sally spencer
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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…
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