Salford R+D newsletter [#15, April 2015]

Issue 15, April 2015

Newsletter

1

U n i v e r s i t y T e a c h i n g T r u s t

Salford R+D is an integrated service overseeing research and development on behalf of Salford Royal NHS Foundation Trust and NHS Salford Clinical Commissioning Group.

2

Salford Research + Development

Photo campaign spreads the message

Sharing the message: Staff from the Barnes Clinical Research Facility

Salford Royal’s Research and Development department is promoting the way research improves patient care and public health through a Twitter campaign.It is tweeting personal messages about the value of research from staff, patients and the wider community using the hashtag #whywedoresearch.

The many comments so far include:

• Whenmedicinegetsbettersodowe!

• WithoutresearchIwouldn’tbehere

• Idon’twantmychildrentohavethesamehealthproblemsasme

• Ithelpedtoextendthelifeofmyniece.

The effort is part of a wider national and international Twitter campaign, launched by research staff at James Paget University Hospitals to raise awareness of research and to introduce members of the team to colleagues, patients and the public.

Here at Salford, the support of Francine Jury and Mel Atack from the Citizen Scientist project has helped to promote the campaign in the community, with many patients, research participants and members of the public offering their messages of support.

You can follow the research team on Twitter @SalfordRD to see more messages from those who carry out research, take part in studies or simply support the way research improvestreatmentsintheNHSandmakesarealdifferencetopeople’slives.

Our new website is now up and running at www.salfordresearch.org.uk. It’s been professionally designed and developed to promote research in Salford and to provide a resource for staff – in particular there’s training information available from Salford Research Training Academy.

It’s also the place to catch up on news and events in research and to find out about our people and facilities. Work is still going on to increase and improve the content - the site is being managed by Communications Officer Claire Mooney, who would be happy to hear your feedback and ideas for developing it. Contact: [email protected]

Log on for our latest news

3

Professor Phil Kalra, Renal Research Lead in Salford, was keen to emphasise the importance of the CRISIS study and especially the fact that so many patients had consented to participate. He said:“CKDisverycommon.Weareverypleased that so many of our patients have signed up for the CRISIS study, and they, also with the great efforts of Sister Bev Lane, have helped make it the third largest CKD cohort in the world. Together we can really make a difference by determining new markers that highlight patients at greater risk, and eventually, by applying new treatments to improve health in this group.”

One area the large epidemiological study is investigating is arterial stiffening, which occurs normally with age but develops earlier in patients with kidney disease.

The metabolic and haemodynamic (blood flow) changes associated with

The kidney crisis: investigating the risks


Chronic kidney disease (CKD) is a worldwide epidemic with more and more patients needing dialysis each year.

Salford Royal is one of the major sites in the UK for renal research, which is crucial to help discover what the risk factors are and how the progression of the disease can be slowed.

It’sthehomeoftheCRISIS(ChronicRenal Insufficiency Standards Implementation Study) project, which has one of the largest chronic kidney disease patient cohorts in the world.

The study, which started in 2002, is investigating the risk factors associated with more rapid progression of chronic kidney disease. Around 300 patients a year join the study, which has its own biobank containing 35,000 samples to help researchers carry out their work. In October the CRISIS study reached a major landmark when it recruited its 3,000th participant. All recruits are out-patients attending renal clinics at Salford Royal.

CKD result in accelerated arterial stiffening–andthatpartlyexplainswhy many renal patients are also at risk of heart conditions and stroke.

Researchers believe measuring arterial stiffness has great potential as a tool tohelpunravelthecomplexitiesandoptimise treatment of cardio-renal disease.

Genetic makeup can also have an influence on why some people develop diabetes and heart disease. It is widely suspected that genetic factors play a role in the development of more severe kidney problems in some people.

• Ifyouwouldlikefurtherinformationon the CRISIS study, please contact 0161 206 1309.

• Therenalresearchteamisholdingitslatest information day for patients on Sunday 17 May, 10.30am-3pm, at the Macron Stadium, Bolton.

At the forefront of kidney research: Some of the Salford Royal renal team

4

Keeping studies fresh and focused


Dr Burden, who has worked as a dietitian for 20 years and is supported by a Senior Clinical Lectureship NIHR/HECFE award, described a virtuous circle where clinical practice sparks fresh and relevant research ideas and researchers benefit from responding to real life situations to keep their work patient-focused and up to date.

Her current research programme began with an investigation of colorectalcancerpatients’experiencesofpre-operativeweightloss– about two thirds are affected by this – which has led to further work around integrating nutrition into the care pathway.

She has also worked on evaluating nutritional interventions during the perioperative period, nutritional assessment of dietary intake using dietary assessment methodology, and determining body composition and nutritional status in clinical practice and research. Dr Burden, a Clinical Senior Lecturer at the School of Nursing, MidwiferyandSocialWorkattheUniversityofManchesterwhichisajointpositionwithSalfordRoyal,wasthesixthsenioracademicto give a presentation in the seminar series, which was launched in February 2014. Three further seminars will take place in 2015:

• 15April-ProfessorFionaLeckyontraumaresearch

• 15July-ProfessorPeterBoweronhealthservicedeliveryresearch

• 15October–ProfessorJohnKeadyondementiaresearch

R+D’sprogrammeofeventsalsoincludestwoProfessoriallectures:

• 18June–ProfessorMaxinePower,SalfordRoyal’sDirectorofInnovation and Improvement Science and Managing Director of Haelo

• 16December–ProfessorAlistairBurns,NationalClinicalDirectorfor dementia in England, Professor in Old Age Psychiatry at The University of Manchester and Honorary Consultant Old Age Psychiatrist in the Manchester Mental Health and Social Care Trust.

R+D seminar: Dr Sorrel Burden

Dietitian Dr Sorrel Burden championed involvement in research for nurses and allied health professionals in the latest of Salford R+D’s research seminars.

SupportinginnovationisakeystrandoftheCCG’sbusinessmodel and it works closely with partner organisations such as MAHSC and Haelo to improve population health and healthcare in the City of Salford.

Kirstine writes: “I am currently on secondment as Head of Innovation and Research four days a week at Salford Clinical Commissioning Group, while retaining one day a week as consultant dietitian specialising in intestinal failure at Salford Royal. “

“I oversee the CCG innovation fund and aim to build the existingresearchportfolio,aswellasremainingactiveinclinical practice.

“WithintheCCGwehaveanambitiontodevelopqualityimprovement capabilities with a focus on safety strategies in primary care, which may facilitate and support more engagement in research and innovation in Salford.”

Kirstine has previously worked closely with the CCG on the national pilot for the Malnutrition Task Force which brings togetherexpertsfromAgeUKSalford,health,socialcareand the council to tackle avoidable malnutrition in older people–amajorcauseandconsequenceofillhealth.

Shehasextensiveclinicalexperience,especiallyinthemanagement of clinical nutrition, short bowel syndrome and home parenteral nutrition (delivery of nutrients into a vein).

Her work as a Consultant Dietitian has been recognised at a national level - including working with the National InstituteforHealthandClinicalExcellenceonitsExpertGuideline Group on Nutrition Support Standards for adults in hospital and the community who are at risk of malnutrition or who have become malnourished, and adults who are receiving oral nutrition support, being fed by a tube into the gastrointestinal tract or who need parenteral nutrition.

She was appointed as an ambassador for the British Dietetic Association in 2014, where she works to help to raisetheprofileoftheprofessionandsharesherexpertknowledge.

5

Kirstine leads CCG push for innovation and safety

New role: Kirstine Farrer


NHS Salford CCG has recently appointed Kirstine Farrer as its Head of Innovation and Research.

Primary care research: GPs are well placed to know what matters to patients

Research is crucial to all parts of the NHS – it’s how we improve patient care and treatment.Traditionallyit’softenbeenseenasthejoboflargesecondarycare institutions (hospitals) and universities.

But in the modern NHS, primary care research is growing at a pace and that includes here in Salford, where Salford R+D supports research on behalf of NHS Salford CCG as well as Salford Royal.

According to the Department of Health, about 90 per cent ofpeople’scontactwiththeNHSisinprimarycare–GPanddental surgeries, pharmacies, family planning clinics and so on – so it makes sense that research takes place there too.

Added to that are the fact that the management of many long-term conditions such as diabetes, asthma and chronic obstructive pulmonary disease (COPD) is in primary care and that growing numbers of patients have several conditions (multiple morbidities) which need to be dealt with together.

“Growing a culture of research in primary care is a statutory duty for clinical commissioning groups. Quite simply patients reside in primary care, not hospital beds, so in order to optimise

6


Patient knowledge at heart of primary care research

recruitment we need to encourage the researchers to be there too,” says Kirstine Farrer, the recently appointed Head of Innovation and Research at NHS Salford CCG. “GPs have lots of innovative ideas and a wealth of knowledge about what matters to patients because they have so much day to day contact with them.

“Primary care is also often key to finding the patients to participate in research – we have numerous practices that act as patient identification centres and five are partner sites with the Greater Manchester Clinical Research Network (CRN: Greater Manchester).

“TheSalfordLungStudy(seepage8)isagroundbreakingexampleofhowresearchcanbecarriedoutin the community health system. Salford GPs have also recruitedtheirtargetof4,000patientsaged65andover into a major new study – called CLASSIC – which isexaminingSalford’spioneeringintegratedcareprogramme for older people.”

Other research currently being carried out in primary care includes studies into diabetes, tooth decay in children, acute kidney injury, stroke and suicide by prisoners.

7


Researchers will evaluate a new patient safety initiative aimed at preventing acute kidney injury (AKI).Dehydration is a risk factor for AKI, a sudden reduction in kidney function and a growing problem with a high mortality rate.

The sick day rules project will see community pharmacies and GP practices hand out information cards to patients taking certain medicines, warning them to stop taking them temporarily during illness that can lead to dehydration, such as vomiting, diarrhoea and fever.

The medicines – such as ACE inhibitors, diuretics and Metformin, a medicine for diabetes – can either increase the risk of dehydration or can have potentially serious side effects because of dehydration.

Thecreditcard-sizedpatientcardsexplainthatthemedicinescanberestartedwhenwellafter24-48hoursofeatinganddrinkingnormallybutadviseanyonewithconcernstosee their pharmacist, GP or practice nurse.

The initiative has been developed in collaboration with NHS Salford CCG, Salford Royal and the NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC GM) and is based on a scheme developed by NHS Highland.

Inthesecondphaseoftheproject,uniquetoSalford,practicepharmacistsworkinginGPpractices will identify and offer targeted advice to people at high risk of AKI. As part of a larger innovation project, about 50 per cent of practices will have an attached practice pharmacist.

DrRebeccaElvey,ResearchAssociateatTheUniversityofManchester’sInstituteofPopulation Health, will lead the evaluation of the project, looking at perceptions and experiencesofthoseinvolved,includingpatients,GPsandpracticenurses,pharmacistsand support staff.

Card project aims to prevent acute kidney injury

• NHSSalfordCCGis the only clinical commissioning group in the UK to be part of an AcademicHealthScienceCentre,apartnership between universities and health organisations leading the way in research and innovation.

• 47GPpracticesand 59 community pharmacies in SalfordareGCP(Good Clinical Practice) trained – a totalofabout1,300people. GCP training is a key requirement for anyone involved in clinical trials research.

• Salford’sIntegratedElectronic Patient Record links GP and hospital health records so contains valuable and detailed data for researchers.

8


It’sapioneeringcollaborationbetweenGSK, the NHS, The University of Manchester andNorthWestEHealth(NWEH)thatrecognisesonesimplething:patient’slives are complicated. It is designed to help the doctors who prescribe medicines understand how they work in the real world, where patients are all individuals.

They may have a number of conditions or characteristics - they may smoke, take a number of medicines, not always remember when to take those medicines or not take them as often as they should.

Traditionally the efficacy and safety of a medicine is tested through double blind randomisedcontrolledtrials(RCTs).It’sanapproach that is scientific and robust.

But to take part in an RCT, people often have to meet strict recruitment criteria. For example,thosewithanumberofillnessesareoftenexcluded.Thismeanspatients

inthetrialsdon’talwaysrepresentthepopulation as a whole.

For respiratory conditions, this is particularly problematic: just seven per cent of COPD patients and three per cent of asthma patients would be eligible for a traditional RCT – because their age, the severity of their disease or the presence of other illnesses meanstheydon’tmeetthecriteria.

The Salford Lung Study began recruitment in 2012, with the basis that enrolment would be open to a much broader population with a diagnosis of COPD or asthma in the area, regardless of whether or not they had other conditions such as cancer or high blood pressure. It completed recruitmentofaround2,800patientswith COPD in Salford last autumn, with results for this COPD population

2,800COPDpatientssignuptogroundbreakingstudy

Flashback: The launch of the Salford Lung Study in 2012

expectedin2016.Recruitmentofasthmapatients to the study is ongoing.

ThestudyutilisesSalford’selectronichealthrecords (EHR) system and is delivered in collaboration with local healthcare providers to allow patients to be closely monitored in real-time, but with minimal intrusion into their everyday lives.

TheEHRwassetupbyNWEH,anot-for-profit organisation formed by a partnership between The University of Manchester, Salford Royal NHS Foundation Trust and NHS Salford Clinical Commissioning Group, andlinkspatients’recordsacrosstheirGPsurgeries and hospitals. This removes the need for the enforced interventions and controlsrequiredinRCTswhichmayaffectthewayapatientbehaves-forexamplehow and when they take their medication.

“The Salford Lung Study is a new and excitingwayofstudyingamedicinewhichmaintains the robustness of a randomised controlled trial while more closely reflecting the real world in which the medicine is used,” says David Leather, Global Medical Affairs Leader, GSK.

The Salford Lung Study is a world first - a new way to explore how effective a treatment for asthma and chronic obstructive pulmonary disease (COPD) is in the real world.

9

The fifth Science Society on Tour event took place in March, attracting more than 70 young people from Salford City College and local high schools.Joinedby15exchangestudentsfromJohanna-WittumSchool Pforzheim in Germany, the young people spent the evening finding out about nutritional research, from dealing with rare inherited metabolic diseases, to how nutrition links to sports performance.

Over the past two and a half years, more than 300 young people have attended these events, which have providedauniqueopportunitytomeet researchers and clinicians from the NHS, The University of ManchesterandGlaxoSmithKline,many of whom are involved in ground breaking research.


ScienceSocietygetshands-onEngaging young people in research: Some of the activities during the five Science Society on Tour events held so far

Fromexploring‘Howaddictionaffectsthebrain’/‘Skinagingandrepair’/‘Manvs.Bug’to‘DownsizetoSupersizeMe’awiderangeoftopics have been on offer, bringing the world of research into everyday education. These engaging sessions have also given young people a more‘hands–on’approach,bygiving them the chance to have a go at the type of tests that are used in a wide range of research activities. From testing their lung capacity to visiting the dementia Reminiscence Pods, each event gives an insight into what research is and how it is carriedout.March’seventwasnoexception,withstudentshavinga chance to do a series of tests to check their muscle strength, body watercontentandbodymassindexand learn how these simple tests can help to treat people with certain illnesses.

Hundreds of young people have been introduced to the world of research thanks to a series of Science Society on Tour events organised by the Salford Research and Development Engagement Team.

A small team from Salford R+D took part in the Salford Clinical Quality Academy 2014. The aim was a reduction in R+D study set up times. Slow set-up times affect the ability of studies to recruit, and make organisations less attractive as a result. In 2012, national benchmarks were introduced, including a key target around study initiation. Failure to meet these benchmarks has negative implications both for the reputation and the income of the Trust.

Theteam’soriginalaimwasrevisedinlinewith these national benchmarks. Learning and utilisingQualityImprovementtechniques,withthesupportoftheTrust’sQualityImprovementteam, we identified drivers and planned small tests of change. This was a very positive experiencefortheR+Dteam,bothintermsofimproving our own performance and developing Quality Improvement skills, but also in the opportunity to work with clinical teams from across the organisation.

Quality Academy helps focus on target

10


• Communication: An increased focus was put on improved communication, through attendance at meetings and by introducingasinglepointofcontactforqueries.

• Cultural shift : Theteamandcolleaguesexternallyfeelthattherehas been a significant shift in the R+D culture of the organisation, but there is still further work to do with understanding the place of R+D within clinical divisions.

• Performance management: The R+D process has been robustly process mapped, with input from research teams and clinical services. This has helped to identify flaws within the current process. The process has been re-mapped and will be made available via the R+D website. It is also forming the basis for a new Task Ownership Matrix(TOM)tobeintroducedacrosstheresearchteamsinthenextfew months. There has been increased clarity about the targets that teams need to meet, with deadlines added to NHS Permission letters. An escalation process has also been introduced.

• Information: Sharing information about research studies across the Trust has always been a challenge, due to multiple networks and informationsystems.Wedevelopedasinglesharedspreadsheet,using the Salford Royal Sharepoint, but this still proved to be difficult for all teams to access, and time-consuming to update. This problem should be addressed by the introduction of a new Local Portfolio Management System by the NIHR Clinical Research Network during 2015.

Natalie Garratt

SalfordRoyal’squarterlyreturntotheNIHRisused by the Department of Health to assess performance, and in particular improved performance. Repeated failure to deliver the initiation benchmark, or to demonstrate significant improvement, could result in a cut in research capability funding.

Wehavebeenworkinghardtoimproveour performance on both initiation and delivery, while still maintaining an open and transparent approach to the set-up of studies, ledbysponsorandresearcherrequirements.

This has involved better notification of target dates for individual studies, improved performance management of study set-up issues and escalation of problems, close working with support departments, and better communication of the need for rapid study set-up.

Wehaveseenslowbutsteadyimprovementonourperformanceininitiating studies, thanks to a great deal of hard work by colleagues across the Trust, but there is still a long way to go.

WhiletheNIHRacceptsthataproportionofdelaystoset-upandrecruitment are outside the control of the NHS (such as sponsor delays, or very rare patient populations), we are keen to eliminate any delays that could be avoided. It is essential that R+D, research teams and wider clinical teams and departments work together to achieve these benchmarks, and recognise their importance to the organisation.

SalfordRoyal’sExecutiveMedicalDirector,DrChrisBrookes,said:“It’sfantastictoseetheimprovementthathasbeenmadeinourresearchperformancefiguresandI’mgratefultoeveryonewhohas worked hard to bring this about. There is more to do but I am confident we will rise to this important challenge to ensure we are delivering our commitment to clinical research.”

11

R+Dupdate:Performanceoninitiationand delivery of research


Welcoming improvement: Dr Chris Brookes

Research active NHS organisations have to report quarterly on their performance against two key benchmarks:

• Initiation-Recruitmentofthefirst patient to an interventional study at a research site within 70 calendar days of receiving a valid application (the ’70 day’ target).

• Delivery-Recruitmenttotimeand target for commercial clinical trials.

Natalie Garratt

Geoffrey Jefferson was an important early pioneer of modern day neurosurgery in the UK and was also recognised for his great expertise in neuroanatomy and neurophysiology.

© G15040104. Design Services, Salford Royal NHS Foundation Trust. All Rights Reserved 2015. This document MUST NOT be photocopied.Unique Identifier: TE02 (15) Review date: january 2017

12

Historyofhealth:SirGeoffreyJefferson


Sir Geoffrey Jefferson: Portrait by Gerald Festus Kelly. Image courtesy of the Society of British Neurological Surgeons

JeffersonwasborninCountyDurhamin1886,andcametotheNorthWestwhenhisfather,aGP,tookoverapracticeinRochdale. He was educated at Manchester Grammar School and studied medicine at Manchester University. His talent for surgery was recognised at an early stage, gaining his FRCS in 1913 and thegoldmedalforhisMasterofSurgeryexaminthesameyear.

Jefferson met his future wife, Gertrude Flumerfelt, a Canadian medical student, while in Manchester. They married in 1914, emigrated to Victoria BC, Canada, and eventually had three children. They set up a general medical practice in Canada but Jefferson was frustrated by his limited opportunity for surgery and his desire to be involved in the war effort in Europe.

In1916hewasappointedasasurgeonattheAnglo-RussianHospitalinPetrogradandquicklybecameinterestedingunshotwounds to the head and brain. He was also responsible for a surgical unit in Lutsk on the Eastern Front. He was awarded the Order of St George by the Russian Government for his work there. He returned to the UK in 1917 and worked in the 2nd WesternGeneralHospitalinManchesterbeforebeingpostedtoFrancein1918.

Jefferson was described as being one of the three great men whodominatedmedicineinManchesteraftertheGreatWar.He was appointed as a surgeon in Salford in 1919 where he developed his work on phantom limbs, pituitary lesions and intracranial aneurysms. In 1924 he was the first person in the UK to perform an embolectomy (emergency surgical removal of material blocking circulation) and in 1931, operate on a patient with glosso-pharyngeal neuralgia (severe pain in the tongue, throat, ear and tonsils). He left Salford Royal in 1935.

InWorldWarII,JeffersonbecameamemberoftheMRCBrainInjuries Committee and was instrumental in establishing 12 neurosurgical training centres. He later became the first chairman of the MRC Clinical Research Board.

Jefferson became a Fellow of the Royal Society in 1947, a rare distinction for a surgeon and was made an honorary fellow of the Royal College of Physicians. He was awarded honorary degrees from five universities, made a Commander of the Order of the British Empire in 1943 and knighted in June 1950. He died ofaheartattackinManchesterin1961.

• Jefferson’sarchiveisheldattheJohnRylandsLibrary,Manchester.

His interest in brain surgery developed at the old Salford Royal Hospital on Chapel Street and he later established a small neurosurgical unit at Manchester Royal Infirmary. He was eventually awarded a chair at the University of Manchester (1939), the first ever neurosurgical chair in England.

The legacy of his activity and reputation still remain in Salford as all neurosurgery and treatment of head and spinal trauma for Greater Manchester today is delivered by Salford Royal NHS Foundation Trust. Bill Ollier

Salford R+D newsletter [#15, April 2015]

Documents

Transcript of Salford R+D newsletter [#15, April 2015]