outcome), depression, anxiety, resilience, cognitive dysfunction, physical activity and quality of life.)
Project objectives:	Background 420 patients with rheumatological diseases will be recruited and randomised into one of three groups: 1) Pilates classes 2) Tai Chi classes, 3) Control (usual care). Participants will complete questionnaires on their health and quality of life at baseline, 8 weeks, 16 weeks, and 6 months. In addition, the ADAPT trial will: Evaluate the cost and cost-effectiveness of online classes versus usual care, from the perspective of the NHS, patients and families. Gather participant views and experiences of the online exercise classes via in-depth qualitative interviews.
Project organisation
Start date:	1st April 2025
End date:	31st March 2027
Contact person:	Dr Melanie Sloan and Prof Felix Naughton
Contact Details:	Primary Care Unit Strangeways Research Laboratory Worts Causeway Cambridge CB1 8RN UK Mel Sloan (Principal Investigator), mas229@medschl.cam.ac.uk Miranda Van Emmenis (Trial Coordinator), mv404@medschl.cam.ac.uk
Project contributors:	Multidisciplinary team encompassing patient partners, rheumatology, neuropsychiatry, health psychology and health economics.
Partner institutions:	University of East Anglia, Kings College London
Funding information
Funding Organisation:	NIHR
Funding amount:	£493,000

Further Information, References and Publications

Research Projects