About the Project
Older people living in care homes are often excluded from research, and there is a need to identify approaches to optimise care pathways and treatment to improve health and quality of life for these individuals. This includes research into the care and treatment people receive in care homes following a stroke. People living in care homes post-stroke have higher levels of disability compared to people living in the community post-stroke. Yet, relatively little research has been conducted with people following a stroke living in care homes.
The first part of the project will utilise the Secure Anonymised Information Linkage (SAIL) Databank, a data linkage resource which contains anonymised data about the health and service utilisation for the population of Wales. The SAIL Databank contains billions of records which can be linked including birth and mortality data, demographic data and primary and secondary care data. Utilising SAIL, for older people (≥65 years) who lived in care homes in Wales between 2003-2018, the aims will be to:
• Determine the prevalence of stroke and trends over time
• Determine if there are health inequalities in the incidence and prevalence of stroke and temporal trends, by examining factors including ethnicity, gender, educational attainment, previous income and occupation before retirement and location of care home according to the Welsh Index of Multiple Deprivation (measure of relative deprivation for small areas in Wales)
• Examine treatments and medications older people with stroke receive in care homes and compare this to people with stroke living in the community, and determine if there are health inequalities in treatment and medication use in this population
• Determine factors which may be associated with treatment pathways which are not in line with guidelines, for example participant co-morbidities such as dementia and health inequalities
• Analyse associations between treatment people receive in care homes post-stroke and outcomes such as recurrent stroke and mortality
• Externally validate and refine risk prediction models for stroke and AF at the time of entry into care homes in people free from stroke and AF at entry.
After discharge from hospital, stroke survivors may have physical, cognitive and psychological care needs. The aims of the second part of the project are to:
• Conduct qualitative guided structured interviews with people with experience of stroke who are resident in care homes in the North West Coast region, their family members and staff in care homes who have directly cared for people post-stroke
• Determine the experiences of care and treatment people living in care homes have following a stroke and any gaps in care or areas which are particularly valuable to enhance wellbeing or quality of life
• Decipher if factors related to health inequalities impact the experiences of people post-stroke in care homes.
The Liverpool Centre for Cardiovascular Science where this PhD will be hosted is a collaborative partnership including ARC member organisations such as the University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital NHS Foundation Trust and Liverpool Health Partners. For LCCS research themes, see:
Website: https://www.liverpool.ac.uk/health-and-life-sciences/lccs/ Twitter: https://twitter.com/LiverpoolCCS
There is an opportunity to join an AF research team that is globally recognised for AF research [http://bit.ly/2wJswe4].
The successfully appointed student would have a background in health informatics or quantitative epidemiology. Familiarity with a statistical software such as R or Stata would be a major advantage as would an ability to learn to program. Skills in qualitative methodology would be an advantage, although training in these skills would be part of this PhD methodology.
It is expected the successful applicant (s) must commence on or before 1st February 2021.
For any enquiries please contact Professor Gregory Lip on [Email Address Removed]
If you wish to apply, please send a covering letter, full CV together with names and contact details of two academic referees, stating the research proposal/s of interest to you and why you think you are suitable. Please send to Professor Gregory Lip on [Email Address Removed] and Dr S Harrison on [Email Address Removed]
Funding Notes
The studentships will be for 4 years full-time (subject to satisfactory progress) and will cover the cost of tuition fees at Home/EU rates. A stipend in line with the UK Research Council is payable at £15285 per annum, and an additional allowance of up to £1000 per year will be paid for approved research costs. Please note that funding is only available for the first 3 years but a 4th year is unfunded for writing up. Due to funding restrictions, the studentships are open to Home/EU applicants only.
References
Kozieł M, Simovic S, Pavlovic N, Kocijancic A, Paparisto V, Music L,
Trendafilova E, Dan AR, Kusljugic Z, Dan GA, Lip GYH, Potpara TS. Impact of multimorbidity and polypharmacy on the management of patients with atrial fibrillation: insights from the BALKAN-AF survey. Ann Med. 2020 Aug 4:1-9. doi:10.1080/07853890.2020.1799241. Epub ahead of print. PMID: 32700579.
Fauchier L, Bodin A, Bisson A, Herbert J, Spiesser P, Clementy N, Babuty D,Chao TF, Lip GYH. Incident Comorbidities, Aging and the Risk of Stroke in 608,108 Patients with Atrial Fibrillation: A Nationwide Analysis. J Clin Med. 2020 Apr 24;9(4):1234. doi: 10.3390/jcm9041234. PMID: 32344603; PMCID:PMC7230460.
Chao TF, Lip GYH, Liu CJ, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Liao JN, Chung FP, Chen TJ, Chen SA. Relationship of Aging and Incident Comorbidities to Stroke Risk in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2018 Jan 16;71(2):122-132.
Lip G, Freedman B, De Caterina R, Potpara TS. Stroke prevention in atrial
fibrillation: Past, present and future. Comparing the guidelines and practical decision-making. Thromb Haemost. 2017 Jun 28;117(7):1230-1239.