Comprehensive Clinical Research Network Research Articles

Research activity and the association with mortality.

IntroductionThe aims of this study were to describe the key features of acute NHS Trusts with different levels of research activity and to investigate associations between research activity and clinical outcomes.MethodsNational Institute for Health Research (NIHR) Comprehensive Clinical Research Network (CCRN) funding and number of patients recruited to NIHR Clinical Research Network (CRN) portfolio studies for each NHS Trusts were used as markers of research activity. Patient-level data for adult non-elective admissions were extracted from the English Hospital Episode Statistics (2005-10). Risk-adjusted mortality associations between Trust structures, research activity and, clinical outcomes were investigated.ResultsLow mortality Trusts received greater levels of funding and recruited more patients adjusted for size of Trust (n = 35, 2,349 £/bed [95% CI 1,855–2,843], 5.9 patients/bed [2.7–9.0]) than Trusts with expected (n = 63, 1,110 £/bed, [864–1,357] p<0.0001, 2.6 patients/bed [1.7–3.5] p<0.0169) or, high (n = 42, 930 £/bed [683–1,177] p = 0.0001, 1.8 patients/bed [1.4–2.1] p<0.0005) mortality rates. The most research active Trusts were those with more doctors, nurses, critical care beds, operating theatres and, made greater use of radiology. Multifactorial analysis demonstrated better survival in the top funding and patient recruitment tertiles (lowest vs. highest (odds ratio & 95% CI: funding 1.050 [1.033–1.068] p<0.0001, recruitment 1.069 [1.052–1.086] p<0.0001), middle vs. highest (funding 1.040 [1.024–1.055] p<0.0001, recruitment 1.085 [1.070–1.100] p<0.0001).ConclusionsResearch active Trusts appear to have key differences in composition than less research active Trusts. Research active Trusts had lower risk-adjusted mortality for acute admissions, which persisted after adjustment for staffing and other structural factors.

The Medicines for Children Research Network: building on current success as we move forward

The National Institute for Health Research (NIHR) Medicines for Children Research Network (MCRN) was established in 2005, in response to the European Union Paediatric Regulation. Subsequently the Paediatric (Non-Medicines) Speciality Group (PSG) was set-up in 2009 as part of the NIHR Comprehensive Clinical Research Network to support a national portfolio of pediatric research studies that do not involve medicines. After 9 years in operation, the NIHR Clinical Research Network has been undergoing reconfiguration and from April 2014 the two portfolios, of MCRN and PSG, have come under combined management of the NIHR Clinical Research Network: Children's Theme. The formation of the Children's Theme provides an even greater opportunity for healthcare professionals and all those working in this field to collaborate to strengthen still further the delivery of children's research as the new theme is taken forward. This update will outline the achievements of the NIHR MCRN and the PSG to date; and will describe t...

027 THE IMPACT OF STRATEGIC UK NATIONAL HEALTH SERVICE (NHS) FUNDING ON THE PATIENT RECRUITMENT TO ‘ATHEROTHROMBOSIS’ RESEARCH STUDIES. THE UK NHS ATHEROTHROMBOSIS RESEARCH NETWORK

Aim Atherothrombotic disease is endemic throughout the world. In the UK a new system for supporting clinical research was introduced in 2007 with the creation of the National Institute of Health Research (NIHR) which acts as the research arm of the National Health Service (NHS). In the current study our primary objective was to assess the impact of this important government initiative on patient involvement in research. Methods All clinical studies that wish to have support from the NIHR funding stream have first to be adopted onto a central research portfolio. This process is ‘automatic’ for studies with specific recognised grant support, and is otherwise based upon an assessment by an expert panel. Information regarding study design and recruitment are collected at the time of adoption and then at monthly intervals. Studies are allocated to an NIHR Clinical Research Network and to the relevant ‘Specialty’ which includes ‘Cardiovascular’ and within that to a subspecialty portfolio—in this case ‘Atherothrombosis’. It is further noted if a study is (i) multicentre or single centre (ii) national or international (iii) observational or interventional. Results The change in monthly recruitment between April 2008 and August 2012 is charted relative to study infrastructure (Panel A) and design (Panel B). Monthly recruitment rates have grown significantly to a maximum of 818 patients per month. Conclusions Since the NIHR was set up along with the development of a NIHR Comprehensive Clinical Research Network (CCRN) which includes support for cardiovascular research within its remit, the number of patients involved in studies of atherothrombosis has increased substantially. The recruitment rate is currently around 800 patients per month, representing an increase of eightfold since April 2010. The coordination of research into atherothrombosis through a national networked approach, along with effective local mechanisms for delivering support and a system for directing funding based on previous recruitment performance has had a significant effect on the UK9s capacity to undertake research into atherothrombosis.

The Ophthalmology Specialty Group and the National Institute for Health Research: the first 6 years

The Ophthalmology Specialty Group and the National Institute for Health Research: the first 6 years

GRIST: Growing Recruitment in Interventional and Surgical Trials

GRIST: Growing Recruitment in Interventional and Surgical Trials

The Comprehensive Clinical Research Network; Implications for Urological Research in England

The UK Clinical Research Network (UKCRN) was established by the National Institute of Health Research to improve quality and delivery of clinical research in the UK. The Comprehensive Clinical Research Network (CCRN) is its newest element, made of Comprehensive Local Research Networks (CLRNs) covering the whole of England, and underpinning the infrastructure and delivery of NHS clinical research in a range of specialty groups. The Urogenital Specialty Group is responsible for advising the UKCRN on feasibility of potential studies, topic-specific training, overseeing the relevant parts of the UKCRN portfolio of research and brokering interactions with research funders or professional bodies developing clinical trials. The CLRNs will have a major impact on research activity of urologists; they can provide flexibility and sustainability funding, and support research infrastructure. However, the CLRNs are performance managed, such that delivery of projected recruitment to trials will be crucial. Furthermore, research activity not in the UKCRN portfolio will no longer be supported free of charge. Interactions with equivalent bodies in Wales, Scotland and Northern Ireland have not yet been formalised.

A new paradigm for musculoskeletal clinical trials in the UK: the Arthritis Research Campaign (ARC) Clinical Studies Groups initiative

In October 2007, the UK Arthritis Research Campaign (ARC) launched a new approach for the support of clinical trials and related research in the UK. The initiative depends on a partnership between ARC, the UK Clinical Research Network (UKCRN) and the pharmaceutical and related industry. The aim is to develop nationally agreed strategic plans for intervention research for the major musculoskeletal disorders. These will range from testing experimental therapies to novel approaches/ways of using existing interventions, taking advantage of the opportunities afforded for the enhanced support for clinical trials promised by the establishment of local research networks within the National Institute for Health Research (NIHR) Comprehensive Clinical Research Network (CCRN). The initiative encourages greater collaboration with industry with a move to enhance industrial support for research strategies prioritized by the key stakeholders of health care professionals and patients.

The UK Clinical Research Network--building a world-class infrastructure for clinical research

The recognition by both the academic and commercial sectors that clinical research in the UK was under threat led to the development of the UK Clinical Research Collaboration (UKCRC) in 2004. This brought together for the first time funders of clinical research in the UK from the public, charity and private sectors, academic institutions, regulatory bodies and patients and the public. Strengthening the research infrastructure for clinical research was one of the key workstreams of the UKCRC with the goal of building on the UK’s unique advantage of the NHS to produce a world-class infrastructure for clinical research. The establishment of the National Cancer Research Network (NCRN) in 2000 demonstrated that providing new resources to strengthen the research workforce led to a more than doubling of recruitment to clinical trials and other well-designed studies in 3 yrs. The provision of new resources to set up research networks in five additional topics, mental health (in 2003), dementia and other neurodegenerative diseases, diabetes, medicines for children and stroke (all in 2005) was the next step and a primary care network followed in 2007. All of these networks were tasked both to establish the infrastructure within the NHS in England to support clinical trials and other well-designed studies and also to oversee a portfolio of high-quality research. Parallel activities were initiated in Northern Ireland, Scotland and Wales. It was widely acknowledged that there were other important areas of disease and health care need, particularly those such as musculoskeletal, respiratory and cardiovascular diseases that cause major morbidity and/or mortality, which also need to be supported and this was addressed in the new NHS R&D Strategy Best Research for Best Health that was launched in 2006. This included plans for the National Institute of Health Research (NIHR) and for a Comprehensive Clinical Research Network (CCRN) in England to support clinical research in all areas of disease and health care need.