This document provides summaries from several presentations about driving progress in health care through research supported by the National Institute for Health Research (NIHR) in the UK. The first presentation introduces the NIHR and its role in supporting different types of health care research. The second presentation describes a clinical academic fellowship funded by the NIHR and the research and career development it enabled. The third presentation summarizes a large clinical trial called DRAFFT that compared wire fixation and plate fixation for distal radius fractures and found wires to be as effective and cost less, leading to a change in practice. The last presentation discusses the experience of patients who participate in research and how it can benefit the NHS.
3. • Provide a flavour of the many different ways in which the NIHR is driving
progress in healthcare
• Share our experiences of the NIHR, but also provide a wider national view
• This will be followed by a Q&A panel session
4. Come talk to us about how the NIHR can help your NHS improve through
research – stand 119
5. The benefits and impact of clinical academics and NIHR trainees
Gilly Howard-Jones, Lymphoma Clinical Nurse Specialist,
University of Southampton NHS Foundation Trust and NIHR Clinical Doctoral
Research Fellow
6. Overview
• My background
• My research
• Clinical development during the fellowship
• Outcomes so far
• Looking to the future
8. My Research : The influence of social networks on self-management
support in cancer survivors: A mixed methods Study
Quantitative postal survey
Qualitative
interviews
Invited to
participate from
survey
Interpretation based on
Quantitative (qualitative )
results
9. Undertaking clinical development
• Planning the application with clinical staff
- Member of NICE Guidance Development Group for NHL
- Patient Triggered Follow Up
- Advanced Nurse Practitioner role development
• Engagement with Lymphoma Association
- Supporting development of survivorship services
10. Outcomes so far…..
• Patient experience
• Team
• Hospital Trust
• University
• National influence
11. Looking to the future
•Completing my PhD !
•Creating a new clinical academic post
•Clinical Lectureship application- TIME and RESOURCES
13. How DRAFFT improved care, made cost savings and achieved
consistency across the NHS
Mike Reed, Consultant Trauma and Orthopaedic Surgeon,
Northumbria Healthcare NHS Foundation Trust
14.
15. About Me
Trauma and orthopaedic surgeon
Full time clinician
I just do regular trauma on call
I’ve run some clinical trials
No involvement in this study (although I did do
some surgery)
“So why are you here?”
16. Background
In the Western World,
6% of women will have sustained a fracture of the distal
radius by the age of 80 and 9% by the age of 90
23. Numbers
• Screened: 12,000 patients with a distal radius fracture
• Eligible: 639 patients
• Recruited: 461patients (more than anticipated)
• Follow-up: over 90% at each time-point
25. The result
This large, multi-centre, pragmatic clinical trial shows that
there is no difference in patient-reported wrist
evaluation in the twelve months following Wire fixation
versus locking-plate fixation.
Confidence intervals exclude a clinically relevant effect
(95% CI; -4.5 to 1.7)
26. The result: sub-groups
No difference in under 50 years versus over 50
years
No difference in those with intra-articular
extension versus extra-articular
27. Result: further surgery
• 5 patients in the wire group and 2 in the plate group
required revision surgery for loss of reduction
• 9 patients in the plate group required removal of
symptomatic metalwork (4 for screw penetration of the
joint) and 1 patient with a buried K-wire required removal
in theatre
28. The result: Health Economics
Economic evaluation completely driven by the choice of
implant
Wires were cheaper: £54 vs £854
No difference in Quality of Life in the 12 months after
surgery
Therefore, wires are cost saving
29. So what happened next?
• Did anyone take any notice?
• Did anyone get upset?
• And, did anyone change their practice?
44. Conclusions
• Use more wires. Save lots of money.
• UK Orthopaedic Trauma Surgeons can deliver multi-
centre clinical trials
• They really do change clinical practice!
45. How the money stacks up…
DRAFFT cost the taxpayer about £1.5 million
The 25% shift in practice has already saved £1.6 million
Will continue to save year on year.
48. Patient experience of participating in research
Vee Mapunde, Associate Consumer Lead
National Cancer Research Institute
49. The NCRI Consumer Forum – Background
Formed in April 2015, funded by NCRI (with NIHR support), follows CLG (funded by
NIHR Clinical Research Cancer Specialty Group)
Objective:
To create a professional, focussed and committed constituency of consumer research
partners, who can help NCRI achieve its aims
Nine specific points, including:
To provide a pool of well-trained consumers to input into NCRI and partner research
activities, committees and groups, as equal and valued partners
50. How I got involved
Diabetes
• Why him? And why now?
• Could I have stopped this?
Prostate Cancer
• Why is it that some people can “live” with this condition?
• Why is it more aggressive in some ethnic groups?
• How does this affect patient outcomes?
• What impact can I make?
51. How patient involvement benefits the NHS
• Patient experiences can drive service improvements and promote research
• Patients get involved in finding solutions when researchers bring ideas or problems to
them
• Taking part in research is associated with better experience of care – 88% of all
cancer patients are satisfied/v satisfied with care; increases to 93% for participants
• Increase our understanding of challenges associated with hard-to-reach groups,
geographical inequalities of access to research opportunities, gaps in clinical trial
portfolios, matching patient priorities
• We can change practice faster – working with the NIHR, NICE and MRC CTU
Firstly a bit of background to the reason this study came about. Apparently a huge number of people will sustain a dr#, 6% of women will have by the age of 80 and 9% by the age of 90 and a cochrane review exposed a serious deficiency in the evidence available for their treatment
So the trial is comparing Kirschner wires with volar locking plates for the fixation of dorsally displaced distal radius fractures in adult patients.
The 18 centres as you can see from this slide are spread across England
Our primary outcome is the PRWE taken at 12 months and we are collecting a number of secondary outcomes including DASH, x-rays, complications and health economics.
Here is what our recruitment graph. This was an incredibly successful phase of the trial and as you can see our actual line exceeds the target the whole duration of the trial and we actually recruited 461 patients in total which will help improve the power of the study (this is 71 over our original target). This was due to a number of factors not only the enthusiasm and commitment from all of our 18 centres but we managed to open a few centres earlier than intended. We had a bad winter in 2010, and due to lots of interest from centres we opened at more centres than originally planned. So these lessons will help when putting future applications together. But a big thank you to everyone involved for making this happen.
One huge part of the study was collecting the screening data on all patients with a dr# across all 18 centres. You all have a copy of this consort diagram in your delegate packs and as you can see we screened a over 11,000 pts which is a huge number and of whom 638 were eligible and 461 consented which is 72%. As expected not all patients received their allocated interventions.
Additional background notes:
Same members initially, but new Terms of Reference
Patient experiences of research opportunities can drive service improvements and promote research awareness
Patients get involved in finding appropriate and relevant solutions when researchers bring ideas or problems to them
Taking part in research is associated with better experience of care; 88% of all cancer patients are satisfied/v satisfied with care; increases to 93% for participants
We increase our understanding of challenges associated with hard-to-reach groups, geographical inequalities of access to research opportunities, gaps in clinical trial portfolios, matching patient priorities
We can change practice faster – working with NIHR CRN & NICE, with NIHR’s Dissemination Centre and with MRC CTU