A retrospective on health research and the nature of collaboration

Prof Sally SpencerDirector of Research, Postgraduate Medical Institute, Edge Hill UniversityEditor: Cochrane Dementia & Cognitive Improvement Group

Cochrane Airways Group

edgehill.ac.uk

2014

edgehill.ac.uk

Aims to:- Lead innovation in professional education;- Develop applied research to drive evidence-informed care;- Provide a partnership forum for enterprise and innovation

Cross-faculty, interdisciplinary, partnership focused

Education

Research

InnovationTranslation

Improved Practice

edgehill.ac.uk

Medicine MMed

SurgeryMCh *

Dental EducationMSc Dental Implantology *

Assisted ConceptionMSc Advanced Fertility PracticeMSc Clinical Reproductive Medicine

Medical LeadershipMSc Medical Leadership (Contract with HEE for North West)

Medical and Clinical EducationMA Clinical EducationPGCert Teaching and Learning in Clinical PracticePGCert Simulation and Clinical LearningPGCert Workplace-based Postgraduate Medical Education

Postgraduate Education

edgehill.ac.uk

• NIHR Internship (funded)

• MRes - Clinical and Health Research

• PhDGraduate Teaching Assistants (FT student stipend)Part-time study

• Full-time and part-time RA’s

Research

edgehill.ac.uk

• Relevant and responsive• Commissioned work• Collaborative research

• Funding• Internal• External

Research

The research journey• First impressions• What have we learned?• Advice

Who am I?• Bethlem Royal Hospital• St George’s Hospital

• Worked with a range of professionals across primary & secondary care, third sector, local government and industry

• Generated research income £3million +• Led establishment of a cross-sectoral collaborative research

consortium at Lancaster (10 partners)• Research: QoL in clinical trials and systematic review (Cochrane)

University of London

Kingston University

Brunel University

Lancaster University

Edge Hill University

First impressions

Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease (COPD): the ISOLDE trial

Study Protocol

990 eligible pts

8-week run-in period

239 withdrew

751 randomised

500g FP 2*day via MDI

& spacer

375 Placebo

212 completed

175 completed

376 FP

3-yr dble-blind

3-yr dble-blind

164 withdrew

200 withdrew

My first ‘trial’• Joined as a research assistant• Patient-focused outcome measures: SGRQ,

SF36, SIP, MRC dyspnoea• Approx 10,0000 questionnaires over 3 years,

generating over 338,000 datapoints

My first ‘trial’• What was it like?• Data presentations, analyses, conferences• Scary, enlightening and exciting

My first ‘trial’ – the worst bitsSpeaking at my first conference: American Thoracic Society, attendance 15,000, audience 500

My first ‘trial’ – the best bits• Acquiring new skills: statistical modelling• Meeting new people: US, Europe, Australia• Building confidence• Publications: BMJ, AJRCCM, Chest, Thorax, etc• PhD: Role and analysis of QoL in trialsAnd……………………………..

Adventure!

But did it make any difference?• Impact on research?• Impact on practice?• Impact on patients?

The Research

CycleEvidence

Evaluation

Research Design

Research Evaluation

Research Synthesis

Practice Guidelines

Early 90’s – evidence of effectiveness in asthma.

ISOLDE : ICS v placeboAJRCCM, 2000

Lung Health Studies (US) & CCLS (EU) → Cochrane Review, 2002

What about COPD?

GOLD, 2003NICE (2004)ATS/ERS (2004)

What have we learned about doing health research?

Be determined to succeed• Passionate people make it happen• How to get your foot on the research ladder?

– acquire research skills– develop unfunded research and publish the results– join a research team to gain experience

Start from the right place• What is the evidence base, i.e. has it been

done?• What is the problem?• What is the solution?• Will it have an impact beyond your own frame

of reference?

Collaboration – know what you don’t know• Few research projects are led by 1 person• Research funders expect multi-disciplinary

teams– NHS - Commissioners– Academia - Service users– Industry - Research infrastructure– Voluntary sector

Manage expectations• Academics, clinicians, businesses• Roles and responsibilities?• Time scale?

• Manage ego’s to avoid misunderstandings…

Oct 1995, radio conversation between US Navy and Canadian authorities off the coast of Newfoundland.

Canadians: Please divert your course 15 degrees to the South to avoid a collision

Americans: Recommend you divert your course 15 degrees to the North to avoid a collision

Canadians: Negative. You will have to divert your course 15 degrees to the South to avoid a collision

Americans: This is the Captain of a US navy ship. I say again, divert YOUR course!

Canadians: No. I say again, divert your course.

Americans: THIS IS THE AIRCRAFT CARRIER USS LINCOLN, THE LARGEST SHIP IN THE US ATLANTIC FLEET, ACCOMPANIED BY 3 DESTROYERS, 3 CRUISERS AND NUMEROUS SUPPORT VESSELS. I DEMAND THAT YOU CHANGE YOUR COURSE 15 DEGREES NORTH OR COUNTER MEASURES WILL BE UNDERTAKEN TO ENSURE THE SAFETY OF THIS SHIP!!!

Canadians: This is a lighthouse. Your call.

Regulations and process can be confusing.

Seek help from:

- Trust R&D- HEI R&D- NW Research Design Service- NIHR Clinical Trials Units- Funders guidelines

Effective time management …..

Research clinic, Friday morning in July

Me: How can I help?

Clinician: (Hands over 2 A4 sheets).My consultant wants me to submit this project to RfPB for funding and I need help with the application

Me: (Reads the sheets) Ok, the project might have potential but it needs a lot work. Which deadline are you aiming for?

Clinician: Monday.

In my experience…

Be gutsy and determined!

Some characteristics help…….

Lead you up a blind alley…

or lead you into eureka sunshine

Research can…

or lead to lifelong friendships

Can get you into a fight…

scare the pants off you….

and give your life purpose give you sleepless nights….

and be deeply rewarding

Research can…

Be ambitious, but realistic!

So, my advice is…

Keep an open mind.People are often more than they appear to be

and…

develop networks with new friends and colleagues

and…

Have fun!

and…

…don’t forget the things that matter.

and most of all…