South Manchester University Hospitals NHS Trust

 

 

R&D Annual Report 2005

 

 

 

 

 

Signature of Chief Executive or delegated authority:

I hereby confirm that the following document is the R&D Annual Report 2005 for South Manchester University Hospitals NHS Trust. I also confirm that it has been completed in accordance with the guidance issued by the Department of Health and provides an accurate representation of South Manchester University Hospitals NHS Trust's position.

Signed: _________________________________________________

Designation: _____________________________________________

Section 1: Contact details
Organisation Name: South Manchester University Hospitals NHS Trust
 
NHS Organisation Code: RM2 
NRR Organisation Code(s): N0226 
 
Strategic Health Authority: Greater Manchester 
 
Contact Name: Dr Andrew Maines 
Address: R&D Directorate
Education and Research Centre
Wythenshawe Hospital
 
City: Manchester 
PostCode: M23 9LT 
 
Telephone: 0161 291 5775 
Fax: 0161 291 5771 
 
Email: amaines@fs1.with.man.ac.uk 

Section 2A-2E: NHS Research programmes

RBV Greater Manchester Cancer Programme

2A Programme details
1) Programme Identifier: RBV Greater Manchester Cancer Programme
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 New
1c) Are you the administrative organisation for this programme? No 
2) Role of organisation in programme Principal investigator site 
 
2B NHS R&D priority and needs areas
  Not applicable to this programme record
 
2C Parties involved in the programme
  Not applicable to this programme record
 
2D Changes to the programme from description in the 2004 Annual Report
6a) Does this new programme incorporate elements of deleted programmes from 2004? Yes 
6b)
Identifiers of incorporated 2004 programmes
RM2 Breast cancer risk, detection and prevention  
RM2 Breast Cancer: Imaging and Treatment  
RBV Research, development and clinical application of new cancer therapies  
6c) Contribution of organisation to the programme As a major cancer research site the Trust is a key partner in the new Manchester Cancer Programme, as part of the Manchester Research Alliance.
South Manchester University Hospitals takes a lead role in Breast and Lung cancers.

Breast Cancer Imaging and Treatment:
1. Basic science research into factors controlling growth in situ and invasive breast cancer;
2. Development of imaging technology in the diagnosis of breast cancer;
3. Evaluation of new technology (eg sentinel node) and minimally invasive breast biopsy;
4. Entry of patients into clinical cancer trials of novel agents and NCRN trials;
5. Studies to determine the factors producing site specific metastases to bone and agents which prevent bone metastases.

Breast Cancer Risk, Detection and Prevention: The focus of this theme is to develop methods of risk assessment, early detection and prevention of breast cancer. The major investigation areas within the theme are
1. risk assessment (Family History Clinic; genetic testing; other risk predictors e.g. diet, weight and exercise; prophylactic mastectomy)
2. detection (e.g. MRI vs mammography)
3. randomised clinical trials for prevention
4. surrogate markers of the effect of treatments on the breast (breast surface temperature; nipple aspirate proteins; breast electropotential; breast density; positron emission tomography; MRI)
5. broadly-based laboratory programme to define potential new preventive agents and new approaches to prevention (stem cells; differentiation pathways; 'Breast Change'; new agents).

Breast cancer research at South Manchester will be significantly enhanced by the recent confirmation of funding (£14m) to construct a new Breast Care Unit at Wythenshawe Hospital which will include research space and will incorporate Europe's first breast cancer prevention centre.

Lung Cancer:
1. identification of high risk groups (epidemiological and genetic/humoral)
2. early detection (sputum cytology and fluorescence bronchoscopy)
3. local endobronchial therapy (photodynamic therapy/brachytherapy/chemotherapy)
4. clinical trials of new chemotherapeutic agents and neoadjuvant chemotherapy
5. symptom control; patient involvement in clinical decision-making
This theme was previously incorporated into the Lung Disease programme and will continue to work closely with this programme.

Other cancers:
The Trust also contributes research activity in gastrointestinal cancers, both upper (e.g. oesophageal) and lower (e.g. colorectal) GI, urological cancers (e.g. prostate and bladder) and gynaecological cancers. Also Interventional radiology for cancers.

NCRN
The Trust is a major partner in the Greater Manchester and Cheshire Cancer Research Network and leads several NCRN accredited trials in breast and lung cancers as a Chief Investigator site as well as contributing to other NCRN trials as a local PI site. The Trust has consistently been one of the most successful recruiters to NCRN trials within the top-recruiting region nationally. 
7) How have changes to the programme affected your organisation? The new programme incorporates:
RM2 Breast Cancer: Imaging and Treatment
RM2 Breast cancer risk, detection and prevention
plus Lung Cancer elements of RM2 A Programmed Investigation Of Obstructive And Parenchymal Lung Disease
RBV Research, development and clinical application of new cancer therapies

All Trusts in Greater Manchester that receive NHS R&D Support Funding, together with the University of Manchester, have signed up to the NHS R&D Alliance in Greater Manchester. The Alliance has in the past year integrated many of the existing R&D Programmes into co-ordinated R&D Programmes across the Strategic Health Authority area. The Trusts involved are still in the process of developing revised strategies and co-ordinated management arrangements, a Greater Manchester R&D Director has been appointed to lead this work. The programme fully satisfies the DH criteria for a Priorities and Needs Funded Programme.

South Manchester University Hospitals is committed to ongoing activity as a major cancer research centre and will continue to lead activity on a Pan-Mancheser basis focusing on breast and lung cancers. The development of the Alliance allows the Trust to strengthen collaboration and to develop and influence city-wide research strategy.

Note: lung cancer research was previously reported under "RM2 A Programmed Investigation Of Obstructive And Parenchymal Lung Disease". There will continue to be strong clinical and research links into this programme. 
 
2E Research deliverables
  Total for reporting organisation
8) Number of projects ongoing on 31 March 2005 40 
9) Number of peer-reviewed publications
(calendar year 2004)		 43 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(financial year 2004/05)		 2 
 
11) Examples of impact on health services or policy 1. Breast: Harvie et al. The effects of weight loss and weight gain on IGF and IGF binding proteins in premenopausal women. (Proceedings of American Institute for Cancer Research, Journal of Nutrition November 2004 134). The major finding of the paper on weight gain in breast cancer patients showed significant gains in fat and abdominal fat amongst women receiving adjuvant chemotherapy. This data has been presented at 2 national meetings to highlight the need for weight management in this patient group. Firstly to medical oncologists, breast surgeons and scientists at the British Breast Group (July 2004) and also to Breast care nurses at the National Breast Care Nurse Conference (December 2004). Follow up work has involved a survey of the views of the need for the weight management amongst oncology dietitians, medical oncologists and breast care nurses. We are planning to survey breast cancer patients for their views of optimum weight loss programmes in 2005. We are currently working with breast care nurses within the Withington and Christie sites to establish pilot studies of weight management amongst breast cancer patients.

2. Lung: Anderson et al. Study to investigate the feasibility and acceptability of administering single-agent gemcitabine to patients with advanced non-small-cell lung cancer (NSCLC) in their own homes. Gemcitabine is an active agent in NSCLC with a good toxicity profile and lends itself to this type of investigation. This showed that domiciliary gemcitabine is feasible. Furthermore, both the patients and carers reported positively on the use of domiciliary gemcitabine and preferred it over hospital administration. There was no evidence of increasing burden to community services during the domiciliary chemotherapy. 
 

Section 2A-2E: NHS Research programmes

RBV Research, development and clinical application of new cancer therapies

2A Programme details
1) Programme Identifier: RBV Research, development and clinical application of new cancer therapies
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Deleted

Section 2A-2E: NHS Research programmes

RM2 A programmed investigation of obstructive and parenchymal lung disease

2A Programme details
1) Programme Identifier: RM2 A programmed investigation of obstructive and parenchymal lung disease
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Unchanged
1c) Are you the administrative organisation for this programme? Yes 
2) Role of organisation in programme Principal investigator site 
 
2B NHS R&D priority and needs areas
3) Primary NHS R&D priority or need area Respiratory disease 
4a) Subsidiary NHS R&D priority or need area Primary care 
4b) Subsidiary NHS R&D priority or need area Children's services 
 
2C Parties involved in the programme
5)
Party involved in programme
(listed in alphabetical order)		 Type Written agreement?
Blackpool, Fylde and Wyre Hospitals NHS Trust   NHS   Yes  
Central Manchester and Manchester Children's University Hospitals NHS Trust   NHS   Yes  
Christie Hospital NHS Trust   NHS   Yes  
Manchester Mental Health and Social Care Trust   NHS   Yes  
Manchester Metropolitan University   Academic   Yes  
Marmaris University Istanbul, Turkey   Academic   No  
Penine Acute Hospitals NHS Trust   NHS   No  
Salford Royal Hospitals NHS Trust   NHS   Yes  
South Manchester Primary Care Trust   NHS   Yes  
St George's Medical School, London   Academic   No  
Trafford Healthcare NHS Trust   NHS   Yes  
UMIST   Academic   Yes  
University Children's Hospital, Copenhagen   Other   No  
University College London   Academic   No  
University Hospital, Zagreb, Croatia   Other   No  
University of Aberdeen   Academic   No  
University of Cardiff   Academic   No  
University of Edinburgh   Academic   No  
University of Manchester   Academic   Yes  
University of Nottingham   Academic   No  
University of Otago, New Zealand   Academic   No  
University of Salford   Academic   No  
University of Viginia, USA   Academic   No  
University of York   Academic   No  
 
2D Changes to the programme from description in the 2004 Annual Report
6a)
6b)		 Incorporation of deleted programmes Not applicable to this programme record
6c) Summary of programme area and objectives The programme encompases research activities relating to asthma, allergy and atopy; chronic obstructive pulmonary disease (COPD, chronic bronchitis); environmental impacts on Respiratory Disease (RD); aetiological factors, markers of disease activity; new therapies in the management of RD; early identification of RD; health economics of RD; management of cystic fibrosis, interstitial lung disease and lung cancer (link to Cancer Programme); epidemiology of RD; primary and secondary prevention of RD.
It reflects long-established national and international collaborations involving both university-based and clinically-based research partners and including innovative patient partnerships.

Asthma, Allergy and Atopy
Determination of the gene environmental interaction in the development of atopy, asthma and other allergic diseases; identification of early predictors of low pulmonary function in young children and the impact of a family history of atopic disease; objective measurements of parental atopic phenotypes and environmental exposures; effectiveness of environmental manipulation and early therapeutic intervention in existing disease; investigation and management of difficult bronchial asthma. Findings are being used to develop preventative strategies and better targeting of resources for primary prevention and effective secondary prevention.

Environmental Impacts
Examination of the effect of the working environment on health; objective measurement of environmental exposures and the associated human responses. Findings are being used to develop safe, comfortable, more productive working environments.

Aetiology/Markers of Disease/New Therapies
Investigation of aetiological factors, markers of disease activity and new therapies in the clinical management of lung fibrosis / lung transplantation.

Cystic Fibrosis
Clinically based investigations of aspects of cystic fibrosis including osteoporosis, diabetes, extent and prevention of cross-infection, oxygen therapy, pulmonary hypertension and evaluation of novel inhalational drugs.

Lung Infection
World leader in fungal infection of the lung (details reported in RM2 Invasive Fungal Disease).
Collaborative work with Central Manchester has also lead to the development of International guidlines for pneumonia.

Chronic Obstructive Pulmonary Disease (COPD)
Work on inflammatory basis of COPD leading to potential new therapies.
Major collaborative link developing with Central Manchester trust on cardiovascular disease in COPD patients.

External funding 2004/05 = £815,321; 2003/04 = £748,039; 2002/03 = £1,051,348

Note: During 2004/05 this has become Greater Manchester Alliance programme lead by South Manchester University Hospitals with key partners at University of Manchester, Central Manchester University Hospitals, South Manchester Primary Care Trust and Salford Royal Hospitals. For further details of the Alliance see the new Manchester Cancer Programme. 
7) How have changes to the programme affected your organisation? Not applicable to this programme record
 
2E Research deliverables
  Total for reporting organisation Total for programme across all organisations
8) Number of projects ongoing on 31 March 2005 32  35 
9) Number of peer-reviewed publications
(calendar year 2004)		 58  62 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(financial year 2004/05)		 2  2 
 
11) Examples of impact on health services or policy 1. Work exploring information needs in adults with asthma identified nine core areas which patients considered to be priorities for information-giving. These core areas have been fed-back to key producers of asthma patient information materials (eg Asthma UK and pharma companies) and have contributed to revisions made in their educational materials.
2. Study exploring information needs and preferred level of involvement in treatment decisions in patients with chronic obstructive pulmonary disease (COPD) identified nine areas which patients considered to be priorities for information-giving and identified factors which patients felt either facilitated or hampered their participation in treatment decisions. The work resulted in an invitation to present at an event held by the National Primary Care Development Team as part of their national quality improvement initiative related to COPD management in primary care. Some 100 primary care practitioners and lay representatives from 24 practices across the North West region were present and each practice is required to develop an action plan after the meeting. Our findings will therefore feed directly into improvements in COPD care provision in primary care.
3. Trial of individualised unsupervised exercise training in adults with cystic fibrosis showed that lung function and therefore survival can be maintained by exercise.
4. Studies on Chronic bronchitis in textile workers demonstrated in high risk groups an increased risk of developing symptomatic chronic bronchitis with evidence of reduced lung function. The effect is strong with an odds ratio in excess of 4, after accounting for the effects of smoking. Recently invited to present this data and other data we have on cotton textile workers to the Industrial Injuries Advisory Council. This government body a reconsidering a change to National Benefit Regulations which may allow cotton workers who develop COPD to claim industrial injuries benefits. 
 

Section 2A-2E: NHS Research programmes

RM2 Arterial and venous diseases, thrombosis, coagulation and blood transfusion

2A Programme details
1) Programme Identifier: RM2 Arterial and venous diseases, thrombosis, coagulation and blood transfusion
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Unchanged
1c) Are you the administrative organisation for this programme? Yes 
2) Role of organisation in programme Principal investigator site 
 
2B NHS R&D priority and needs areas
3) Primary NHS R&D priority or need area Coronary heart disease 
4a) Subsidiary NHS R&D priority or need area Older people 
4b) Subsidiary NHS R&D priority or need area Vascular disease (except CHD) 
 
2C Parties involved in the programme
5)
Party involved in programme
(listed in alphabetical order)		 Type Written agreement?
AstraTech Ltd   Other   Yes  
Aventis Ltd   Other   Yes  
Birmingham Heartlands and Solihull NHS Trust   NHS   No  
Central Manchester and Manchester Children's University Hospitals NHS Trust   NHS   Yes  
Guy's and St Thomas's Hospital NHS Trust   NHS   No  
Hammersmith Hospitals NHS Trust   NHS   No  
Imperial College School of Medicine   Academic   No  
Intercytex Ltd   Other   Yes  
Renovo Ltd   Other   Yes  
St George's Hospital NHS Trust   NHS   No  
UMIST   Academic   Yes  
University Hospitals Coventry and Warwickshire NHS Trust   NHS   No  
University of Manchester   Academic   Yes  
Unomedical Ltd   Other   Yes  
Wrightington, Wigan and Leigh NHS Trust   NHS   No  
 
2D Changes to the programme from description in the 2004 Annual Report
6a)
6b)		 Incorporation of deleted programmes Not applicable to this programme record
6c) Summary of programme area and objectives The programme comprises 2 themes:

Venous disease
Research is focused on venous disease including the treatment of varicose veins and the prevention and treatment of venous ulceration.
The theme includes
1. Prevention of chronic wounds, new treatment therapies for leg ulceration and prevention of recurrence upon healing.
2. Assessment and treatment of varicose veins
3. Physiology and haemodynamics of venous disease
4. Reduction in the risk of MRSA infection

Thrombosis, Coagulation and Blood Transfusion
1. Venous thromboembolism
2. Coagulation disorders and anti-coagulation
3. Autologous transfusion, cell salvage and transfusion triggers

External funding:
2004/05 = £256,263; 2003/04 = £254,677; 2002/03 = £292,792 
7) How have changes to the programme affected your organisation? Not applicable to this programme record
 
2E Research deliverables
  Total for reporting organisation Total for programme across all organisations
8) Number of projects ongoing on 31 March 2005 7  7 
9) Number of peer-reviewed publications
(calendar year 2004)		 10  10 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(financial year 2004/05)		 1  1 
 
11) Examples of impact on health services or policy Blood transfusion
Clinical trial on acute normovolaemic haemodilution (ANH) in patients undergoing hip arthroplasty presented at the Association of Surgeons of GB & Ireland and manuscript accepted for publication in Transfusion Medicine. Large-scale multicentre clinical trial on ANH now being considered by the MRC.

An audit of the 24h cell salvage service implemented in 2003 has confirmed significant reduction in homologous blood used, improved patient outcomes and a reduction in NHS costs.

The Blood Transfusion research group have played a key role in the publication of a report "A national blood conservation strategy for NBTC and NBC" which has been disseminated through the NBTC Executive Group.
The Group are now involved in Nationally recognised training schemes.

Varicose veins: studies on a nurse lead service for varicose veins presented at National meetings and published in Phlebology. Follow-up study confirmed that patients with minor and moderate varicose veins may be treated conservatively. Research on the safety of microfoam as a less invasive treatment for varicose veins presented to FDA.

DVT: study funded by CRC has identified that Oncologists and Radiotherapists rarely prescribe DVT prophylaxis despite a substantially increased risk of DVT during these cancer treatments. The pro-coagulants responsible for this increased risk have been identified and a manuscript is being prepared for publication.A major clinical trial on DVT prophylaxis in cancer therapies (chemotherapy and radiotherapy) is being initiated.

Abdominal Aortic Aneurysm: Collaborative research has confirmed that endovascular AAA repair has a low initial mortality compared with open surgery.
Our previous research on small abdominal AA and the cost effectiveness of AAA screening has contributed to national developments in AAA screening.
The National Screening Committee have recommended to the Government that a National Screening Programme be set up for AAA. 
 

Section 2A-2E: NHS Research programmes

RM2 Breast cancer risk, detection and prevention

2A Programme details
1) Programme Identifier: RM2 Breast cancer risk, detection and prevention
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Deleted

Section 2A-2E: NHS Research programmes

RM2 Breast Cancer: Imaging and Treatment

2A Programme details
1) Programme Identifier: RM2 Breast Cancer: Imaging and Treatment
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Deleted

Section 2A-2E: NHS Research programmes

RM2 Burn, Plastic and Reconstructive Surgery

2A Programme details
1) Programme Identifier: RM2 Burn, Plastic and Reconstructive Surgery
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Unchanged
1c) Are you the administrative organisation for this programme? Yes 
2) Role of organisation in programme Principal investigator site 
 
2B NHS R&D priority and needs areas
3) Primary NHS R&D priority or need area Emergency care 
4a) Subsidiary NHS R&D priority or need area Rehabilitation 
4b) Subsidiary NHS R&D priority or need area Wound healing 
 
2C Parties involved in the programme
5)
Party involved in programme
(listed in alphabetical order)		 Type Written agreement?
Central Manchester and Manchester Children's University Hospitals NHS Trust   NHS   Yes  
Manchester Metropolitan University   Academic   Yes  
Renovo Ltd   Other   Yes  
Royal Free Hampstead NHS Trust   NHS   No  
University College London   Academic   Yes  
University of Lancaster   Academic   No  
University of Leicester   Academic   No  
University of Manchester   Academic   Yes  
University of Salford   Academic   No  
West Hertfordshire Hospitals NHS Trust   NHS   No  
 
2D Changes to the programme from description in the 2004 Annual Report
6a)
6b)		 Incorporation of deleted programmes Not applicable to this programme record
6c) Summary of programme area and objectives This programme builds on Wythenshawe Hospital's clinical role as a major burns and plastic/reconstructive surgery centre. It forms an inter-disciplinary centre of excellence for research in tissue injury and repair, with the objectives of developing an internationally recognised facility at the leading edge of translational research to develop new therapies to maximise clinical and social outcomes.

The Programme links closely to the University of Manchester Plastic & Reconstructive Surgery Group within the Medical School, with state of the art laboratory facilities focusing on peripheral nerve repair and wider links to the internationallly-recognised wound healing research teams within the University.

There is also a key collaborative link to the Dept of Biological Sciences at Manchester Metropolitan University with a focus on wound infection and antibiotic resistance.

Wythenshawe Hospital is the main NHS site for clinical trials of innovations arising from the University laboratories, taking basic science through to clinical applications. 
7) How have changes to the programme affected your organisation? Not applicable to this programme record
 
2E Research deliverables
  Total for reporting organisation Total for programme across all organisations
8) Number of projects ongoing on 31 March 2005 9  9 
9) Number of peer-reviewed publications
(calendar year 2004)		 21  24 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(financial year 2004/05)		 3  4 
 
11) Examples of impact on health services or policy 1. Edwards-Jones et al: study of the effect of essential oils on methicillin-resistant Staphylococcus aureus (MRSA) using a dressing model. Patchouli, tea tree, geranium, lavender essential oils and Citricidal (grapefruit seed extract) were used singly and in combination to assess their anti-bacterial activity against three strains of Staphylococcus aureus: Oxford S. aureus NCTC 6571 (Oxford strain), Epidemic methicillin-resistant S. aureus (EMRSA 15) and MRSA (untypable). A combination of Citricidal and geranium oil showed the greatest-anti-bacterial effects against MRSA, whilst a combination of geranium and tea tree oil was most active against the methicillin-sensitive S. aureus (Oxford strain). This study demonstrates the potential of essential oils and essential oil vapours as antibacterial agents and for use in the treatment of MRSA infection.

2. Cano et al: study to develop and validate a new patient-based outcome measure for hand/arm disorders for use in audit, clinical trials and effectiveness studies. 3 stages: interviews with patients with hand/arm disorders to develop and pilot questionnaire content; postal survey with pre- and post-surgery patients which reduced the number of items and identified scales; postal survey with pre- and post-surgery patients evaluated the psychometric properties of the measure. Findings confirmed the acceptability, reliability, validity and responsiveness to clinical change of the questionnaire. The Patient Outcomes of Surgery-Hand/Arm (POS-Hand/Arm) is a new surgical outcome measure that can be used before and after surgery to evaluate and compare new techniques, surgical teams and units. 
 

Section 2A-2E: NHS Research programmes

RM2 Invasive Fungal Diseases

2A Programme details
1) Programme Identifier: RM2 Invasive Fungal Diseases
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Unchanged
1c) Are you the administrative organisation for this programme? Yes 
2) Role of organisation in programme Principal investigator site 
 
2B NHS R&D priority and needs areas
3) Primary NHS R&D priority or need area Infectious and immunological disease 
3b) Justification of primary need's importance for the NHS and the potential impact of the research evidence Systemic fungal infections are often fatal: 40% for candidaemia, 60% for invasive aspergillosis. 1 in 15 hospital deaths in the NHS are due to invasive fungal infection. In 2002, the NHS spend on antifungals was £48m in primary care and £50m in secondary/tertiary care. Two new antifungal drugs have been licensed in 2001-2003. The most recent is caspofungin (per diem cost/patient = £280). Antifungal resistance is an increasing problem, and without effective susceptibility testing procedures, combination therapy will become the recommended treatment despite associated patient toxicity and high prescription costs. Therapeutic drug monitoring is an increasing need.

The key objective of the research programme is to improve survival in invasive fungal infection by:
- improving diagnosis
- understanding pharmacodynamics of antifungal drugs
- standardising antifungal susceptibility testing
- sequencing several genomes of Aspergillus
- disseminating information about Aspergillus fumigatus to patients, doctors and researchers via the World Wide Web
- molecular typing methodologies to support epidemiological investigations 
4a) Subsidiary NHS R&D priority or need area Respiratory disease 
4b) Subsidiary NHS R&D priority or need area Genetics 
 
2C Parties involved in the programme
5)
Party involved in programme
(listed in alphabetical order)		 Type Written agreement?
European Society for Clinical Microbiology and Infectious Diseases, Zurich   Other   No  
Institute of Genome Research, USA   Other   Yes  
National Institute of Advanced Industrial Science & Technology, Tokyo, Japan   Academic   Yes  
Salford Royal Hospitals NHS Trust   NHS   Yes  
The Wellcome Trust Sanger Institute, Cambridge   Other   No  
University of Manchester   Academic   Yes  
University of Texas   Academic   Yes  
Whitehead Institute, Massachusetts Institute of Technology   Academic   Yes  
 
2D Changes to the programme from description in the 2004 Annual Report
6a)
6b)		 Incorporation of deleted programmes Not applicable to this programme record
6c) Summary of programme area and objectives The key objective of the research programme is to improve survival in invasive fungal infection by:
- improving diagnosis
- standardising antifungal susceptibility testing
- sequencing several Aspergillus genomes
- disseminating information about Aspergillus fumigatus to patients, doctors and researchers via the World Wide Web
- molecular typing methodologies to support epidemiological investigations

External funding: 2004/05 = £465,401; 2003/04 = £479,762; 2002/03 = £995,888 
7) How have changes to the programme affected your organisation? Not applicable to this programme record
 
2E Research deliverables
  Total for reporting organisation Total for programme across all organisations
8) Number of projects ongoing on 31 March 2005 7  7 
9) Number of peer-reviewed publications
(calendar year 2004)		 22  22 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(unspecified year type)		 0  0 
 
11) Examples of impact on health services or policy 1. Genome of Aspergillus fumigatus completed and partially published.
2. New (better) method of susceptibility testing of echinocardins for Aspergillus.
3. Therapeutic Drug Monitoring (TDM) guidelines for voriconazole.
Keevil et al; Boyd et al
The description of how best to measure voriconazole levels and the arguments for therapeutic drug monitoring are new. Voriconazole has an interpatient plasma concentration variation of >100-fold in adults, and is subject to accelerated metabolism in children. We have observed toxicity at high concentrations, and poor responses in the few patients with very low plasma concentrations. These papers lay the foundation for therapeutic drug monitoring. Detailed guidelines will need to be developed for adults and children, but trough concentrations of <250ng/mL are currently recommended as required for efficacy, and >6,000ng/mL as potentially toxic, justifying a lower dose.
4. Molecular understanding of flucytosine resistance in Candida albicans.
5. Caspofungin for the treatment of invasive aspergillosis.
Maertens et al
The first study conducted in invasive aspergillosis with this new class of antifungal drug. It has marked efficacy in patients who would otherwise have died, with little toxicity. As there are ~5,000 patients in the UK with invasive aspergillosis annually, with ~50%+ mortality, this new agent will get used extensively. 
 

Section 2A-2E: NHS Research programmes

RM2 Medical Education

2A Programme details
1) Programme Identifier: RM2 Medical Education
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Unchanged
1c) Are you the administrative organisation for this programme? Yes 
2) Role of organisation in programme Principal investigator site 
 
2B NHS R&D priority and needs areas
3) Primary NHS R&D priority or need area Building capacity to deliver health and social care 
4a) Subsidiary NHS R&D priority or need area Education research 
4b) Subsidiary NHS R&D priority or need area Service delivery and organisation 
 
2C Parties involved in the programme
5)
Party involved in programme
(listed in alphabetical order)		 Type Written agreement?
American Board of Internal Medicine   Other   No  
Central Manchester and Manchester Children's University Hospitals NHS Trust   NHS   Yes  
Central Manchester Primary Care Trust   NHS   Yes  
Christie Hospital NHS Trust   NHS   No  
Harvard Unversity   Academic   Yes  
Lancashire Teaching Hospitals NHS Trust   NHS   Yes  
Royal College of Physicians and Surgeons of Canada   Other   No  
Salford Royal Hospitals NHS Trust   NHS   Yes  
University of Keele   Academic   Yes  
University of Leeds   Academic   Yes  
University of Liverpool   Academic   Yes  
University of Maastricht   Academic   Yes  
University of Manchester   Academic   Yes  
University of Newcastle-upon-Tyne   Academic   Yes  
University of Oxford   Academic   Yes  
University of Sheffield   Academic   Yes  
 
2D Changes to the programme from description in the 2004 Annual Report
6a)
6b)		 Incorporation of deleted programmes Not applicable to this programme record
6c) Summary of programme area and objectives The Medical Education Research Programme is evaluating outcomes of the new undergraduate medical curriculum at the University of Manchester (preparation of new graduates for practice vis-a-vis clinical skills, communication skills, dealing with uncertainty, time management, understanding clinical audit, looking after people from different cultures, using informatics, understanding the legal and ethical aspects of medicine). Also during 2003-2005 there has been an increasing focus on interdisciplinary and non-medical education.

Programmes objectives are:
1) to develop and evaluate innovative approaches to teaching and learning in undergraduate medical education (eg IT-based learning, multidisciplinary learning, clinical skills teaching);
2) to evaluate and maximise the abilities/quality of the graduates of the problem-based learning programme at the University of Manchester Medical School;
3) to develop and evaluate multidisciplinary learning strategies;
4) to increase competencies/skill levels in the newly qualified doctor and in other clinical professions
5) to develop workforce capacity.

External funding: 2004/05 = £112,497; 2003/04 = £160,404; 2002/03 = £115,565 
7) How have changes to the programme affected your organisation? Not applicable to this programme record
 
2E Research deliverables
  Total for reporting organisation Total for programme across all organisations
8) Number of projects ongoing on 31 March 2005 5  10 
9) Number of peer-reviewed publications
(calendar year 2004)		 12  12 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(unspecified year type)		 0  0 
 
11) Examples of impact on health services or policy 1. Furber et al: Study of interprofessional education for students of midwifery, nursing and medicine to evaluate outcomes of an intervention (a problem-based learning (PBL) scenario) with interprofessional students and facilitators. FINDINGS: student midwives participating in the PBL scenario in this interprofessional format improved their attitudes to working in this environment. All students enjoyed the opportunity to learn in an interprofessional team, and they felt that the experience provided a safe environment to help prepare for their future roles. The learning opportunity enabled all students to reflect on each other's role and to discuss differing perspectives of care, although the student midwives had mixed feelings about the PBL experience. IMPLICATIONS FOR PRACTICE: interprofessional learning using PBL is a useful environment for students to learn about each others' role, and to prepare for working together as qualified professionals in a collaborative manner. However, time and commitment is required to plan joint working in order to maximise the benefits.

2. The translational research group co-lead with Salford Royal Hospitals has, over the last year, developed or contributed to the development of virtual managed learning environments for the following curricula:
•     University of Manchester undergraduate medical curriculum
•     University of Manchester doctorate in clinical psychology
•     Foundation training for newly qualified doctors
•     Nurse education within the Salford Royal Hospitals Trust
•     Community-wide education of diabetes health professionals, as part of the implementation of the National Service Framework for diabetes

 
 

Section 2A-2E: NHS Research programmes

RM2 Medicines Management

2A Programme details
1) Programme Identifier: RM2 Medicines Management
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Unchanged
1c) Are you the administrative organisation for this programme? Yes 
2) Role of organisation in programme Principal investigator site 
 
2B NHS R&D priority and needs areas
3) Primary NHS R&D priority or need area Building capacity to deliver health and social care 
4a) Subsidiary NHS R&D priority or need area Service delivery and organisation 
4b) Subsidiary NHS R&D priority or need area Pharmacy 
 
2C Parties involved in the programme
5)
Party involved in programme
(listed in alphabetical order)		 Type Written agreement?
Central Manchester and Manchester Children's University Hospitals NHS Trust   NHS   Yes  
Christie Hospital NHS Trust   NHS   Yes  
Manchester Mental Health and Social Care Trust   NHS   Yes  
Salford Royal Hospitals NHS Trust   NHS   Yes  
South Manchester Primary Care Trust   NHS   Yes  
St. Anne's Hospice   Other   Yes  
University of Manchester   Academic   Yes  
University of York   Academic   Yes  
 
2D Changes to the programme from description in the 2004 Annual Report
6a)
6b)		 Incorporation of deleted programmes Not applicable to this programme record
6c) Summary of programme area and objectives The Pharmacy Departments within the Manchester Trusts have continued to develop their R&D strategy devoted to optimising medicines management, the delivery of pharmaceutical care to patients and demonstrating the pharmacy contribution to an evidence-based health service. There is a citywide collaboration with NHS Trusts, PCTs and the School of Pharmacy and Pharmaceutical Sciences at the University of Manchester. Pharmacy practice research is undertaken to investigate problems in day-to-day practice and the results are used to improve services. Examples of R&D work that have been translated into practice include the development of pharmacy ward-based teams, pharmacist interventions to prescribing decisions, drug utilisation and health economic studies and the use of patients’ own drugs and self-administration of medicines in hospital. Work under the national clinical pharmacy programme for prudent antimicrobial use has resulted in a number of publications and presentations that have demonstrated improved utilization and cost effectiveness.
The clinical tutor posts within the 3 teaching hospitals continue to evaluate the learning environment within which the undergraduate students are placed. This programme is being expanded in 2005 with the appointment of 3 additional tutors.
Dissemination of R&D work within the programme has resulted in numerous conference presentations and journal papers.

South Manchester:
Continues to be very active with presentations at many national conferences, including key presentations at the inaugural SACAR antibiotic conference: a presentation about the north west regional audit of MI centres, at the MI conference; a poster at BPC about the impact of pharmacists in pre-admission clinics ; oral and poster presentations at the CF conference and both oral & poster presentations about antibiotics at the UKCPA autumn symposium.
In addition the medicines management audit programme produced 6 oral/poster presentations for the local R&D conference including audits of the appropriateness of Clopidogrel , Aminoglycoside and Vancomycin usage, adherence to Warfarin initiation protocols, anti-emetic prescribing for chemotherapy patients and one poster from the aseptic unit about accreditation of a training programme for senior ATO's. An original assessment of patient's opinions and attitudes following interviews with pharmacy undergraduate students was also presented and expected to be published in 2005. The specialist CF pharmacist had a paper about the pharmacist's role in the adult CF unit published in The Journal of the Royal College of Medicine and Dr J Cooke had numerous publications about antibiotics, PCT views of influencing prescribing and economic evaluation of Heparin's.

Ongoing projects include:
- Collaboration with School of Pharmacy around patient assessment of student's communication skills
- Medication error reporting culture
- Work with Hope and MRI about assessing the impact of a pharmacist team approach to patient care.
- National antimicrobial databases and links to surveillance 
7) How have changes to the programme affected your organisation? Not applicable to this programme record
 
2E Research deliverables
  Total for reporting organisation Total for programme across all organisations
8) Number of projects ongoing on 31 March 2005 4  17 
9) Number of peer-reviewed publications
(calendar year 2004)		 11  19 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(unspecified year type)		 0  0 
 
11) Examples of impact on health services or policy 1. Re-engineering oncology pharmacy services. Objective: to modernise pharmacy services making optimal use of resources, human and financial, and improving timeliness of chemotherapy provision. Parameters: stability of chemotherapy agents, clinical significance and acceptability of rounding and banding; role of pharmacist prescriber in chemotherapy clinic. Includes both technical as well as clinical aspects.
The technical aspects included investigation of dose rounding of different chemotherapeutic agents in order to increase the efficiency of chemotherapy services as well as reduce wastage and save pharmacy staff time. We have contributed to various publications and presented posters on dose banding and development of key performance indicators which measure chemotherapy services. These have enhanced and informed the national debate.
The clinical aspect includes looking at the role of the technician and the pharmacist; our work on pharmacist supplementary prescribing has been published and presented at the British Society of Haematology this year.

2. Pharmacy Information technology. Objective: to harness developments in information technology for maximal effect on pharmacy services to improve quality and efficiency
Parameters: acceptability of IT incorporation into systems of work, systems analysis, user involvement.
We have already assessed the use of webcam, prescription tracking systems and have commenced electronic prescribing of complex chemotherapy regimens. Ongoing work includes remote access of pharmacy databases for on call purposes as well as harnessing information technology for pharmacist interventions.
All our work has been published or submitted for publication to inform the national agenda. 
 

Section 2A-2E: NHS Research programmes

RM2 Multidisciplinary research on coronary artery disease, stroke, paradoxical emboli and cerebral injury

2A Programme details
1) Programme Identifier: RM2 Multidisciplinary research on coronary artery disease, stroke, paradoxical emboli and cerebral injury
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Unchanged
1c) Are you the administrative organisation for this programme? Yes 
2) Role of organisation in programme Principal investigator site 
 
2B NHS R&D priority and needs areas
3) Primary NHS R&D priority or need area Coronary heart disease 
4a) Subsidiary NHS R&D priority or need area Older people 
4b) Subsidiary NHS R&D priority or need area Vascular disease (except CHD) 
 
2C Parties involved in the programme
5)
Party involved in programme
(listed in alphabetical order)		 Type Written agreement?
Bolton Hospitals NHS Trust   NHS   Yes  
Central Manchester and Manchester Children's University Hospitals NHS Trust   NHS   Yes  
Edinburgh Neurosciences Trials Unit   Other   No  
Karolinska Hospital, Stockholm, Sweden   Other   Yes  
Leeds Teaching Hospitals NHS Trust   NHS   No  
Manchester Mental Health and Social Care Trust   NHS   Yes  
Penine Acute Hospitals NHS Trust   NHS   No  
Royal Brompton and Harefield NHS Trust   NHS   No  
St Georges Medical School London   Academic   Yes  
Stockport NHS Trust   NHS   No  
The Cardiothoracic Centre Liverpool NHS Trust   NHS   No  
University of Liverpool   Academic   Yes  
University of Manchester   Academic   Yes  
University of Warwick   Academic   Yes  
Wrightington, Wigan and Leigh NHS Trust   NHS   No  
 
2D Changes to the programme from description in the 2004 Annual Report
6a)
6b)		 Incorporation of deleted programmes Not applicable to this programme record
6c) Summary of programme area and objectives The programme comprises 3 research themes:

1. Cardiology, cardiothoracic surgery and cardiopulmonary transplantation.
It builds on existing academic links and clinical strengths and promotes new collaborations between South Manchester, the University of Manchester and other Trusts in Greater Manchester.
Key areas within the theme are:
- Aetiology of myocardial infarction in young people
- Inflammatory processes in coronary disease and cardiac transplant vasculopathy
- Early detection of left ventricular dysfunction
- Treatment of heart failure
- Mechanisms and prevention of rejection in cardiopulmonary transplantation

2. Stroke
This theme is concerned with the secondary prevention of stroke due to cardiovascular disease
and includes:
1. On going research involving national and international collaborations
2. Pilot studies
3. Epidemiological studies

3. Paradoxical emboli and cerebral injury
This theme is concerned with all aspects of paradoxical embolisation and cerebral injury and includes:
1. The role cerebral embolisation in the causation of dementia
2. Cerebral and paradoxical emboli as a cause of acute cerebral injury following surgery
3. Pilot studies on treating patent foramen ovale

External funding:
2004/05 = £770,662; 2003/04 = £456,631; 2002/03 = £496,215 
7) How have changes to the programme affected your organisation? Not applicable to this programme record
 
2E Research deliverables
  Total for reporting organisation Total for programme across all organisations
8) Number of projects ongoing on 31 March 2005 20  20 
9) Number of peer-reviewed publications
(calendar year 2004)		 28  28 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(financial year 2004/05)		 0  0 
 
11) Examples of impact on health services or policy Myocardial infarction and stroke in young adults: following the YAMIS study (BHF) and DYAMIS study (Wellcome Trust), results of this research have been presented at National and International meetings and manuscript accepted for publication in Am J Cardiology. The need to investigate young adults suffering ischaemic stroke for venous to arterial circulation shunts is now established. This research has also influenced the decision on whether or not a PFO should be closed as only major venous to arterial circulation shunts are associated with ischaemic stroke.
The BHF have now funded a study to compare differing diagnostic approaches to the detection of venous to arterial circulation shunts and patent foramen ovale.

Our research on the timing of surgery following symptoms of cerebral ischaemia or anterior circulation strokes has influenced regional and national stroke protococols.

Paradoxical embolism: case-control studies on paradoxical embolism as a cause of sudden monocular blindness and sudden monaural deafness have been funded by Defeating Deafness. A major research proposal on spontaneous cerebral emboli and paradoxical embolism in the initiation of migraine is being considered by the Migraine Trust, Migraine Action and the MRC.

Dementia studies: the results of a major case-control study in Alzheimer's disease and vascular dementia have been presented at National and International meetings.
A study on the influence of spontaneous cerebral emboli on the rate of deterioration in patients with both Alzheimer's disease in vascular dementia is nearing completion (funded by the Alzheimer's Society).
The weak association between venous to arterial circulation shunts in dementia has resulted in a further proposal to Wellcome for a second larger case-control study. A cohort study in patients at risk of dementia is being proposed to the MRC with the objective that we may be able to identify patients with a potentially preventable cause of dementia. 
 

Section 2A-2E: NHS Research programmes

RM3 Studies of the gastrointestinal tract in health and disease, and development of methods to improve patient care

2A Programme details
1) Programme Identifier: RM3 Studies of the gastrointestinal tract in health and disease, and development of methods to improve patient care
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Unchanged
1c) Are you the administrative organisation for this programme? No 
2) Role of organisation in programme Principal investigator site 
 
2B NHS R&D priority and needs areas
  Not applicable to this programme record
 
2C Parties involved in the programme
  Not applicable to this programme record
 
2D Changes to the programme from description in the 2004 Annual Report
6a)
6b)		 Incorporation of deleted programmes Not applicable to this programme record
6c) Contribution of organisation to the programme The unit at South Manchester University Hospitals concentrates on research into the clinical, epidemiological and pathophysiological aspects of the functional gastrointestinal disorders. At the basic laboratory level the emphasis is on genetics, gender, neuropeptides and inflammation in relation to these disorders. Clinical studies focus on the various ways these conditions present and impact on patients’ lives. Particular attention is paid to developing better treatments and exploring new therapeutic options such as recent studies on probiotics, food antibodies and hypnosis. 
7) How have changes to the programme affected your organisation? Not applicable to this programme record
 
2E Research deliverables
  Total for reporting organisation
8) Number of projects ongoing on 31 March 2005 16 
9) Number of peer-reviewed publications
(calendar year 2004)		 22 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(unspecified year type)		 0 
 
11) Examples of impact on health services or policy Recent outputs should have major impact in the field of irritable bowel syndrome.
1. Atkinson et al demonstrated, for the first time, that an exclusion diet based on the presence of IgG food antibodies can improve the symptoms of IBS and offers a completely new way of treating the condition.
2. Miller et al demonstrated an extraordinarily high rate (38%) of suicidal thoughts in hospital patients with IBS. This highlights just how devastating the condition can be for some individuals and underlines the need for this condition to be taken much more seriously by health care providers.
3. Serotonin (5-hydroxytryptamine) concentrations in the blood are abnormal in patients with irritable bowel syndrome, with high concentrations being recorded in patients with diarrhea predominant IBS and low concentrations being measured in patients with constipation predominant IBS. The data provides a rational basis for current new developing pharmacological approaches for modulating different 5-HT receptors in patients with constipation and diarrhea predominant IBS.
4. Abdominal bloating is a frequent and bothersome symptom of irritable bowel syndrome, affecting approximately 96% of patients. To date it has been unclear whether the patient report of bloating was associated with a visible increase in girth (ie distension). We have shown approximately half of IBS patients who bloat also physically distend. Those that bloat alone appear to have an increased sensitivity of the gut compared with those that bloat and distend, suggesting different pathophysiologies may be responsible for the symptoms of bloating and distension in IBS. These observations along with our current research on the relationship between bloating and distension and the transit of food through the gut, may help us identify more appropriate treatment for these debilitating symptoms. 
 

Section 2A-2E: NHS Research programmes

RM3 The Greater Manchester Diabetes and Obesity Research Network (DORN) Programme

2A Programme details
1) Programme Identifier: RM3 The Greater Manchester Diabetes and Obesity Research Network (DORN) Programme
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 New
1c) Are you the administrative organisation for this programme? No 
2) Role of organisation in programme Contributing site 
 
2B NHS R&D priority and needs areas
  Not applicable to this programme record
 
2C Parties involved in the programme
  Not applicable to this programme record
 
2D Changes to the programme from description in the 2004 Annual Report
6a) Does this new programme incorporate elements of deleted programmes from 2004? Yes 
6b)
Identifiers of incorporated 2004 programmes
RW3 Clinical Diabetes and Endocrinology  
6c) Contribution of organisation to the programme South Manchester University Hospitals is a leading partner in the Greater Manchester Research Alliance and a contributing partner to the new Greater Manchester Diabetes and Obesity Research Network (DORN) Programme which incorporates the existing diabetes and endocrinology research programmes of Trusts in Greater Manchester. This larger pan-city will provide critical mass and enhanced collaborative opportunities across the region. 
7) How have changes to the programme affected your organisation? Incorporation of diabetes and endocrinology research into the new Alliance Programme administered by Salford Royal Hospitals NHS Trust. 
 
2E Research deliverables
  Total for reporting organisation
8) Number of projects ongoing on 31 March 2005 5 
9) Number of peer-reviewed publications
(calendar year 2004)		 15 
10) Number of higher degrees directly funded by NHS R&D Support Funding
(unspecified year type)		 0 
 
11) Examples of impact on health services or policy 1. Lawson et al: study to identify factors associated with regular diabetes care-seeking and to compare the performance of the Illness Perception Questionnaire (IPQ) and a modified version of the Personal Models of Diabetes Interview (PMDI) in predicting care-seeking. Findings were that patients not seeking regular care held more negative views of the control, course and consequences of diabetes than those who received regular care. Regression analyses showed that the most important construct was treatment effectiveness. Treatment effectiveness (PMDI) and control (IPQ) dimensions were associated with clinic attendance. PMDI constructs of treatment effectiveness, threat and worries were associated with regular care-seeking. In order to understand diabetes care-seeking behaviour it is important to measure beliefs about the benefits of treatment recommendations in addition to those of the disease itself. Emotional and cognitive responses to diabetes should be assessed.

2. van Schie et al: study to examine the relationships among muscle weakness, foot deformities, and peroneal and tibial nerve conduction velocity in diabetic and nondiabetic men found important relationships between motor nerve conduction deficit and muscle weakness; however, it is still not clear whether abnormal nerve function, leading to a decrease in muscle strength, could be responsible for the development of foot deformities. 
 

Section 2A-2E: NHS Research programmes

RW3 Clinical Diabetes and Endocrinology

2A Programme details
1) Programme Identifier: RW3 Clinical Diabetes and Endocrinology
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Deleted

Section 2A-2E: NHS Research programmes

RW3 Rehabilitation and Ageing

2A Programme details
1) Programme Identifier: RW3 Rehabilitation and Ageing
1b) Status on 31 March 2005
(compared to the 2004 annual report)		 Unchanged
1c) Are you the administrative organisation for this programme? No 
2) Role of organisation in programme Contributing site 
 
2B NHS R&D priority and needs areas
  Not applicable to this programme record
 
2C Parties involved in the programme
  Not applicable to this programme record
 
2D Changes to the programme from description in the 2004 Annual Report
6a)
6b)		 Incorporation of deleted programmes Not applicable to this programme record
6c) Contribution of organisation to the programme South Manchester University Hospitals rehabilitation research relating to chronically ill, disabled and elderly people is conducted principally within the Departments of Rheumatology, Elderly Care, Physiotherapy, Speech Therapy and the Disablement Services Centre. Continence research, which is also part of this programme, is undertaken within the Department of General Surgery and the Cystic Fibrosis Unit.
There is also rehabilitation research activity embedded within other programmes e.g. the research of the Consultant Cystic Fibrosis Physiotherapist, within the Lung programme.

Examples of research themes include the innovative work of Disability Services on rehabilitation of amputees and design of new devices for the disabled (e.g. new award-winning wheelchair designs currently under commercial development); legal capacity to consent for elderly patients; collaboration of Elderly Care with the