Building a Multi-centre Clinical Research Facilitation Network: The ARC Experience

Introduction: In order to practice evidence-based veterinary medicine, good quality clinical evidence needs to be produced, in order that it can be apprasied systematically by the EBVM network, and used by vets. There is very little good-quality veterinary evidence for most of the veterinary procedures carried out every day across the world. Very few, if any, individuals have all the necessary qualities (case-load, time, research expertise, financial support) to be able to systematically produce good-quality, and relevant, clinical research on their own, in a timely manner. The Association for Veterinary Soft Tissue Surgery (AVSTS) www.avsts.org.uk is an affiliate group with the British Small Animal Veterinary Association (BSAVA), and functions as a clinical network of like-minded individuals. In 2013 AVSTS sought to create a role for itself in facilitating the production (by its members) of multi-centre clinical research of relevance to its members.Materials and methods: Members of AVSTS were asked to join the AVSTS Research Cooperative (ARC), with a veterinary epidemiologist and an experienced multi-centre veterinary clinical researcher (to help with study design and statistical planning), and the Animal Health Trust clinical research ethics committee. An email list was established, and a page was set up on the AVSTS website, to allow information to be disseminated. The AVSTS spring and autumn meetings were used as a regular forum by ARC, to discuss its direction, to generate interest, to create and promote specific studies (in order to widen participation amongst different centres), and to update members about previous studies.Results: Membership of ARC has grown to 224 people, although the epidemiologist left. One multi-centre study has been published, two have been presented and await publication, one has been accepted for presentation, two other studies are gathering data at present, and further studies are in the pipeline. There has been interest from general practitioner members but as yet no studies of general practice procedures have been forthcoming.Discussion: Vets want to be involved with clinical research. ARC has had early successes and will continue to grow - though more work is needed to encourage general practitioner members. Multi-centre research allows more cases to be recruited more quickly, adding weight to studies and shortening the period of data-gathering. These initial retrospective studies have generated a committed core of individuals seeking to create prospective studies together. An online tool is planned, to facilitate real-time case-recruitment for prospective multi-centre studies including randomised controlled trials. Anyone can join ARC, please email [email protected]. <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" />

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Attempting to set up a randomised controlled trial

Nursing Standard ◽

10.7748/ns2000.02.14.21.32.c2762 ◽

2000 ◽

Vol 14 (21) ◽

pp. 32-36 ◽

Cited By ~ 2

Author(s):

Lorraine Ellis ◽

Sue Davies ◽

Sara Laker

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Set Up ◽

Randomised Controlled

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Arthur Conan Doyle and Medical London: Reading the Topography of Round the Red Lamp

Victoriographies ◽

10.3366/vic.2021.0435 ◽

2021 ◽

Vol 11 (3) ◽

pp. 295-313

Author(s):

Roger Luckhurst

Keyword(s):

General Practitioner ◽

Full Time ◽

Medical Institutions ◽

Short Period ◽

Arthur Conan Doyle ◽

Set Up

This essay explores the short period of time that Arthur Conan Doyle spent between March and June 1891 when he moved his family into rooms in Bloomsbury and took a consulting room near Harley Street in an attempt to set up as an eye specialist. This last attempt to move up the professional hierarchy from general practitioner to specialist tends to be seen as a final impulsive move before Conan Doyle decided to become a full-time writer in June 1891. The essay aims to elaborate a little on the medical contexts for Conan Doyle’s brief spell in London, and particularly to track the medical topography in which he placed himself, situated between the radical, reformist Bloomsbury medical institutions and the fame and riches of the society doctors of Harley Street. These ambivalences are tracked in the medical fiction he published in Round the Red Lamp, his peculiar collection of medical tales and doctoring in 1894.

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Piloting the EHR4CR Feasibility Platform across Europe

Methods of Information in Medicine ◽

10.3414/me13-01-0134 ◽

2014 ◽

Vol 53 (04) ◽

pp. 264-268 ◽

Cited By ~ 15

Author(s):

R. Bache ◽

M. McGilchrist ◽

C. Daniel ◽

M. Dugas ◽

F. Fritz ◽

...

Keyword(s):

Electronic Health Records ◽

Clinical Research ◽

Test Data ◽

Data Access ◽

Data Warehouses ◽

University Hospitals ◽

Local Networks ◽

Health Records ◽

Electronic Health ◽

Set Up

SummaryBackground: Pharmaceutical clinical trials are primarily conducted across many countries, yet recruitment numbers are frequently not met in time. Electronic health records store large amounts of potentially useful data that could aid in this process. The EHR4CR project aims at re-using EHR data for clinical research purposes.Objective: To evaluate whether the protocol feasibility platform produced by the Electronic Health Records for Clinical Research (EHR4CR) project can be installed and set up in accordance with local technical and governance requirements to execute protocol feasibility queries uniformly across national borders.Methods: We installed specifically engineered software and warehouses at local sites. Approvals for data access and usage of the platform were acquired and terminology mapping of local site codes to central platform codes were performed. A test data set, or real EHR data where approvals were in place, were loaded into data warehouses. Test feasibility queries were created on a central component of the platform and sent to the local components at eleven university hospitals.Results: To use real, de-identified EHR data we obtained permissions and approvals from ‘data controllers‘ and ethics committees. Through the platform we were able to create feasibility queries, distribute them to eleven university hospitals and retrieve aggregated patient counts of both test data and de-identified EHR data.Conclusion: It is possible to install a uniform piece of software in different university hospitals in five European countries and configure it to the requirements of the local networks, while complying with local data protection regulations. We were also able set up ETL processes and data warehouses, to reuse EHR data for feasibility queries distributed over the EHR4CR platform.

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Private Provision of ‘outreach’ Clinics to Fundholding General Practices in England

Journal of Health Services Research & Policy ◽

10.1177/135581969800300106 ◽

1998 ◽

Vol 3 (1) ◽

pp. 20-22 ◽

Cited By ~ 5

Author(s):

Susan Kerrison ◽

Roslyn Corney

Keyword(s):

General Practitioner ◽

Postal Survey ◽

Medical Specialist ◽

Private Provision ◽

Private Practitioners ◽

General Practices ◽

Outreach Clinic ◽

Set Up ◽

Second Wave ◽

Relative Quality

Objectives: To establish the contribution of the private sector in providing outpatient ‘outreach’ clinics in general practitioner fundholding practices. Method: Postal survey of all 13 first-wave fundholders and four of the 13 second-wave fundholders in the former South East Thames Region of the National Health Service in 1995. Results: Fourteen practices responded. Ten practices had set up at least one medical specialist ‘outreach’ clinic and 12 at least one paramedical clinic since becoming fundholders. Eight practices reported their arrangements for consultant ‘outreach’ clinics and ten practices their arrangements for paramedical clinics. Forty-nine per cent of the total medical specialist hours and 46% of total paramedical hours were provided by private practitioners. The largest number of hours provided privately was in gynaecology. Conclusion: This small study identified considerable private provision of fundholders' ‘outreach’ clinics. However, there is no system in the NHS to monitor the extent of this market, the types of activities undertaken or the relative quality and cost of the services provided.

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PO 8719 INTRODUCING A NEW AFRICA MENINGITIS NETWORK – A NORTH-SOUTH COLLABORATION

BMJ Global Health ◽

10.1136/bmjgh-2019-edc.165 ◽

2019 ◽

Vol 4 (Suppl 3) ◽

pp. A63.1-A63

Author(s):

Mosepele Mosepele ◽

Cecilia Kanyama ◽

David Meya ◽

Fiona Cresswell ◽

Timothee Chammard ◽

...

Keyword(s):

Treatment Strategies ◽

Sub Saharan Africa ◽

High Dose ◽

Diagnostic Strategies ◽

Cns Infections ◽

Study Protocols ◽

Sub Saharan ◽

Novel Treatment Strategies ◽

Set Up ◽

Randomised Controlled

BackgroundCentral nervous system infections, including meningitis, continue to cause significant morbidity in Africa. HIV has contributed to the epidemiology of CNS infections in this setting. Notable advances in the study of CNS infections by several groups have demonstrated the utility of new diagnostic strategies and impact of novel treatment strategies. However, efforts to coordinate meningitis research in Africa, and between Africa and the rest of the world remain very limited.MethodsIn a bid to promote a coordinated study of CNS infections across Africa, and in collaboration with other meningitis groups globally, the researchers of the AMBITION study (High Dose Ambisome on a Fluconazole Backbone for Cryptococcal Meningitis Induction Therapy in Sub-saharan Africa: A Randomised Controlled Non-inferiority Trial) are leveraging the EDCTP support for the AMBITION trial to set up an Africa Meningitis Trials Network.ResultsThe Africa Meningitis Trials Network (AMNET) was launched in Malawi in early 2018. Main achievements since the launch of the network, include an internal review of meningitis research across network sites and launch of the network website. The network also has two study protocols pending ethics review at all sites. These studies will provide much needed information on resources available for meningitis care, research and provide a baseline epidemiology of meningitis in Africa.ConclusionAMNET provides a rare opportunity for investigators interested in meningitis research to leverage the ongoing AMBITION trial to conduct Africa-wide preliminary research on meningitis. The network is recruiting additional members in Africa and globally to collaborate on meningitis research, and also apply for research funding to support meningitis work. Anyone interested in knowing more about the network should contact the AMNET communications officer, Ms Phum’lani Machao, [email protected]

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Soft tissue surgery and scanners: applications and perspectives into clinical research

BDJ ◽

10.1038/s41415-020-1845-7 ◽

2020 ◽

Vol 229 (3) ◽

pp. 190-195

Author(s):

Danielle S. Dineen ◽

Matthew J. Brennand Roper

Keyword(s):

Soft Tissue ◽

Clinical Research ◽

Soft Tissue Surgery

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N15 A ‘real-world’ observational multi-centre study comparing the side effects and patient acceptability of budesonide MMX with prednisolone in patients with mild to moderate ulcerative colitis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.998 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S664-S665

Author(s):

J Kearns ◽

L Scullion ◽

C Masterson ◽

N Kennedy ◽

C Butcher

Keyword(s):

Ulcerative Colitis ◽

Side Effects ◽

Real World ◽

Additional Data ◽

Patient Acceptability ◽

Multi Centre Study ◽

Real World Evidence ◽

Randomised Controlled ◽

The Impact

Abstract Background Budesonide MMX is indicated for the induction of remission in mild to moderate Ulcerative Colitis (UC) patients when 5-ASA treatment is not sufficient. Unlike traditional first-generation glucocorticoid steroids such as prednisolone, budesonide MMX has demonstrated a robust safety profile, comparable to placebo in several randomised controlled trials1,2,3. There is however limited real-world evidence to substantiate this safety claim in clinical practice. The aim of this observational analysis is to evaluate the tolerability and ease of administration of budesonide MMX in the real-world setting using prednisolone as a benchmark. Methods Patients receiving treatment for mild to moderate UC were identified in 3 treatment centres between April and October 2019. After providing privacy and data consent, patients completed a detailed nurse-led questionnaire regarding their experiences with prednisolone treatment. Following 6 weeks of therapy with budesonide MMX, patients were sent a follow-up questionnaire. Data from both the initial and subsequent questionnaires were entered by the nurse into a database for assimilation and analysis. Results Twenty-eight patients completed initial and follow-up questionnaires. Of these, 78.6% (n = 22) had experienced ≥1 prednisolone-related side effects. In comparison, following treatment with budesonide MMX, 21.4% (n = 6) reported ≥1 side effects. Instances of these side effects are shown in Figure 1. 46.4% of patients (n = 13) reported the impact of prednisolone-related side effects on daily life as moderate or severe vs. 7.1% (n = 2) following treatment with budesonide MMX. By week 2 of treatment with budesonide MMX, rectal bleeding was resolved in 32.1% of patients (n = 9) and stool frequency in 35.7% (n = 10). 93.1% (n = 27) found the instructions to take budesonide MMX given by the health care professional very easy to understand and of those expressing a preference, 71.1% of patients (n = 19) would take budesonide MMX again if prescribed. Additional data will be presented. Conclusion Data from this ‘real-world’ observational study appear to support the safely profile of budesonide MMX reported in clinical trials. The incidence of patients who experienced > 1 side-effect was nearly 4 times lower for budesonide vs. prednisolone. In addition, budesonide MMX therapy was acceptable to the majority of patients and accompanying instructions easy to understand. Additional data will be presented. References

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Evaluation of a community based service for urgent psychiatric assessment

Psychiatric Bulletin ◽

10.1192/pb.20.10.592 ◽

1996 ◽

Vol 20 (10) ◽

pp. 592-595 ◽

Cited By ~ 2

Author(s):

M. J. Crawford ◽

D. Kohen ◽

J. Dalton

Keyword(s):

General Practitioner ◽

Initial Assessment ◽

Medical Professionals ◽

Hospital Services ◽

Community Based ◽

Psychiatric Assessment ◽

Assessment And Treatment ◽

Set Up

The Urgent Assessment Service (UAS) was set up to provide community based urgent psychiatric assessment to a range of referrers. The work of the service was assessed over a six month period. Results show that it was popular with a broad range of medical and non-medical professionals. Patients generally presented with depression or psychotic illnesses and those referred from non-medical sources were more likely to be suffering from schizophrenia and assessed as being at least as unwell as those referred by GPs and hospital based doctors. Rates or referral to hospital services were low with the vast majority of patients being referred back to their general practitioner after initial assessment and treatment.

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