Author: Louise Stanley

Fourth NHS member for Birmingham Health Partners extends specialist expertise

Written by Louise Stanley on 26/09/2022. Posted in Birmingham Health Partners.

Birmingham Health Partners (BHP), the second city’s University-NHS partnership, has further expanded its membership by welcoming the Royal Orthopaedic Hospital NHS Foundation Trust (ROH) on board – its fourth NHS member. The ROH joins fellow Trusts University Hospitals Birmingham (UHB), Birmingham Women’s and Children’s Hospitals and Sandwell and West Birmingham Hospitals as BHP’s NHS members, with the University of Birmingham (UoB) and West Midlands Academic Health Sciences Network (WMAHSN) completing the alliance.

The ROH is one of Europe’s largest specialist orthopaedic units, offering a comprehensive range of treatments including joint replacement, orthopaedic oncology, spinal surgery, as well as physiotherapy, hydrotherapy, pain management and a range of musculoskeletal services. Its dynamic portfolio of clinical trials and research programmes includes exploration of advanced therapies to regenerate diseased bone tissue; new prosthetics to restore normal joint function; and new pharmaceutical treatments which reduce the need for invasive surgery and speed up recovery.

It is also a renowned teaching and training trust, hosting students from Birmingham Medical School on placements since 1891, and was already an established collaborative partner of BHP organisations prior to formally joining the alliance. Most recently, a team from the ROH, UoB and the University of Bath identified a new and specific cell population that influences how arthritis affects the body and the levels of pain individual patients experience, paving the way for more precise pain-relieving therapeutics.

BHP Director Professor David Adams, who is Head of UoB’s College of Medical and Dental Sciences, explained: “Birmingham is home to a concentration of leading centres of excellence, and a particular area of expertise – both in patient care and research – is orthopaedics and trauma. UHB hosts the renowned Royal Centre for Defence Medicine at the Queen Elizabeth Hospital and also, in partnership with UoB, the NIHR Surgical Reconstruction Microbiology Research Centre which improves trauma and orthopaedic care and outcomes for patients through translational research built on military, NHS and scientific partnership. Extending the partnership of BHP to the ROH – the longest-established hospital of its kind in the UK – is therefore a natural progression, and all partners are committed to collaborating on research that matters to patients: specifically in areas such as inflammation, arthritis, bone and soft tissue cancer, and trauma.”

Jo Williams, Chief Executive of the ROH, commented: “We’re excited to join BHP because it provides us with an opportunity to collaborate and innovate. As a specialist Trust, ROH is a knowledge leader in orthopaedics, and we look forward to being part of such a distinguished network of peers and the impact this will have in the future.”

BHP is committed to achieving health and economic impact through harnessing the combined strength and expertise of its members.

Drugs to delay preterm birth are safe for global reduction in neonatal death

Written by Louise Stanley on 16/08/2022. Posted in Health inequalities, Maternal health.

Women around the world should be able to access the best drug treatments that help to delay preterm births and improve outcomes for newborns, suggests new research.

Researchers from BHP founder-member the University of Birmingham worked with colleagues from the World Health Organization to review 122 randomised trials – published between 1966 and 2021, involving 13,697 women and conducted in 39 countries including high, middle and low-income states. The study, published in Cochrane Reviews, has allowed researchers to create a league table of drugs that delay birth, called tocolytics, based on their effectiveness and side effects.

Women benefitted from all preterm delay treatments included in the meta-analysis of studies, although the research team noted that the effectiveness of different drugs was less clear in some of the studies. The team also looked at the side effects of different drugs and combinations, including the likelihood of having to stop treatment.

The team have bought together the evidence on the benefits as well as the harms of these treatments (compared to no treatment or placebo), to arm clinicians and policy makers around with world with the information to decide upon the best treatment for the women in their care in their specific setting.

Dr Amie Wilson, Research Fellow Global Maternal Health at the University of Birmingham said: “The findings show that the benefits of these drugs outweigh any risks associated with unwanted side effects. These treatments are leading to a significant reduction in the number of deadly preterm births, and we now need to further understand the effectiveness of tocolytics for specific groups depending on pregnancy length.

“Our previous research has led to the improvement of guidelines for use of tocolysis drug use to delay preterm birth in the UK. Knowing that this paper helped to inform the forthcoming recommendations of the World Health Organization on the use of tocolytics, we hope that many more women around the globe will have access to these drugs, and have healthier births.”

Dr Victoria Hodgetts Morton, NIHR Clinical Lecturer in Obstetrics at the University of Birmingham and co-author of the paper said: “Preterm birth is the most common reason why a newborn baby may die, and the leading cause of death in children under five years of age.

“Tocolytics aim to delay preterm birth and allow time for the women to receive medicines that can help with baby’s breathing and feeding if born preterm, and medicines that lower the chance of cerebral palsy of the infant. Crucially, a short delay in preterm birth can enable women to reach specialist care.”

Professor Peter Brocklehurst responds to the Women’s Health Strategy

Written by Louise Stanley on 04/08/2022. Posted in Birmingham Health Partners, Maternal health.

The Chair of the Birmingham Health Partners Commission which led the Healthy Mum, Healthy Baby, Healthy Future report has welcomed the first ever Women’s Health Strategy for England to tackle the gender health gap.

The commission set out a raft of recommendations for the UK to lead the development of safe, effective and accessible medicines for use in pregnancy. The key ambitions in the Women’s Health Strategy which are aligned to the recommendations from the Healthy Mum, Healthy Baby, Healthy Future report include:

- - Boosting participation of pregnant women in clinical research, particularly clinical trials, key components to improving maternal health outcomes for women and their babies
  - A greater use of routine health data to improve outcomes for pregnant women
  - Improving the safety of medicines in pregnancy to ensure women have access to high quality and updated information about medicines that they may need to take during pregnancy

Commenting on the Women’s Health Strategy, Professor Peter Brocklehurst, Professor of Women’s Health and Director of Research and Development for the Birmingham Clinical Trials Unit (BCTU), said:

“I am really pleased to see that women’s health is being given the prominence it needs and I find the plans outlined in the Women’s Health Strategy encouraging. It is vital that women are treated as equal partners in the delivery of their care and that they have the option to be included in research and clinical trials that affect them. Over 50% of respondents to the initial call for evidence felt that pregnancy should be included in the strategy, providing a clear message that healthy pregnancies are a health priority for women, their families and society.

“The focus on the importance of research to continue to improve health is also very encouraging, however, there is little mention of the research needed to ensure that new therapies, particularly safe and effective medicines, are developed for many of the women’s health problems highlighted in the report. Investment in discovery science and the need for close collaboration with other groups, particularly the pharmaceutical industry, is essential if we are to continue to improve health outcomes for women. I look forward to building on these plans with colleagues in Government and across sectors to reduce the gender health gap, place women’s voices at the heart of research, increase participation in research and ultimately improve maternal health outcomes for women and future generations.”

Baroness Thornton – the Shadow Women and Equalities Minister, recently spoke about the Healthy Mum, Healthy Baby, Healthy Future report during her statement to the House of Lords on the Women’s Health Strategy. The full debate can be watched here. (Baroness Thornton’s speech starts at 16:07:05 and is answered by Baroness Penn at 16:23:45, she ends her point on the report at 16:25:15).

The BHP Starter Fellowship – Pip’s story

Written by Louise Stanley on 23/06/2022. Posted in Birmingham Health Partners.

Pip Nicholson is a clinical lecturer in haematology at BHP founder-member the University of Birmingham, and completed his BHP Starter Fellowship between 2015 and 2016. His research is currently focused on translating tyrosine kinase inhibitors to be used as anti-platelet drugs, and investigating the mechanisms of vaccine-induced thrombocytopaenia with thrombosis. He holds research grants from the British Heart Foundation, Wellcome Trust Translational Discovery Fund, the NIHR and a number of pharmaceutical companies, and is also chair of the HaemSTAR Network. He spoke to BHP about how his experience of the fellowship had led him to this point in his research career.

What attracted you to apply for the fellowship?

The fellowship was announced at a really opportune time for me. I’d just had a discussion with my now supervisor about the idea for the research and we’d been puzzling over how we could fund my salary to allow me to be released from my clinical duties. One of the limitations with other fellowships is that they require such detailed background and large amount of preliminary data. This means that doctors without a research background are effectively excluded from getting their foot on the first rung of the research ladder. While competitive, the BHP fellowship (or ITM fellowship as it was known then), didn’t require such extensive background information and the preliminary data required was a reasonable amount that could be generated by someone without any dedicated research time.

What were the benefits of fellowship?

The fellowship didn’t come with any significant strings attached such as teaching requirements. This meant that I could get on with the job of learning techniques and quickly generating further data to submit for larger, prestigious fellowship applications to support a full PhD.

Were there any challenges during the fellowship?

The main challenge was getting a full research fellowship application written and submitted in time for the various deadlines. To a clinician, a year to learn new skills and develop preliminary data seems like a huge chunk of time (my experience is that clinicians in training are happy if they get an hour to work on our own projects!). But the research environment is very different and long periods of time are required to learn skills, iron out issues with laboratory assays, and gain ethical approvals for the work.

While a year is sufficient time to generate data if you are focussed about things, the deadlines for the full research fellowships didn’t fall nicely near the end of the BHP fellowship and meant I had to put in applications before they were really ready. Towards the end of the fellowship I was still left wondering whether I had any ongoing research funding and this led to quite a lot of anxiety. I was fortunate to be placed in a well-funded lab where the brief shortfall in funding between finishing my BHP fellowship and subsequent funding from a British Heart Foundation Clinical Research Training Fellowship could be picked up.

How much clinical work did you do while undertaking your fellowship?

I very much wanted to keep my ‘hand in’ clinically, and so I did continue doing some clinical work. I was worried that if I didn’t, I wouldn’t be safe to look after patients when I returned on a more regular basis. So, I undertook in one outpatient clinic a week at the Queen Elizabeth Hospital, and I also did daytime on-calls at weekends at about a 1 in 5 frequency. In hindsight I think this probably slightly hindered my progress in the lab and actually my clinical skills probably wouldn’t have suffered significantly if I’d just stopped doing any clinical work for that year of the BHP fellowship.

Did the fellowship help with your clinical practice?

It definitely helped me identify the area of subspecialist clinical practice I wanted to do long term (i.e. thrombosis and haemostasis). It also gave me time to delve more into the clinical literature of this sub specialist area in order to better understand the pathophysiology and existing treatments and where the current limitations are in our knowledge. I also gained experience in dealing with ethics applications and working with NHS Trust Research and Development departments which have been a useful skill.

Do you feel that the fellowship has helped you with your career development and aspirations?

Without a doubt, if it wasn’t for the BHP fellowship I can’t see how I would have got my foot in the door of the clinical academic world. I’m now a clinical lecturer, chair a national research network and am in the process of applying for intermediate clinical research fellowships to support me in a consultant role and as a senior clinical lecturer. I wouldn’t be in this position without that initial year of funding that the BHP fellowship provided.

What would your advice be to anyone thinking of applying for a BHP fellowship?

Talk to people who have successfully been award the fellowship and have completed it and moved on to higher research degrees and other fellowships. Ask them to look at their successful applications to use as a template. Talk to them about their experience of the fellowship itself. Identify a supportive research environment and speak to various members of that research group (e.g. PhD students and post-doctoral researchers). They are the ones who will be able to tell you what the research training in that group is really like. Don’t just rely on your impression of the supervisor!

BHP launches Seed Fund to invest in innovation

Written by Louise Stanley on 20/06/2022. Posted in Birmingham Health Partners.

Today (20 June) Birmingham Health Partners officially launches its BHP Seed Fund – a new initiative which will kick-start innovation by providing researchers with up to £100,000 initial investment.

Designed to support our culture of research-embedded healthcare practice while simultaneously addressing common challenges across our member organisations, the Seed Fund will bring together healthcare professionals, academics, students and entrepreneurs, to deliver the initial steps towards implementable solutions. The aim of the fund is to provide early-stage support and proof-of-concept for projects which will have swift impact on patients outcomes and experiences, but can also be further developed or rolled out more widely.

Working with NHS partners, BHP has identified a number of broad themes which are both of key importance to the region, and are also primed for innovation and investment. We will therefore strongly support applications for projects which directly relate to these priority areas for our region:

- - Health data and AI
  - Engineering into health settings
  - Sustainability
  - Health inequalities
  - Health systems and evaluation

BHP Chair, Ed Smith, commented: “Birmingham Health Partners is delighted to offer this opportunity for innovation, funded with seed money to stimulate support and growth for health-based solutions for the West Midlands and beyond. We hope and expect this funding will be exciting for applicants and deliver meaningful contributions.”

Colleagues from all healthcare professional backgrounds working across all BHP’s partner organisations are welcome to apply.

Visit our BHP Seed Fund page for full details

‘Cellular brake’ offers clue to autoimmune response during immunotherapy

Written by Louise Stanley on 13/06/2022. Posted in Cancer outcomes, Experimental medicine.

A ‘cellular brake’ which could prevent lung cancer patients from developing a dangerous autoimmune response during treatment has been identified by scientists.

The finding, published in Nature Communications, is the first clue to the cause of autoimmune toxicity, in which patients develop dangerous additional conditions during immunotherapy treatment.

Immunotherapy works by enabling the body’s immune cells (T cells) to engage with and kill tumour cells. They do this by suppressing proteins called immune checkpoints. These exist to prevent an immune response from being so strong that it destroys healthy cells in the body.

Autoimmune toxicity, which includes conditions such as pneumonitis, or inflammation of the lungs, can affect lung cancer patients undergoing immunotherapy treatment. Pneumonitis is responsible for around 35 per cent of treatment-related deaths in lung cancer patients.

Given the increasing use of immunotherapy treatment against cancer, the management of these reactions has become a significant healthcare challenge. Most commonly, clinicians will recommend discontinuing the treatment and exploring other options.

Led by Professor Gary Middleton, the team, in the University’s Institute of Immunology and Immunotherapy pinpointed a specific biological response among patients who develop autoimmune toxicity. They found a ‘cellular brake’ – a protein which would normally limit the activity of the T cells – is missing or not functioning properly.

By identifying patients who lack this cellular brake, it may be possible to recognise patients at high risk of developing severe autoimmune complications.

Lead author Dr Akshay Patel said: “Immunotherapy is an extremely important weapon in cancer treatment and so identifying people who are at particular risk of developing these potentially life-threatening autoimmune conditions is key to weighing the risks and benefits of different treatments. It would enable clinicians to closely monitor high-risk patients, develop preventative strategies, or pursue alternative treatments altogether.”

The research was funded by Cancer Research UK and the National Institute for Health and Care Research (NIHR) Biomedical Research Centre.