Reading health partners

Predicting pain 

Around one third of women who undergo a  womb surgical procedure called fibroid embolization find it intensely painful, while others find their pain can be controlled with drugs and are in and out of hospital in a day.

Consultant radiologist Mark W Little and Dr Richard Harrison, postdoctoral researcher in pain at the University’s Centre for Integrative Neuroscience and Neurodynamics (CINN) Pain Lab, are leading a study to predict which women will be vulnerable or more sensitive to pain. 

The work could avoid unnecessary hospital stays in women who will experience less pain and flag those most at risk of severe pain, concentrating NHS resources where they are most needed. Study findings are due in June 2020.

Visualising blood vessel damage

Research to better visualise blood vessel damage in kidney disease patients could help clinicians better understand why some patients go on to develop blockages or narrowing of the blood vessels and how it happens.

Narrowed blood vessels (stenoses) are often seen in patients with kidney disease who need regular dialysis to clean their blood. This involves connecting one of their arteries to a vein, so the vein expands under pressure (known as a fistula) and can have a needle inserted to run blood through the dialysis machine. 

The narrowing is thought to be caused by high pressure and irregularities in blood flow through the vessels and the body attempting to heal damage from fast flowing blood. Up to 75% of fistulas end up needing surgery or stretching with a balloon to clear the blockage within the first year of treatment – at a cost to the NHS and adding to the discomfort and time in hospital for patients.

A team led by RBH radiologist Farhan Ahmad and involving Dr Richard Harrison from the University's CINN Lab, created 3D models of the blood vessels in the arms of three healthy volunteers using ultrasound and Magnetic Resonance Imaging (MRI) to take image veins and arteries. 

The team wanted to test if ultrasound, which is far cheaper and more widely available than MRI, could be used to produce accurate 3D models of blood vessels to monitor blood flow in diabetes patients with fistulas.

Working with Dr Yongmann Chung and computational modellers at the University of Warwick, the team applied dynamic fluid modelling to the images to simulate the flow of blood through the vessel. Early results are highly promising. These models offer an exciting new avenue to help predict who is at risk of complications emerging from their fistulas.

The research could help clinicians better understand why some patients go on to develop blockages or narrowing of the veins and how it happens. It will also support an application to the National Institute for Health Research (NIHR) – the research arm of the NHS – to study fistulas in haemodialysis patients over time.

Personalised diabetes medicine

Diabetes is an increasing problem across the world, affecting nearly 4 million people in the UK alone. People with the disease have too much sugar in their blood because they can’t produce enough of the hormone insulin, which keeps blood sugar levels steady.   

Henley Business School’s Dr Weizi (Vicky) Li is leading informatics research to develop personalised treatments for those diabetes patients who are at higher risk of having dangerous swings in their blood sugar levels, helping them to see off spikes in blood sugar before they happen.

Working with 100 patients at the Royal Berkshire Hospital, the team used data from continuous glucose monitors - a sugar sensor that sits under the skin – to pick out those individuals who are at risk of spikes in glucose levels. They also looked at the amount of exercise patients did and their dietary intake of carbohydrates. Patients were then grouped according to their patterns of blood sugar variability.

By grouping people according to individual characteristics and collecting their data, computerised models can be ‘trained’ to predict a patient’s peaks and troughs in blood glucose over the course of the day so that they can judge the amount of insulin they will need to inject more accurately. It will also help to design bespoke diets for this group of patients that keeps blood sugar levels steady, and a more tailored treatment approach.

In the future, the computer model that predicts glucose variability could be developed into a ‘closed loop’ insulin pump which automatically adjusts the amount of insulin required. This could give patients a far better quality of life, for example they would be able to get a full night’s sleep without having to wake and take their insulin.

Results from the study show that the team’s deep learning model can predict blood glucose an hour ahead with higher prediction and clinical accuracy than existing methods. It shows promise for supporting patients with type 1 diabetes to better manage their behaviour to prevent dangerous spikes in blood sugar.

Dancing away risk of falls

Falls in elderly people are common and can cause injuries from which a frail older person will never fully recover. They also cost the NHS around £2.3 billion every year.

Geriatrician Dr Margot Gosney and Juliane Honisch (Psychology) are  leading a project to discover whether regular dancing can improve balance and reduce risk of falls in this group, and which types of dance might be effective. Dancing the tango, for example, may be more effective than the waltz for improving balance.

The study is currently recruiting over 50 patients who will take part in either conventional exercise programmes or regular dance classes with a partner. If successful, the research findings could provide the evidence for a low cost, simple and enjoyable way to reduce risk of falls. Result are expected in October 2020.

Why is heart disease more common in diabetics? 

Platelets are blood cells that are involved in blood clotting. People with diabetes have a higher risk of getting heart disease than healthy people, and research suggests that platelets play a part in this by triggering unwanted blood clotting in the heart (thrombosis) – but it’s not yet known why this is.

One reason could be that not everyone’s platelets are the same. A team led by Professor Jon Gibbins from the School of Biological Sciences and Charlie McKenna, Consultant Cardiologist, is working on grouping patients with heart disease and diabetes by the particular characteristics of their platelets (their phenotypes).

The research project will run tests on patients’ blood samples and then use machine learning to allocate people to different phenotype groups. The first patient was recruited to the study in January 2020. 

Mental health and wellbeing - For more than twenty years, the Anxiety and Depression in Young People Research Unit (AnDY) has been working hard to tackle anxiety disorders and depression – disorders which affect up to one fifth of children and adolescents. The Unit works closely with children, young people and their families, working both in the community and in clinical settings, and develops, evaluates and then implements new treatments which are used across many NHS Trusts for anxiety disorders in children.

Speech and language therapy services - Our purpose-built NHS speech and language clinic is free to the public and open throughout the academic year. The clinic works closely with the University’s world-class Centre for Integrative Neuroscience and Neurodynamics (CINN) and Centre for Literacy and Multilingualism (CeLM). We also host an NHS paediatric disorders of fluency service and provide an NHS community clinic service for adults with acquired communication disorders and adults with voice problems.

Diet and lifestyle in people with dementia - The Berkshire Memory and Cognition Research Centre brings together clinicians, scientists, businesses and charities, who have access to some of the best neuro-imaging and clinical research facilities in the UK to tackle dementia, which is estimated to affect more than 1% of the population of the Thames Valley alone. The Centre conducts research into how diet and lifestyle can affect dementia.

Working with autism - The Centre for Autism was set up in 2014 and offers diagnostic services to children and adults carried out by specialist clinical psychological and speech and language therapists. It works closely with businesses and schools to help them support individuals diagnosed on the autism spectrum. Past and current funders have included the Medical Research Council, the Leverhulme Trust and the European Research Council.