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UOA 12 - Allied Health Professions and Studies

University of Abertay Dundee

RA5a: Research environment and esteem

Introduction

The University has a long history as a high quality provider of education in nursing and allied health professions. Over the last six years, this provision has been complemented by the planned development of a significant research infrastructure. Specifically, the Tayside Institute for Health Studies (TIHS) was founded in 2003, to replace the Division of Nursing. The explicit remit of TIHS is to act as a driver for the coordinated study of healthcare in the University. In addition, we draw on expertise from all parts of Abertay, significantly including the resources of our flagship research grouping, the SIMBIOS (Scottish Informatics, Mathematics, Biology and Statistics) Centre for modelling of biological and environmental systems.

In previous RAE submissions healthcare research at Abertay was included within psychology. However, the growth of our research infrastructure and capacity has resulted in a body of work and a research culture that enables us to submit to UoA12 in our own right. Examples of our health-related research growth include our contributions to a range of cross Universities initiatives, such as the Scottish Nursing, Midwifery and Allied Health Professions research ‘pooling’ initiative – the Alliance for Self Care Research (ASCR); the Scottish School for Primary Care (SSPC); and the Scottish Psychotherapy and Counselling Research Consortium (ScotCon). We have also published in leading journals such as Nature Medicine, The Lancet, BMJ and Investigative Ophthalmology & Visual Science.

Research structure

Our research is structured in two Groups; Biomedical Sciences, researching molecular and ethical aspects of disease and disease intervention; and Health and Well-being. The latter Group has three themes: 1) e-Health and mechatronics, focusing on the design, development and implementation of systems for telecare and physiotherapy; 2) Effectiveness of healthcare interventions, which is helping to establish the evidence-base for a range of healthcare interventions; and 3) Mental health, counselling and psychotherapy, which is addressing client experiences in a range of mental health issues to inform care delivery at the individual, organisational and policy level..

We are full participants in a range of national partnerships.

  • ASCR – a consortium between the Universities of Abertay, Aberdeen, Dundee, Robert Gordon, Stirling and St Andrews and the NHS groups in Forth Valley, Highland, Western Isles, Tayside, Fife, Grampian, Orkney and Shetland, funded by the Nursing, Midwifery and Allied Health Professions (NMAHP) Strategic Research Development Grant from the Scottish Funding Council, Scottish Executive Health Department and NHS Education for Scotland: SM is lead systematic reviewer and Co-Mental Health leader for ASCR, and SC and SM are members of the Executive Committee and Steering Group.
  • SSPC – a consortium of nine Universities, designed to develop rigorous methodology and research of relevance to primary care in Scotland, and the international care community: As members of the SSPC Management Group, SC and SM contribute to strategic decisions on future research directions.
  • ScotCon – a partnership of the Universities of Abertay, Aberdeen, Glasgow Caledonian and Strathclyde, which is enhancing the development, scientific quality and social relevance of counselling/psychotherapy research in Scotland: JM is Co-Director and co-ordinates the research activities of the counselling research clinic at Abertay with that at Strathclyde University.
  • The proposed Scottish Informatics and Computer Science Alliance (SICSA), where we will supply expertise in modelling of complex data sets such as those associated with the cell cycle.

These partnerships, developed in Scotland in response to its particular health and other research needs, are supplemented by a range of international linkages, detailed in the following sections.

1. Biomedical sciences

We undertake laboratory science-based methods to understand disease development and to identify potential treatment agents. Our research adopts a range of technological approaches, including whole animal models and molecular analyses. We also research the ethical considerations of modern developments in molecular medicine. In particular, we have:

  • developed, in conjunction with the Bulgarian Medical Academy, a novel model for heart hypertrophy which will allow evaluation of drug candidates by a highly predictive, new system (NZ2);
  • developed, in conjunction with Harvard Medical School and the University of Olomouc, Czech Republic, novel live cell-based assays incorporating genetically engineered kinase marker systems to evaluate anti-cancer drugs and evaluated the role of modelling in the identification of drug targets (NZ1,3);
  • investigated a key gene defect which leads to blindness and predisposition to embryonic lethality in chickens and identified the causative pathological defect as being in the ubiquitously expressed Guanine Nucleotide Binding Protein (GNB3): the chicken GNB3 mutant has great potential as a model system for investigating hypertension and the many other GNB3 associated diseases (DL1,4);
  • developed a novel assessment of the possibilities for human germ line genetic modification (KS1);
  • explored a range of ethical considerations associated with genetic modification and gene therapy (KS2,3);
  • developed novel models for transgenic integration (KS4).

The retirement, in 2007, of a number of non-research active staff, has allowed us to recruit three new staff who have made significant contributions relevant to healthcare research and are being fully integrated into our team. Specifically: i) Brown, whose research focuses on ion channel expression and cloning, regulation of ionic currents and links to various disease states and the development of novel electrophysiology research systems related to lung function (SB1,2) or cardio systems (SB3,4); ii) Zhu, who has used mathematical modelling to understand atrium excitation patterns (JZ1); and iii) Deeni, whose work relates to the cytochrome P450 system in a variety of disease states (YD1-3) and the role of MC1R in the development of melanoma (YD4), the next target of a substantial Abertay cancer modelling project.

For the past three years, NZ, in conjunction with SIMBIOS, has been developing a new generic methodology to model the dynamic behaviour of the key regulatory pathways implicated in the majority of cancers, funded by an anonymous Trust (the underlying theoretical framework is described in NZ1). Through partnership with the Director of the University of Edinburgh’s Cancer Research Laboratories, we have applied this generic approach to the study of breast cancer, the DNA damage response pathways and the role of P21/P53 coupling in cell death. We have developed what is, to our knowledge, the most comprehensive mathematical model for breast cancer, and have succeeded in applying it to develop software tools for personalised diagnosis and drug treatment protocols. Whilst the strategic focus of our work is the development of new computational approaches, we have found it necessary to build capacity in lab-based research to collect new kinds of data to meet the demands of quantitative approaches. As yet only a small proportion of this work, which has associated IPR considerations, has been published. Facilities for this work exist in the molecular and cellular biology laboratories associated with SIMBIOS whose work is grounded in environmental science (submitted to UoA17).

2. Health and well-being

We are developing a robust research evidence base to inform the delivery of a wide range of interventions across three increasingly overlapping themes: 1) E-health and mechatronics; 2) Effectiveness of healthcare interventions; 3) Mental health, counselling and psychotherapy.

Theme 1: e-Health and mechatronics

Our research focuses on the design, development and implementation of systems for telecare and physiotherapy. Telecare studies have defined the underlying technologies, such as sensors, which underpin data collection and developed methods of interpreting and analysing such data to support independent living. The work on rehabilitation resulted in development of a prototype robotic system to support the rehabilitation and therapy of the lower limbs and is linked to the EPSRC funded 'SMART2' EQUAL consortium, within which DB has a research consultancy role. The research has led to the:

  • identification and modelling of the costs associated with the development and implementation of a telecare system (DB2), the integration of telecare systems with other forms of assistive technologies (DB1,4) and understanding the client/user perspective (DB3);
  • definition of a telecare system of potentially significant commercial value, developed in conjunction with Barnsley Hospital NHS Foundation Trust (BHFT), who administered awards from Yorkshire Forward (£60k) and the Health Technology Devices programme of the Department of Health (£180k), and working in association with a commercial partner (the work is commercially confidential - the commercial partner is currently developing a prototype system based on the results - and hence details are not yet available for publication);
  • integration of expertise in system design, patient management, physiotherapy, clinical practice and stakeholder need to develop automated and robotic physiotherapy devices – funded by the Department of Health New and Emerging Technologies (NEAT) programme (£240k) in collaboration with Sheffield (where DB was Visiting Professor from 2004-06) and Sheffield Hallam Universities and BHFT (the prototype devices produced are subject to patent and IPR considerations and hence full details of the underlying technology are not yet available for publication);
  • use of systematic review methods to understand the scope and nature of e-Health and help set the NHS research agenda in this area (SM3 – project commissioned by NHS SDO).

Theme 2: Effectiveness of healthcare interventions

Research into the effectiveness of healthcare interventions, supported by involvement in ASCR, SSPC and ScotCon, has occurred within two strategic domains: systematic reviews, and the conduct of clinical trials. Within the domain of systematic reviews, we have:

  • developed two meta-analyses of antidepressant efficacy and tolerability in primary care (SM1,2);
  • produced a systematic review establishing the efficacy of personal asthma action plans in clinical practice (commissioned by Quality Improvement Scotland), in collaboration with Dundee, Edinburgh and Stirling Universities (SM4);
  • undertaken a review of interventions to enhance self care in chronic disease, in collaboration with Dundee and Stirling Universities, funded by NHS Tayside; this provided evidence which has directly informed the development of strategies (via the ‘Long-term Conditions’ Group, NHS Tayside) to manage chronic disease (SM);
  • produced a systematic review of the effectiveness of counselling interventions in workplace stress (JM).

At an international level, Abertay is working with various partners to publish two meta-analyses in the Cochrane Library: with Auckland University, New Zealand, on antidepressant efficacy in primary care, and Dublin University and the Australian National University Medical School, on lactose avoidance in children with acute diarrhoea (SM). A further Cochrane review on providing patients with records or summaries of their consultations is being updated with Dundee and Liverpool Universities (SM). We have also collaborated on two large scale systematic reviews of effectiveness for NICE (Interventions, approaches and models aimed at changing health outcomes through changing knowledge, attitudes and behaviour; and mass media interventions which encourage quit attempts in smokers (SM)). These reviews were published (NICE, 2007) as part of their public health programme and contribute to NICE guidance in these areas.

Within the clinical trials domain we have conducted a:

  • trial of clinical pathways in abnormal uterine bleeding for the NHS Health Technology Assessment Programme (JG4);
  • randomised control trial (RCT) of the role of omega-3 in patients who have had an acute myocardial infection (HS);
  • needs assessment for referrals to allied health professionals in oncology and palliative care (HS).

Research into the clinical effectiveness of counselling as a health intervention has been facilitated by the establishment in 2006 of the Tayside Centre for Counselling (TCC), a community counselling service based within the University, supported by funding from the Carnegie Trust (£30k), with additional funding (£25k) from the British Association for Counselling and Psychotherapy (BACP) and the Universities of Abertay and Strathclyde. The TCC has been designed as a facility for clinical trials on the role of counselling in depression, anxiety and other health disorders; its research programme is informed by patients via a User Consultation Group. The TCC is regarded by the BACP as a national demonstration site, and as the first of a network of such facilities that will eventually enable multi-site studies to be conducted.

Theme 3: Mental health, counselling and psychotherapy

A broad portfolio of research, again facilitated through participation in ASCR, SSPC and ScotCon, has addressed client experiences in a range of mental health issues, for example:

  • self-management strategies of patients with schizophrenia (SM);
  • the experiences of patients with ME (JG1) and problematic uterine bleeding (JG3);
  • attitudes of health professionals (SC2,3) and the public (SC1,4) toward specific groups experiencing mental health problems;
  • counselling interventions in individuals with alcohol and drug problems (JM2), and Alzheimer’s disease (JM); 
  • providing descriptors and accounts of alcohol consumption (JG2)

These studies have an applied focus aimed at informing care delivery at the individual, organisational and policy levels, particularly in relation to the incorporation of service user perspectives. The applied focus is also reflected through a DTI-funded (£47k) project with the offshore oil and gas industry, which recently investigated occupational demand/stress within this workforce. The findings will inform the design and implementation of interventions to improve the occupational health of industry workers.

A key dimension of this theme has been an emphasis on the promotion of practice-based research, through the development of research skills in counselling and mental health practitioners. For example, JM is PI on a recent ESRC seminar series award (£18k), in collaboration with Strathclyde University, intended to enhance the use of rigorous case study methodologies in practitioner-researchers. He is also a member of the Steering Committee for an ESRC Research Development Initiative project based at Leicester University.

Promoting and fostering a research culture (including staffing policy)

As well as the normal methodologies for developing the research culture (internal and external research seminars, methodology masterclasses, mentoring, etc.) Abertay has been a key advocate of, and participant in, the range of healthcare and healthcare-related research consortia that have developed in Scotland in recent years. So, for example, membership of the ASCR has provided the opportunity for staff to attend a range of research seminars and training events, and to network with a wide range of new and established academics and clinicians working in the area. Similarly, the counselling research consortium holds monthly seminars, as well as three day long research seminars.

An important part of our research agenda is to grow the proportion of research active staff. Applicants for, and appointees to, new academic positions at Abertay must have considerable and relevant research skills. The University's Operational Plans (2007-2011) explicitly state that new staff appointments must be research active, reflecting recent practice, for example, the appointments of SB,YD (biomedical science), JG and SM (health and well-being). In this respect, funding from the ASRC award (£177,668) has increased capacity (SM's appointment); the University are investing a further £68k to support SM's post over the initial 5-year funding period and are committed to fully funding this post on a permanent basis. Further capacity building is reflected in the joint appointment (2007) with NHS Tayside of the first Nurse Consultant in Dementia Care. Additionally, the University's commitment to the SSPC (£25k over five years) will ensure involvement of UoA12 staff in the collaborative development of research programmes within primary care settings. Through the SSPC Abertay are contributing to a scoping exercise to inform the future research agenda of NHS-24.

The integration of new staff into the Abertay research culture is achieved through our systems of probation, mentoring, career review, and staff development. For example, all new staff members are subject to probation, with appropriate targets for research. New staff are assigned an academic mentor, and wherever possible, benefit from reduced teaching loads in their first year (typically 50%). All staff participate in annual career review, for which they complete and discuss an individualised 3 year research plan. This research plan also serves as a guidance and developmental tool. Staff members are regularly supported in conference attendance through University funds. As part of developing the research culture we have allocated (in October 2006) an existing Professor to the newly created post of Director of Research and External Development (Health). 

Investment in physical infrastructure to support UoA12 staff and students includes the use of LTIF (£600k) to develop clinical care training and research laboratories as part of the development of TIHS and SRIF/European Regional Development Funds (>£2M) for the provision of new, state of the art, laboratories for molecular and cellular analyses within SIMBIOS. The close links between the Biomedical Sciences Group and SIMBIOS have been noted and contacts between SIMBIOS and the other elements of this UoA will increase in the coming years. With its cohesive group of research students and supervisors and excellent track record of attracting external funds, the SIMBIOS link will assure the sustainability of healthcare research at Abertay.

Research governance

The University has strict procedures and regulations covering research governance and ensures that research is conducted within an appropriate ethical framework. All research requires initial approval from one of the School Research Ethics Committees, the work of which is monitored and audited by the University's Research Ethics Sub-Committee. Where appropriate, researchers are then directed to a Local or Multi-Centre Research Ethics Committee.

Research strategy – the next five years

The strategy is closely linked with the University’s Strategic plan (2007-2011), meaning that we can benefit from institutional allocations of funding, draw on University-wide expertise and that there is a focussed reference point for all of our research activities.

Interdisciplinary research is a key component of the culture at Abertay; the compact nature of the University campus facilitates cross-fertilisation between research Groups. The increasing involvement of SIMBIOS in biomedical and healthcare research provides a unique opportunity to combine experimental approaches to identifying and evaluating healthcare interventions with the mathematical analysis of highly complex systems (e.g. the highly complex network of signalling, transcription and biochemical pathways which mediates cancer, and the multiple factors and interactions associated with the transmission of hospital acquired infections or the development of operational models to combat bed-blocking). In combination with our commitment to external partnerships, this strategy will ensure a significant and distinctive contribution from Abertay to health-related research. Specific research strategies for each Group are described below.

Biomedical sciences

As of 2007 we have a new team in Biomedical sciences and the major focus of our research is now our innovative approach to the modelling of cancer. Our work is helping to define a new discipline of ‘systems pathology’, in which measurements on real tissues are linked to a molecular-level diagnosis and treatment protocol. We have been invited by Nature Reviews Clinical Pathology to write an article on this approach. NZ (fixed term contract to be renewed) and YD, who has recently been working on tumour xenograft models and the use of small molecule inhibitors, will provide the biological and laboratory expertise required to develop this area, with modelling expertise provided by JZ and colleagues in SIMBIOS. Links will be established with YD’s former Dundee University laboratory, providing additional capacity/expertise.

We have been invited to partner with Scotland’s leading computer science departments in a research pooling initiative (SICSA) that would provide two new senior appointments in computational modelling at Abertay. This will help meet the growing demands on the theoretical programme as we face the considerable scientific challenges of tissue-scale modelling. Additionally, we have secured funding from the Carnegie Trust (£29k) and the charity Breast Cancer Campaign (£15k) to pursue this work with Edinburgh University and are developing further collaborative proposals for submission to the MRC, EPSRC and CRUK. Finally, we are discussing potential exploitation of the technologies with Wyeth UK and have been awarded a joint PhD studentship with St Andrews University via SULSA (the Life Sciences Research pool).

In parallel, the shared interests and complementary skills of DL, NZ, SB and YD in cell signalling mechanisms in epithelial tissue will provide the basis for new understanding of disease processes, including cystic fibrosis, skin cancer and hypertension, and ensure the effective integration of SB and YD into the Abertay research culture. In conjunction with colleagues from SIMBIOS, this collaboration will open up new possibilities for an integrated approach including molecular, physiological and computational expertise. The research directions over the next five years, particularly in relation to systems pathology, will offer KS exciting opportunities to contribute in biomedical ethics.

Health and well-being

Following consultation with Government and Health Boards, and a range of service user groups, our research will contribute to an improved health agenda for Scotland and beyond. We will achieve this through:

  • Research focus: further development of the enhancement of self care as a unifying focus for our research in the health and well-being area;
  • Strategic national partnerships: continuing to develop our contribution to the national partnerships of ASCR, SSPC and ScotCon, in particular working across disciplines and institutions (academic and non-academic) to build capacity to respond effectively to government priorities for healthcare policy and practice;
  • Informing policy and practice: e.g. active involvement, with ScotCon colleagues, in current Scottish Government policy-making concerning access to psychological therapies;
  • International partnerships: e.g. we are currently seeking EC FP7 funding to support a 4-year research programme, which seeks to understand and evaluate a recovery-based approach in severe mental illness.

Examples of specific studies with a focus on enhancing self care we are currently either planning or conducting include: systematic reviews of non-pharmacological interventions to manage obesity in schizophrenia and of interventions to enhance self-care in dementia; evaluation of the role of community mental health nurses in counselling for early-stage dementia; RCTs to establish the effectiveness of psychotherapeutic interventions in primary care for the treatment of depression.

Knowledge transfer

Reflecting continuing close consultation with Government and Health Boards, we will focus on applied research that prioritises delivery. We will sustain and increase our knowledge transfer activities, e.g. through Knowledge Transfer Partnerships - KTPs (on an FTE basis Abertay is the most successful university in Scotland for delivering KTPs). Three staff submitted to UoA12 have led KTPs since 2005; these include projects with the Tayside Health Board to develop a dependency tool for workplace planning in the NHS (SC) and with QCMD Ltd. to develop statistical tools for assessment and validation of clinical molecular diagnostics (HS). A second project with Tayside Health Board, led by SIMBIOS (initially with HS), aims to minimise the incidence and spread of hospital acquired infections.

Conclusion

Allied Health research at Abertay is maturing into two sustainable themes: 1) the use of modelling in healthcare and drug development; and 2) enhancing self care. From a position in RAE2001 of submitting three healthcare related staff in the psychology UoA, an emerging healthcare research culture and critical mass is developing. Whilst we recognise that there is still much work to be done, levels of funding are increasing, and the range of projects in which the team are now involved, both nationally and internationally, will result in sustained growth.

Key indicators of esteem not previously stated

Editorial activities

  • Sue Cowan: Editorial board, Journal of Psychiatric and Mental Health Nursing.
  • John McLeod: founding Editor, Counselling and Psychotherapy Research; Editorial board member: Counselling and Psychotherapy Research; British Journal of Guidance and Counselling; Counselling Psychology Quarterly; Pragmatic Case Studies in Psychotherapy; Person-centred and Experiential Psychotherapies; Journal of Critical Psychology, Psychotherapy and Counselling.
  • Kevin Smith: will become Editor, The Scientific Review of Alternative Medicine, when the incumbent retires.
  • Nikolai Zhelev: Editorial board member: Technology in Cancer Research and Treatment; Biotechnology & Biotechnological Equipment; Medicine and Sport; Zone4science.
  • Yusef Deeni: Editorial board member, Open Drug Metabolism Journal.

Peer review

Submitted staff regularly review journal articles (e.g. BMJ; Journal of Consulting and Clinical Psychology; International Journal of Cardiology) and grant applications (e.g. CSO HSR; ESRC; BBSRC). Our early career researchers are involved in the following peer review activities.

  • Sean Brown: American Journal of Physiology.
  • Yusef Deeni: Archives of Biochemistry and Biophysics; Carcinogenesis; Journal of Neurochemistry; European Journal of Biochemistry; Molecular Pharmacology.
  • Jennie Guise: Health Education Research; Health Expectations; Mental Health; Religion & Culture; Journal of Family Planning and Reproductive Health care.
  • Jiujiang Zhu: Materials and Design.

Membership of committees and groups

  • David Bradley: EPSRC College (1998-2006). Member/Chair of EPSRC Panel E covering interdisciplinary programmes and member of other programme panels (1998-2004); Member, Mechatronics Forum Committee (IEE/IMechE).
  • Sue Cowan: Member, Primary Care Mental Health Research and Development Programme Advisory Group; Chair, Scottish Recovery Network Research Forum; Member, Mental Health Nursing Forum (Scotland), Convener, Research sub-group; Member, NHS Education for Scotland Research Steering Group, evaluation of Mental Health (Care and Treatment) Act teaching and learning resource.
  • Steve MacGillivray: Member, three Cochrane Review groups (Infectious Diseases; Depression Anxiety Neurosis; Consumers and Communication); Founding member, Network for Systematic Reviewers in Scotland and Ireland (NetSIS).
  • John McLeod: Member, Research Committee, British Association for Counselling and Psychotherapy; Organising Committee, Society for Psychotherapy Research Annual Conference.
  • Kevin Smith: Member, HEA Special Interest Groups, Final Year Projects and Teaching Ethics; HEA Biosciences and Health Sciences and Practice Representative.
  • Harry Staines: Member, EPSRC Life Sciences Panel (1999-); Statistics Expert Member, Tayside LREC (1998-2002);

Keynote research papers or invited addresses

  • David Bradley: One of four presenters at three-day workshop on mechatronics, Universitary Militaire, Bogota, Colombia (2002); Developing Systems for the Rehabilitation of the Lower Limb – The NeXOS project, Telemedicine and the Grid, Institute of Physics and Engineering in Medicine, York (2004).
  • John McLeod: 2nd European Conference on Qualitative Research in Psychotherapy, University of Magdeburg, Germany (2002); International Conference on Client-centred and Experiential Psychotherapies, University of Leuven, Belgium (2004); British Association for Counselling and Psychotherapy Research Conference, Glasgow (2006); Conference on Narrative Approaches to Psychotherapy, University of Tokyo (March, 2007). New Developments in Psychotherapy Research, University of Jyvaskyla, Finland (June, 2007).
  • Nikolai Zhelev: Plenary lecture, 40th Jubilee International Scientific Conference, Sofia University, Bulgaria (November, 2003); Invited lecture, Modern University Innovation and Commercialisation Conference, Edinburgh (March, 2007).
  • Kevin Smith: Medicine and the Body Politic Conference, Centre for Applied Philosophy Politics and Ethics, University of Brighton (2006).