Your Impact on Research

Breast Care

Katherine Klimczak £19,991 – FAST MRI OPERA

Optimisation of the FAST MRI protocol: an evaluation and analysis of what makes a good breast MRI through detailed analysis of scans from multiple NHS sites contributing to the FAST MRI Programme Finding breast cancer early saves lives.  The NHS Breast Screening Programme (NHSBSP) uses mammograms to detect early breast cancers. However, not all cancers show on a mammogram so a cancer can be missed and continue to grow until the woman finds it herself.  Magnetic Resonance Imaging (MRI) scans are better at detecting cancers than mammograms.  However, MRI is expensive, and the NHS only uses it to screen women classed as high risk (women with a 4 out of 10 chance of developing breast cancer during their lifetime, almost 3 times the chance of most women (average = 1 out of 7 chance).  

Recent studies have shown that using only part of the full breast MRI scan detects cancer equally well as the full scan but is a much quicker scan with lower costs. This technique is called FAST-MRI and has the potential to save more women’s lives by finding breast cancers earlier than a mammogram and providing value for money for the NHS.  A group of research studies led by North Bristol NHS Trust aim to develop a better breast screening programme using FAST-MRI for women who currently have mammograms to screen for breast cancer.

How easy it is to see a breast cancer on an MRI scan depends on the scan quality and the technical details of the scan, known as the protocol. Quality control is therefore crucial for breast screening to optimise the detection of cancers.  This pilot study will develop a standardised and optimised protocol to be used in a separate multicentre trial of FAST-MRI for women having their first screening mammogram (current shortlisted application to NIHR by the NBT-led FAST-MRI programme). 

Neurology

Richard Ibitoye £17,550 - Detecting Cerebral Venous Thrombosis: An Artificial Intelligence Approach

Clots in veins are an uncommon but important cause of stroke in younger adults (under 50 years old). Unlike arterial strokes, cerebral venous thrombosis is far more difficult to diagnose. Prompt diagnosis and treatment is however key to minimising the risk of disability and death. Patients present with a range of symptoms, meaning stroke may be unsuspected. Furthermore, the initial plain head CT scan is often ‘normal’ – so the problem may be missed. Additional scanning of the brain’s veins (venography) is essential to diagnosing cerebral venous thrombosis. Additional scans however cost time and radiology resources, and may expose patients to unnecessary risk through X-rays and contrast injections. It is not clear which patients should be offered venography in addition to a plain head CT, particularly when headache is the presenting symptom. As over 60,000 people are admitted with headaches each year in England, the challenge is significant.

Many studies have shown that plain CT scans contain useful information about the chance of cerebral venous thrombosis. Even with the best reporting by a radiologist, 1 in 4 cases of cerebral venous thrombosis are missed. A quick and accurate way to decide who will benefit from venography does not exist. Machine learning – the use of advanced computation to learn patterns in images – may help. Machine learning benefits from large amounts of data on patients with cerebral venous thrombosis to be used to train a decision-maker/classifier. Lack of access to such clinical and scan data has previously made such work impossible. A recent collaboration between North Bristol NHS Trust (NBT) and University of Bristol - the Stroke Imaging and Clinical Database for AI (artificial intelligence) – for the first time provides access to the large amount of anonymised imaging and diagnostic data necessary for this type of work.

This proposal aims to use machine learning to support decisions in diagnosing cerebral venous thrombosis. This will involve selecting pre-existing anonymised data in the Stroke Imaging and Clinical Database for AI from patients with cerebral venous thrombosis and controls, then applying machine learning. If successful, an ‘AI classifier’ would be a critical step towards supporting clinicians in making more rapid, and more accurate diagnostic decisions in cerebral venous thrombosis. Unnecessary tests can be avoided – saving patients both time and risk, while simultaneously supporting the earlier detection of cerebral venous thrombosis. A successful outcome has the potential to transform the diagnosis of cerebral venous thrombosis across the NHS with better outcomes for patients.

Intensive Care Medicine

Matt Thomas £17,686.86 - DINE-N - Does Intermittent Nutrition Enterally Normalise hormonal and metabolic responses to feeding in critically ill adults? 

Everyone needs food but many people don’t eat well enough, and especially those with illnesses are often malnourished. For example, up to half of intensive care patients are malnourished on admission to hospital. Malnourished patients are less resilient and consequently suffer more complications and are less likely to survive. 

When patients can’t eat enough, while on intensive care, we put a tube through their nose into their stomach (a nasogastric (NG) tube). We give liquid food through the tube, hour after hour, day and night, minimising breaks – we call this continuous feeding. The idea is to correct the harmful effects of malnutrition. 

This is a very abnormal way to provide feed. It has unpleasant side effects like nausea, diarrhoea and insomnia.  It often does not give enough calories. Importantly it also changes the way the nutrients are used by the body. This could mean the food does not correct the harmful effects of malnutrition. It could even mean continuous feeding makes the problem worse.   

This study aims to assess the response of critically ill adults to intermittent daytime feeding and overnight fasting. We know critically ill patients are all at high risk of malnutrition, have NG feed routinely, and are very closely monitored. The response will be assessed clinically (calories delivered) and with multiple laboratory measures (for example blood insulin levels).   

Respiratory

Geraldine Lynch £19,644 - REPLICA  - Can performing extra tests on non-diagnostic biopsy samples avoid the need for further invasive biopsies in people with suspected cancer of the lung lining? 

Pleural mesothelioma (PM) is a cancer that affects the outside lining of the lung, caused by asbestos exposure. The UK has the highest rate of PM in the world, but despite recent treatment advances, average life expectancy remains under a year from diagnosis. Prompt diagnosis is therefore vital. 

People with suspected PM usually require a biopsy of the lung lining to confirm the diagnosis, guide treatment and assist with compensation claims. However, some people need multiple biopsies which increases the risk of biopsy-related complications and prolongs the diagnostic process, causing additional stress and anxiety.

We previously conducted a study of people with suspected PM who required further biopsies as their first biopsy did not diagnose the condition. All patients consented to be in this trial and an application is underway for approval to perform additional tests on the trial samples. We want to re-test their original and follow-up biopsy samples for BAP1, p16 and MTAP to see whether this would have made the diagnosis sooner and removed the need for further biopsies. We will investigate how many biopsies could have been avoided, how much time would have been saved, and what cost-savings this would have offered the NHS. 

We hope our research will show how useful these tests are and how much benefit they offer to patients and NHS services, so they can be used more widely in routine care. Ultimately, we expect our research to be included in national guidelines and change clinical practice across the UK and worldwide.

Breast Care

Katherine Klimczak £19,366.00 - FAST MRI ENAID - Selection for personalised screening with FAST MRI: Evaluation of an Artificial Intelligence (AI) tool, developed within and owned by the NHS to accurately measure mammographic breast density 

Finding breast cancer early saves lives. The NHS uses mammograms to try and detect early breast cancers. However, as mammograms do not show some cancers very well, a cancer can be missed and continue to grow until the woman finds it for herself. MRI (Magnetic Resonance Imaging) is a test that can find cancers better than mammograms, but it is expensive and so the NHS only uses it to screen women at very high risk of breast cancer. A quicker, shorter MRI test is now available called FAST MRI. Not only might this test benefit more women, it may also provide better value for money for the NHS to find breast cancers early and save lives. 

Every woman’s breasts are different. One way they differ is in their composition, which affects how they look on mammograms. Women with denser breasts can have their cancers missed on mammograms, as the dense normal tissue can hide the cancer. FAST MRI is better at finding these cancers.

To find out which women have dense breasts and could benefit from a FAST MRI, the mammograms need to be studied and measured. Currently, breast density is looked at and estimated by the radiologist but as each radiologist might view images slightly differently, results for breast density might not always be correct. There are now better systems to do this using (expensive) technology.

The research aims to evaluate the accuracy and reliability of a breast density measurement tool. This will provide the National Breast Screening Programme (NHSBSP) with the ability to describe a woman’s breast density. If this tool is successful, it will further enable the North Bristol NHS Trust led FAST MRI research programme to develop a better breast screening programme.

Respiratory

Rahul Bhatnagar £19,919 – SPOTLight - A study to better understand and diagnose patients with conditions which affect the lining of the lungs 

The pleural membranes are two thin layers of tissue which cover the outside of the lungs. The pleura are vulnerable to many different diseases, which can cause them to become inflamed (leading to excess fluid buildup, called an effusion), or to become filled with trapped air (called a pneumothorax). In both situations, this can cause severe breathlessness. Unfortunately, a general lack of research means there are many unanswered questions when choosing how to best diagnose and manage pleural diseases.

At Southmead Hospital, since 2008, we have created the largest collection of pleural fluid samples and data in the world, involving over 1500 people. Using this resource, we have been able to help patients and doctors better understand pleural effusions. However, with science rapidly evolving, it is unlikely that this resource will be able to meet the needs of the next generation of NBT researchers. We therefore plan to create a new, long-term study to replace and improve on the current one, allowing us to help more types of patient; apply more cutting-edge tests; and improving patient involvement in our research. 

We plan to invite every patient who attends Southmead hospital with a pleural condition to take part in a simple follow-up study. We hope to involve at least 1200 people over 10 years, although this application only asks for support to help establish the study over the first 2 years. We would ask participants for permission to record data about their health, and to store small amounts of blood and fluid for future laboratory tests. This study would not require any additional visits to hospital as we would only collect information about what happens to them during their usual care. We would also ask patients to fill out a brief questionnaire about how they are affected by their condition. 

After 4 and months 12 months, we would send an email to the patient with the same symptom survey, so we can monitor the results over time. We would also check their medical records to confirm their diagnosis and to see how their disease was affecting them.

We hope that this project will allow us to improve our understanding of patients with pleural diseases, leading to better medical tests, while also ensuring NBT remains at the forefront of research in this area.

Women’s & Children’s

Katherine Lattey & Abi Merriel £7,990 - In preterm birth does vaginal delivery or caesarean section lead to the best outcomes?

60,000 babies are born early, before 37 weeks’ gestation (preterm) every year in the UK. These preterm births contribute to half of the 25,000 baby deaths in England and Wales each year. Of the babies that survive being born early, some have long-term health problems, which impacts the baby and their families for life and has far-reaching implications for the NHS and society. Currently, we do not know the safest way to help deliver these high-risk babies. Birth options include a vaginal birth or a caesarean section. It has been argued that caesarean section can be safer for preterm babies, however some doctors disagree and highlight that a caesarean section is more risky for the mother, for example bleeding, infections and future risk of stillbirth. 

The aim of this project is to carry out an in-depth review of the existing evidence about ways to deliver preterm babies (the “mode of birth”), to see if, when we combine all of the available research, we have enough evidence to support doctors and women in making this difficult decision.

We will identify all the research studies, based in wealthy countries since 1990, looking at outcomes for both the baby and the mother. We will combine this evidence, to see if there is a clear answer. We will look at short-term problems for the babies, such as being born unwell, but also assess longer term health. The main outcomes will be birth injury and starvation of oxygen to the babies’ brain and for the mother admission to intensive care.

Our evidence search will use electronic databases for research and then two members of our team will assess and select the research studies to be included. With the support of a statistician we will analyse the data to bring together many different studies that have been designed in different ways.

Infectious Diseases and Microbiology

Maha Albur £5,650 - CHARM - Comparing heat -moisture exchange filter (HMEF) and Lower Respiratory Tract (LRT) microbiomes in mechanically ventilated adult patients by using advanced molecular techniques.  

Despite extensive infection-control efforts, hundreds of millions of patients become infected in hospitals every year around the world. Of particular concern is pneumonia developing during artificial ventilation or ‘life support’ (using a machine called ventilator and breathing tube containing a filter) to support the lungs in critically ill patients admitted to an intensive care unit. This is called ventilator associated pneumonia (VAP). VAP is the leading cause of death from infections acquired in the Intensive Care Unit. There is, at best guess, an extra cost of at least £10,000 per patient with VAP in the UK.

Trauma & Orthopaedics 

Emma Clark £11,787 - Testing Vfrac in men: A osteoporotic vertebral fracture screening tool for use in older people with back pain

Having a broken bone in your back (vertebral fracture) is a marker of weaker bones (osteoporosis) and greatly increases the chances of having another broken bone, including hip fracture. Vertebral fractures are common, with approximately 12% of adults aged over 50 years having at least one. Quality of life in people with vertebral fracture is hugely reduced: they experience more pain and are unable to do things they used to, so are more likely to be socially isolated. Our experienced PPI group feel this is a very important area that needs researching to improve patient care.

The aim of this project is to test our Vfrac checklist in men. Although all development work for Vfrac has been carried out in women, men also get vertebral fractures. There is clear evidence that vertebral fractures in men predict future hip fractures in a similar way to women, and medications for osteoporosis work equally well in men and women in protection against future fractures. However, specific questions remain: 

• Do men with vertebral fractures describe their back pain similarly to women?

• Does our checklist work equally well in men or do we need a new checklist specifically for men?

We hope to address these questions with this study.  

Respiratory

James Dodd £17,273 - BRistol Evaluation of novel Airways diagnostics, Therapies & Healthcare outcomEs: BREATHE study

The team at Southmead complex airways clinic specialise in helping patients with problems of wheeze, shortness of breath, cough, and chest-tightness. We diagnose some people with Asthma or chronic obstructive pulmonary disease, but these symptoms may also be caused or made worse by other conditions. For example, problems with the voice box, referred to as Inducible Laryngeal Obstruction (ILO) and Breathing Pattern Disorders (BPD). Both ILO and BPD cause significant symptoms and distress and are often mis diagnosed. What is Inducible laryngeal obstruction (ILO)? ILO occurs when the vocal cords tighten in response to harmless triggers such as perfume or exercise, making it difficult for to breathe. The best way to diagnose ILO is to pass a small flexible camera into the back of the mouth to examine the vocal cords. This is known as a Continuous Laryngoscopy during Exercise/Provocation (CLE/P). Southmead is the only hospital in the Southwest of England that performs CLE/P and access to the test is limited with long waiting lists. What is a breathing pattern disorder (BPD)? Patients with BPD have developed abnormal breathing patterns e.g. hyperventilation. During these episodes patients experience shortness of breath and noisy breathing, which can be hard to distinguish from asthma/COPD. BPD is diagnosed through a medical history and observed breathing during CLE/P. There are effective treatments for ILO and BPD, including exercises & support from specialist therapists.

 The need for research ILO and BPD diagnoses are often missed or delayed it and is not clear exactly how common they are, or the best way to select patients for testing with CLE/P. The dangers of delayed diagnosis of ILO & BPD include inappropriate treatment for asthma/COPD, medication side effects, excess hospital appointments and A&E visits and inappropriate NHS costs.

Women’s & Children’s

Anna Davies £19,185 - Identifying barriers to taking low-dose aspirin in pregnancy, to prevent pre-eclampsia.

Pre-eclampsia (PET) is high blood pressure and protein in urine, and is a common, serious pregnancy complication. PET causes growth restriction, pre-term birth, and serious illness for mother(fits, organ problems, cardiac disease, death), with substantial NHS care-related costs for mother and baby.

Daily low-dose aspirin (LDA) can prevent PET in women with risk and is safe. At-risk women are prescribed LDA or asked to buy it(approximately £0.25p), depending on midwifery hub attended. Importantly, 40-60% of women do not take LDA as recommended(called non- or sub-optimal adherence), making it less effective. 

Women less likely to take it are smokers, younger, Black or Asian, and less affluent. No studies have investigated the reasons for this. By understanding what prevents adherence in these women, we can identify solutions to support them to take LDA, reducing PET risk. This is particularly important in these groups, who have higher risk of pregnancy-related complications and death. 

We interviewed non-adherent pregnant women, to identify adherence barriers. These women were largelyWhite/University-educated. They reported that healthcare professionals(HCPs) did not explain their PET risk, what LDA prevents, and could not answer questions. No studies have investigated HCP’s experiences of informing women about PET and LDA. In our evidence review we found no studies reporting effective interventions to support adherence to LDA or other medications. Therefore, we need to develop an effective intervention to support LDA adherence.

Women’s & Children’s

Jo Crofts £19,045 - A study investigating the feasibility of a ‘Time to Transition Caesarean section’

In the womb, a baby’s lungs are filled with fluid, which helps them develop. During labour and birth, most of this fluid goes away, and the baby adapts to breathing air.

When babies are born quickly by caesarean, they may not have enough time to clear the fluid, so the lungs remain “wet”, making it harder to breathe. They breathe faster and shallower, a condition called Transient Tachypnea of the Newborn (TTN), and often need antibiotics, breathing support, and a stay in a Neonatal Intensive Care Unit.

Reducing TTN could reduce the need for this extra care. This study will assess a new ‘Time-to-Transition Caesarean Birth’. 

Rather than being born rapidly after opening the womb, the doctor will deliver the baby’s head, keeping the body inside the womb until the baby starts to cry (for a maximum of 2 minutes). This extra time may help the baby transition to breathing air and reduce the risk of TTN.

As with any caesarean, the mother and baby will be closely monitored. If there are any concerns the baby will be immediately delivered. Everything else about the birth and recovery remain unchanged.

Urology

Jonathan Aning £18,781 – MUTO - A qualitative evaluation of patient, carer and clinician perspectives on Percutaneous Nephrostomy and Ureteric Stenting for malignant upper tract obstruction towards the end of life.

Advanced cancer can block the ureter, of one or both kidneys, preventing urine flow and causing kidney failure. This commonly happens in people approaching the end-of-life. Blockage symptoms may include pain, feeling sick/tired and suffering infections. 

There are two treatments available:

1. Percutaneous Nephrostomy(PCN): the doctor places a tube through the patient’s skin into the kidney whilst awake using local anaesthetic. Urine then drains into a collection bag outside the body.
2. Retrograde Ureteric Stent insertion(RUS): the doctor places a tube through the bladder into the kidney whilst the patient is asleep. Urine then drains through the ureter.

It’s not known whether these treatments improve quality-of-life or increase length of life beyond a few weeks/days for people with advanced cancer and we may be doing harm without knowing. These treatments can be troublesome for patients, causing long term pain, inconvenience to daily life including multiple additional hospital and/or GP visits. Over 2900 PCNs are inserted each year for this condition in England. This number is increasing and inter-hospital variation has been demonstrated.  

Limited information exists to help people decide between PCN/RUS/no surgical intervention. Most people with these blockages are treated as an emergency which usually doesn’t allow time to fully consider options. This study aims to investigate the degree to which patients, carers and HCPs value these treatments and their information needs.

The questions the research looks to answer are:

What are the experiences of patients with kidney blockages due to cancer and of the healthcare professionals(HCPs) responsible for treating them in hospitals with differing first-line treatment approaches(PCN/RUS)?

How do patients view the information they receive before making their treatment decision?

Infection Sciences

Fergus Hamilton £16,640 - Scavenge sampling for optimising antibiotic dosing in critically unwell patients

Antibiotic therapy is a critical component of modern medicine, but it is increasingly recognised that dosing of antibiotics in the critically ill is imprecise. For our commonly used antibiotics, actual drug levels after the same dose are very variable, with up to 500-fold variation in drug levels. This means around 15-20% of patients in intensive care do not achieve adequate drug concentrations to effectively kill bacteria, and these patients have a significantly increased mortality.  Alongside this, there is a potential for sub-optimal therapy to lead to antimicrobial resistance as we do not adequately treat infections. Currently, international guidance recommends measurement of antibiotic drug concentrations during therapy in the critically ill in order to ensure the correct dosing of the drug. 

However, this guidance is not currently widely followed as taking drug levels requires a specific sample, taken and placed immediately on ice, both before and shortly after the drug is given, between the hours the laboratory is open. This complexity precludes widespread adoption of this policy, despite supporting guidance.

This complexity often means the real turn-around time is often 48-72hrs; during which time the patient is on potentially the incorrect dose.

In this study, we want to investigate whether we can use already taken ‘scavenged’ blood samples taken as part of routine care to measure these drug levels and get reliable results on same day samples. In all unwell intensive care patients, a blood sample is taken routinely at around 4am for monitoring of biochemistry. After this analysis has been performed, we will then ‘scavenge’ the left-over sample from the biochemistry department and perform testing on this sample. This means we will get an antibiotic drug level result by midday on the day after the drug is started, improving the turnaround time by > 24hrs. This has the potential to improve antimicrobial treatment in the critically unwell and allow us to provide precision dosing to many more patients with critical infection.

Renal

Maria Pippias £6,365.56 - Incidence and outcomes of in-hospital cardiac arrest in the United Kingdom kidney replacement therapy population.

When a person’s kidneys fail, they may start kidney replacement therapy by means of dialysis or receive a kidney transplant. Although these replace some of the kidney’s functions, individuals living with kidney failure are at high risk of serious health problems, including sudden death (1-3, 7-17). Cardiopulmonary resuscitation (CPR – heart massage) can prevent death for a small number of people whose hearts stop beating (cardiac arrest). Several research studies have tried to understand how often cardiac arrest happens in people with kidney failure, how likely they are to survive, and what quality of life they are left with. However, the findings of these studies are not always in agreement with each other and none of them come from the UK.

To understand which treatments someone would or would not want in the future, healthcare professionals need to discuss these situations ahead of time. This process is called advance care planning. It gives the patient and their loved ones the opportunity to consider their wishes about care and health outcomes that they would find acceptable. However, we do not have enough information about how many people survive and what quality of life they have after having a cardiac arrest and receiving cardiopulmonary resuscitation. 

To answer these questions, we have designed a study that plans to look back at data already collected and available in data registries in people receiving kidney replacement therapy between 2012 and 2021. Using statistical analysis, we will describe how often people receiving kidney replacement therapy have a cardiac arrest when in hospital. We will also describe how many people receiving kidney replacement therapy survive a cardiac arrest after receiving cardiopulmonary resuscitation, how long they live for and what quality of life they have after leaving hospital. To measure quality of life, we will use data that measures a person’s ability to work and perform activities of daily living. We will also describe how these findings change in different groups, for example if receiving dialysis or a transplant, whether the individual has diabetes or not and by their age and sex. By using already collected data, this study does not place additional burden on patients or services. Alongside statistical analysis, we will work with a group of people living with kidney disease. They will help us to better understand the information they need to decide whether they would like to receive CPR, how they would like to be told about their options and the language that is acceptable to them when discussing treatment outcomes. 

To inform patients about our findings, we will work with UK kidney charities to make information accessible and available via their websites and patient information leaflets. This will help inform advance care planning conversations and allow patients to make decisions that are in keeping with their wishes and views on living and dying with kidney failure. The improved decisions will result in less harm and more benefit for patients.

Respiratory

Shaney Barratt £8,892 - Investigating novel approaches to prognostication and disease monitoring in fibrotic interstitial lung disease

The Progressive Fibrotic Interstitial lung diseases (PF-ILD) are progressive, scarring lung conditions, affecting up to 70,000 people in the UK. They have a life expectancy of 3-5 years from diagnosis; a prognosis worse than some forms of lung cancer. PF-ILD progresses differently in individual patients, making the timing of introduction to advanced care planning or referral for lung transplantation challenging and creates barriers to drug development. We have established a multi-centre research study investigating the role of new technologies and biological markers in disease prognostication and monitoring in PF-ILD. This study, PREDICT-ILD, will examine how specialised computer software called quantitative CT (qCT) can aid patient assessment in predicting and quantifying disease progression. This feasibility study has been funded as part of Dr Giles Dixon’s 3-year PhD programme application and is due to start recruitment from June 2023. Dr Shaney Barratt, colead of the Bristol Interstitial Lung Disease service is joint academic supervisor of the study.

Respiratory

Dr. James Dodd
Award: £19,914 – Remote teaching of home spirometry in patients with respiratory symptoms

Spirometry is a breathing test performed by blowing at maximum force into a tube. This is deemed to be high risk for COVID-19 transmission. Safety measures have led to the number of patients having spirometry tests halving and a long waiting list.

Spirometry can be performed at home, and the results can be sent via email to hospital staff using an app. However, we do not know how patients can be effectively taught how to perform spirometry.

This study is to determine the most effective way of performing spirometry in patients own homes.

James and his team will find out how accurate the home spirometry is by comparing the results to spirometry performed in the hospital.

If this study shows that patients can be effectively taught to perform spirometry at home remotely, this will reduce the number of hospital visits patients have to make in a place where respiratory patients are vulnerable and at risk of contracting COVID-19, decrease the hospital waiting list and reduce the costs associated with face-to-face visits.

Mental Health

Jo Daniels
Award: £19,757 – COVID-19 clinicians cohort (CoCCo) study: trauma needs and preferences

Many frontline doctors are experiencing mental health problems due to the impact of coronavirus, particularly traumatic stress.

Doctors who struggle with their mental health are known to take time off sick, perform poorly at work and experience high levels of psychological distress. This can then have a knock-on effect in terms of their patient care.

Studies completed during COVID-19 have outlined how important it is to hear from doctors from their own individual point of view, so services are shaped around what these doctors want and need. 

Jo’s study aims to explore the key issues faced by doctors to understand the experience of working in a pandemic. Jo wants to know what treatment doctors want and how doctors want it.

The team will interview around 40 doctors from three groups (those working in emergency medicine, intensive care, anaesthetics). They will identify common themes from the interviews and note any differences between them.

The team will use their knowledge to develop treatment recommendations to professional groups, so that care for doctors is improved.

Renal and Urogenital

Nikki Cotterill
Award: £18,574 – Lower urinary tract dysfunction with SARS-CoV-2 infection

Nikki is interested if symptoms associated with bladder disorders start or worsen with the development of COVID-19 symptoms. There are very few studies that have addressed this question, and the preliminary results from these studies demonstrate a link between COVID-19 infection and bladder problems.

Nikki’s study aims to follow two groups of volunteers: those who have been infected with SARS-CoV-2 and display COVID-19 symptoms, and a comparable group who haven’t had COVID. Participants will be asked to fill out three questionnaires to document their symptoms to answer these questions:

• Has COVID-19 contributed to the development of these symptoms?
• Does COVID-19 infection alter the severity of existing symptoms?
• Do symptoms change over time: do they rise and fall with time; do they get progressively worse; do they lessen with time?

Whether COVID-19 increases the prevalence of these bladder symptoms in the population, especially in the older group, is yet unknown but could have an impact on everyday life, need for services, and how nursing homes might respond.

Early detection and any proactive easing of symptoms can have an impact. If we know that bladder symptoms are associated with COVID-19 infection we can inform healthcare staff so that they can manage these symptoms more effectively.

Respiratory

Dr Anna Bibby
Award: £19,979 – Can we diagnose cancer of the lung lining (mesothelioma) by testing cancerous fluid for a gene called BAP1?

Mesothelioma is an incurable cancer that affects the outside lining of the lung. In the UK, 2500 people die from mesothelioma every year, which is equivalent to one person dying every four hours.

Anna will use her funding to establish whether it is possible to diagnose mesothelioma on the fluid when it is first removed. This could allow us to make the diagnosis within two weeks of the patient’s first appointment. This would shorten the anxious, uncertain time and potentially mean patients didn’t need to have additional tests. 

Anna will test a gene called BAP1, which is part of the DNA building blocks found in every cell in our bodies that make up who we are and how our bodies behave. In normal cells, the role of BAP1 is to stop tumours appearing and, if they do appear, prevent them growing. However, when mesothelioma tumours take over normal cells, the BAP1 gene disappears, which is why mesothelioma tumours can grow inside the body. 

We can currently test biopsy samples for BAP1. If it has disappeared, then the diagnosis is definitely mesothelioma. We want to find out whether we can test BAP1 in fluid as well as biopsies and whether this will be a reliable test for mesothelioma. 

Respiratory

David Arnold
Award: £5000 – Rapid Diagnostics in Pleural Infection

Pleural infection is the collection of infected fluid around the lung. It affects around 15,000 adults in the UK every year. The usual length of hospital admission for this condition is over 2 weeks. Part of the need for such extended hospital stays is due to difficulty for doctors in working out which patients might get better with antibiotics alone, who will need the infected fluid draining and who will require surgery.

David is testing to see whether testing levels of a protein called suPAR in pleural fluid can help us to predict which patients will require hospital admission, a chest drain or surgery,

If this marker could show that some patients could be managed less invasively then this has the potential to reduce the need for procedures and hospital admissions which would be beneficial to patients and the health service.

Intensive Care Medicine

Matt Thomas
Award: £19,688 – Early beta-blockade in severe traumatic brain injury: a pre-randomised controlled trial qualitative study

Damage to the brain following an accident has two forms. Primary injury happens at the moment of impact and cannot be altered. Secondary injury happens in the minutes, hours and days after the event and can be improved by medical treatment. Less secondary injury means patients are more likely to survive, and to survive with less disability.

One cause of secondary injury is adrenaline, a natural hormone released at times of stress. Too much adrenaline can make blood vessels leaky. This causes brain swelling which leads to secondary brain damage.

For this funded research, Matt will be investigating the challenges that researchers face when carrying out this type of research in intensive care to ensure that future trials into beta blockers and traumatic brain injury are successful.

Vascular

Shona McIntosh
Award: £19,986 – Is prognosis discussed with adult patients who have peripheral arterial disease?

Peripheral arterial disease (PAD) is a disease of the circulatory system affecting both sexes and increases in occurrence with age. It happens when arteries narrowed by calcium, cholesterol and fat deposits prevent adequate blood flow to the legs. Patients with inadequate blood supply to limbs are also likely to have narrowed arteries in other areas of their body putting them at increased risk of stroke, heart disease and kidney disease.

Patients with PAD who are facing amputation are likely to have a reduced life expectancy: four in ten patients undergoing amputation die within a year after surgery, and approximately seven out of ten will die within five years. This is a poorer life expectancy than for many people with cancer. Physical and psychological needs may be overlooked in patients with PAD in the last 6-12 months of life by clinicians looking after them because their declining health is difficult to predict.

The aim of Shona’s research is to understand the factors affecting discussions about life expectancy for patients who have PAD, and whether the barriers to having these conversations lie with the patient, the clinician or both.

Psychology

Dr Jo Daniels
Award: £13,805 – A study establishing need and experience of high impact users in A&E with abdominal pain

People who attend the Emergency Department (ED) between 5-10 per year classed as high impact users and over 31,000 people attend ED over 10 times a year. The third most common reason for visiting the Emergency Department is abdominal pain which can be difficult to accurately diagnose or treat. Additionally, there is often no medical cause for the pain.

This is problematic for ED doctors, because although they do not want to overlook a serious medical emergency, they also want to avoid prioritising and spending excess time on patients who could be treated by GPs or self-manage at home There is no clear plan of action yet developed for doctors to treat abdominal patients effectively; there are no treatments that work and very little in terms of guidelines. This is surprising given how distressed these patients are and how much they cost the NHS.

Patients often find it difficult to hear that there is nothing medically wrong when they are in so much pain and distress. This can make them more worried (thinking perhaps something has been missed) which can cause symptoms to worsen by focussing on them, which then for some gives panicky symptoms such as feeling hot and palpitations which may be taken as evidence that something is really wrong

Jo aims to understand the needs and experiences of these patients attending A&E. She plans to use this information to help develop treatments in the future, improve quality of life for these patients and also benefit the NHS through expected cost savings.

Women's Health

Katharine Gale
Award: £19,992 – The Working Lives of Menopausal Women in the NHS

The overall aim of Katharine’s research project is to investigate the working lives of women in the NHS, focusing on the menopause to discover what women describe as supportive management and explore how the organisation can improve support & guidance for their female staff within the organisation.

The menopause is the time in every woman’s life when her periods stop and usually occurs between the ages of 45 and 55, with the UK median age of the menopause being 51. The average duration of moderate to severe hot flushes is 10 years but symptoms include night sweats, poor concentration, tiredness, poor memory and lowered confidence, with 25% of women experiencing symptoms they describe as severe. There are over 3,000 female employees in NBT aged between 41 and 60 years and therefore either likely to be affected by the menopause or have a lived experience of dealing with the impact at work.

The aims of Katharine’s research project are:

• To identify the unique health needs of menopausal women
• To explore the experiences of these working women during the menopause
• To identify any barriers to accessing health care, support and advice
• To make recommendations on how women’s working lives could be improved in our organisation