The NRCM meeting was held in Manchester on the 7th of December 2018. This page provides a brief overview of each session in the meeting, it is a useful meeting to gain a wider understanding of collaborative research in this country.
Session 1- Ten priority research questions for the UK Collaboratives: a Delphi Study
This session was the third round of the Delphi technique by a cross collaboration group to identify the the key research question for the future. Delphi technique is repeated rounds of voting, progressively narrowing down the best questions until eventually one/ multiple are chosen. They started with 85 questions and in this round the delegates had to score the top 10 questions. There were three areas assessing geriatric involvement in surgical patients, three were related to training and trainees and two were on antibiotic use.
Though the questions were not specific to urology, it does raise the potential of reviewing management of patients in the elderly since it such a prevalent issue with a large proportion of patients being over 75 years of age. There is a potential to evaluate training provided to trainees regarding complex CoTE conditions. The Delphi technique is also a potential method to select future projects, similar to Dragon’s den.
Session 2- Getting it right first time: designing high quality collaborative research
This was an excellent session relevant to not only those planning large scale research projects, but also clinical trainees and alike who have a good research idea and are not sure where to start. The range of expert speakers was extremely well planned and offered the ideal balance to answer those often tricky questions.
The importance of the research idea itself cannot be overestimated – this is where it is vital that prior research into the subject / objective is thorough, and the question has not yet been answered. Early patient and public involvement is essential, and is a key driver in ensuring the inception of research is well thought out and relevant to patient outcomes – link to the COMET initiative.
The way to catch the funders attention is not just with your idea, but to tailor it to their requirements – and to be aware of any recent changes in priorities and policies that the funding body has published. Surprisingly, funder review advice is not always followed – so be sure to pick out each separate feedback point and address it in a timely fashion – you won’t have long to respond to the first review, which is often given a tight deadline of around 2 weeks.
A good tip is to find out who the programme director and programme leads are, and where their interests lie – they may not be specialists in the field you are proposing to research, so shy away from abbreviations and keep language easy to read and interpret. When it comes to planning your intervention, explain the rationale, and consider retention of recruitment target as well as the value for money – this is what the funders are looking for in the sadly restricted world of research funding.
Making your study proposal original can be tricky, but this is what will earn you the attention you want to drive it to fruition. Seek advice for every stage – from inception through to methodology and funding. Clinical Trials Units relevant to your research can offer invaluable advice, and do not have to be based in your region to offer support – make the most of any resource available to you. Selecting the most appropriate methodology and statistical analysis to answer your research question and objectives is crucial. Consider this early, for example matching characteristics in parallel arms – relevant prognostic markers, for example, will reduce confounding and strengthen the interpretation of causality. Most importantly, however, remember to enjoy the whole journey!
Session 3- Active studies from NRC e.g. SPARCs, EUROSURG, ROCSS
This session covered new trial designs and the results of some recently completed project, it was useful to learn about multiple trials and their designs. Plenty of thought-provoking designs and questions were presented that could inspire future studies
Almost 14,000 patients
At risk of Common Bile duct stones
MRCP prior to lap chole
Global SURG trials – overseas central UK government funding – Developed a pipeline to run multiple trials simultaneously / slight staggering.
4 arm RCT testing 2 factors- Again to do with wound infection
Multiple hubs around the world for a hub and spoke model of delivering collaborative research.
Cluster RCT- Change of gloves for wound infection rates and skin prep
Co-enrolment with ROSSINI II – this is interesting as they recruit into 2 trials simultaneously
RECON – StarSurg – The Student Audit and Research in Surgery (STARSurg) collaborative is a national, student-led audit and research network with representation from medical schools across the UK and Ireland
This is their sixth project- Postoperative Pulmonary Complications after abdominal surgery
Post-op ileus in colorectal surgery- Role of NSAID’s
No worsening of ileus or AKI and decreased opioid requirements.
Session 3- Winning oral abstracts
Oral presentations on the winning abstracts- including IDENTIFY.
Winning abstract was WAX – orthopaedic study assessing the length of time a patient is non-weight bearing after ankle fixation.
Relatively straight forward, non-contentious project.
Very similar to PROPEL but timelines were a bit different i.e. theirs were 2 vs 6 weeks whereas ours might be 4 days vs 2 weeks.
Session 4- Social Media, Altmetrics and Collaborative Research
This session focused on how social media can be used to benefit research collaboratives, gave a fascinating insight into the growing world of altmetrics, and revealed the top 10 visual abstracts by twitter engagement for #NRCM2018. Much of what was covered in this session can be found of the BURST twitter page(!) but below is a breakdown of some of the key take home messages.
- Social media, particularly twitter, is a powerful tool for engaging healthcare professionals, governing bodies, patients and the general public in research. It makes research more accessible and transparent, offers a platform for debate, and more easily gives a voice to patients.
- Very important to stick to GMC guidance and local trust guidance on social media use at all times.
- Data presented showed patients are increasingly keen for clinicians to have professional social media accounts – shows transparency & modern approach.
- Could be a useful tool for recruitment – more professional guidance due on this.
- The future – gifs? Instagram?
- Altmetrics – an alternative way to assess impact. Looks at professional citations in public documents/government use, social media engagement etc. Potential flaws e.g. when clickbait-esque titles used, but countered if you click on the altmetric number – gives breakdown of where an article has scored highly. Growing field – worthy of further Ix.
- IDENTIFY study visual abstract came 3rd overall!
Session: What the National Institute for Health Research (NIHR) can offer you
This session involved short presentations as it was designed as an interactive Q & A session.
Main points covered were:
The NIHR budget
Bulk of Clinical Research Network (CRN) goes on clinical delivery, e.g research nurses
Insight into NIHR surgical portfolio studies
Key theme was the importance of engaging with trainees early to facilitate research onwards into consultant level. These consultants will then engage the next generation of trainees. The associate PI scheme was also highlighted and discussed.
Session: How to get funding from NIHR
This was an excellent session that covered in detail how to approach a funding application to the NIHR.
The research for patient benefit (RfPB) scheme
– up to £350k for three years
– All NHS researchers eligible
– Three competition rounds per annum
– Two stage process
– Eight regional advisory panels
Key aspect is a clear trajectory to patient benefit. There is an option to have a joint lead application for NIHR funding which is a new option. Scale of impact is important and needs to be clearly articulated. Other important considerations for an application:
– Expertise of the research team, eg. health economics, statistics.
– Collaboration with clinical trial units encouraged
– Dissemination strategy vital to achieving patient benefit
Session: How can pilot and feasibility studies optimise the design and conduct of surgical trials?
This session looked at some of the challenges of conducting surgical trials, what feasibility studies are and how they can be useful in surgical trials, and took the format of a discussion followed by group work designing a pilot study.
o Feasibility study = piece of research done before a main study – should we proceed and, if so, how?
o Pilot study = piece of research more similar to main trial done prior to main trial – a version of the main trial, do all these components work together?
o All pilot studies are feasibility studies, not vice versa.
- Challenges in surgical trials can be broadly grouped into methodological/design (recruitment, intervention, measurement of outcomes) and cultural (equipoise). Feasibility studies can help to optimise design by addressing uncertainties, establishing routes of interest and optimising/streamlining the process.
- Important to remember feasibility studies are not powered/designed to detect a significant difference – interpret pilot data with caution!
- Feasibility studies can help ensure relevance of research question, test recruitment and enable tweaks to be made.
- Ensure feasibility study enables you to accurately assess outcome measures – does it test their definitions, the follow-up, adherence, attrition etc?
- Also worth considering – will intervention stabilise after initial recruitment in pilot study?
- When designing a pilot study, how much uncertainty with the design is there?
o If high – external pilot – cannot use data in end study.
o If low – internal pilot – data will contribute to main study.
Session: Data management tips & tricks
This session covered optimising Case Report Form (CRF) and database management in research.
- When designing CRFs
o Think about computerisation – can it be done on an electronic collection tool? If not, how easy is it to computerise the hard copy form?
o Keep it simple – use numbers, dates, clearly defined values, use yes/no questions, and if more complex use category lists.
o Consider using code lists, shading to make clear your desired responses (appropriately, obviously), and notched boxes to clearly denote exactly how many figures you’re after.
o Above all, be consistent and be specific.
- Only collect what is needed; should be relevant to primary and secondary outcome measures. Adhere to your protocol.
- Remember, if you have the data, you are obliged to be checking it!
Session: Associate Principal Investigator (PI) scheme
The PI scheme aims to provide formal recognition to trainees who are involved in local research, as long as certain criteria are met:
– 6 month duration of involvement
– Good Clinical Practice (GCP) compliant
– Involvement in CRF completion/documentation
– Involvement in trial planning or progress meetings
– Involvement in patient recruitment
At present only 2 general surgical studies are signed up to the program but any study could potentially be involved as long as the PI and the Trial Management Group (TMG) contact the co-ordinators of the scheme (Mr. Richard Wilkin). More details available in the surgical section of the NIHR website.
Session: JCST Quality Indicators in Academic Surgery
This session was an interactive one designed to create quality indicators for NIHR integrated academic clinical jobs (e.g. NIHR Academic Foundation Program, NIHR ACF, NIHR ACL). The idea was to identify key aspects of these jobs that should be specified as measurable outcomes to allow the evaluation of the quality of a particular academic job. Things that we learnt that trainees identified as being important included:
- Dedicated space and university infrastructure for the trainee to use during their academic time
- Two named contacts for academic supervision
- Clear and transparent method of accessing funding and resources for research methodology training
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Session: One-stop NIHR Research Clinic
This was a one-one session with an academic Dr. Ian Fletcher from the research design service (NIHR RDS). There are different research design offices in each region e.g. Central and SouthWest (London), East of England etc that can help researchers plan their research projects and trial. They also help you with the NIHR funding application.
Contact your local research design office in the early stages of your project planning.PPI or Patient Public Involvement is something NIHR look for from the inception of the project. They can also help us by providing a PPI member to join our team for the NIHR funding application- this makes the application much stronger. There are also clinical trial units that can help us set up, recruit and analyse RCTs, these are all chargeable but the costs are covered by the NIHR funding. Again, something that would make the funding application stronger.
Finally, a member of the team with a previous grant from NIHR would also add to the application. The services offered by the research design office are free- contact your local RDS for further information.
Session- Research clinic
This was a very useful session providing critical appraisal of upcoming studies from trainee led collaborative groups like BURST by a panel comprising of a senior urologist, statistician and NIHR committee member. Three upcoming BURST projects were discussed- IDENTIFY RCT, DETORT and PROPEL. The committee made good points about the protocols and helped BURST gain an external perspective on their projects, we took a lot away from this session. It is also useful to defend and debate your study protocols prior to conducting large scale research.