Clinical Operational Research Unit

For the first time, teams that care for children needing heart surgery have been able to review their short-term results across all the different operations they perform.

In this week’s BMJ (1), Tom Treasure and Martin Utley of UCL’s Clinical Operational Research Unit challenge the utility of repeated surgery for sarcoma which became accepted practice 40 years ago. Sarcoma is the name given to cancers of the structural tissues of the body (bone, muscle, fat) as opposed to organs (breast, lung, prostate). Sarcoma, particularly of bone, tends to affect younger people and if it spreads it tends to be by blood borne seeding in the lungs where the nodules of secondary cancer are called metastases. They can be removed by surgery - an operation called metastasectomy.

Dr Sonya Crowe of CORU has been awarded an Improvement Science Fellowship by the Health Foundation, one of five appointments to develop and champion a rigorous, scientific approach to improving the quality of healthcare in the emerging field of improvement science. Sonya will be mentored by Martin Utley and by Professor Naomi Fulop of the UCL Department of Applied Health Research and is funded for three years from March 2013, one of several collaborative endeavours between these groups.

Last year, Save the Children launched a health financing website (equitablehealthfinancing.org) designed with the help of Christina Pagel and Martin Utley of CORU and colleagues at the UCL Institute of Global Health. We initially reported on this last year, but now early reviews are in! Preliminary feedback has proven very positive and we are hopeful that this methodology could become a new way to bridge the gap between academic evidence and policy.

CORU’s work on the NIHR funded project “Developing evidence based and acceptable stepped care systems in mental health care: an operational research project” has highlighted some of the challenges in implementing modelling software and distributing it effectively to healthcare managers. Our work on this has just been published in the Journal of Operational Research.

Martin Utley of CORU contributed to work at Thames Cancer Registry, Kings College London to project the number of people living with or beyond cancer in the coming decades. The work has generated a lot of interest and is described in recent articles in The Guardian and The Independent newspapers and BBC News Online.

Over fifteen years ago, researchers at CORU collaborated with heart surgeons to produce charts that could be used to monitor risk-adjusted outcomes following surgery in a routine manner. These charts are called Variable Life-Adjusted Displays (VLAD) Charts and are now routinely used in cardiac units across the UK and internationally. VLAD Charts have also started to be used to monitor other outcomes, almost always in hospital settings, and almost always in high income contexts. They are most useful for allowing users to quickly spot trends in outcomes that might warrant further investigation or aid understanding of a dataset.

Our paper on the scale of unattended births over the next five years in sub-Saharan Africa and South Asia has become a BMC Highly Accessed paper just over two weeks after its publication!  

Sonya Crowe, Christina Pagel and Martin Utley have been working with Anthony Costello, director of the UCL Insitute of Global Health, to assess the extent to which women in two of the world's poorest regions (South Asia and sub-Saharan Africa) will continue to give birth without a skilled birth attendant (SBA).

CORU partner Tal Golesworthy (left in the project team photo below) was awarded The Engineer's Medical & Healthcare Award at The Royal Society.  Golesworthy in 2004 became the first person fitted with the External Aortic Root Support (EARS) implant which he had himself devised. A process engineer, Golesworthy worked with MRI scans, CAD and rapid prototyping technology to design and manufacture the textile external support which has NICE Technology Appraisal in the UK.

Save the Children have just launched a health financing website (equitablehealthfinancing.org) designed with the help of Christina Pagel and Martin Utley of CORU and colleagues at the Centre for International Health and Development. The website aims to help policy makers in low and middle income countries navigate the complex evidence around different ways of financing a health system, especially given the gradual phasing out of fees at point of use. The website uses a variety of methods to summarise the evidence of a rapid literature review, fully exploiting web architecture by including cross-referencing and searchable and sortable tables. Most innovative are new ‘scattar plots' (a combination of scatter and radar) showing a graphical summary of the evidence of impact for different tools (see also figure) where the distance of each study (dot) from the centre depends on how closely the context of that study matches the country of the user.

Patients suffering from cancer of the lung cavity do not survive any longer if surgeons remove the lung and cavity linings, compared with those who do not have this major surgery. That is the conclusion of a ten-year series of studies carried out by a team at UCL and the Institute of Cancer Research led by CORU's Tom Treasure.

CORU's work with the UK Department of Health last year has resulted in a paper¹ published in Vaccine. One of the major complications of flu is pneumonia and it was thought that vaccinating the population against pneumococcal pneumonia at the start of a pandemic might prevent deaths due to complications of flu. We built a mathematical model to investigate the potential effect of such a policy using a variety of estimates over the efficacy of the pneumonia vaccine, the virulence of the flu and the achievable coverage of such a vaccination programme. We found that there were substantial reductions in deaths only under specific circumstances - a virulent flu where most complications were due to pneumococcal pneumonia. 

Pulmonary metastasectomy for colorectal cancer is a commonly performed and well-established practice of over 50 years standing. The absence of strong evidence, in the form of controlled studies, to support this practice led three of CORU's researchers to investigate the evidence base that has been used in establishing its status as a standard of care. Using citation network analysis on a total of 344 publications, they found frequent use of historical or landmark papers while, on the other hand, the few papers expressing opposing viewpoints were rarely cited (the four papers outside the main citation network in the figure below). They concluded that this citation pattern tends to escalate belief in clinical practice even when it lacks a high-quality evidence base and helps create an impression of more authority than is warranted.

CORU's recent work with Papworth Hospital, developing a simple stratification scheme for identfying patients at risk of excessive post-operative bleeding has been published in the European Journal of Cardio-thoracic Surgery (EJCTS)¹. The work was discussed in an editorial for EJCTS² where we were praised for the effort that went into the score and for its easy-to-use nature, facilitating its potential use across several different hospitals. 

Tom Treasure's presentation at the 2011 Annual Meeting of the Society of Cardiothoracic Surgery was ranked among the top three at the entire meeting. 

CORU has informed UKpolicy on the use of vaccination against pneumonia as a countermeasure to pandemic flu.

CORU developed a mathematical model for estimating the number of deaths and hospitalisations that could be avoided by use of a vaccine against pneumonia in the advent of an influenza pandemic. This work directly informed the policy process within Department of Health and led to the Joint Committee on Vaccination and Immunisation decision that "using PPV23 as a countermeasure against pandemic influenza would not be cost effective and is not advised".

The Ekjut Trial, which Christina Pagel was a co-author on (Lancet 2010;375: 1182-92), has been recognised as Trial of the Year by the Society for Clinical Trials. 

Christos Vasilakis has been invited to give a keynote talk at the biannual Young OR conference in Nottingham this April. 

CORU has had its paper examining the foundations of triage published in Critical Care Medicine.

Working with consultant intensivists from Great Ormond Street Hospital, we developed simple analytical models to inform thinking concerning processes of triage to determine access to critical care during a pandemic. Our work focused attention on the need to be clear as to the objectives of triage and explored the nature and scale of differences that would have to exist between different patient groups for triage to have the intended benefits.

Christina Pagel gave an invited talk at the 2010 annual conference of the Royal College of Midwives in Manchester. Her talk was entitled "What is Operational Research and what’s it got to do with health?"

Martin Utley gave an invited talk at the MASHNET workshop entitled "More for less: the modeller’s dream or a rude awakening?" in November 2010.  His slides are available from the MASHNET website.

Christina Pagel from CORU is a contributor to a new guide aimed at journalists and the general public called "Making Sense of Statistics". The guide is published by the charity Sense about Science in collaboration with the Royal Statistical Society.

Professors at UCL have helped an engineer develop and evaluate a device to repair a defect in his own heart.

The findings of a UCL study investigating possible improvements to maternity care in Africa have appeared in the Lancet. The study was conducted by Christina Pagel of CORU, along with Professor Anthony Costello (UCL Institute of Child Health) and colleagues.