NIHR HIC- Themes

Introduction to the themes

A clinical and research theme has been established for each of the five HIC therapeutic areas explored to date: in acute coronary syndromes, viral hepatitis, critical care, ovarian cancer, and renal transplantation. In each theme, clinicians, scientists, and informaticians from the partner organisations work together to deliver the HIC capability - the data flows and the governance framework - and to demonstrate that capability through exemplar research studies.

Each of the five themes is led by a different university-hospital partnership:

  • acute coronary syndromes, by Imperial College Healthcare NHS Trust and Imperial College London

  • viral hepatitis, by Oxford University Hospitals NHS Foundation Trust and the University of Oxford

  • critical care, by University College London Hospitals NHS Foundation Trust and University College London

  • ovarian cancer, by Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge

  • renal transplantation, by Guy's and St Thomas' NHS Foundation Trust and King's College London

The current themes

Critical Care

NIHR HIC Critical Care

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A critical illness is any illness that may be a direct threat to life, for example:

  • Serious infection such as pneumonia or meningitis
  • Major trauma such as a serious road traffic accident
  • Serious stroke or heart attack
  • Following major surgery
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Critically ill patients are usually cared for in Critical Care Units, Intensive Care or High Dependency Units staffed by specialist doctors, nurses and therapists with access to high levels of monitoring (such as continuous blood pressure and oxygen levels) and treatments that allow the critical care teams to rapidly detect and respond to any deterioration.

Critical Care has become increasingly sophisticated over the years and patient survival and outcomes have improved. However less is known about survival beyond hospital. Research as to what treatment works best is difficult, as there are not enough patients with the same critical illness from which to draw significant conclusions. Even with large studies, there is too much variation to always be helpful.

A number of important questions remain unanswered about people who have been treated in critical care. For example:

  • Does a critical illness have an impact on life span?
  • If there is an impact, is it greater for those having had an infection or following a major accident?
  • Do survivors require more input from hospitals following discharge and how long is that input required?

Aims of the NIHR HIC

The Critical Care theme within the NIHR HIC aims to bring together data for analysis and interpretation to help identify what is known about survival outcomes for people who have received critical care. This will help us to:

  • Better understand critical illness and the long term effect of our treatments so we can tailor these treatments to individual patients
  • Improve our understanding of the long term consequences of multiple organ failure and treatment so patients have a better quality of life once discharged.

Participating Critical Care Units display posters about this project and information leaflets are given to all patients (and if appropriate next of kin). A brief video explaining what is involved for those who participate can be viewed in the critical care video

Further information

For further information about the activities involving the public and patients, please visit the NIHR UCLH BRC

For research queries contact: Dr David Brealey, Consultant in Intensive Care Medicine and UCLH Critical Care Research Lead, via nihrhic@uclh.nhs.uk

You may also find further information via the following links:

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Lead BRC:

University College London Hospitals NHS Foundation Trust
Renal Transplantation

NIHR HIC Renal Transplantation

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Renal Transplantation is the largest of the solid organ transplant programmes with around 3,000 performed annually in the United Kingdom. It is the optimal treatment for patients with end stage kidney disease in terms of survival, quality of life and economic advantages. The limited lifespan of the transplanted kidneys means that multiple transplants are often required which places a burden on patients and restricts the availability of organs for all suitable recipients.

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A barrier to understanding and research is the limited availability of clinical data from large numbers of patients. Four collaborating centres in the NIHR HIC perform around one third of all renal transplants in the United Kingdom. By working in collaboration, we can answer questions that would not have been possible otherwise. Analysis of the rich sources of renal transplantation data held in the systems of these four hospitals will provide insights into outcomes and ultimately improve patient care.

Aims of the NIHR HIC

An important reason for transplanted kidney loss is recurrent disease. Our understanding of the disease remains limited. We have chosen this area to research in order to make the most of the collaborative approach. We will study risk factors for the development of recurrent disease in kidney transplants, including genetic differences, which could be valuable in predicting which groups of patients are at high risk of disease recurrence.

The BRC combining Guy's and St Thomas' NHS Foundation Trust and King's College London is leading the transplant theme within the NIHR-HIC. The other BRCs taking part are:

  • Cambridge University Hospitals NHS Foundation Trust and University of Cambridge
  • Oxford University Hospitals NHS Trust and University of Oxford
  • Imperial College Healthcare NHS Trust and Imperial College, London

Further information

If you would like further information please contact us by email at brc@gstt.nhs.uk For further information on renal transplantation and related research, you may find the following links useful:

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Lead BRC:

Guy's & St Thomas' Hospital NHS Foundation Trust
Acute Coronary Syndromes

NIHR HIC Acute Coronary Syndromes

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Acute coronary syndrome refers to a group of conditions that are due to decreased blood flow in the coronary arteries in the heart. When untreated, part of the heart muscle is unable to function properly or dies. This syndrome is typically caused by a blood clot forming on a narrowing in one or more of the arteries supplying the heart. This makes the artery very narrow and usually causes chest pain at rest.

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The disease can range from a tight narrowing - which causes pain but no damage - to a complete blockage causing a major heart attack. This is a common condition and many hundreds of patients attend our major centres every year. Patients often receive invasive treatment to open up the arteries to improve blood flow to the heart muscle and this can save lives.

Aims of the NIHR HIC

This theme aims to collate clinical information on patients presenting with this condition, in addition to information on the state of the arteries and the heart muscle and a measure of the degree of damage to the heart. The project is collecting information from five of the UK's major cardiac centres, including Imperial, University College London, St Thomas', Oxford and Cambridge. This information will provide a very large pool of data to help our understanding of the factors that are important in the outcome of patients with acute coronary syndromes.

Further Information

For research queries please contact Dr Jamil Mayet via brcofficer@imperial.ac.uk

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Lead BRC:

Imperial College Healthcare NHS Trust
Ovarian Cancer

NIHR HIC Ovarian Cancer

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In 2011, the ten year estimated survival rate was only 35% following diagnosis. As with most cancers, an earlier diagnosis results in a better outcome. Ovarian cancer is the fifth most common cause of cancer among women in the UK. Cancer Research UK (CRUK) estimates that 19 women each day are diagnosed with ovarian cancer.

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Dr James Brenton, of the CRUK Cambridge Cancer Centre, is working with other ovarian cancer specialists, to share key information on ovarian cancer in order to make recommendations about how diagnosis and treatment can improve survival for women with this type of cancer.

While ovarian cancer is a big health concern in the UK, the number of women looked after at any single NHS facility is too small for reliable studies of the population. Treatments may also differ between hospitals, and it is therefore very important to gather data from different places to understand the best treatments and other factors for long-term survival.

Aims of the NIHR HIC

The specific objectives from the NIHR HIC for treatment of ovarian cancer are to:

  • Securely and anonymously collect and share data on ovarian cancer patients
  • Review what information we already have on ovarian cancer and see if they can add to the overall picture
  • Evaluate how ovarian cancer surgery is carried out and determine which of the different methods best achieve the expected outcomes, e.g. reaching the five year survival, reducing a recurrence of ovarian cancer, and slowing down the progression of the disease

We aim to keep everyone who is interested in this area up to date and informed of the progress we make. Currently all participating sites have adopted the same process of collecting data on ovarian cancer from initial diagnosis to discharge and beyond. The data that is gathered, cannot be linked to the identity of a single patient. Cambridge University Hospitals (CUH) has established a secure location for receiving the data from each participating site, and for storing and analysing this information on behalf of the NIHR HIC.

Preliminary analysis of data will begin in Autumn 2016. We will share our findings with other scientists and doctors through specialist publications. Independent experts will also audit and check what we find, how we found it, and how we interpreted it.

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Lead BRC:

Cambridge University Hospitals NHS Foundation Trust
Viral Hepatitis

NIHR HIC Viral Hepatitis

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Hepatitis is commonly caused by viral infections that cause inflammation or swelling of the liver. There are four viruses that commonly infect the liver; hepatitis A, B, C and E. Hepatitis D is also well recognised, but only occurs in people that are already infected with hepatitis B.

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Hepatitis A and E typically cause acute (short-term) infection and although patients are often unwell at the time, these viruses do not generally persist long-term. In contrast both hepatitis B and C may cause a silent infection for many years, and are often only diagnosed once liver disease is well advanced.

This NIHR HIC's theme is focusing on hepatitis B/D, C, and E. Each of these infections brings different challenges to clinicians and researchers in the UK. The epidemiology and risk factors for hepatitis E are very poorly understood in the UK. For hepatitis B the key questions are the factors that predict response to drug treatment, and the role of hepatitis D co-infection. For hepatitis C, treatment has recently undergone a revolution, with many new and effective - but expensive - drugs available to treat patients. Even so, some patients with hepatitis C fail to respond to the newest drugs, and in this theme we will collect data on the outcomes of treatment in these patients.

The NIHR HIC Viral Hepatitis Theme will develop a database of anonymised clinical data:

  • to address important questions related to clinical outcomes in viral hepatitis
  • to share clinical data to demonstrate its usefulness in clinical research

The database has been fully reviewed by the National Research Ethics Service

Further Information

The theme leads for Viral Hepatitis are shown below

Name
Position
Organisation
Ellie Barnes
Chief Investigator
Oxford University Hospitals
Graeme Alexander
Local Investigator
Cambridge University Hospitals
Kosh Agarwal
Local Investigator
Guy's and St Thomas' (London)
Graham Cooke
Local Investigator
Imperial College Healthcare
Eleni Nastouli
Local Investigator
University College London Hospitals

For research queries please contact Dr. Ellie Barnes via obrcenquiries@ouh.nhs.uk

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Lead BRC:

Oxford University Hospitals NHS Foundation Trust

The additional themes

Prostate Cancer

NIHR HIC Prostate Cancer

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The NHS has pioneered novel diagnostic and treatment paradigms in prostate cancer. The prostate cancer NIHR HIC theme aims to use the data collected during routine practice and cancer registry submissions to answer important questions in prostate cancer management.

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A major lesson learned from the phase 1 project in ovarian cancer was that data completeness and quality was problematic. This is felt to be due to the particular problems associated with manual data entry into electronic health records – these include problems in IT, process and clinician engagement.

Aims of the NIHR HIC

The first major aim of the prostate cancer theme is to investigate the current baseline of data collection, using the National Prostate Cancer Audit dataset, before instituting changes to improve data completion. The site leads will act as champions to deliver this change. The team will also work with COSD and Genomics England to improve data collection for these projects. The resulting datasets will afford novel insight into the disease processes underlying prostate cancer.

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Leads:

University College London Hospitals NHS Foundation Trust
Guy's & St Thomas' Hospital NHS Foundation Trust
Breast Cancer

NIHR HIC Breast Cancer

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Breast cancer is the most common cancer and accounts for 15% of all new cases of cancer in the UK (source: Cancer Research UK 2013)

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The NIHR HIC breast cancer theme is led by Dr Elinor Sawyer from Guy's and St Thomas' Hospital / Kings College London and Dr Richard Baird from the Cambridge Cancer Centre. They are working with other breast cancer experts in the UK through their BRCs Centres and the NIHR HIC to securely and anonymously share key information on breast cancer diagnosis, treatment and outcomes.

Aims of the NIHR HIC

There are different subtypes of breast cancer that can be categorised by tumour grade, hormone receptor and Her2 expression. The NIHR HIC breast cancer theme will look at the frequency of these different subtypes of breast cancer across the different BRCs to assess whether there is any evidence of an association of certain subtypes with ethnicity and age and whether these two factors influence the type of treatment given or the stage at which the cancer presents.

The NIHR HIC breast cancer theme will also develop tools to analyse mine radiology and histopathology text reports to help establish a robust database on patients with metastatic disease to assess outcomes across the Biomedical Research Centres. Having done this the theme will investigate how many patients are being entered into trials and the use of novel treatments from the cancer drugs fund, and assess response rates to these newer agents.

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Leads:

Cambridge University Hospitals NHS Foundation Trust
Guy's & St Thomas' Hospital NHS Foundation Trust
Colorectal Cancer

NIHR HIC Colorectal Cancer

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Treatments are surgery, neoadjuvant radiotherapy (for patients with rectal cancer), and adjuvant chemotherapy (for patients with stage III/IV and high-risk stage II colon cancer). 5-year relative survival ranges from 90% in patients with early stage disease to 10% in patients with end stage disease. Colorectal screening has been shown to reduce colorectal cancer incidence and mortality. 1.1 Million patients are diagnosed with colorectal cancer every year. Incidence is closely related to western lifestyle and increases with age.

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Aims of the NIHR HIC

The aim of the project is to collect detailed information from five of the UK's major colorectal cancer centres at Imperial, University College London, St Thomas', Oxford and Cambridge. This information will provide a significant data resource outside of a clinical trial setting, to help our understanding of the factors that are important in the outcome of patients presented with colorectal cancer, which helps the development of new and improved treatments and medicines.

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Lead BRC:

Oxford University Hospitals NHS Foundation Trust
Lung Cancer

NIHR HIC Lung Cancer

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The Lung cancer theme is led by Imperial College Healthcare NHS Trust and University College London Hospitals.Initial work in this theme will focus on non-smoking related lung cancer. Recent research indicates that the levels of non-smoking related lung cancer are rising and it is becoming increasingly recognised as an important and distinct entity.

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Aims of the NIHR HIC

The HIC data collection will allow us to determine the incidence, management and outcomes of patients with non-smoking related lung cancer compared with smoking related cancers within the HIC Centres.

The data collection will contain data from patients with all forms of lung cancer (both smoking and non-smoking related) so as to enable access to larger volumes of quality data for use in approved research studies aiming to understand and improve treatments and outcomes for patients diagnosed with lung cancer in the future.

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Leads:

Imperial College Healthcare NHS Trust
University College London Hospitals
Infection

NIHR HIC Infection

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The existing HIC therapeutic area Viral Hepatitis has been extended, to take advantage of strategic opportunities for collaboration, impact, and benefit, and to build upon a range of existing NIHR, NHS, and Public Health England (PHE) investments.

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Aims of the NIHR HIC

This has led to a new HIC theme focussing on infectious diseases of particular relevance to NHS infection control and PHE strategy, with a focus upon anti-microbial resistance, including E. coli, K. pneumoniae, S. aureus, Tuberculosis, Pseudomonas aeruginosa, and C. difficile.

Of initial interest is E. Coli infections and the antibiotic prescribing practice to inpatients, at the NHS Acute Trusts involved to help enable research and improve clinical practice in this area. A better understanding of the relationship between antibiotic use and resistance is key.

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Leads:

Oxford University Hospitals NHS Foundation Trust
Guy's & St Thomas' Hospital NHS Foundation Trust
Cambridge University Hospitals NHS Foundation Trust
Imperial College Healthcare NHS Trust
University College London Hospitals NHS Foundation Trust