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Caroline Shulman

Biography

Caroline Shulman is a GP in Homeless and Inclusion Health, working as clinical lead for a homeless team at Kings College Hospital. She is also Honorary senior lecturer within the division of psychiatry at UCL leading on work addressing palliative care for homeless people and is a Research Fellow at the homeless charity, Pathway.

Caroline qualified in Medicine in 1984 at Kings College Hospital, London, then as a GP obtaining MRCGP in 1989. Caroline's early career was spent in East Africa, working in Tanzania as a clinician following which she went to work at the London School of Hygiene and Tropical Medicine (LSHTM) in 1994-2003, based in Kenya for a number of these years. She was awarded a PhD in 2001.

Caroline returned to UK general practice 2007, where she has specialized in homeless and inclusion health, working in specialist practice for homeless people before becoming clinical lead in a homeless Pathway team at Kings College Hospital (part time).

She is now combining her clinical and research roles seeing the need for better understanding of the unmet need for palliative care for many people who are homeless.

Research summary

· Caroline was a clinical researcher, lecturer then clinical senior lecturer at London School of Hygiene and Tropical Medicine between 1992 and 2002.

· Her main research interests at the time were international maternal health, malaria and anaemia in pregnancy.

· She was the principal on a number of studies in Kilifi, Kenya, funded by DFID and Wellcome Trust, in collaboration with the Kenya Medical Research Institute, Kenya Ministry of Health and Oxford University addressing the importance of malaria as a contributor to anaemia in pregnancy. This included a large RCT, the result of which contributed to policy change nationally and internationally.

· Following return to UK Caroline became clinical senior lecturer at LSHTM in 2001 on the Gates malaria programming, where she developed a number of further studies on malaria in pregnancy.

· Since 2015, Caroline has been leading on some work addressing the palliative care needs of people experiencing homelessness, in collaboration with Pathway, St Mungo's and the Marie Curie Palliative Care Research Department.  During the first qualitative phase, this research explored the growing concern that many homeless people were dying in unsupported, unacceptable situations. Gaps identified and recommendations from this research have been widely disseminated. Currently Caroline and her team are developing, piloting and aiming to roll out a sustainable model for embedding multidisciplinary, person centred care and support for sick homeless people by bringing together palliative care and multidisciplinary support into homeless hostels and day centres.

Teaching

· Caroline supervised MSc and PhD students and taught on malaria in pregnancy and epidemiology while based at LSHTM

· Between 2008-2013 she was a tutor for 1st year medical student at UCL on a vertical module on professional development

· Caroline currently teaches doctors working in an acute hospital and GP's on homelessness and health 

Grants held

· Oak Foundation: Grant held by Pathway: September 2018-December 2020 £337,668

· Oak Foundation: Grant held by Pathway: September 2015-March 2018 £250,130

· Gates Malaria Partnership, LSHTM: Case-control study to assess the association between malaria and pre-eclampsia, and the possible mechanisms £20,000 small project grant.

· Gates Malaria Partnership, LSHTM: Trial to establish the health impact, acceptability and cost effectiveness of alternative antimalarial interventions in preventing malaria and anaemia in pregnant women in The Gambia: 2002-2005 £330,023. Grant Number ITDCVG27:

· DFID, HP ACCORD: R6141: 1994 -1998. Prevention of malaria and anaemia in pregnancy: £399, 725.

· DFID, HP ACCORD: R5676: Sept-Jan 1993. Preliminary study on causes of anaemia in pregnancy, and development of intervention £19,970

Some Selected Key Publications

A full list of publications can be found on Caroline's research gate profile:

https://www.researchgate.net/profile/Caroline_Shulman

Palliative care for people who are homeless

Hudson, B. F., Flemming, K., Shulman, C., & Candy, B (2016). Access to palliative and end of life care for people who are homeless: A systematic review of qualitative research. BMC palliative and supportive care. 15:96 DOI 10.1186/s12904-016-0168-6

Shulman, C., Hudson, B.F., Low, J., Hewett, N., Daley, J., Kennedy, P., Davis, S., Brophy, N., Howard, D., Vivat, B., & Stone, P (2017). End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care. Palliative Medicine;0(0):0269216317717101.

Hudson, B.F., Shulman, C., & Stone, P (2017). 'Nowhere else will take him' - Palliative care and homelessness. European Journal of Palliative Care;24(2).

Hudson, B.F., Shulman, C., & Brophy, N. (2017). Time to link palliative care and homelessness services. Inside Housing. http://www.insidehousing.co.uk/time-to-link-palliative-care-and-homeless...

Hudson, B. F., Shulman, C., Low, J., Hewett, N. Daley, J., Davis, S., Brophy, N., Howard, D., Vivat, B., Kennedy, P. &, Stone, P. (2017) Challenges to discussing palliative care with people who are homeless: a qualitative study. BMJ Open 2017;7:e017502. doi: 10.1136/bmjopen-2017-017502

Shulman, C., Hudson, B. F., Kennedy, P., Brophy, N., & Stone, P. (2018). Evaluation of training on palliative care for staff working within a homeless hostel. Nurse education today, 71, 135-144.

Malaria and Pregnancy

Shulman CE, Graham W, Jilo H., Lowe B, New L, Obiero J, Snow R, Marsh K (1996) Malaria as an important cause of anaemia in primigravidae: evidence from a district hospital in coastal Kenya. T. Roy Soc Trop Med H, 90:535-9.

Shulman CE, Dorman E, Talisuna A, Lowe B, Nevill C, Snow R, Jilo H, Peshu N, Bulmer J, Graham S, Marsh K (1998). A community randomised controlled trial of insecticide treated bednets for the prevention of malaria and anaemia among primigravid women on the Kenyan Coast. Trol Med Int Health, 3:197-204.

Shulman C, Dorman EK, Cutts F, Kawuondo K, Bulmer J, Peshu N, Marsh K. (1999) Preventing severe anaemia secondary to malaria in pregnancy: a double blind randomised placebo controlled trial of sulphadoxine-pyrimethamine, The Lancet 353: 632-636

Geissler P, Prince R, Levene M, Poda C, Beckerleg S, Mutemi W, Shulman C. (1999) Perceptions of soil-eating and anaemia among pregnant women on the Kenyan coast. Social Science and Medicine, 48:1069-1079)

Shulman CE, Marshall T, Dorman EK, Cutts F, Bulmer JN, Peshu N, Marsh K (2001). Malaria in pregnancy: adverse effects on haemoglobin levels and birthweight in primigravidae and multigravidae, Trop Med and Int Health 6: 770-778 

Weiner, R, Ronsmans, C., Dorman, E., Jilo, H., Muhoro,  A., & Shulman, C (2003). Labour complications remain the most important risk factors for perinatal mortality in rural Kenya. Bulletin of the World Health Organization, 81 (7).

Staalso, T., Shulman, C., Bulmer, J.N.,  Kawuondo, K., Marsh, K & Hviid, L (2004). Variant surface antigen-specific IgG and protection against clinical consequences of pregnancy associated P falciparum malaria. Lancet, 363, 283-289

Mulenga M, Malunga F, Bennett S, Thuma PE, Shulman C, Fielding K, Alloueche A, Greenwood BM. A randomised, double-blind, placebo-controlled trial of atovaquone-proguanil vs. sulphadoxine-pyrimethamine in the treatment of malarial anaemia in Zambian children. Trop Med Int Health. 11:1643-52. 2006

Cumberland P., Shulman, C.E., Maple, C., Bulmer., J. N., Dorman, E., Kawuondo K., Marsh, K., Cutts F.T (2007). Maternal HIV Infection and Placental Malaria Reduce Transplacental Antibody Transfer and Tetanus Antibody Levels in Newborns in Kenya. The Journal of Infectious Diseases;196:550-557