Imogen Skene

Project: Improving asthma control in adults attending Emergency Departments with asthma attacks by understanding health beliefs and behaviours on asthma control and attitudes to switching Maintenance and Reliever Therapy (MART) inhaler – a mixed-methods study

Asthma exacerbations are still a major cause of ill health and lost lives despite an ever-increasing range of asthma therapies. There are 75,000 emergency admissions to hospital with asthma every year in the UK. The recent National Review of Asthma Deaths found that 21% of patients dying from asthma exacerbations had attended Emergency Department with asthma symptoms in the preceding year identifying this as a key opportunity to improve their asthma treatment.

Inhaled therapy is the cornerstone of long-term asthma management and prevention of exacerbations, however poor adherence to preventer inhalers is a major problem and is associated with increased ED attendances for acute asthma. The aim of this research is to ascertain in patients presenting to the ED with uncontrolled asthma their health beliefs about inhaled asthma treatment.

Newer MART inhalers provide an inhaler type that allows the safe titration of preventer medications each time they take their reliever. These inhalers are generally will received in primacy care. This research will also explore feasibility of improving long-term asthma control by switching to Maintenance and reliever (MART) inhaler therapy in the ED.

About me

I completed my BSc in adult nursing at the University of Southampton, followed by a Masters in Clinical Research at City University London. I am an experienced emergency department nurse and clinical research nurse. I am interested in how we deliver care in the emergency department, patients experiences, health education and applied health research. 

Publications

• Skene I, Kinley E, Pike K, et al. Understanding interventions delivered in the emergency department targeting improved asthma outcomes beyond the emergency department: an integrative review. BMJ Open 2023;13:e069208. doi: 10.1136/bmjopen-2022-069208

• Stefanidis C, Bush A, Newby C, Nwokoro C, Liebeschuetz S, Skene IP, Griffiths CJ, Martineau AR. Vitamin D replacement in children with acute wheeze: a dose-escalation study. ERJ Open Research Apr 2022, 8 (2) 00609-2021; DOI: 10.1183/23120541.00609-2021
• Kinley, E, Skene, I, Steed, E, Pinnock, H, McClatchey, K. Delivery of supported self-management in remote asthma reviews: A systematic rapid realist review. Health Expect. 2022;  1- 15.  doi:10.1111/hex.13441
• Baker E, Battle C, Banjeri A, Carlton E, Dixon C, Ferry J, Hopkins P, Jones R, Murrells T, Norton C, Patient L, Rasheed A, Skene I, Tabner A, Tunnicliff M, Young L, Xyrichis A, Lee G. Prospective observational study to examine health-related quality of life and develop models to predict long-term patient-reported outcomes 6 months after hospital discharge with blunt thoracic injuries. BMJ  Open 2021;11:e049292. doi: 10.1136/bmjopen-2021-049292
• Skene I. The complex issues that lead to nurses leaving the emergency department. In: Murray E, Brown J, editors. The mental health and wellbeing of healthcare practitioners: Research and practice: Wiley and Sons Ltd; 2021. p. 88-99.
• Skene IP, Pfeffer PE Improved asthma control during the COVID-19 pandemic: are there lessons to be learnt? Thorax Published Online First: 09 April 2021. doi: 10.1136/thoraxjnl-2021-216930
• French, C., Pinnock, H., Forbes, G. et al. Process evaluation within pragmatic randomised controlled trials: what is it, why is it done, and can we find it?—a systematic review. Trials 21, 916 (2020). doi: 10.1186/s13063-020-04762-9
• The Crash 3 Trial Collaborators, Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (Crash-3): a randomised, placebo-controlled trial, Lancet 2019
• Lyttle, MD., Rainford, NEA., Gamble C et al.  with the support of the PERUKI collaborative,  Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial, Lancet 2019, doi: 10.1016/S0140-6736(19)30724-X
• Brunsdon, D., Biesty, L., Brocklehurst, P., Brueton, V., Devane, D., Elliot, J., Galvin, S., Gamble, C., Gardner, H., Healy, P., Hood, K., Jordon, J., Lanz, D., Maeso, B., Roberts, A., Skene, I…..Gillies, K. What are the most important unanswered research questions in trial retention? A James Lind Alliance Priority Setting Partnership – The PRioRiTy II (Prioritising Retention in Randomised Trials) Study, Trials doi: 10.1186/s13063-019-3687-7
• Skene, I., Pott, J., McKeown,E. Patients experience of trauma care in the emergency department of a major trauma centre in the UK, International Emergency Nursing Journal, Mar 2017 doi: 10.1016/j.ienj.2017.02.005 
• Naumann, D., Mellis, C., Smith, I., Mamzua, J., Skene, I., Harris, T., Midwinter, M., Hutchings, S . Safety and feasibility of sublingual microcirculation assessment in the emergency department for civilian and military patients with traumatic haemorrhage shock: a prospective cohort study, BMJ Open 2016;6:e014162. doi: 10.1136/bmjopen-2016-014162
• Bellhouse, G., Skene, I., Pott, J. NIHR Celebrating research nurses local meeting, Guys Hospital (1st prize) Poster presentation: Research in the Emergency Department – four challenges and solutions  (2014)

Research activity

• Poster presentation:  Combination inhalers for acute asthma attacks: A TwiCs design, Trials using cohorts and routine health data efficiency and analysis symposium – May 2019
• Oral Presentation: Clinical research practitioners' perceptions of informed consent to clinical research in the emergency department, Global emergency nursing and trauma care conference – October 2018
• Oral presentation: Public involvement and emergency department research, Barts Health – Research matters: Get involved, make a difference – May 2018
• Oral Presentation: Trauma patients experiences of care in the Emergency Department, Royal College of Nursing – International Nursing Research Conference - April 2016
• Oral Presentation: Trauma patients experiences of care in the Emergency Department, London Trauma Conference - Dec 2015
• Oral Presentation: Research in the Emergency Department – four challenges and solutions, National Institute of Health Research – Celebrating research nurses - May 2014