The Planned Care Division Research Newsletter

Transcription

1 The Planned Care Division Research Newsletter Congratulations to Vasiliki Dekou on her promotion to the Senior Burn Research Manager role. We also want to congratulate Andrew Sankey, Mark Cox, Miriam Kadry and Chris Huber for accepting the Principal Investigator roles on the HipAttack clinical trial to accelerate orthopaedic operations on patients with neck of femur fracture. Medical Divisional Research Team "#$%%&'($)&*+,+-+.%$#/&-&$)012&$' 3.%.)$)45&%+.)(#+%+0$#2&067)&) 8$)0&#$"9+:0$401+;+ "#$%&%'($) "$+%8&'+0+%& <%$&-61&-+$ 57)=&)4()+6+0$#($)& <%$&-61&-+$ ").>&--.) ").>&--.) <%')&?/+0& "#$%&%'($) "#$%&%'($) 57)=&)4 ").>&--.) "&)+-A&BB+- "#$%&%'($) ").>&--.) ").>&--.) 8$-$.A$B$6$*$C+%=8$ "*'(+,-%') "*'(+,-%') "$+%8&'+0+%& 5&%+.)(#+%+0$#2&067)&)5&%+.)2&067)&) (1)+-6.-D.%6.,.7%+-+.- E-6,$%F$=4 "#$%&%'($) "*'(+,-%') Welcome to Shen Qiu and Stella Nicolau, who have joined Professor Tekkis clinical research team. Shen has started recruiting patients for the study entitled Evaluating the role of Neurotensin (NT) as a diagnostic marker for colonic polyps and colorectal cancers.

2 2 Divisional Research Team Sharai Chitando Research Associate and Delivery Manager Divisional Research Output Sundhiya has been busy helping the clinical team at CWH and WMUH with sample size calculations, methods for grant applications and drafting manuscripts. The table below illustrates Sandhiya s workload. Jaime Carungcong Research Associate Lead Jaime.carungcong@chelwest.nhs.uk Supporting Research Associates Team Krishbadnie Nundllal Muna Dahir Hassan Rhian Bull Elna Cifra Sundhiya Mandalia Senior Statistician s.mandalia@imperial.ac.uk Sundhiya s annual course on stats for clinicians across sites in August-September has proof once again to be a successful course for clinicians. We have secured 250, from Biomed Catalyst from Innovate UK in November 2016 to Detect Patient Deterioration using Bodytrak. Ensuring patient safety is challenging since patient deterioration can happen rapidly and go un-noticed. Currently, the vital signs are obtained manually by staff, which is an error prone and time consuming task. The primary objective of this project is to determine the feasibility of automatically, continuously and reliably acquiring these vital signs, with emphasis on the Level of Consciousness/Alertness (LOC), Core body temperature (CBT), and heart rate (HR) variability. Planned Care has recruited 89 patients into NIHR adopted clinical studies since June We have opened 5 new NIHR adopted clinical studies and Planned Care is the process to open 3 commercial studies and 6 NIHR adopted clinical studies by the end of the academic financial year. ****Congratulations to the Planned Care Clinical team **** Our contribution to clinical research is growing month by month. The CRN has generated a report from 1 st April 2016 to 31 st October Chelwest remains in third position despite financial constrains (see table below). "#$%&'(")'* +,*-$%.'*/)0* 123*#/'"45$, 6)'"$7")85)/9 :+."$7/85)/9 ;/$4"*<#/9"* <'%0, -5'/9 "#$%&'( )*+,- +*../ +-0 /* )) )*6,1 )*76-7*/1) ACDEF GHD DCHDH 8%9"#:9; 7,7 /7+,..) 2<=,), 0 6,7+ >%&"'%?@A'%$ +-,- )/6 7,/ A342.1 )// 6 7,- 5&((&;BC9; )+ ).7 42D5 / )/6 6 )// 39;@35= ) , A2A5 / )1 7 7,

3 3 Steve Yentis and research in obstetric anaesthesia over the last 15 years at Chelwest "#$#%&"'()*)&+%,'-)""./*'#$'01*2)2+#%'3$&)*2,)*#& 3"#%)'4+))$ 5&+/& 6&"7&$ JB Wyman was the first Hunterian Anaesthetic Professor and later Dean of Westminster Medical School. He was an unsung pioneer in obstetric epidural work. In the earliest nineties Stanley Feldman was appointed as the third Magill Professor, consolidating the Academic Department of Anaesthesia at Chelsea & Westminster Hospital. Amongst the Clinical Research Fellows working in the Department was Dr Steve Yentis who is now the Featherstone Professor, Association of Anaesthetists of Great Britain & Ireland Obstetric Fellowship Scheme There have been 24 Obstetric Anaesthetic Fellows at C&W since the first one in 1998 introduced by Steve Yentis. Two were funded by the Obstetric Anaesthetists Association for specific projects, and the others from reconfiguring the trainees on-call rota to include the new Fellows to reduce their hours, after the European Working Time Directive made excessive on-call hours very expensive for Trusts. Over the years the Fellows have contributed greatly to the running of the anaesthetic service on labour ward, the training of more junior anaesthetic trainees, the clinical service and to various research/audit/quality improvement projects. Highlights for the latter are: Themes of Research Series of studies investigating the best way to top-up an epidural for emergency caesarean section, with an impact on our standard method after each study the current technique reducing our failure rate by approximately half Description and analysis of an improved classification of caesarean section beyond the traditional elective/emergency split; now used across the UK as the national standard classification 2009 Evaluation of methods of warming during caesarean section, rolled out to the main operating theatre suite to save thousands of pounds per year Evaluation of different point-of-care systems for use in obstetric haemorrhage Evaluation of methods of resuscitation/chest compression in late pregnancy Current areas of interest include the ergonomics of the workplace and how anaesthetists and other maternity staff interact with it, fatigue, flow/strength characteristics of spinal needles and various training issues. A recent three-centre study (London, Cape Town and Melbourne) has just finished; this evaluated the use of the six-minute walk test (how far a person can walk in 6 min) in pregnancy. There has been a regular production of abstracts from the unit presented at national/international meetings over the years; those involving the Obstetric Anaesthetic Fellows (gray) and Anaesthetic trainees (white) are shown in the graph:

4 4 Miss Isabel Jones, Mr Declan Collins & Vasiliki Dekou Burns Research Since the foundation of the Burns Academic Research Centre by Professor Takata and support from the CW+ charity in 2011, this area of research has grown exponentially. Over the last year, Mr Declan Collins was supported with 0.5 SPA for Research by Chelwest and CW+ charity funded a Burns Research manager post to expand the clinical research in Burns. Miss Isabel Jones, hard work, tenacity and vision is now paying tribute. A list of ongoing Clinical Research Work led by the Burn Surgical Team follows the PICO approach for an easy understanding of the Population Intervention Control, Outcome of the studies and Funding are listed below: Study 1: Population: Patients requiring improvement of scar appearance through re-modelling collagen. Intervention: Fractional ablative CO2 laser Outcome: Approved appearance, reduced pain and itching. New CO2 ablative laser tariff revenue Funding: Equipment purchased by the CWFT following successful business case proposal. Awarded 127, Study 2: Population: Patients requiring treatment of hypertrophic scars. Hypertrophic scarring after significant burns is common, resulting in raised, erythematous, pruritic, and contracted scars. Intervention: Pulse dye laser (PDL) Outcome: Improved quality of scarring both objectively and subjectively measured. Funding: Equipment on short-term free of charge loan from the company. Will purchase using funds raised through fundraising walk (raised ~ 250,000.00) Study 3: Population: Patients requiring skin grafting Intervention: Vivostat Outcome: Reduction of staples use, Patient reported pain, Number of clinicians trained to use the technology Funding: Equipment on long-term free of charge loan from the company. Consumables paid by the CWFT. Study 4: Population: Patients requiring skin grafting Intervention: Cellutome Outcome: Skin graft success, Cost reduction, Number of clinicians trained to use the technology Funding: Equipment bought following a successful grant application to the All Ladies Committee, roughly 10, Consumables paid by the CWFT. Study 5: Population: Patients with facial burns Intervention: Face masks Outcome: New face mask tariff revenue, Facial burn patient waiting lists for burn mask, Patient satisfaction, Correct fitting masks and adjustments made as needed, all in house by C&W therapists. Funding: CW has awarded us 25, following a successful grant application. Study 6: Population: Suspected infected burn wound Intervention: RCT. Participate in a multi-centre randomised trial laboratory observational Ex- Vivo study to investigate the sensitivity and specificity of a smart dressing to detect clinically relevant wound infection. NIHR, portfolio adopted study. Control: Have not recruited control or patients yet. Due to start this week.

5 5 Outcome: Confirmed technology switch-on in response to clinically relevant wound infection reducing dressing time and avoiding unnecessary antibiotics thus reducing costs. Reimbursement. Funding: MRC. Reimbursement for 18 months for 7,5h a week for one Band 6 researcher. Future plans include further development of different techniques for burn scar depth assessment, eschar removal and tissue mechanostimulation as well as improved diabetic feet care. We are also due to start two more NIHR adopted RCTs clinical studies. A business case to host the Imperial College Tissue Bank at Chelsea & Westminster Hospital is currently under discussion so watch this space Rehabilitation Programme for people with Chronic Pain an innovative project by Rahul Seewal Pain Research Pain management programmes (PMP) are evidence based cost effective rehabilitation for people with chronic pain, which now is the biggest reason for loss of productive years and can have significant effect on people's lives, including work, personal life and socialising. PMP s aim is to reduce the effects of pain on people s lives - for e.g. pain related anxiety, fear, low mood and reduced physical function and sleep. It involves education, cognitive behavioural therapy (CBT) and graded exercises, directed towards time bound realistic goals to return the body to normal movement and activities. The limitations to current hospital based treatments are: 1. It is only available at selected pain clinics. 2. The cost and waiting times for the programmes are quite high. The waiting times at Chelsea and Westminster hospital are around 6-12 months 3. It is difficult to capture outcome data (response of treatment) in real time. 4. It requires a lot of time commitment from patients, who have to come to hospital from treatment from far. Often this is the reason why they drop out without completing the treatment as they are unable to arrange childcare, take time off, or travel to hospital if their pain goes up. There is good scientific evidence that these treatments can be effectively delivered online, especially when guided by a clinician. The retention rates and patient satisfaction are much higher, the costs are lower and most importantly, other clinical outcomes are comparable to hospital based programme. Online programmes can offer the long term support of 3-4 months, needed to sustain new habits that are the basis for successful pain management. Rahul has put together a team and rose funding to research and develop a clinical guided online pain management programme in the UK. The programme is MyPain Compass and it is ready for clinical testing and has now been approved by the national ethics committee for a feasibility study at Chelsea & Westminster hospital. The Intellectual property of this innovative project is shared with Chelsea & Westminster Hospital so if it is successful not only patients but also the trust will benefit financially For comments / suggestions: Marcela at In the next issue, we will cover Professor Masao Takata s Research in Critical Care & share with you the Clinical Research platform for clinical research fellows across the division. First Clinical Research Forum Date: 9 th December Time:1230h to 1830h. Place: Magill Anaesthetic Library (Level 5, Lift Bank B, Opposite to ICU) Aim: To update clinicians on ongoing research conducted by clinical research fellows in Anaesthesia, Critical Care, Obstetrics, Surgery in our division. Come and support the new generation of researchers in our division. Until then Merry Christmas & a Prosperous, Healthy & Happy 2017