Our research
Types of Research
Basic science research takes place in the laboratories of universities and NHS hospitals. It tries to understand the mechanisms behind disease so that we can then understand how to prevent and treat it. For example, researchers in Microbiology are developing new laboratory techniques to reduce the time taken to confirm whether a patient has MRSA – the ‘hospital superbug’ – or not.
Clinical research takes place in NHS settings and tests out whether new ways of diagnosing or treating health problems are better than our current practice. A lot of the clinical research taking place in the Trust and School of Medicine and Dentistry is in the form of clinical trials. For example, testing whether a new anti-cancer drug improves the numbers of patients surviving their cancer compared to current treatments.
Health service research is a newer type of research which looks at ways to evaluate how we can improve models of care can help to improve services to patients. For example, does giving patients access to Walk In Centres enable hospital Accident and Emergency Departments to concentrate on the sickest and most urgent patients?
The Trust and the School of Medicine and Dentistry carry out all three types of research, but we are particularly strong in basic science research and clinical trials research.
How reseearch improves healthcare
The Trust and School of Medicine and Dentistry have a long history of undertaking research that has a real impact on the way health professionals practice and health outcomes for patients.
Our past research has addressed many health issues including input into NICE guidelines for the treatments of hypertension, thalaseamia, faecal incontinence, outbreaks of syphilis and MRSA, as well as diagnostic tests for cancer and bowel conditions.
We aim to build upon our current success and high levels of quality research in the future and our staff contributed towards over 1,000 accredited research publications in the financial year 2008-9.
The following are just three examples of high impact research conducted here in the last year:
Helping high risk patients survive major surgery
High-risk and elderly patients should experience fewer post-operative complications thanks to a major research project at The Trust. Previous small studies suggested that post-operative complication rates could be reduced by as much as 40 per cent. We are now half way through a two-year study, financed by NIHR, examining how early goal-directed therapy can reduce complications and hospital stays for patients following high-risk surgery.
Dr Rupert Pearse, leading a team at Barts and The London, has expanded research in the field of critical care and applying this to clinical practice in order to increase survival rates for our most seriously-ill patients. Ensuring optimal blood flow to vital organs appears to improve the delivery of oxygen to the tissues and may be the key to reducing complications following high risk surgery.
Current research is exploring how administering the right doses of intra-venous fluids and drugs can improve heart function and so reduce these complications. The research grant is allowing us to provide more reliable data on this treatment from a much larger trial which can then be used to support a widespread change in NHS practice. Elderly and other high-risk patients are spending much less time in hospital after surgery, so improving their outcome and experience and releasing beds for other patients. Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust.
Improving the respiratory health of children
Professor Chris Griffiths, at Barts and The London, is carrying out respiratory tests on primary school children over a four-year period. The focus is on children because damage done to their lungs by traffic pollution almost certainly persists, and makes lifelong lung problems - and possibly early death - more likely.
By measuring children’s breathing and lung inflammation over several years and gathering genetic information, the study is establishing links between respiratory health problems, pollution exposure and the role of genetic susceptibility. The European Commission recently announced that they will be starting proceedings against the UK for a rise in pollution levels. This means that there is an urgent need to have a solid evidence base to assess the effects of pollution on respiratory health in inner city areas, such as East London. Researchers involved in the study, which is part of the EXHALE programme (Exploration of Health and Lungs in the Environment), will investigate how air pollutants and vitamin D deficiency interact to enhance airway inflammation, and will use innovative imaging techniques to identify new ways to investigate airway inflammation. The findings are already informing policy nationally and internationally as well as answering important questions about asthma. These include the role of genetic factors, and how pollutants deposit in the lungs and damage respiratory cells.
This research is shedding light on how two major environmental factors, pollution and sunlight, affect the development of asthma in children from a range of different ethnic backgrounds. As the UK has one of the highest rates of childhood asthma in the world, with over a million children currently receiving treatment, this could have major implications for Government environmental policies in the future.
Anticoagulants improve post surgical outcomes
Professor Ajay Kakkar, of Barts and The London, has undertaken two streams of related research that compared the effects of differing anti-coagulant drugs in the prevention of deep vein thrombosis following hip surgery and preventing blood clots following major hip surgery.
The RECORD-1 study – Regulation of Coagulation in Orthopedic Surgery to prevent Deep-Vein Thrombosis and Pulmonary Embolism - was conducted to compare the efficacy and safety of a post-operative dose of rivaroxaban given once daily, with that of a 40-mg subcutaneous dose of enoxaparin (a low molecular weight heparin) starting the evening before surgery and administered once daily thereafter, for extended thromboprophylaxis after hip surgery. The trial showed that rivaroxaban was significantly more effective than other anti-coagulants: A 70 per cent relative risk reduction of deep vein thrombosis, pulmonary embolism, or death from any cause, and an 88 per cent risk reduction of major venous thromboembolism was achieved.
The RECORD-2 study concluded that use of extended duration oral rivaroxaban is significantly more effective at preventing venous thromboembolism after total hip arthroplasty (THA) compared with short-term subcutaneous enoxaparin plus placebo. Venous thromboembolism – a blood clot, which can be fatal – is high after THA and can persist after hospital discharge. Consensus guidelines recommend heparin-based therapy in such patients for a minimum of 10 days, and up to 35 days after surgery, as this prevents the further risk of blood clots. However, such preventive treatment is often not continued once a patient leaves the hospital. This research demonstrated that patients in a placebo group were more than four times as likely to suffer from DVT, NFPE, or die, than those in the rivaroxaban group. The RECORD2 study showed that continued use of the new orally active anticoagulant drug rivaroxaban for up to 5 weeks after surgery substantially reduced risk of potentially serious blood clots, providing convincing evidence for the need for extended treatment to ensure safer patient outcomes related to thrombosis prevention. These signal very positive outcomes for patients.
