Case studies

 

Case studies

On this page is a small selection of projects the RDS NW has advised.  More will be added over time.

Dr Anton Krige: A randomised controlled trial of thoracic  epidural analgesia versus rectus sheath  catheters for open midline incisions in major  abdominal surgery within an Enhanced  Recovery Program (TERSC)

Dr Anton Krige: A randomised controlled trial of thoracic epidural analgesia versus rectus sheath catheters for open midline incisions in major abdominal surgery within an Enhanced Recovery Program (TERSC)

Dr Anton Krige, a Consultant in Intensive Care Medicine and Anaesthesia as well as the Clinical lead for the Enhanced Recovery Programs at East Lancashire Hospitals NHS Trust, has a particular interest in providing good pain relief to patients after major surgery so that patients can recover quickly and avoid post-operative complications.

Dr Krige approached the RDS NW for advice on how to develop his research idea of comparing the most common approach of pain relief – epidural, and another approach – Rectus Sheath Catheters (RSCs). Epidurals, which use a fine tube being placed in the spine through which local anaesthetic is given, numbing the nerve supply to the abdomen and controlling the pain, can be very effective but they do have a number of possible side effects including common side effects such as headaches and low blood pressure as well as very rare side effects such as nerve injury.

The Rectus Sheath Catheters can be used when surgery involves a midline (vertical) incision of the abdomen. In this technique, local anaesthetic is infused directly into the abdominal wall, blocking the nerves around the wound site. An old technique, RSCs are now in use again as ultrasound allows doctors to site the catheters accurately between the muscle layers of the abdomen.

Many of the side effects associated with epidurals do not apply to rectus sheath catheters and this may confer an advantage. However, no formal research had been conducted and so it is not known for sure which technique results in the best pain relief with the least side effects. This is the question that the TERSC research study aims to answer.

Dr Krige approached the RDS NW for general advice on how to apply for the RfPB programme and was allocated an adviser who initially explored the options for the appropriate research study design to develop to answer Dr Krige’s research questions. The adviser brought on board other methodological advisers as required in clinical trial design, qualitative methods and health economics.

Dr Krige and his team attended a dedicated advice support programme organised by the RDS NW for applicants to the RfPB programme.

The RDS NW also provided advice on how to develop the proposal further with PPI and these activities were supported by the RDS NW PPI bursary to facilitate the bringing together of past patients who had undergone such surgery in the past to advise on the most appropriate design and study materials ahead of a submission for RfPB funding.

Some of these patients have since agreed to stay with the project by being involved in managing and delivering the study now that patients are being recruited into the TERSC study.

This is the first research grant that Dr Krige has been awarded in his role as a hospital consultant.

The RDS NW were able to recommend other research methodologists who may be interested in supporting the application for funding and becoming co-applicants.

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Funding:
Research for Patient Benefit
Amount:
Over £249,000
Prof Martin Tickle: A randomised controlled trial comparing  the quality of life (QoL) and masticatory  efficiency of patients with implant-retained  (IRMO) compared with mini-implant-retained  mandibular overdentures (MIRMO).

Prof Martin Tickle: A randomised controlled trial comparing the quality of life (QoL) and masticatory efficiency of patients with implant-retained (IRMO) compared with mini-implant-retained mandibular overdentures (MIRMO).

It is estimated that there are over three million people in the UK who have no teeth at all. There is national and international evidence that these patients should be provided with dental implants in the lower jaw to help to retain their lower denture. However, this treatment is costly and considered invasive by potential patients.

A team at the University of Manchester Dental Hospital, led by Professor Martin Tickle and Dr Craig Barclay, have secured a NIHR Research for Patient Benefit (RfPB) award of £250,000 to fund a pilot randomised controlled trial comparing standard dental implants to smaller diameter ‘mini’ implants, which are cheaper and simpler to place.

This project was propelled into action when a member of the research team attended an RDS NW RfPB development series in the autumn of 2011.

The project was also awarded a PPI bursary from RDS NW to help with the inclusion of PPI in the proposal development.

Mark Harrison and Tanya Walsh from the RDS NW Greater Manchester team provided advice in areas including: evaluation design, health economics, statistics, trial design and they also critically read the proposal.

Warm thanks to all those who helped facilitate

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Funding:
Research for Patient Benefit
Amount:
£250,000
Dr Paul McNamara: A pilot study to assess whether humidified oxygen  is more effective than standard oxygen therapy in  treating children with acute severe asthma

Dr Paul McNamara: A pilot study to assess whether humidified oxygen is more effective than standard oxygen therapy in treating children with acute severe asthma

Asthma is a big problem in the UK with about 1.1 million children having this condition and 30,000 hospitalised with it every year. About a third of children admitted to hospital need oxygen during their stay. Often this is given as cold, dry oxygen, piped straight from the wall. However, there are very good physiological reasons why oxygen therapy given for acute severe asthma attacks should be warmed and humidified. We want to find out which is the best way of giving oxygen to these children. We have recently been successful in applying for a RfPB grant to study this further. At Alder Hey Children’s Hospital, we have enough children admitted with acute severe asthma to undertake a pilot study to work out what outcomes will be most important to measure in a definitive multi-centre study. The RDS NW were fantastically helpful in aiding the development of this application through their advisers and seminars – we couldn’t have done it without their help!

Funding:
Research for Patient Benefit