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Case study: Developing the workforce to grow stroke research

In this interview, Dr Richard Marigold, a Consultant Stroke Physician talks about UHS awarded with Hyperacute Stoke Research Centre (HSRC)

DR RICHARD MARIGOLD, Consultant Stroke Physician University Hospital Southampton NHS Foundation Trust (UHS)

University Hospital Southampton has been awarded Hyperacute Stroke Research Centre (HSRC) status by the NIHR. The award will make UHS a specialist centre for research carried out within the first few hours of a stroke, when treatment is most likely to be effective.

The status has been given in recognition of the increasing numbers of patients that have been recruited into clinical trials following a stroke, and the Trust’s plan to expand recruitment and research in the future. A multidisciplinary and collaborative approach to research delivery was also key to receiving the award.

A serious and potentially life-threatening condition, a stroke happens when the blood supply to part of the brain is cut off through blockage of a blood vessel, or rupture of a vessel leading to bleeding. Treating a stroke as soon as possible helps to limit the damage caused and improve patient outcomes. As new treatments emerge, continued research is needed to determine which will be the most effective.

With an ambition to offer patients a comprehensive round the clock research service within the next few years, developing the research workforce within the HSRC is now a key priority for the stroke team at UHS.

“This is an exciting time to be in hyperacute stroke care. This award will enable Southampton to be at the cutting edge of acute stroke research and means we can enrol more of our patients into the very latest clinical trials within the first six to nine hours of their symptoms starting.

“There’s going to be a number of new clinical trials opening soon and we’ve got a nice balance in terms of portfolio studies which means that theoretically, every patient has the potential to go into a clinical trial.

“We are aiming to expand our recruiting windows to 12 hours a day, seven days a week, by creating a unique model in which the research nurses work alongside our stroke nurse practitioners with the consultant on call to randomise patients into hyperacute studies. These include trials assessing new drugs for thrombolysis or clot busting treatment for ischaemic stroke, and mechanical thrombectomy which involves removing a clot from a blocked blood vessel using a fine tube on the inside of the artery. Treating bleeding into the brain or intracerebral haemorrhage, there are drugs which are being tested that reverse the effects of anticoagulants, and anti-inflammatory treatments used to treat rheumatoid arthritis which might limit the size of the bleeding area and reduce inflammation around it, leading to less severe neurological damage.

“The whole thing about the HSRC is that it involves multiple agencies so we’ve had support from the A&E department, neuroradiology, neurosurgery, critical care, the Trust and R&D- it’s not just the stroke department.

“We want to have research nurses working alongside our stroke nurse practitioners so that they’re around to support randomisation and consent, and the aspiration is that our research nurse workforce will expand as this develops.

“We’re also hoping to recruit some clinical fellows. It will be great to have trained enthusiasts who spend some of their time perhaps doing a higher degree, and the rest of their time driving recruitment into trials. We’d like to have two or three clinical fellows that we can nurture in the process who then become the stroke academics and physicians of the future.

“We’re also looking at our stroke nurse practitioners to see whether they have a research interest and want to take things to the next level. There’s quite a lot going on at the University of Southampton in terms of cerebrovascular research and this could be a real opportunity for an enthusiastic individual.

“There’s a wide range of people that could step into this role and if we can support members of staff to apply, it will lead to greater things in the future. In addition to higher degrees, we could grow our own study portfolio- it would be really exciting to get our own studies up and running. One of my colleagues has some ideas about this and is currently looking at funding streams. Some of our physios have also been involved in research, so there are things going on in the periphery and the HSRC is a great potential innovation in helping to draw things together.

“We’re currently planning simulation training to run through all the clinical trials as well as the team completing Good Clinical Practice (GCP) training. We’re going to take a mannequin down to the A&E department and actually run through each of the trial scenarios, giving the team some hands on experience so that the team is as prepared as they can be when we open the centre in April.

“It’s a fantastic opportunity and we’ve been given the award at the right time when lots of new trials are coming out. This area of research will continue to grow and I think there will be new trials about devices, imaging and refining the pathways of acute stroke care within the first few hours, because we know that the greatest interventions to prevent neurological damage occurring happen within this critical time period. The quicker we can get these treatments and interventions on board, the better the outcomes for our patients.”