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University of Bristol

UOA 7 - Health Services Research

RA5a: Research environment and esteem

The University of Bristol has built an international reputation as a leading centre of health services research (HSR), epidemiology, and public health. In RAE 2001, these subjects achieved the highest 5-star rating.  HSR developed rapidly in the 1990s, and has been strengthened and consolidated in Bristol since 2001 through core support from the University of Bristol and external funding for research programmes.  Research spend has been stable since 2001 - around £2 million in each year of the assessment period and over £13.5 million in total.  HSR in Bristol is methodological, theoretical and applied.  There is a thriving postgraduate programme of higher degrees and intensive short courses, and a supportive and collaborative culture for the conduct of multi-disciplinary HSR.  Staff were awarded 18 prestigious personal fellowships in the reporting period.  Since 2001, we have continued to develop novel research methods to improve the evidence-base, and tackled issues of high public health importance, including reducing the burden of serious diseases such as cancer and HIV/AIDS, reducing smoking, improving sexual health, and addressing inequalities in health.  We have developed a strong and stable platform on which we can expand in response to the funding uplift for HSR following the changes implemented by OSCHR (Office for Strategic Co-ordination of Health Research).

Research structure

HSR in Bristol is conducted primarily in the Department of Social Medicine, within the context of a major University-wide international research theme encompassing Epidemiology and Health Services Research.  The Bristol Randomised Trials Collaboration (BRTC) was accredited by the National Cancer Research Institute (NCRI) to conduct randomised controlled trials (RCTs) in 2006 (co-Director: Donovan) and adopted by the UK Clinical Research Collaboration (UKCRC) in 2007.  The BRTC brings together all staff working on the methodological development and application of RCTs.  There is also an NIHR/NCCRCD (National Institute for Health Research/National Coordinating Centre for Research Capacity Development) Academic Unit, which provides research training and capacity-building in the South West NHS and is the focus for the conduct of applied HSR (Director: R Campbell).  We provide academic support for the South West Public Health Observatory (Scientific Director: Shaw), and manage a copy of the Hospital Episodes Statistics (HES) database containing data on care provided to NHS patients in England.  The main centre of the MRC’s Health Services Research Collaboration (HSRC) was based in the Department from October 1998 to September 2007, with research programmes developing methods for multi-disciplinary HSR and a remit for capacity-building across the UK (Director: Dieppe, Category D).  The HSRC’s research programmes transferred to the University of Bristol in October 2007 and continue unaffected by the HSRC closure.  In September 2007, the Department launched the new MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), directed by Davey Smith (submitted to UoA 6).  The primary aim of the CAiTE Centre is to use genetic variants to understand causes of disease, but HSR staff will translate findings into intervention studies to improve health care and public health (associate members of CAiTE: Sterne, Donovan).

The Department of Social Medicine thus provides a rich environment for HSR. Department staff include anthropologists, clinicians, epidemiologists, ethicists, geneticists, health economists, psychologists, public health physicians, nurses, sociologists and statisticians.  The array of staff has facilitated the development of innovative multi- and inter-disciplinary approaches to improving health and health care, with clinical and non-clinical scientists collaborating on projects that span activity from in-depth qualitative studies, through evaluations of health technologies, to life-course, genetic and public health epidemiology.  Many staff work seamlessly across the boundaries of UoAs 6 and 7, and some across UoAs 8 and 9.  Six HSR staff are flagged as Early Career Researchers (denoted by *).

Research themes and key findings 

Between 2001 and 2007 our aim was to consolidate and strengthen the methodological and applied HSR that formed part of the 5-star community-based subjects’ submission to RAE 2001 (subsequently up-rated).  We balanced expansion of specific areas of activity in response to initiatives from research commissioners such as the NHS HTA (Health Technology Assessment) Programme, with continuation of work in areas of research priority identified by government policy or the interests of staff with support from research councils, charities and the NHS.  Whenever possible, we integrated methodological studies with applied projects, and capitalised on our multi-disciplinary strengths and collaborative links with service providers.  Our research sought to extend current methodologies; investigate the effectiveness and efficiency of health care interventions, services and policy; and assess the impact of illness and health care on the experiences of patients, the public, and society. HSR in Bristol was undertaken within three major themes. Key findings and achievements are highlighted below, with links to submitted papers:

1. Randomised controlled trials

Randomised controlled trials (RCTs) are accepted as the ‘gold standard’ method for evaluating health care interventions and technologies.  Pragmatic and multi-disciplinary  RCTs are the hallmark of high quality HSR, providing robust evidence about the effectiveness and cost-effectiveness of health technologies.  Their basic design is well-established, but there is a need for methods to improve RCT recruitment, design and conduct in order to maximise internal and external validity, ensure informed consent and increase their relevance to clinical practice and policy.  Our RCTs address substantive health care questions using multi-disciplinary approaches, and often include integrated methodological research.  In the reporting period, our RCTs included all or many of the following: development of outcome measures; concurrent epidemiological studies; embedded qualitative studies; development of novel statistical designs and methods; economic evaluations; and feasibility studies.  Our particular strength lies in tackling complex and difficult RCTs, often with challenging surgical, inactive/conservative or public health interventions, or with controversial issues relating to recruitment and retention.  We have also pioneered the integration of qualitative research at all stages: design/feasibility, recruitment, process evaluation, intervention implementation, and interpretation of findings.  

The ProtecT (Prostate testing for cancer and Treatment) trial exemplifies this approach (PI: Donovan; co-PIs in Sheffield and Cambridge in surgery and oncology).  The ProtecT study received overall funding of £20 million from the NHS HTA Programme between 1999 and 2007, with a further £14 million committed for follow-up between 2008 and 2013.  The research hub is in Bristol (RCT co-ordinator: Lane).  The ProtecT treatment trial evaluates the relative effectiveness, cost-effectiveness, outcome and acceptability of radical surgery, radical conformal radiotherapy and active monitoring (regular testing with no immediate intervention), in men with localised prostate cancer. It is now the largest randomised trial of treatment for localised prostate cancer in the world.  The multi-disciplinary feasibility study comprised community-based testing using the Prostate Specific Antigen (PSA) blood test, a nested RCT of recruitment strategies, and an integrated qualitative study investigating information exchange and optimum trial design.  The study was selected as an exemplar of mixed methods research in a reader published by Sage US, 2007. The key findings were:

·         The RCT of recruitment strategies showed for the first time that that nurses were as effective and less costly than urological surgeons in recruiting trial participants, indicating a new and extended role for nurses in RCT recruitment (Donovan2)

·         The qualitative study identified and drove changes to the content and terminology of study information that established the three-arm design and improved recruitment and randomisation rates (Donovan1

·         Testing for prostate cancer using a blood test and biopsy was acceptable to men aged 45-69 years; while tumours can be found in men aged under 50 years, an age-based PSA cut-off leads to excessive numbers of biopsies (Lane3,4)

·         Multi-level growth curve models were developed for the first time to predict non-cancer PSA level changes, with the promise of identifying cancer progression among men undergoing active monitoring (Tilling1)

Key findings from other RCTs published in the reporting period were:

·         A community-based double-blind placebo-controlled RCT of Helicobacter pylori screening and eradication showed a reduction in the number of people consulting for dyspepsia but not in the overall prevalence of heartburn; an integrated economic evaluation confirmed that a targeted approach to screening and treatment in dyspepsia patients would be appropriate because of the cost of the therapy (Lane1,2)  

·         Three linked RCTs for men with benign urinary problems (CLasP) showed that standard transurethral resection surgery was: (a) superior to minimally-invasive laser therapy for men with acute urinary retention (Donovan4); (b) more cost-effective than conservative management or laser therapy for men with lower urinary tract symptoms (*Noble2); and (c) had unexpected beneficial effects on sexual function (Brookes1).  Conservative management did not adversely affect RCT recruitment or retention (Brookes3)  

·         A low cost booklet-based intervention was ineffective in stopping smoking among  pregnant women smoking at the outset of pregnancy, but an embedded qualitative study showed that the intervention had not been implemented fully in busy routine antenatal care – explaining the finding and suggesting targeted future research (R Campbell2)

·         The implementation of an advanced recovery programme led to better short-term outcomes following laparoscopic compared with open surgery for colorectal cancer (Blazeby1).  Measures of health related quality of life in oesophageal cancer were developed (Blazeby3), and showed that quality of life scores were prognostic for survival (Blazeby4

·         The ASSIST (A Stop Smoking in Schools) cluster-randomised RCT showed that a peer-led approach to smoking prevention in secondary schools was effective in reducing smoking uptake in adolescents (R Campbell4)

Other RCTs addressing specific health care questions or methodological development were published by Brookes, R Campbell, Hollingworth, *Metcalfe and Williams.


2. Systematic reviews, meta-analysis and evidence synthesis

Evidence-based policy needs to be underpinned by high quality systematic literature reviews, supported, where appropriate, by meta-analysis and other approaches to evidence synthesis.  While it is widely accepted that systematic reviews and meta-analyses of RCTs provide the highest level of evidence about the effects of health care interventions, there is a need to develop research methods to extend systematic reviews and synthesis of evidence to other types of study, for example diagnostic test accuracy studies and qualitative research.  Methodological development is needed to integrate evidence syntheses with economic analyses, to support decisions on resource allocation made by organisations such as the National Institute for Health and Clinical Excellence (NICE).  Since 2001, we have continued to conduct systematic reviews and meta-analyses addressing key questions in health care and public health, and extended programmes developing novel methods for evidence synthesis. 

The key findings from systematic reviews were:

·         The accumulated evidence from placebo-controlled RCTs of homeopathic remedies was compatible with the notion that the clinical effects of homeopathy are placebo effects (Egger4)

·         The cyclo-oxygenase 2 inhibitor rofecoxib should have been withdrawn several years earlier than 2004 because of side-effects (Egger2)

·         There was substantial bias in case-control studies of magnetic resonance imaging (MRI) for the diagnosis of multiple sclerosis; synthesis of long-term cohort studies showed the limited utility of MRI for diagnosis (*Gillard4)

·         Percutaneous transluminal coronary angioplasty was the best of seven treatments for acute myocardial infarction, compared using mixed treatment comparisons (Ades3)

Methodological research focussed on diagnostic test accuracy studies and the synthesis of evidence from quantitative and qualitative research studies.  The major findings were:

·         Bayesian Markov Chain Monte Carlo methods can be used to integrate multiparameter evidence synthesis (joint estimation of several parameters, often from more than one type of study) with economic analyses and hence facilitate medical decision making (Ades1,4, Welton4, Lu2)

·         Mixed treatment comparisons of RCTs in which overlapping pairs of treatments are compared can be used to assess evidence inconsistency, identify the best treatment(s), and be integrated with decision analyses (Ades2,3, Lu1,3,4)

·         A tool for quality assessment of diagnostic test accuracy studies (QUADAS) was developed and adopted by the Cochrane Collaboration for routine use in Cochrane reviews (*Gillard3)

·         Two methods for meta-analysis of test accuracy studies, leading to different meta-analytic summaries, were shown to be identical (*Harbord2). This facilitated development of the forthcoming Cochrane handbook for systematic reviews of test accuracy studies

·         The method of meta-ethnography was shown for the first time to permit the synthesis of health-related qualitative research to produce clinically relevant findings and higher level interpretations using the example of lay experiences of diabetes (R Campbell1

Further studies in this area were published by Egger, *Harbord, Macleod and Welton.

3. Other methodological and applied health services research

HSR has developed rapidly, but progress is still required within and across disciplines to develop methods that will enable more accurate and efficient collection of evidence to understand and reduce the burden of disease, address questions about provision of health care, and improve the health of the public.  We appointed staff with a wide range of academic backgrounds and research interests and encouraged intra-disciplinary methodological development where there was sufficient critical mass, for example in medical statistics.  Application to substantive areas enabled cogent themes to develop, in particular around infectious diseases.  There was also research in medical ethics, medical anthropology/sociology and health inequalities.

Infectious diseases

Infectious disease research began with a focus on HIV/AIDS.  It was extended through the formal secondment of Stuart (Category C) from the Health Protection Agency, and by the appointment of key new staff in receipt of personal fellowships (Hickman, Macleod and *Trotter).

Extensive research on the prognosis of HIV-infected patients in the era of highly active antiretroviral therapy (HAART) was based on collaborative analyses of prospective cohort studies. Key findings were:

·         CD4 cell count was the dominant prognostic factor in HIV-infected patients starting HAART, both before and after initial response to therapy, although factors measured at initiation of HAART were less prognostic once initial response to treatment was taken into account (Sterne1,2). This work influenced the development of international treatment guidelines (JAMA 2004;292:251-265)

·         Prognostic models for HIV-infected patients starting HAART, based on newly developed methodology for data from multiple cohort studies, are of use to patients and their doctors. A web-based risk calculator based on these models (www.art-cohort-collaboration.org) has been accessed repeatedly (May2,4)

·         Novel statistical methods (marginal structural models) showed that the beneficial effect of HAART compared with no treatment was greater as time from initiation increased but was less beneficial for those infected with HIV through intravenous drug-use (Sterne3)

·         Although HIV patients in resource-poor settings experienced higher mortality than those in developed countries, excess mortality declined rapidly during the first year on HAART (Egger1)

·         Educational interventions for HIV/AIDS need to be tailored to underlying structural and cultural dimensions of sexual ill-health (Lambert2)

·         A high incidence of hepatitis C and HIV among new injecting drug users indicated that current drug policy is no longer effective in ensuring protection from blood borne viruses in this high-risk group (Hickman3)

Key findings from research on vaccines were:

·         A reduction in serogroup C carriage following the new meningococcal C conjugate vaccine was shown for the first time and influenced vaccination policy in Europe (Stuart1)

·         Meningococcal serogroup C vaccination was highly effective over the long-term, and cost-effective when administered between ages 1-17 years and when incidence of disease was high (*Trotter3

·         Social behaviours such as intimate kissing rather than demographic characteristics and social deprivation explained the higher frequency of meningococcal carriage amongst teenagers, suggesting opportunities for public health intervention (Stuart4)

The NHS HTA Programme-funded Chlamydia Screening Studies (PI: Low, Category B) comprised a large-scale screening and prevalence study. A key finding was that postal screening for chlamydia was feasible, but coverage was incomplete and uptake modest (Macleod4).

Statistical methods and modelling

Key achievements from methodological studies were: 

·         The estimation of relative incidence of heroin-use from routine data using a method correcting for the time-lag between onset of heroin-use and receipt of treatment (Hickman1)

·         The development of multilevel growth curve models to predict recovery after stroke and monitoring of prostate cancer (Tilling1,2,3)

·         The development of dynamic models to predict disease spread and evaluate the effects of the introduction of meningococcal serogroup C conjugate vaccination (*Trotter2)

Other HSR

Research in medical ethics was initiated by A Campbell (Category B, retired).  Issues in informed consent to newborn screening were evaluated, and a protocol developed for the family dissemination of genetic risk for common treatable disease that has been implemented in several European countries (*Newson1).  Medical anthropology/sociology explored how parents make sense of a son’s suicide (Lambert1), and developed a model to explain why young adults do not seek help when mentally distressed (Donovan3).  Gender and age inequalities in health care provision in the UK, and the health of children of teenage mothers were also investigated (Shaw1,2).  

 

Research culture, infrastructure and staffing policy

The Department has built research capacity through strategic appointments of staff and long-term investment in infrastructure. This has produced an exciting, collaborative and supportive environment for early-career and established researchers.  A recent review of the Department praised the collaborative “can do” culture, and the spirit of intellectual generosity between colleagues.  Staff and students develop skills and experience through the conduct of research, together with research training provided by free places on the Department’s short course programme, weekly research seminars and journal clubs.  Career development is supported through formal line-management structures and informally within research and disciplinary teams to encourage the development of individual and collaborative research portfolios.  The University’s annual staff review and development process ensures that staff are aware of career opportunities and receive support for training and grant/fellowship applications.  We offer career pathways and security to talented research and support staff, all of whom receive permanent contracts after four years.  We have increasing numbers of support staff with enhanced research administrative roles in studies such as ProtecT.  Since 2001, six staff members have been promoted internally to personal chairs (Ades, Blazeby, R Campbell, Donovan, Egger, Sterne), and two Category B staff were promoted to other institutions: Coast, Chair in Birmingham; Low, Reader in Switzerland.  

Since 2001, we have retained a suitable balance between senior and junior research staff, clinical and non-clinical staff and different disciplines to provide the optimum environment for HSR.  There is a team of 20 statisticians, including Tilling, Sterne, *Metcalfe, May, Lu, *Harbord, Brookes and Ades, who provide support for study design and analysis. Health economists, epidemiologists, social scientists, statisticians and trialists meet regularly through journal club or discussion groups to support initiation and management of research.  

Our annual programme of high quality intensive short courses on a wide range of basic and advanced methodologies and generic research skills (see http://www.epi.bris.ac.uk/shortc/shortc.htm) has a national and international reputation.  Courses are designed and taught by Bristol staff, with invited teachers from the UK and abroad. During 2006/07 more than 400 students attended from the UK, Europe, North America, Africa and the Far East.  Currently underway is a £4 million extension to Canynge Hall (the building housing the Department of Social Medicine), funded by the University of Bristol and Wolfson Foundation. This will provide improved teaching and clinical research facilities, as well as office space.  

The Department has optimal facilities for research, with its own library, excellent computer facilities and dedicated IT support staff.  The local area network (LAN) is centred around a mixture of LINUX and Windows servers inter-connected on a gigabit backbone.  All staff and postgraduate students have a PC and easy access to network printers that are connected to the servers via the category 5e LAN operating at 100 megabits per second.  There are wireless hotspots and a secure link to the NHS N3 network.  Research staff have rapid and easy access to electronic journals and other web resources.  We have developed a state-of-the-art uniform data management system based on relational databases that enables researchers to work easily within and across studies.  The system provides accurate and rapid data capture and easy linkage between phases of data collection and analysis, providing details of the original questionnaires and automatic coding routines, for example, to code deaths using the International Classification of Diseases.  The system produces cleaned files for statistical analysis in Stata™, and has recently been enhanced with a scanning system that links digital images of questionnaires to the databases.  Data are securely backed up with a copy held offsite.

Research students and studentships

The Department has an active and thriving postgraduate community. Higher degree students are assigned at least two supervisors, whom they meet regularly.  Student progression is facilitated by formal annual reviews based on a 2,000 word report and presentation to the supervisors and at least one member of staff not involved in the project.  Training progress is recorded in a log book and encouraged by free places on the short course programme.  The log book is reviewed regularly by supervisors and the Director of Graduate Studies, who also provides induction for students, organises monthly research skills seminars, provides support and advice for students and supervisors, and oversees the monitoring process.  Maintenance and enhancement of standards and quality are ensured by regular student feedback, annual Departmental Programme Review, and an annual training meeting for supervisors.

In total, 44 students were registered for higher degrees in HSR-related projects during the reporting period, with 20 completions.  Within the reporting period, 28 studentships were awarded, and five further studentships were obtained after July 2007.  Of these 33, 20 were from highly competitive sources (16 MRC or ESRC, 4 DoH); 8 from the University of Bristol, and 5 from other sources.  Of the 28 students who started during the reporting period, 10 completed and were awarded their degrees within four years, and 17 remain ongoing and on schedule - close to a 100% completion rate.  Most completed postgraduate students have moved on to academic or NHS positions in the UK or abroad.  The Department of Social Medicine has also recently been awarded a prestigious Wellcome PhD programme, providing three students per year, 2008-13. 

Research income

£13.5 million was spent in total over the reporting period, at a steady level of about £2 million per year.  Annual income from the NHS R&D Programme (including the HTA Programme) was over £1 million every year, with a sharp increase in 2006/07 to £1.7 million.  In each full year of the assessment period, income from the Research Councils (primarily MRC) was over £0.5 million. The slight dip from the peak in 2004/05 was caused by the completion of recruitment to the ASSIST trial, and a temporary reduction in spend on HIV research.  Funding for the implementation and extension of ASSIST and a new programme in HIV was obtained in 2007.  There was additional MRC expenditure for the HSRC research programmes (£1.3 million per year), but this was not included in RA4 because the spend was not through the University.    

Relationships with the NHS and policy-making

There are active research relationships with NHS clinicians, service providers and policy-makers (local and national).  Four practising clinicians are integral members of the Bristol HSR group: an upper gastro-intestinal cancer surgeon, Blazeby; a GP, Macleod; a paediatric ophthalmologist, Williams; and a public health practitioner, Stuart.  Each has substantial NHS commitments.  In addition, Hickman provides sessions supporting public health in the combined Bristol PCT, and the Scientific Director of the South West Public Health Observatory (Shaw), with associated HES analysis team, are based in the Department. The Department participates actively in the regional NHS public health training scheme.  In response to the national shortage of clinical lecturers, we have obtained a number of Walport clinical academic training posts (three ACFs, two Clinical Lecturers and one senior lecturer).

Much of our research feeds into, or is an integral part of, NHS practice and policy.  UK policy on prostate cancer treatment and screening through the National Screening Committee awaits evidence from the ProtecT trial and its associated studies.  Our research on interventions to reduce smoking among young people and pregnant women was specifically designed to meet two key aims of the white paper Smoking Kills.  Research on Chlamydia and HIV has addressed priorities identified by the Department of Health in 2001: the need for evidence on the impact of combination therapies for HIV and the uptake of population screening for chlamydia.  Research findings estimating of long-term trends in the incidence of opiate/injecting drug use and vaccination coverage were used in the development of Government policy.  Evidence synthesis research contributed to NICE decision-making and public health guidance.

Research strategy

We will continue to conduct innovative methodological and applied research in response to the evolving interests of academic staff, changing health needs, policy priorities and research funding structures.  We will consolidate areas of strength (applied and methodological research in RCTs, evidence synthesis, infectious disease HSR, methodological development in statistics and modelling) and seek to set as well as contribute to the research agenda in these areas.  There are exciting opportunities for HSR arising from the development of the NIHR and establishment of OSCHR following the Cooksey Report.  We aim to expand our existing contributions and extend into new areas in response to this rapidly changing environment while retaining our focus on our core strengths and the need to conduct research relevant to contemporary health needs and health care structures.  

The development of our research strategy is facilitated by research symposia held three times per year to present early results of ongoing research projects and facilitate discussion and collaboration.  These are complemented by regular meetings of academic staff in cognate areas to identify exciting developments and areas for further research, or to discuss responses to commissioned and responsive funding calls.  Our aim is to achieve cohesiveness, consolidation, and a sensible balance between short- and long-term priorities. 

In the short term (1-5 years) we will work on major research projects in progress and recently awarded research grants: 

·         The ProtecT study will complete recruitment of 120,000 men tested for, and 3,000 diagnosed with, localised prostate cancer by mid-2008. The primary analysis for the treatment trial will be in 2015.  Funding for follow-up has been secured from the NHS HTA Programme until 2013.  The CAP (Comparison Arm for ProtecT) study converts the ProtecT trial into the intervention arm of a primary care-based cluster randomised trial of 480,000 men to evaluate the population impact of prostate cancer screening (Donovan, Sterne, Noble).  Funding for data collection has been secured from CR-UK/DoH until 2010.  Eight further linked studies led from Bristol have been funded by CR-UK/NCRI/MRC/WCRF/NIHR: impact on quality of life (Blazeby), economic modelling (*Noble), and epidemiological, dietary and genetic studies of cancer incidence and progression (Donovan, *Metcalfe, Lane, Tilling)  

·         Analyses of the process, outcome and economic evaluation of the ASSIST trial will be completed.  Funding has been secured to investigate the feasibility of extending this successful peer-led school-based intervention to (a) increasing physical activity and improving healthy eating in adolescence (DoH), and (b) drugs prevention (MRC) 

·         We will complete systematic reviews with funding already secured from MRC and NIHR; develop methodology for systematic reviews, evidence synthesis and decision analysis; quantify the effects of bias in the conduct of RCTs and observational studies on intervention effect estimates; and develop statistical methods that adjust the results of meta-analyses for such bias

·         Research on the prognosis of HIV-infected patients will focus on the effect of initial HAART regimens in RCTs and cohort studies, and comparisons between settings, countries and continents, with MRC funding from October 2007 (Sterne, May)

·         The University appointment of Professor John Lynch 20%FTE and a lecturer from January 2008 will enable expansion of research in health inequalities

·         Allied to the MRC CAiTE Centre, we will develop and apply statistical methods that deal with missing data in RCTs and observational studies, and use instrumental variables methods to make causal inferences (MRC funding secured - Sterne).  


Major long-term plans include:

·         Expanding our portfolio of applied RCTs under the aegis of the BRTC to respond to NHS-priorities and interventions emerging from CAiTE

·         Continuing to develop research methods to improve the design and conduct of RCTs, including recruitment and feasibility studies for ‘difficult’ RCTs 

·         Developing a major programme of research on the theoretical basis, development, evaluation and implementation of interventions to tackle risky and unhealthy behaviours, potentially under the umbrella of the proposed UKCRC Centre for Public Health Excellence

·         Responding to the increasing need for evidence-based policy and decision-making, by further developing methods for systematic reviews, qualitative sythesis, meta-analysis, evidence synthesis, decision modelling and cost-effectiveness analysis

·         Developing programmes of research relevant to the diagnosis, management and control of communicable diseases, including evidence syntheses, intervention studies and translational research in collaboration with microbiologists

·         Building critical mass in disciplines such as health economics and medical sociology/anthropology and strengthening collaborative research links with clinical colleagues so that we can respond to OSCHR and NIHR initiatives and encourage methodological development

 

Indicators of esteem

Selected examples are presented below:

Personal fellowships (n=18)

Nine externally-funded prestigious personal fellowships were held by submitted staff during the reporting period:

MRC or NHS/DoH/NIHR training and development fellowships (4) 

·         Tilling 1999-2002, *Metcalfe 2001-4, Hollingworth 1998-2002, Williams 1998-2001

DoH/NIHR post-doctoral fellowship (1) 

·         *Trotter 2006-9

MRC or DoH/NIHR career scientist awards (4) 

·         Blazeby 2000-6, Low 2001-5, Hickman 2001-6, Macleod 2004-8

MRC, NIHR and MRC fellowships were obtained for junior staff by Donovan, Dieppe, R Campbell, and *Trotter (9 in total).

International bodies

Chair

Blazeby:          European Organisation for Research and Treatment of Cancer Quality of Life Group

Donovan:         Symptoms and Quality of Life Committee, WHO International Consultation on Incontinence

Stuart:             Public Health Management Group, European Monitoring Group on Meningococci

Membership

Donovan:         WHO Benign Prostatic Hyperplasia Consultation
WHO Prostate Cancer and Prostate Diseases Consultation

Egger:             Consolidated Standards of Reporting of Trials Working Group
Cochrane
Collaboration Bias Methods Group (CCBMBG)
Strengthening the Reporting of Observational Studies in Epidemiology Group 

Hickman:         WHO HIV/AIDS and Intravenous Drug Use Group

Hollingworth:   American College of Radiology Imaging Network

Lambert:          Society for Medical Anthropology Executive Board

Lane:               Society for Clinical Trials

Sterne:            CCBMG (co-convenor)

Tilling:              International Biometrics Society

National bodies

Chair

Hickman:         Prevention Working Group, Advisory Council on Misuse of Drugs

Lambert:          Royal Anthropological Institute Medical Anthropology Committee

Membership

Ades:               Appraisals Committee, NICE

Blazeby:          NCRI Upper GI Clinical Studies Group

Donovan:         RAE2008 HSR sub-panel B7
NCRI Prostate Clinical Studies Group
Heads of UK NCRI/UKCRC-accredited trials units

Dieppe:            RAE2008 HSR sub-panel B7

Egger:             MRC Sexual Health and HIV Research Strategy Committee

Hickman:         National Academy of Medical Sciences Addiction and Drugs Working Group

Lambert:          RAE2008 Anthropology sub-panel J42

Lane:               MRC/HTA Trial Managers Network Steering Group
UKCRN Quality Assurance Working Group

Macleod:          Home Office Advisory Council on the Misuse of Drugs

Sterne:            MRC Leukaemia Trials Data Monitoring and Ethics Committee
Royal Statistical Society Medical Section Committee

Stuart:             Faculty of Public Health Medicine Board (elected)

Membership of national funding bodies

Blazeby:          Research for Patient Benefit (RfPB) grant committee

R Campbell:    RfPB grant committee

Donovan:         NHS HTA Programme Commissioning Board
Arthritis and Rheumatism Council Research Funding Committee

Egger:             Wellcome Trust Populations and Public Health Funding Committee
Swiss National Science Foundation, Clinical Research Committee
Swiss Academy of Medical Sciences

Hickman:         NCCRD Core panel for personal award scheme

Lane:               NHS HTA Programme Commissioning Board (Associate member)

Sterne:            National Asthma Campaign Research Committee

Membership of NHS advisory committees

Donovan:         Scientific reference group for UK Prostate Cancer Risk Management Programme

Hickman:         Health Protection Agency (HPA) Advisory Board and Hepatitis C Action Plan Group

Macleod:          RCGP representative - Family Planning Association, Sexual Health Economics Working Group, and Coronary Heart Disease Guideline Development Group 

Shaw:              Scientific Director SW Public Health Observatory

Stuart:             HPA Meningococcus Forum (Deputy Chair)

Editorships/Associate Editorships of international journals

Egger:                         International Journal of Epidemiology (IJE)
Clinical Trials 

Henderson:     Archives of Disease in Childhood

May:                 IJE

Shaw:              IJE
Sociology Editor for Social Science and Medicine 

Selected keynote/plenary presentations: 

Ades:               World Conference on Toxoplasmosis, Copenhagen

Blazeby:          International Society of Quality of Life Research, Prague 

Donovan:         International Chinese Continence Society, Guanzhou
British Association of Urological Surgeons Annual Meeting, Manchester

Egger:             Retroviruses and Opportunistic Infections Conference, Los Angeles

Hickman:         National Drug Treatment Conference, London

Hollingworth:   American Society of Neuro-Radiology, San Diego

Macleod:          European Congress on Neuropsychiatry, Paris
International Conference on Early Psychosis, Birmingham

*Newson:        International Chromosome Conference, Amsterdam

Stuart:             European Congress of Clinical Microbiology and Infectious Diseases, Milan 

Indicators of esteem for early career researchers

*Newson:                    Member, European Clinical Ethics Network
BMJ Ethics Committee 

*Metcalfe:        Associate member, NHS HTA Programme Commissioning Board

*Trotter:           Advisor to WHO Institute for Vaccine Research
Member of DoH Committee of Vaccines and Immunisation subgroup