Research
PFCSG Research Awards; Inaugural Competition
PFCSG award on nocturia; A prestigious and valuable award was won by Mr Hashim at the inaugural competition. He will be working with Mr Marcus Drake, Senior Lecturer in Urology at the University of Bristol, to develop a programme grant application to the NIHR. The aim is to develop a clinical algorithm for the assessment, investigation and treatment of nocturia. It will be suitable for use by primary and secondary care in managing people with nocturia. A multidisciplinary structure is envisaged, comprising a collaboration of nephrologists, care of the elderly and other relevant specialties, alongside disciplines managing lower urinary tract function. The programme is evolving with a view to submission to the NIHR for programme grant funding consideration in 2012.
PFCSG Consensus statements initiative
The PFCSG wishes to highlight some areas of clinical practice where the evidence basis is weak, and where approaches to clinical management are disparate. A new Clinical Studies Group initiative will focus on developing consensus statements to help identify areas of weakness, agree recommendations for practical management approaches, and highlight opportunities for future research. Emphasising the collaborative nature of the PFCSG, the following initiatives will be pursued over the next year; The management of recurrent urinary tract infection: The use of bowel segments in reconstructive urological surgery: Obstetric anal sphincter injury surgery. Electronic communications supplemented by face-to-face consensus meetings will be used to derive practical algorithms which will be published and made freely available. There are extensive opportunities for further statements of this type and any interested individual wishing to instigate the project of this nature should contact the PFCSG executive.
A provisional systematic guidance for management of people with recurrent urinary tract infection has been developed by Lap Yin Ho and Marcus Drake. Currently these patients get a very varied assessment in management in the NHS. The evidence basis for the tests and treatments employed is weak. The algorithm is now public for discussion. All comments should be emailed to marcus.drake@bui.ac.uk.
Obstetric anal sphincter injury surgery (OASIS). This very troubling outcome from labour and delivery has a substantial impact on quality of life of young women, with an increasing risk of symptoms with aging. Ruben Trochez and Bob Freeman are working to derive an initial algorithm for discussion for public consultation in 2011.
Refractory overactive bladder. OAB is a common condition and usually responds to conservative intervention and anti-muscarinic drugs. However, an important minority of patients have persistent very bothersome symptoms. A statement is being led by Marcus Drake, to draw together an approach which can realistically be offered to patients in the current NHS climate. A preliminary version has been drafted Authors Abigail Oliver and Marcus Drake.
Bowel segments in the urinary tract. Bowel has to be used in the urinary tract for patients undergoing reconstructive surgery following radical cancer treatment or due to urinary tract dysfunction. Major complications can arise including persistent or recurrent infections, stone formation, renal dysfunction and malignancy. The consultation will be initiated as a collaboration between urology and colorectal surgery, with a view to consultation in late 2011. This statement is awaiting proposals.
Other initiatives are welcomed and any suggestions for topics and people to lead them can be forwarded to the clinical study group executive.
Small Grants to Support Development of NIHR Protocols
The PFCSG is able to offer grants of up to £1000 (or more at the discretion of the clinical studies group executive) to help set up meeting or other small-scale initiatives which NIHR research applicants might find helpful when drawing together their application. Examples might be to pay for a meeting room and catering if face-to-face discussions are needed to help decide study structure. Up to five awards could be made in any one year on a first come first served basis. There is no specific deadline. Applications have to be forwarded to the section executive and should comprise a maximum of 1000 words justifying the support requested, with quotes of anticipated cost.
NIHR Portfolio Activity and Potentially Adoptable Studies
Adoption of a clinical trial into the NIHR portfolio has considerable advantages in terms of research support by the Comprehensive Local Research Networks (CLRN). It is automatic for NIHR studies and for certain other funding bodies. Additionally, the Specialty Groups can consider submissions for discretionary adoption. The current portfolio, including the Urology and Urogynaecology Specialty Group, can be found at the following link http://www.crncc.nihr.ac.uk/about_us/processes/portfolio
Statements of Research Priority
The James Lind Alliance (http://www.lindalliance.org/index.asp) made a statement of top 10 priorities in research in incontinence. The National Institute of Health and Clinical Excellence (http://www.nice.org.uk/) includes statements of research priority and its clinical guidelines and other documents. The PFCSG undertakes initiatives to agree research priorities as these evolve they will be listed at this location on the website.
Why Bother with Clinical Research?
Most clinical research is undertaken by people genuinely interested in developing new knowledge and translating it into novel treatments. The process is challenging but very rewarding. For those new to research, however, these benefits may seem intangible and the prospect may appear daunting. However, research is a very broad term, and starting with a relatively simple project before moving on to larger scale studies does enable new researchers to build their confidence. So why should you bother in the first place? Genuine interest is highly motivating. You should weigh up any new treatment you plan to start offering patients in your clinic, and a background in research is extremely helpful for gauging the strengths and weaknesses of the evidence base. At a more pragmatic level, undertaking a clinical research study does make a candidate much more attractive to an appointment committee, for example at consultant interviews; ability to win a research fund or prize is a strong marker of intellectual strength and an enquiring mind.
Research Strategy
The PFCSG research strategy is to identify areas of clinical need in all aspects of pelvic floor dysfunction, and formulate the research that will deliver solutions for clinical management in the future. In more detail, the research remit of the PFCSG can be set out as follows.
1. Identifying and highlighting areas of clinical need;
2. Developing high quality research protocols at all levels of pelvic floor research;
3. Facilitating the achievement of funding of research in the area -(a) National Institute of Health Research;
(b) Charitable and other grant-giving bodies;
(c) Research in association with industry.4. Identifying current research infrastructure in the United Kingdom and building additional research capacity in the clinical and translational arenas.
5. Brokering new collaborations, initially on an ad hoc basis, subsequently in a sustained collaboration model.
6. Developing new researchers for the future by training and progression support for medical and nursing staff, and scientists.
PFCSG Research Awards
The PFCSG discussions aimed to identify critical research questions and key opportunities, particularly for collaborations. In order to catalyse the development of full research projects, the PFCSG aims to obtain pump priming funding which will be used to underpin awards which will be made in response to competitive applications. The awards will comprise a financial element and expert support from an experienced investigator who will advise on the most effective delivery of the project and how to translate it into a full NIHR application. The first competitions will be held in the autumn of 2009. Once awarded, the trainee principal investigator, supervised and supported by the experienced clinical investigator, will be responsible for the entire process. The trainee will develop the protocol, undertake ethics, regulatory and governance submissions, recruit, analyse and disseminate results. They will be expected to acknowledge the PFCSG in their final outputs.
