This document provides summaries from several presentations about driving progress in health care through research supported by the National Institute for Health Research (NIHR) in the UK. The first presentation introduces the NIHR and its role in supporting different types of health care research. The second presentation describes a clinical academic fellowship funded by the NIHR and the research and career development it enabled. The third presentation summarizes a large clinical trial called DRAFFT that compared wire fixation and plate fixation for distal radius fractures and found wires to be as effective and cost less, leading to a change in practice. The last presentation discusses the experience of patients who participate in research and how it can benefit the NHS.

1. Driving progress in health care
through NHS research
National Institute for Health Research

2. Introduction
William van’t Hoff, Clinical Director for NHS Engagement,
NIHR Clinical Research Network

3. • Provide a flavour of the many different ways in which the NIHR is driving
progress in healthcare
• Share our experiences of the NIHR, but also provide a wider national view
• This will be followed by a Q&A panel session

4. Come talk to us about how the NIHR can help your NHS improve through
research – stand 119

5. The benefits and impact of clinical academics and NIHR trainees
Gilly Howard-Jones, Lymphoma Clinical Nurse Specialist,
University of Southampton NHS Foundation Trust and NIHR Clinical Doctoral
Research Fellow

6. Overview
• My background
• My research
• Clinical development during the fellowship
• Outcomes so far
• Looking to the future

7. My background
• RGN Diploma 1993
• Cancer nursing
• BSc. Nursing 1996
• MSc. Medical Anthropology 2000
• NIHR MRes 2012, NIHR Internship 2013
• NIHR Clinical Academic Fellowship 2014

8. My Research : The influence of social networks on self-management
support in cancer survivors: A mixed methods Study
Quantitative postal survey
Qualitative
interviews
Invited to
participate from
survey
Interpretation based on
Quantitative (qualitative )
results

9. Undertaking clinical development
• Planning the application with clinical staff
- Member of NICE Guidance Development Group for NHL
- Patient Triggered Follow Up
- Advanced Nurse Practitioner role development
• Engagement with Lymphoma Association
- Supporting development of survivorship services

10. Outcomes so far…..
• Patient experience
• Team
• Hospital Trust
• University
• National influence

11. Looking to the future
•Completing my PhD !
•Creating a new clinical academic post
•Clinical Lectureship application- TIME and RESOURCES

12. Thank you
Email: ghhj1e11@soton.ac.uk
Twitter : @GillyhjJones

13. How DRAFFT improved care, made cost savings and achieved
consistency across the NHS
Mike Reed, Consultant Trauma and Orthopaedic Surgeon,
Northumbria Healthcare NHS Foundation Trust

15. About Me
Trauma and orthopaedic surgeon
Full time clinician
I just do regular trauma on call
I’ve run some clinical trials
No involvement in this study (although I did do
some surgery)
“So why are you here?”

16. Background
In the Western World,
6% of women will have sustained a fracture of the distal
radius by the age of 80 and 9% by the age of 90

17. Most common interventions in the UK
• Wires
• Volar fixed-angle plates

18. Most common interventions in the UK....
VS

19. Funding
• National Institute for Health Research
Health Technology Assessment
• Why?
• Clinical and cost-effectiveness

20. DRAFFT
Centres

21. Outcome Measures
Primary
• Patient Reported Wrist Evaluation (PRWE)
Secondary
• Disability of the Arm, Shoulder and Hand (DASH)
• Radiographic changes
• Complications
• Health Economics (EQ-5D, resource use)

22. Recruitment
0
50
100
150
200
250
300
350
400
450
500
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Overall
Projection
Actual
Patients

23. Numbers
• Screened: 12,000 patients with a distal radius fracture
• Eligible: 639 patients
• Recruited: 461patients (more than anticipated)
• Follow-up: over 90% at each time-point

24. Patient-rated wrist evaluation
Lower score = better outcome

25. The result
This large, multi-centre, pragmatic clinical trial shows that
there is no difference in patient-reported wrist
evaluation in the twelve months following Wire fixation
versus locking-plate fixation.
Confidence intervals exclude a clinically relevant effect
(95% CI; -4.5 to 1.7)

26. The result: sub-groups
No difference in under 50 years versus over 50
years
No difference in those with intra-articular
extension versus extra-articular

27. Result: further surgery
• 5 patients in the wire group and 2 in the plate group
required revision surgery for loss of reduction
• 9 patients in the plate group required removal of
symptomatic metalwork (4 for screw penetration of the
joint) and 1 patient with a buried K-wire required removal
in theatre

28. The result: Health Economics
Economic evaluation completely driven by the choice of
implant
Wires were cheaper: £54 vs £854
No difference in Quality of Life in the 12 months after
surgery
Therefore, wires are cost saving

29. So what happened next?
• Did anyone take any notice?
• Did anyone get upset?
• And, did anyone change their practice?

30. National/international presentations:
• Trauma Trials Meeting
• OTS
• BSSH
• BOA
• EFORT
• OTA
• NZOA

31. Local presentations/meetings
• Many site visits
• Local presentations by the Principal Investigators
• Teaching courses

32. Papers
• British Medical Journal
• NIHR-HTA Monograph
• Bone and Joint Journal
• Patient newsletters

33. Modern stuff…
• Podcasts
• Journal Blogs
• ‘Tweeting’…

34. So did anyone get upset about DRAFFT?

35. Yes
…mostly the hand surgeons…!

36. Reaction…
• “…in my hands…”
• “I’m not a statistician, but I have concerns about the
statistics”

37. So people heard the results, but did they take any
notice?

38. English Hospital
Episode
Statistics:
surgery for
fracture
of the distal
radius

40. Cool!
• But surely not everyone changed their practice…
• Surely not the hand surgeons…

41. 0
10
20
30
40
50
60
70
80
90
Time 0 Pre trial Pre results Post results
hand units plate
hand units wire
non-hand units
plate
non-hand units
wire

42. So everyone is changing?

43. NORTHUMBRIA

44. Conclusions
• Use more wires. Save lots of money.
• UK Orthopaedic Trauma Surgeons can deliver multi-
centre clinical trials
• They really do change clinical practice!

45. How the money stacks up…
DRAFFT cost the taxpayer about £1.5 million
The 25% shift in practice has already saved £1.6 million
Will continue to save year on year.

46. NIHR Musculoskeletal Trauma Trials
P
R
O
F
H
E
R

47. RESULTS NEXT WEEK

48. Patient experience of participating in research
Vee Mapunde, Associate Consumer Lead
National Cancer Research Institute

49. The NCRI Consumer Forum – Background
Formed in April 2015, funded by NCRI (with NIHR support), follows CLG (funded by
NIHR Clinical Research Cancer Specialty Group)
Objective:
To create a professional, focussed and committed constituency of consumer research
partners, who can help NCRI achieve its aims
Nine specific points, including:
To provide a pool of well-trained consumers to input into NCRI and partner research
activities, committees and groups, as equal and valued partners

50. How I got involved
Diabetes
• Why him? And why now?
• Could I have stopped this?
Prostate Cancer
• Why is it that some people can “live” with this condition?
• Why is it more aggressive in some ethnic groups?
• How does this affect patient outcomes?
• What impact can I make?

51. How patient involvement benefits the NHS
• Patient experiences can drive service improvements and promote research
• Patients get involved in finding solutions when researchers bring ideas or problems to
them
• Taking part in research is associated with better experience of care – 88% of all
cancer patients are satisfied/v satisfied with care; increases to 93% for participants
• Increase our understanding of challenges associated with hard-to-reach groups,
geographical inequalities of access to research opportunities, gaps in clinical trial
portfolios, matching patient priorities
• We can change practice faster – working with the NIHR, NICE and MRC CTU

52. Q&A panel session

53. Remember, we’re on stand 119 if you would like to find out more

54. Thank you all for attending and taking part