The Clinical Research Podcast

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Spend an evening with blood, urine, saliva and Nottingham researchers, looking to the future of research at NUH, helping children and young people with mental crises, and how to show a researcher you love them.

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In this clinical research bulletin from Nottingham:

In this episode - clinical research news of ASSIST MS study, World Hearing Day, NIHR researcher appointments, Liver Partnership launch, and the Tummy Tracker app for cystic fibrosis patients.

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Weekly updates from research and innovation team at Nottingham University Hospitals NHS Trust and NIHR Nottingham Biomedical Research Centre

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As the NIHR Nottingham Biomedical Research Centre embarks on its second tranche of funding, we're developing our existing partnerships with other clinical research organisations in the East Midlands, especially Nottingham Trent University.

One of our closest links there is Professor John Hunt, who's Head of NTU's medical technologies and advanced materials research theme. He's also just taken on a role as deputy director of the NIHR Nottingham Clinical Research Facility, based at Nottingham University Hospitals NHS Trust.

I talked to him about his own research in clinical sciences, and particularly biomaterials, as well as his new role at the clinical research facility

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Chronic lung diseases are the third biggest cause of death in the world, and in Nottinghamshire, about 1 in 8 people have been diagnosed with asthma or COPD - so finding new treatments is high on the list for clinical researchers. And our particular expertise here is understanding how the disease works at a cellular level and it's why we're part of new £8.8million study funded by the Wellcome Trust.

But environmental factors - like smoking, or working down a mine - are only part of the story. Genetic make up means some people are more at risk than others, and this study is about understanding how we can detect who's more likely to develop lung disease.

It's being led here by Nottingham University Hospitals NHS  Trust respiratory consultant Professor Ian Hall, who's also the director of the NIHR Nottingham Biomedical Research Centre.

Leaps forward in the understanding of the Human Genome in recent years stand to offer huge benefits to patients - including the possibility of personalised care.

As a large acute hospital, Nottingham University Hospitals NHS Trust is one of the organisations at the forefront of this exciting health revolution, which also brings some challenges.

But what does Genomics mean in reality to healthcare professionals working at NUH? And how can they access genetic medicine services - including testing for patients, in their day-to-day practice?

Dr Matt Hall, a consultant nephrologist based at Nottingham University Hospitals NHS Trust, is medical lead for the Genomics Medicines Service Alliance (GMSA), which is trying to embed genetic medicine into everyday practice. 

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Nottingham's long been a leader in researching and treating blood cancer - we pioneered blood stem cell transplantation and we're still one of the biggest centres in the UK. We bring together oncology, clinical haemotology, neuro imaging and surgery and over the last five years we've increased our experimental cancer research trials by 30 percent.

So it's naturally one of the priorities of our new Clinical Research Facility, which recently had its £2.6 million pound funding confirmed by the National Institute for Health and Social Care Research.

The Nottingham facility's team delivers early phase experimental trials not just in cancer, but across the board, including areas such as gastro intestinal disorders, inflammatory conditions, musculoskeletal conditions and respiratory diseases. It's closely integrated with the hospital  and is expanding its inpatient, day beds and out patient facilities, including for children as well as adults.

Its new deputy director is Professor Chris Fox, a consultant haematologist at Nottingham University Hospitals NHS Trust, who has a track record of research into lymphoma and stem cell transplantation, among other things. I spoke to him as he was taking up his new post.

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However good research is, if it stays in the lab or on a hard drive somewhere, isn't going to help anyone and of course the reality is that researchers do literally get points for how many people see their publications. But how do you do that? How do break out of the world of peer reviewed journals and 

This episode is an interview with Rory Cellan Jones who was the BBC's tech editor so he's been explaining complicated stories to mainstream audiences - by which I mean non-technical audience =s - for forty years. Now he's freelance, publishing a weekly newsletter and tweeting about tech, and particularly health tech. He's also been diagnosed with Parkinson's so unsurprisingly he has a particular interest in its treatment.

I met him recently at a conference organised by Health Data Research UK and sat down with him to pick his brains about the care and feeding of journalists - how researchers can get journalists' attention, how to explain complicated, nuanced ideas to journalists, and whether being a patient has given him a new perspective.

One in eight women in the UK will be diagnosed with breast cancer, and like most cancers, the sooner it can be detected, the better the patient's prospects. That's why there's a national screening programme for women over fifty. which has been successful at cutting the mortality rate.

But it's a one size fits all solution at a time where medicine is getting more personalised. Some breast tissue is denser than others, and the denser it is, the more likely it is to develop a cancer, and the more aggressive that cancer is likely to be. So anything that can help differentiate fom person to person what's going on, early on, will improve how effectively we can treat cancer.  

Being able to use dye to help imaging is one of those ways, and Nottingham University Hospitals NHS Trust was one of the first hospitals to be able to to carry out contrast mammograms using dye. That expertise has meant we're part of the BRAID trial  the acronym in this case stands for Breast Screening – Risk Adaptive Imaging for Density and means we can offer it at early stage in the process. 

Dr Elisabetta Giannotti, a consultant breast radiologist, is leading the trial at Nottingham.

More information on the the BRAID study website: https://radiology.medschl.cam.ac.uk/research/research-themes/breast-imaging/braid-trial/ 

When a child or young person comes to hospital in an emergency and mental health issues are clearly involved, how do we know how we can help them best?

Health professionals can be unsure what to look for, what to do about they see, and how to judge how much they're helping the situation.

Dr Joseph Manning MBE, a clinical academic nurse at Nottingham University Hospitals NHS Trust and NIHR lecturer at the University of Nottingham, is leading the SAPHE study which is researching how to make treatment of children and young people with mental health crises more effective and consistent. It's doing that by working **with** those children and young people.

Joseph mentioned Prof Jane Coad, another of our researchers at Nottingham, and there's an interview with her coming up in and episode soon.

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When a child or young person comes to hospital in an emergency and mental health issues are clearly involved, how do we know how we can help them best?

Health professionals can be unsure what to look for, what to do about they see, and how to judge how much they're helping the situation. 

Dr Joseph Manning MBE, a clinical academic nurse at Nottingham University Hospitals NHS Trust and NIHR lecturer at the University of Nottingham, is leading the SAPHE study which is researching how to make treatment of children and young people with mental health crises more effective and consistent. It's doing that by working **with** those children and young people.

Joseph mentioned Prof Jane Coad, another of our researchers at Nottingham, and there's an interview with her coming up in and episode soon.

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About one in eight people in the UK have asthma attacks and researchers at the Nottingham Asthma Centre (part of Nottingham University Hospitals NHS Trust) are studying how to stop the early symptoms of an attack turning into a serious event.

We need volunteers to help us research the different triggers and symptoms, so we can find new ways to treat the condition and reduce the use of steroid tablets, which can have undesirable side effects.

This study is about recording your breathing and other signs - we are not testing any new treatments and your current treatment won't change.

Alcoholism is one of the biggest factors in liver disease, and a dual diagnosis of alcoholism and mental health problems is very common  - it's more than solely a physical illness - so understanding how to support people as they recover from alcoholism is a really important way to help cut liver disease. 

This interview with Professor Ana Valdes was done in February but we're only posting it now (in April) because it relates to a paper she co-authored which has only just been published in the Lancet Infectious Diseases. It's about covid and the Zoe app, and focuses on the omicron variant.

Now government funding for the Zoe app's been stopped (though the app itself is still going strong) and omicron has been superceded by BA2, and in part thanks to this study, the official UK symptom list for covid has been updated. So as well as talking about the Lancet paper, I asked Professor Valdes about how viruses evolve over time and whether the laws of natural selection would tend to push them towards having less severe effects.

But we started off with what made this study different to its predecessors. 

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The contents of your stomach may not seem to have much to do with skin cancer, but one of our  studies seems to show that there are specific microbiome bugs which may be the key to treating melanoma more effectively with immunotherapy.

Exactly how the microbiome helps us fight cancer is still a newish area of research and this study is one of the largest of its kind, with data from across the UK, the Netherlands, and Barcelona. It's just been published in Nature Medicine, and I talked to one of the authors,  Amrita Vijay, who's a research fellow at the University of Nottingham.

Research needs data and data needs - in the end - patients. Our researchers spend a lot of time Identifying the right patients for our studies, and more importantly, our patients spend a lot of time  helping us. The more efficiently we can  use the samples and other data they give us, the more we can help them.

That's what the new Nottingham Bioresource is about - it pulls together samples and data from patients into one central bank, which is secure, controlled and confidential. Then we can help researchers identify the data they need, and let them access it in the most useful secure way possible. So everybody wins. That's the theory.

To find out more, we talked to Jen Boston, Head of Research Governance and Quality at Nottingham University Hospitals NHS Trust, and to Natasha Hill, the bioresource operations manager -  who explained how it's going to help researchers.

One of the problems for treating gastro intestinal conditions is that it's hard to predict exactly how things dissolve in our guts. The food industry would dearly like to know more, and so would our gastro intestinal researchers, because if we knew how things fall apart in our colons, we can make drugs for conditions like Crohn's disease far more effective.

But even with the latest imaging techniques that we use in Nottingham, it's difficult to see what's going on inside someone and for patients, it's uncomfortable.

How can you make a difference as a clinical researcher? University of Nottingham respiratory medicine professor and NHS consultant, Dominick Shaw, talks to Matt Hurst about the four things you need to when you're starting out. 

How we make the most of their huge capacity for data, and processing, and artificial intelligence and the issues they  might bring is actually the bit that is increasingly important these days, and this episode is a discussion about what Nottingham data scientists are doing in that area.

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For obvious and unavoidable reasons, all the research heroes experiences this year have been about dealing with Covid, but this particular hero had something else going on.

Before Covid, Zoe Rose, was a research nurse in gastroenterology, but she was also coping with a personal tragedy of her own. Looking back on it now, she talks about how  the intensity of the work during that first wave, and the help of a supportive team around her, help her find a way towards her own recovery. 

It's a really thoughtful and thought provoking interview, and Zoe talks very openly about her own mental health and how knowing she was able to help other people helped her. 

Now she works in the the Rapid Response Team, handling research across many specialisms at NUH - it's the R and I version of special forces.

Content warning - there's some discussion of suicide in this episode. 

If you're affected by issues in the episode you can find help on:

'Big data' is often a bogeyman term, but at the start of the Covid-19 outbreak, reworking how we used data helped keep Nottingham University Hospitals NHS Trust running, and our radiologists were at the forefront of pioneering diagnostic techniques.

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An introduction to a report on a joint project between Nottingham University Hospitals NHS Trust (and the Major Trauma Centre it hosts), and national charities Redthread and the Health Foundation.

Violent crime victims are often caught up in a lifestyle that's going to see them returning to Nottingham's emergency department over and over again, often with more and more serious injuries. It's not just a healthcare issue, it's also about law and order, safeguarding and social care. 

But while we're treating their injuries, there's also a chance to break that repeated pattern. Nottingham University Hospitals sees a lot of victims of violence, partly because it's in a big city, but also because it hosts the Major Trauma Centre for the East Midlands region.

We've been working with Redthread and the Health Foundation on how we can bring together healthcare, law and order, and social care, and we've just published a report on what we found.

This report has been written independently under the guidance of The Health Foundation, an independent charity committed to bringing about better health and health care for people in the UK.

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Kathryn Fairbrother is the new Head of Nursing for Research & Innovation at Nottingham University Hospitals NHS Trust. 

In this episode of The Clinical Research Podcast she talks about what inspired her as a nurse to get involved in clinical research and how she is hoping to now inspire other nurses - and healthcare professionals - to embark on their own research careers. Kathryn is in conversation with Matt Hurst from the Research & Innovation Communications Team.

This episode's Research Hero is Laura Looby a children's clinical research nurse - normally. Fairly early on in the Covid outbreak it became clear that relatively few children were being affected so she was drafted to help with adult covid patients many of whom were at the other end of the age spectrum.

She mentions 'dex' at one point. That's dexamethasone, one of the drugs trialled against Covid-19 early on, which turned out to be so effective it very quickly became part of the standard treatment. it's a really clear example of how research can lead to clinical treatment and researchers talk about it a lot.

In the UK, about 1.3 million people are living with COPD - chronic obstructive pulmonary disease - , and there's no cure - but there's a lot of research into its treatment.

In one type of COPD, emphysema, disease destroys alveoli in the lung so they can't transfer oxygen into the blood. It doesn't just mean there's less working lung, it means the now useless lung is taking up chest space so the patient can't inhale as deeply as they need to in order to get sufficient oxygen to the remaining working alveoli. So treatment often focuses on creating space in the chest so that patients can inhale more deeply - that means either surgery, or finding a way to make the emphysematic lung tissue take up less space. And either of those approaches have their own complications.

Ask most people who they are, and they'll talk about their job, their likes and dislikes, their appearance. But there's another way of defining your identity - by the groups of people you mix with. We're a social species and who we choose to be with affects how we see the world, and ourselves. It can be a vital part of mental health. That's why occupational therapist and researcher Emilia Deakin chose to study how people with psychosis interact with the groups as they recover, for a study for her PhD, called UNFOLD. And then lockdown happened, and all of the normal social groups stopped. She told me how she solved the problem.

Clinical research is very much about collaboration, which means it can often also be very much about lots of organisations, with lots of initials. We try not to burrow too deeply into that particular rabbit hole unless we really have to, but for this episode - we really have to. Rather than people or particular studies, It's about plans for the future of clinical research in Nottingham, which means understanding a little bit of how all the parts fit together.

Increasingly clinical research is being led by a broader range of clinical professionals - but there is more to do to encourage physiotherapists, healthcare scientists and every profession to make research part of their careers.

In this episode Vicky Booth, a physiotherapist from Nottingham University Hospitals NHS Trust explains to Matt Hurst of the Research & Innovation department how working with falls patients who also had dementia led her to develop her own career as a clinical academic. 

John Sweeney is a cleaner working at Nottingham City Hospital who was nominated for an award by the Respiratory Research Team for his part in supporting them on a number of COVID-19 research studies in 2020. 

But in turns out that not only is John a genuine NHS hero, he also has a pretty inspirational story about how he came to be working at the Hospital at all. He tells his remarkable life story to Matt Hurst from Research & Innovation. 

This episode is a tribute to the countless unsung heroes who together combine to make clinical research possible. It is also a tribute to everyone who "lives for the day". Thank you to John.

Our research hero this time is one of the people who helps set up studies in Nottingham, research facilitator Irfan Aslam.  Later in the pandemic, he took on co-ordinating the Virus Watch study in Nottingham, which gave one of the early hints of just how important asymptomatic infection was going to be, but as he told Andrew Bennett - at the beginning, his job switched from working on a range of studies to focussing on just one thing - covid.

Staff, patients, and just about anyone else who wants to, at Nottingham University Hospitals NHS Trust will be wearing red today (18 June 2021). They're joining thousands of people across the world showing their support for the huge international research effort which brought us vaccines and treatment for covid-19so quickly. It's the second year that June 18th has been marked as Red4Research day, and Divisional Lead Research Nurse Nicola Hall told Ash Rolfe about why red is such an important colour for researchers at the hospital.

In the latest of our interviews with winners of our Research Heroes awards, Andrew Bennett talks to clinical research manager Lucy Ryan, who works on the DREEAM team at Nottingham University Hospitals NHS Trust.

DREEAM is the Department of Research and Education in emergency and acute medicine at the hospital, and Lucy and her team were heavily involved with covid patients, especially collecting data for a study called ISARIC which became a key resource for fighting the virus.

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Glaucoma is when the optic nerve is damaged, generally by high pressure in the eye, and it's treated by lowering that pressure to minimise any further damage.

This episode looks at research into advanced glaucoma treatment, and a study called TAGS (the Treatment of Advanced Glaucoma Study). It's led by Professor Anthony King, Consultant Ophthalmologist at Nottingham University Hospitals NHS Trust and it's investigating whether it's better to treat glaucoma with eyedrops or with surgery.

Last year, research practitioner Georgia Melia had to learn new skills on her feet as she was moved to the lab from patient wards, as part of our work on Covid-19 research. Andrew Bennett spoke to her about big change in her working life.

Lindsay Crate is a nurse by background, but now her role is about making sure that studies run smoothly - that  there are enough staff, they're properly trained, they understand research protocols and that we're recruiting enough patients. Amongst other things. She's a clinical research manager.

Normally, planning is the key to all this - but when Covid-19 hit, planning joined the long list of things that became a luxury, and everything changed.