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Author: Louise Stanley

BHP welcomes Birmingham Community Healthcare to strategic research alliance

Written by Louise Stanley on . Posted in Birmingham Health Partners, Health inequalities.

Birmingham Community Healthcare NHS Foundation Trust (BCHC) has become the sixth NHS member of Birmingham Health Partners – and its ninth overall – adding crucial community care to the city’s strategic health research alliance for the first time.

BCHC provides more than 100 core NHS community services for the 1.1m people in Birmingham, as well as specialist rehabilitation and dental services for the wider West Midlands population of 6.5m. Its vision is to provide the best care possible to support the people who use its services, many of whom are among the most vulnerable in our society, to live well in healthy communities.

The Trust is active in research, with live projects including the EPIC Neck Study – evaluating a new approach to exercise for people with persistent neck pain – and Move More, which is testing the feasibility of an app to help people with long-term disabilities to increase their activity levels. Both of these studies are being delivered collaboratively with BHP founding member the University of Birmingham, with whom BCHC also works closely at Birmingham Dental Hospital.

Professor Lorraine Harper, Managing Director of BHP, commented: “BCHC provides vital services to adults and children across the city and beyond. Being responsible for the healthy management of long-term conditions and chronic illnesses, and a strategic focus on promoting equity and reducing health inequalities, their values align perfectly with BHP’s strategic objectives. We are excited to extend our collaborations with BCHC across our membership for the benefit of the patients and communities we serve.”

Dr Robbie Dedi, Chief Medical Officer at BCHC commented: “We are on a challenging journey to improve the health of our communities whilst ensuring equitable access and outcomes. Joining with BHP provides a really exciting opportunity to expand the research and evidence base across this field and translate this into practice. We look forward to BHP supporting research capability of our teams so they can make a lasting impact on patient care within their fields.”

‘Symptom triggered’ test can detect early-stage aggressive ovarian cancer in 1 in 4 cases

Written by Louise Stanley on . Posted in Cancer outcomes, Early diagnosis and detection.

Symptom triggered testing, prompted by symptoms such as pain, abdominal bloating/swelling, and feeling full soon after starting to eat, can pick up early-stage aggressive ovarian cancer in 1 in 4 of those affected, according to new research.

A study published in the International Journal of Gynaecological Cancer and funded by the National Institute for Health and Care Research found that the UK’s protocol for picking up early-stage disease in women with high grade serous ovarian cancer—the most common, aggressive, and lethal form of the disease— is an effective way to diagnose even early-stage ovarian cancer.

The findings also show that complete surgical removal of the cancerous tissue is possible even in more advanced disease, providing that women with suspicious symptoms are expedited for investigation and treatment, they add.

A team of researchers led by BHP founding member the University of Birmingham analysed data for 1741 women taking part in the Refining Ovarian Cancer Test accuracy Scores (ROCkeTS) study, which involves 24 UK hospitals. The women had all been fast tracked for treatment under the symptom-triggered testing rapid access pathway.

Sudha Sundar, Professor of Gynaecological Cancer at the University of Birmingham and the Pan Birmingham Gynaecological Cancer Centre at BHP member Sandwell and West Birmingham Hospital NHS Trust said:

“Our figures demonstrate that in a real-world setting, symptom-based testing can potentially lead to diagnosis of high grade serous ovarian cancer with low disease spread and results in a high proportion of complete surgical removal of the cancer.”

“These findings challenge the assumption that the disease should always be considered to be in its advanced stages in women once they develop symptoms.

“More importantly, our findings emphasise the importance of increasing an awareness of ovarian cancer symptoms to facilitate earlier diagnosis via referral through the fast-track pathway to improve patient outcomes.”

Key findings

  • Among participants in the study, 119 (7%) were diagnosed with high grade serous ovarian cancer with an average age of 63, and 90% had gone through the menopause.
  • In most of these women (112; 94%) cancer didn’t hugely interfere with their daily lives, as they were classified with a performance status of 0 or 1, meaning they either were fully active, or were able to do everything but strenuous activities.
  • One in four (30; 25%) had early stage I or II disease.
  • Visible cancerous tissue was completely removed in 73 (61%) and almost completely removed in 18 (15%). The disease was only deemed to be inoperable in 9 (8%).
  • The extent of cancer was low in 43 of the 119 (36%), meaning that it was localised in the pelvis; moderate in 34 (29%), meaning that it had spread to the lower abdomen; and high in 32 (27%), meaning that it had spread up to any of the liver, pancreas, diaphragm or spleen. Information on disease extent wasn’t available for 10 (8.5%) women.
  • Surgery to remove as much of the tumour as possible, which is associated with longer survival, was carried out in more than three in four women (93 ,78%), with almost two thirds receiving surgery ahead of chemotherapy (78, 65%,). 36 (30%) were given chemotherapy to shrink the tumour ahead of surgery; 5 (4%) women didn’t have surgery, information on this was not available for 17 (14%) women.

The UK adopted symptom-triggered testing for ovarian cancer in 2011. Women, especially those over 50 years with these symptoms are tested for levels of the tell-tale protein CA125 in their blood and given an ultrasound scan. Abnormal results prompt a fast-track referral for hospital review by a gynaecologist within 2 weeks.

Ovarian cancer is the seventh most common cancer amongst women worldwide, and the sixth most common cause of cancer death in the UK. While most (93%) women diagnosed with early-stage disease (I or II) survive for more than 5 years, only 13% of those diagnosed with advanced disease (stages III or IV) do so.

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Birmingham launches pioneering trial to improve pregnancy outcomes for severe haemolytic disease

Written by Louise Stanley on . Posted in Clinical trials, Maternal health.

A pioneering study that took place at Birmingham Women’s Hospital has found an antibody that can improve the survival rate of unborn babies with rare, early-onset fetal anaemia, as a result of haemolytic disease of the fetus and newborn (EOS-HDFN).

Pregnant mothers have taken part in the UNITY trial, which has found that nipocalimab, an investigational, fully human, monoclonal antibody, has the potential to improve the survival rate of these babies.

BHP members the University of Birmingham (UoB) and Birmingham Women’s and Children’s NHS Foundation Trust (BWC) were a study site for a global, multicentre, open-label trial, in which nipocalimab was given for the treatment of pregnancies at high risk of severe EOS-HDFN, and evaluated safety, efficacy and the maternal metabolism of the monoclonal antibody.

Site investigator Mark Kilby, Emeritus Professor of Fetal Medicine at UoB and Honorary Consultant of Fetal Medicine at BWC said: “For mothers with severe HDFN the outcome not only of the condition but of the treatment, can be devastating. This is why the search for therapies to reduce the consequences of the maternal immune response has been focused on this cohort of women. The clinical study has found that nipocalimab is well tolerated and greatly increases the chance of unborn babies surviving severe EOS-HDFN, requiring less in-utero transfusion therapy.”

Haemolytic disease of the fetus newborn (HDFN), which is also sometimes referred to as Rhesus disease, is caused by a system of red blood cell antigens (most commonly of Rhesus D type) which raises the pathological antibody response in a pregnant person. These ‘pathological antibodies’ or alloantibodies can cross the placenta to the fetus and destroy its red cells, leading to progressive fetal anaemia and – if untreated – death of the fetus. 

Professor Kilby added: “These are fantastic results. In this group of pregnant women with severe HDFN, the medical management with nipocalimab has significantly reduced the need for early-onset in-utero fetal transfusion and improved the survival of these babies, reducing risks of miscarriage and stillbirth. Furthermore, and very importantly, nipocalimab seems to be well tolerated and safe for the mother and her unborn/newborn baby.   

“This research is a huge step forward for mothers who experience severe HDFN, as well as their partners, extended families, and of course, their children.”

Rosemary and Darren from Ireland were expecting baby Nessa when they took part in the clinical trial. Rosemary had had a previous in-utero transfusion for HDFN, and the couple had a child following treatment. Sadly, the couple lost a second baby after another in-utero transfusion. 

She was desperate to avoid another in-utero transfusion and was referred to the Fetal Medicine Centre at Birmingham Women’s Hospital eight weeks into her pregnancy after seeing news of the trial online and contacting her doctors at Dublin’s Rotunda Hospital. She had cell-free fetal DNA testing to confirm the baby was ‘suspectable’ to the antibodies she had produced. Rosemary then had maternal infusions of nipocalimab intravenously at weekly intervals from 14 to 35 weeks. 

Baby Nessa was born at 36 weeks weighing six pounds and 13 ounces and without the need for any IUTs.

Rosemary said: “When we were accepted onto the trial, we were both relieved and excited. Following the loss of our little girl Liliana, we were advised not to have any further pregnancies and we were devastated. This trial gave us hope of having another baby.”

“We were pregnant during the COVID lockdowns and as I was commuting from Ireland to Birmingham, it was a big worry but throughout our involvement in the trial, we felt supported, informed, understood and safe. We are forever grateful, the level of professionalism, compassion and empathy shown towards us is something we will never forget.” 

“Our two sons, Ollie and Joey now have a little sister, Nessa, who is a bubbly happy healthy four-year-old, full of mischief, giggles, and fun. To think the trial has given us what we believed was impossible, is a dream come true. To hear the trial has also given others living healthy children is fantastic. In a situation where we, like so many others felt was hopeless, to now know there is a treatment is like a miracle.”

New funding supports West Midlands healthcare and social work students into research

Written by Louise Stanley on . Posted in Birmingham Health Partners.

A collaboration between the NHS, social care and academic institutions across the West Midlands – including BHP’s Universities and NHS members – will inspire registered healthcare, social work and public health students to consider a range of research careers.

The National Institute of Health and Social Care Research (NIHR) has pledged £34.9m to encourage the regulated healthcare and social work professions into research roles as part of the new INSIGHT: Inspiring Students into Research scheme. This strategic move will accelerate the numbers of nurses, midwives, pharmacists, social workers and allied health professionals (AHPs) leading research and generating evidence to underpin care.

The West Midlands NIHR INSIGHT Consortium, led by BHP founding member the University of Birmingham, has been awarded £2.5m to provide fully funded research master’s courses to early career healthcare professionals and social workers. Working with local NHS trusts, students will be able to take the courses full or part time so they can continue their career pathways in healthcare. It is envisaged this initiative will provide the right start for the future research workforce and retain talent in the region.

For further information and to apply, visit the INSIGHT West Midlands Consortium page.

According to NIHR, the most recent headcount from 2017 showed that less than 0.1% of the nursing, midwifery and allied health professional workforce were involved with research. Yet it is well documented that research led by nurses, midwives, pharmacists, AHPs and other healthcare and social work professionals, and the contributions they can make as members of multidisciplinary research teams, can drive change to policy and patient care. Research is integral to high quality evidence-based care and has also been shown to increase job satisfaction for staff and improve retention, when conducted alongside delivering care.

The consortium sees seven universities and eight NHS trusts come together to accelerate the development and growth of future health and social work researchers. Suitable candidates will be allocated to higher education institutions and programmes according to discipline, personal and professional needs and student choice. The first cohort of places start from September 2024.

The programme will target those professions that don’t have much exposure to research during their professional training.

Professor Waljit Dhillo, Dean of the NIHR Academy, said: “We know how important early exposure to research is for building capacity within health and social care. The INSIGHT programme will offer over 300 funded research masters places per year and provide engagement activities that have the potential to excite and capture the imagination of students at an early stage in their career.

“I’m delighted that we can invest in our next generation of researchers in the West Midlands, and show students all of the benefits that research roles and careers have to offer.”

The West Midlands bid, put together with input from final year nursing students, patient ‘experts by experience’, early career clinical academics and research delivery staff from across our health and social care community, emphasised that research must reach out to all communities if it is to make a difference to the health and wellbeing of those living and working in the West Midlands. Collaborating institutions will seek to ensure that future practitioner researchers represent the communities they serve by ensuring access to funded postgraduate study.

Professor Liz Moores, deputy dean of Aston University College of Health and Life Sciences, said: “As a healthcare professional, having the knowledge and the ability to critically review others’ research and to meaningfully evaluate your own practice is a key part of improving healthcare for the future. This programme will help to support the workforce to develop those skills and Aston University is proud to be a partner in it.”

Dr Nikolaos Efstathiou, School of Nursing and Midwifery, University of Birmingham said: “We seek to provide a sustainable regional pipeline via which those motivated next generation researchers can acquire the skills and capabilities so they can have fulfilling careers delivering and leading research. With our many NHS, social care and research infrastructure partners we are fully committed to creating a positive place-based research and innovation environment for our talented graduates who aspire to be future clinical academics and research leaders.”

Professor Anne Topping, Professor of Nursing University Hospitals Birmingham NHS Foundation Trust and University of Birmingham said: “The programme is important for future-proofing our sustainable regional research workforce. Our programmes will produce those professionals, who are able to work collaboratively, generate, translate and implement best available science and evidence into real world interventions, ultimately bringing benefits to care, and the health and wellbeing of our communities.”

Led by the University of Birmingham, the programme is a partnership with (BHP members in bold): University of Keele, University of Warwick, Birmingham City University, Coventry University, Aston University, Staffordshire University, as well as Midlands Partnership NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, Birmingham Community Healthcare NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust, Birmingham Women’s and Children’s NHS Foundation Trust, Sandwell and West Birmingham Hospitals NHS Trust, University Hospitals of North Midlands NHS Trust and Birmingham and Solihull Mental Health NHS Foundation Trust and other health and social care providers across the region.

Fitness app could transform care of rheumatoid arthritis patients

Written by Louise Stanley on . Posted in Clinical trials, Inflammation and chronic disease.

Researchers at BHP members Sandwell and West Birmingham NHS Trust and the University of Birmingham aim to transform the care of rheumatoid arthritis (RA) patients by developing an app which links to the Fitbit – a popular activity tracker.

The rheumatology medical team and researchers are leading the groundbreaking clinical trial to create the app which they hope will ease the pain of patients suffering from the crippling disease and provide extra support.

It’s called MISSION-RA which stands for MovIng to Support Sustained Improvement of Outcomes iN Rheumatoid Arthritis.

Sally Fenton, Chief Investigator for the study, said: “The app will be specifically designed for and by people with RA.

“This will be done in two ways. Firstly, a series of interviews, co-design studies and workshops will be carried out to develop the app. Then, artificial intelligence will be used within the app to provide personalised support for people living with RA, based on symptoms such as pain, fatigue and mobility. It is expected the app will be available to download for free so it can be used on a Fitbit in the future.”

RA leads to inflammation of the joints and surrounding tissues which causes flare ups – this is when symptoms become worse. One of the ways to help ease these episodes of pain can be through exercise, physiotherapy and occupational therapy.

Dr Sangeetha Baskar, Clinical Specialty Lead for Rheumatology and Principal Investigator for MISSION-RA explained: “Rheumatoid arthritis is an extremely painful, tiring, psychological and physically debilitating disease. Patients face countless challenges while doing basic daily activities such as dressing, cooking and walking and often become dependent on family members to perform some of their daily tasks. Through this innovative study and the mobile app, we are hoping to help patients increase their physical activity tailored for them and improve their quality of life.”

The first patient from the Trust has already been recruited into the study.

Ana Duarte, Clinical Research Practitioner (CRP) and also Associate Principal Investigator, said: “Overall, the MISSION-RA study has overcome our initial expectations. Patients are very keen and have enjoyed their experience so far. This has also been a great opportunity for the study staff which has led to progression in their careers. Most importantly, this we hope will place SWB’s R&D department and rheumatology team as international leaders in healthcare AI and machine learning.”

MISSION-RA is being delivered in partnership with the National Institute for Health and Care Research (NIHR) and National Rheumatoid Arthritis Society (NRAS).

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Researchers at the Royal Orthopaedic Hospital and Aston University explore novel bone cancer therapy

Written by Louise Stanley on . Posted in Cancer outcomes, Experimental medicine.

Lucas Souza, Research Laboratory Manager for the Dubrowsky Regenerative Medicine Laboratory at the Royal Orthopaedic Hospital (pictured), is partnered with Professor Richard Martin, director of the Advanced Materials Research Centre at Aston University to explore a new way to treat bone cancer.

As bone cancer researchers, we are seeking to tackle the problem of bone tumours across all fronts. We are currently exploring how the metal element gallium could be used to support the treatment of bone tumours due to its cancer-killing properties.

Bone tumours can be either primary (originated in the bone tissue) or secondary (originated in another tissue and metastasise to bone tissue). We have already proved in a previous study that primary bone cancer cells are four times more sensitive to gallium than normal cells. In that study we wanted to understand if doping bioactive glasses, used in orthopaedic and dental surgeries for its bone forming properties, with gallium would support positive outcomes for bone cancer patients. We were able to show that the use of gallium embedded in bioactive glasses is an excellent strategy to support bone repair whilst selectively killing bone cancer cells which can potentially culminate with better treatment outcomes and reduced cancer recurrence rates.

The next phase of this study is exploring the use of gallium against bone metastases – cancer that originated in another tissue before spreading to bone. The ultimate goal is to prove whether cells from bone metastases also have greater sensitivity to gallium so it could be used as an adjuvant medicine to control metastatic growth in the treatment of other types of cancer that usually metastasise to bone, such as breast, lung, and prostate cancer.

If successful, we will combine the gallium-doped bioactive glass powder with biodegradable polymers to make a minimally invasive injective gel that surgeons can use to treat both primary and secondary bone tumours. This gel will have the potential to reduce cancer recurrence and implant failure rates, leading to reduced time in hospital beds, reduced use of antibiotics, fewer revision surgeries, and increased survival rates.

It is also hoped that this innovation could be used to improve outcomes for patients with vertebral metastases and other types of primary bone tumours where surgery and radiation is less effective due to their proximity to the spinal cord.

The safety and effectiveness of these biomaterials will need to be tested further, but the initial results are really promising. Treatments for a bone cancer diagnosis remain very limited and there’s still much we don’t understand. Research like this is vital to support in the development of new drugs and new methodologies for treatment options.

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