28th May 2021: Your ADVANCE day explained- Cardiovascular Tests
In this week’s blog we are going to explain a section of the ADVANCE Study day in a bit more detail to help explain what participants experience and we would like to explain the assessments we do to measure cardiovascular health. In particular, we are interested in looking at the risks of developing high blood pressure and diabetes which, if left untreated, can increase the risk of developing cardiovascular disease (CVD), such as heart disease and stroke, in the future.
What is the Cardiovascular system?
‘Cardiovascular’ refers to the circulatory system – this is the heart and blood vessels. These carry oxygen and nutrients around the body and help remove carbon dioxide and waste products.
Why is it part of the ADVANCE study day?
Over the 20-year study period we are investigating many factors that can have an impact on cardiovascular health and whether sustaining battlefield injuries such as loss of limb(s) or gunshot injuries increases the risk of cardiovascular disease. To do this, we will compare the injured group to our non-injured group of similar age, rank, size etc..
What cardiovascular tests do we do?
Blood tests: We take blood samples from participants during every visit. The tests that relate to CVD that we look at are cholesterol, HbA1c and High Sensitivity Creatine Reactive Protein (HsCRP). Abnormal cholesterol levels (LDL, HDL and triglycerides), if left untreated, can develop into fatty deposits which can cause a narrowing of blood vessels. This puts an increased pressure on the heart. LDL is considered ‘bad’ cholesterol, as over time it can cause fatty build-up in arteries. HDL is ‘good’ cholesterol, as it carries blood fats to the liver to be excreted. We also observe the total cholesterol/HDL ratio – a higher ratio indicates a higher risk of CVD. HbA1c tests the average amount of sugar that has been in the blood over the last several months. Previous research shows that an increased HbA1c carries an increased cardiovascular risk. HsCRP is a protein that indicates inflammation which, when raised, is associated with heart disease
Vicorder: The aorta is the largest artery carrying oxygenated blood away from the heart. Vicorder measures whether the aorta is becoming stiff and inflexible – indications of potentially developing a high blood pressure. The Vicorder test is carried out by applying pressure cuffs to a participants thigh, arm and neck. This gives an in-depth measurement of blood pressure and heart rate. It also measures the speed of blood flow from neck (carotid artery) to thigh (femoral artery).
Heart Rate Variability: Heart rate variability is a measure of variation between heart beats. This test is carried out by recording a resting 5-minute electrocardiogram (ECG), followed by a 5-minute paced breathing ECG. The heart rate variability test identifies the effectiveness of their autonomic nervous system and gives some indication of fitness levels and cardiovascular health.
Waist-to-hip ratio: We also carry out waist and hip measurements during every participant visit. This is done to find out if the waist-to-hip ratio is connected to an increased health risk and increased blood cholesterol levels.
We review all of the above results, and if there are any concerns we inform the participant and their MO or GP. We also provide advice which, in most cases, will be on healthy lifestyle choices, and monitoring their blood pressure or doing follow-up blood tests.
Some of the above measurements can be fed into a QRisk calculator which helps identify those most at risk of heart disease and stroke. The calculator can be accessed here: qrisk.org/2017/.
29th April 2021: Meet the Team – Dan Dyball
What is your role within ADVANCE? I am a research assistant. This is something of a jack of all trades job. Do you need to contact a participant about their follow-up appointment? Do you need someone to code data? Do you need a coffee? I do all of those things. And it’s the best damn coffee you’ve ever had.
What was no. 1 in the UK charts on the day you were born? I just can’t stop loving you by Michael Jackson.
What jobs have you done before joining ADVANCE? I used to work in psychology. I was an assistant psychologist for around five years after university, then moved to research in 2015. Never looked back – research work is much more my bag.
What do you enjoy most about your job? Getting into the data analysis and finding answers to important questions. It’s very satisfying to say “look, this group is doing very well / aren’t doing so well and it’s because of this. Here’s the numbers to prove it” and then have clinicians use that proof to amend their practice.
What are the biggest challenges of your job? Military personnel, serving or veterans, do like to move around a lot. One minute you can be in London, then next you’re in Somalia, or perhaps somewhere even more dangerous, like Glasgow. If you can spare a minute to think about poor research assistants all over the world and donate to us your most up-to-date contact details every now and again, we’d be eternally grateful.
If we could see all our participants together, what would you say to them? “Who’s buying the first round?”
What’s your favourite meal? Proper adult meal: Dim sum. Student meal: Plain spaghetti, vegetarian hotdogs, cheese and ketchup.
What’s your favourite drink? Moscow mule or espresso martini.
What do you enjoy doing in your spare time? I cycle, break my bike, try to fix my bike, fail to fix my bike, buy new bike, repeat.
What’s the last book you read? Probably a statistics book or something science-y. Last fictional book was The Book of Dust by Phillip Pullman.
List three words that your friends or partner would use to describe you. Utterly sarcastic b******.
29th March 2021: This April is Limb Loss and Limb Difference Awareness Month
This April is Limb Loss and Limb Difference Awareness Month. Limb Loss & Limb Difference UK is a consortium of charities working with families and individuals with limb loss and/or limb difference. They offer services designed to empower the communities they are supporting across the UK. Blesma – one of the funders of the ADVANCE Study – is just one of the several charities who are part of Limb Loss & Limb Difference UK.
The consortium’s objective for the month-long campaign this April is to empower and connect with people with limb loss and limb difference to reduce isolation and loneliness. Persons with a disability have been disproportionately affected by the COVID-19 pandemic. As lockdown easing is within sight, it is important to spread awareness of the support network and opportunities available to re-engage in a safe, friendly and supportive environment.
Throughout April Limb Loss & Limb Difference UK will be sharing events and resources to entertain, educate and connect individuals and families to empower them to live a healthier and fuller life. You can find more information on their website and by following the hashtag #LLLDAM on Twitter this April.
22nd March 2021: ADVANCE interviewed by the BFBS
The BFBS (British Forces Broadcasting Service) recently interviewed ADVANCE participant Ben Zissman and the King’s College London ADVANCE lead Professor Nicola Fear. You can watch the interview here. King’s College specifically focus on psychological and psychosocial outcomes of ADVANCE participants.
15th March 2021: Spring Newsletter 2021ADVANCE-newsletter-March-2021
23rd November 2020: New funding from FiMT to look at military to civilian transition of the ADVANCE cohort
We are really excited to announce that the Forces in Mind Trust (FiMT) have awarded a £500k grant to ADVANCE to look at the military to civilian transition experiences and outcomes of the ADVANCE cohort in detail, including their well-being, quality of life and mental health. The project will be led by ADVANCE’s King’s College lead Professor Nicola Fear.
A big thank-you to FiMT! We look forward to seeing the positive impact this project will have on the lives of our servicemen and their families in years to come! You can read the full FiMT press release here.
9th November 2020: The first ADVANCE publication is now out!
Ever wanted to know how the ADVANCE Study actually works from a research point of view? Well now you can! The first ADVANCE Study paper was published in BJM Open in September 2020 and describes in detail how the Study and the protocol of the Study work. The paper is called ‘Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the ADVANCE Study’. You can read the full paper here. Enjoy! And, as always, do get in touch via the Contact Us page if you have any questions.
13th October 2020: Help improve health and wellbeing support for armed forces families!
NHS England have asked us to circulate this survey on how to improve services and support to armed forces families in England (regular, reserve and veteran families).
We know this is important to you, our ADVANCE Study friends and family, so do check out and fill in the survey. Your input WILL make a difference!
The NHS in England provides healthcare services for families of serving personnel who have registered with an NHS GP and the families of veterans.
Even though most armed forces families enjoy healthy lives, the unique circumstances of military life can cause pressure for some and have an impact on health and wellbeing. Moving home every few years can also make it more difficult to access NHS services. NHS England want to help change this, so that armed forces families are able to access local NHS services easily wherever they might be in England. They also want to ensure that the best possible care and support is provided.
The survey is an opportunity for you to share your views on how this is done!
9th October 2020: Autumn Newsletter 2020
Please use the interface below to scroll through the pages of our latest newsletter.ADVANCE-newsletter-Oct-2020
27th June 2020: Armed Forces Day
Happy Armed Forces Day 2020 from the ADVANCE Study team! Thank you to all our participants and to the Armed Forces. We hope you enjoy the audio clip below about how excited we are about ADVANCE helping soldiers past, present and future.
25th June 2020: Marking Armed Forces Week
Today is Veterans Day on Armed Forces Week and all of us from the ADVANCE Study would like to say thank you to our Veteran participants as we salute our Forces.
In the photos above is one of our participants, Ben, who is an ex Royal Engineer and currently helping us recruit the last few participants to the Study. We asked him what the best part of the day on his ADVANCE visit was. Ben replied: ‘I enjoyed the accessible nature of the day; a great way to connect with like-minded people. Meeting other participants who share the same experiences, who understand ‘what it was like’ in Afghanistan on any Op Herrick.’
11th June 2020: Hello from the ADVANCE team!
We hope you and your loved ones are all well during this time. As you know, our doors are still closed to participants for now but we just wanted to say hello and to let you know we’re still here and we will be in touch as soon as we know when we can see you all again!
We are working hard to find a way of seeing you back at Stanford Hall whilst adhering to government guidelines on safe practices – this will mean a few changes, and smaller numbers of participants permitted to attend per week, but we are positive you will all find the experience just as valuable and rewarding as before when we had more space and freedom.
We will be in touch soon with our latest newsletter and also to let you know about other other research projects that you may be interested in.
Don’t forget – advice and support for the veteran community is available 24/7 here: www.veteransgateway.org.uk.
18th March 2020: Message to ADVANCE participants regarding COVID-19
In light of the COVID-19 pandemic, to ensure the safety of our participants and to follow government guidelines, we are temporarily postponing ADVANCE visits until it is safe to recommence. We will be contacting all our booked participants to reschedule as necessary.
If you want to get in touch with us, either to reschedule or to book an appointment, please email us on email@example.com or call us on 07554438263/07342065095.
In the meantime, we are still busy in the background looking at all the important data we have collected so far and preparing for your next visit.
Don’t forget, we always need your up-to-date contact details, and you can update them here.
The safety and wellbeing of ADVANCE participants is our top priority, and we wish you all well in these testing times. And we look forward to seeing you in due course!
17th February 2020: The ADVANCE Study Secures Long Term Funding
The ADVANCE Study (ArmeD SerVices TrAuma RehabilitatioN OutComE Study), a unique twenty-year study into the health of military veterans, has secured crucial funding for the next ten years.
The Study has received a very substantial grant from the Headley Court Charity (£10M), complemented by a special grant from the Nuffield Trust for the Forces of the Crown (£1M) to mark the Trust’s 80th anniversary, and a five-year commitment from Blesma, The Limbless Veterans (£250K).
These grants will assure the future of the ADVANCE Study for the next ten years and will build on the funding from the Ministry of Defence, LIBOR fines and Help for Heroes which enabled the setup of the study and the initial recruitment into the study. To realise the full potential of ADVANCE, multiple follow-ups of the study participants over many years are essential. This will result in many significant research outcomes that will improve the clinical care of combat casualties.
These enabling grants were donated to the ADVANCE Study Charity which supports all ADVANCE activity within Imperial College London, King’s College London and the Ministry of Defence.
Group Captain Alex Bennett, Defence Professor of Rheumatology and Rehabilitation and Chief Investigator of the study, commented: ’We are hugely grateful to the Headley Court Charity, Nuffield Trust for the Forces of the Crown, and Blesma for their generous support which will secure the next ten years of research and allow us to improve our understanding of the long term outcomes of being a combat casualty.’
Lord Boyce, Chairman of the ADVANCE Study Charity commented: ‘We are extraordinarily fortunate to be the beneficiaries of the generous decisions of the trustees of the Headley Court Charity, Nuffield Trust and Blesma. Our thanks go to them on behalf of those who will benefit from the unique learning of the ADVANCE Study, and we shall look forward to demonstrating the impact their donations will enable for our wounded and their families.’
ADVANCE investigates the long-term physical and psycho-social outcomes of battlefield casualties from the UK Armed Forces following deployment to Afghanistan between 2003 and 2014. This study, costing over £1M per year to run, is a collaboration between the Academic Department of Military Rehabilitation at the Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Imperial College London and King’s College London, and is the first prospective cohort study in this area. It aims to follow up and support this group of UK service personnel – 600 severely injured servicemen and 600 uninjured servicemen who act as a comparison group – for a period of 20 years. The ADVANCE Study is investigating a wide range of outcomes, including cardiovascular disease, osteoarthritis, mental health and social outcomes.
The participants will have multiple and thorough health checks over the 20 years of the study and by being involved will contribute towards world class research that will improve future combat casualty care.Participant Jonathan Grave said: ‘I have a genuine interest in health and research and really believe the study has good intentions. And more importantly, I wanted to contribute towards ADVANCE and help research that will support long-term care outcomes for serving personnel and veterans. It is vital for ADVANCE to continue researching the long-term health outcomes of battlefield casualties from 2003-2014. ADVANCE will benefit current and future serving personnel and veterans – it’s just what we need.’
Recruiting participants is one of the biggest tasks of the ADVANCE Study team. As of the end of January 2020 ADVANCE is fewer than 100 participants away from meeting its target of 1,200 participants.Over the next few months the study team will be busy recruiting those last 100 participants. It will be a big milestone to reach 1,200 participants and finish the baseline recruitment, and the subsequent follow-up visits at 3, 6, 10, 15 and 20 years will reveal the results that really will influence future care.
Interested in taking part in ADVANCE? If you were deployed to Afghanistan and sustained an injury which required you to be case-evaced to a UK hospital, or were deployed to Afghanistan without injury and would like to check to see if you are eligible to take part, please call the ADVANCE team on +44 (0)1509 251 500 (ext. 3408) or email firstname.lastname@example.org. You can also contact the team via the online contact form. If you take part, the study will cover your travel expenses, offer accommodation and give you £100 as a thank you for the initial review and £200 for each follow-up visit.
14th August 2019: ADVANCE at the INVICTUS trials in Sheffield
The ADVANCE team had a great week in Sheffield in July for the INVICTUS Games Trials and the Military Rehabilitation and Recovery Symposium. At the Games we had a space dedicated to ADVANCE allowing us to spread the word about this exciting, landmark study, as well as the lovely opportunity to catch up with participants, old and new! HRH Prince Harry even stopped by to hear about the innovative work of ADVANCE during his visit to Sheffield. We also had the chance to cheer on our very own Pete Dunning as he took part in indoor rowing and wheelchair rugby, of which his team won a bronze medal – well done Pete!
At the symposium we heard all about the latest research on military rehabilitation and recovery from experts in the fields of academia, medicine and from the patients themselves. Several members of the ADVANCE study team gave presentations on the study and shed light on the importance of this research. We are now recruiting the last 100 participants for both our injured and comparison groups and look forward to presenting the results from the first phase of ADVANCE! #Last100
13th August 2019: ADVANCE on Radio 5
April 2019: Help for Heroes and the ADVANCE studyHeroes Magazine ADVANCE 2019