Case study: Portsmouth research teams show the power of collaboration

An interview with:

• Sharon Glaysher – Translational Research Laboratory Manager.
• Chrissie Minnis – Clinical Trials Service Manager.
• Dr Laura Wiffen – Respiratory Research Fellow.
• Zoe Daly – Senior Research Nurse Katrina James – Ward Manager.

Staff at Portsmouth Hospitals University NHS Trust (PHU) have been working together to deliver COVID-19 research throughout the pandemic. We talked to five team members helping to shine a light on the important role of research and collaboration in tackling this devastating disease.

Sharon Glaysher: I manage the laboratory that supports research and clinical trials at Queen Alexandra (QA) Hospital. I help to commission studies and coordinate in-house research collaborations, alongside conducting sample analysis and managing the distribution of samples to other locations if we’re involved in multi-centre trials. 

I also support our in-house research fellows across all different disciplines – I help them to devise their trials, develop new techniques for their research, explore devices and drugs that allow them to shape the work that they do and liaise with different pathology teams to help them establish their studies. I collaborate with universities and companies who are also establishing research trials, so my role is very varied. 

Before the pandemic, I had around 90 different clinical studies ongoing in the laboratory and we’re only a team of three people so we achieve a lot! 

When coronavirus appeared, a lot of research was paused which reduced the amount of samples we would get on a day-to-day basis so we were re-distributed to support with COVID-19 research. 

On the Friday before we went into the first national lockdown, I had a call from a close contact at the University of Portsmouth saying that his lab was closing down but he wanted to join the research effort. So he packed up his car with all of his equipment and drove to QA Hospital, where we set up our own research project – STOP-COVID19. 

Five weeks after this we were actively recruiting participants into the study which looks at the entire viral genome sequence to help us understand how the virus spreads. We've sequenced data from around 8,000 Portsmouth participants so far. Across the UK, as part of the COVID-19 Genomics UK Consortium, we’ve also collected viral data from almost 2 million people. 

Usually, it would take six months to a year to establish a trial of this size so the speed has been astounding and allowed us to make an impact very quickly. We have a much better understanding of how the virus transmits from person to person, which allows us to feed into public health information on social distancing and preventative measures but also to be able to help staff and the public to understand how outbreaks occur within the hospital and the wider community. 

I’ve also been working on the SIREN study where we’re taking samples from staff and testing them for antibodies so that we can explore how immunity and vaccine efficacy impacts the spread of the virus. Overall, collaboration in the hospital has become much more multi-disciplinary in a very short space of time which is amazing. Everyone benefits from this approach to research as different perspectives and approaches allow for much faster learning and exploration

Chrissie Minnis: Before I took on my role as Clinical Trials Service Manager in November 2019, I didn’t have a lot of research experience. This changed very quickly because supporting clinical trials in the pharmacy naturally involves working across departments and supporting research in lots of different areas. Add into that a global pandemic, and it’s been the steepest learning curve of my life! 

Ordinarily we support clinical trials by helping researchers to deliver what they need – that could be dispensing trial drugs and delivering them to participants, or working alongside our technical colleagues to manufacturer new treatments. 

During the pandemic, this was accelerated even further. Normally it would take around 30 days to review and set up a clinical trial, but to accelerate access to potentially lifesaving treatments we were doing it in 48 hours. We currently have more than 60 active COVID-19 trials running simultaneously alongside sustaining our regular trials. We also had Brexit and COVID-19 related supply issues to contend with too, so it has been important to make sure participant supplies to trial treatments haven’t been disrupted. 

During the lockdowns, we worked in partnership with the Wessex Blood Bikes, an award-winning volunteer delivery programme, so that we could ensure people self-isolating or shielding could continue to receive their medications at home. 

One of the largest COVID-19 studies that I'm involved with is the RECOVERY trial and the QA Hospital is currently the 10th highest recruiting site. We currently have more than 100 participants in the Regeneron arm, receiving a combination of two antibodies that work on the spike protein to reduce the effects of the disease. We have just a small window of 36 hours once the drug is created to administer to participants, which puts a lot of pressure on us. 

Although challenging to supply through the trial, it’s been rewarding to see patients getting better whilst on this drug. Shortly we will start to see the benefit of this targeted treatment in our local communities which aims to reduce the number of people being admitted to hospital with more severe symptoms. 

We’ve expanded our team to help us deliver these different approaches and to help us continue to support our existing research – it’s vital that other studies don’t suffer as a result of the impact of the pandemic. We are also supporting CRN Wessex to deliver COVID-19 vaccine booster studies in the region, as prioritised by the UK Government’s Vaccine Taskforce. 

I’ve learned a lot about myself during the pandemic. I have worked really well under the pressure and have been able to put research theory into practice very quickly which has changed the speed of delivering trials. 

Laura Wiffen: I have been working as a Respiratory Research Fellow at PHU since August 2019. I support the delivery of the large respiratory research portfolio including both commercial and locally sponsored studies as well as developing new studies with the Portsmouth Technologies Trials Unit (PTTU), particularly research evaluating novel diagnostic testing in asthma. I am also a clinical fellow within the Portsmouth Severe Asthma Service.

In March 2020 with the onset of the COVID-19 pandemic, I re-joined the clinical team and on-call rota as a respiratory registrar to support patient care alongside the delivery of urgent public health studies including the RECOVERY trial, RECOVERY-RS and STOP-COVID19. The research team was transformed into a single multi-disciplinary team tasked with delivering these trials. It was also our role to ensure that every single patient admitted to QA Hospital with COVID-19 was offered the opportunity to take part in and had access to potential treatment options that they wouldn't otherwise have had. 

Although this has been the most challenging and difficult period of my career, it has taught me so much. It has been a privilege to work in both a trust and a department that has shown such adaptability, dedication and commitment and to watch knowledge and expertise from across the hospital come together to manage a devastating disease that so little was known about. 

The success of the COVID-19 research depended on removing historical barriers and embedding the true ethos of integrated working, resulting in research becoming part of routine clinical care. Research is now front and centre. What we have achieved in such a short space of time would normally have taken years. 

It has provided a platform on which to build and deliver more hospital-wide and cross-specialty studies, breaking down historic barriers between clinical medicine and research, with so many people engaged and enthusiastic to take part because they can see the difference it is making. This will ensure that research is easily available to both patients and staff, allowing us to continue evidence-based medicine and therefore provide the best care we can for our patients whilst continuing to work collaboratively across the trust. 

Zoe Daly: My normal role as a Critical Care Research Nurse would involve managing different clinical trials at different times. I would have some in progress, some starting and some finishing so I am used to working on multiple trials at any one time but it’s usually quite a smooth process. 

Equally, I’m used to reacting quickly to recruit patients into trials – heading down to the Emergency Department in the event of a cardiac arrest to assess whether a patient is suitable for a trial, but on a much smaller scale than now. 

COVID-19 changed all of that really quickly. With information about the disease being updated daily, I’m always screening the Critical Care Unit patients to see who might meet the criteria for the different studies we are running. As the disease changes in patients, so do the treatments that we are trialling, so one day they might not be suitable for a trial and the next they are. 

I have much more contact with the clinical teams on the ward now because they are our lifeline for recruiting patients to the trials. In addition to us taking blood samples, distributing trial drugs and recruiting patients, we’re also training and supporting nurses to do those things too. 

My role now involves a lot of teaching so that we can embed our research within clinical practice and educate other nurses about what is needed. This isn’t just great for me and my research, but trials in general as we’re now in a fortunate position of being able to match skills to the studies. By expanding the experience of our clinical teams, we can enable more studies which is so positive. 

It’s also been an opportunity for us to add important data to existing studies. Back in 2019 I began working on the REMAP-CAP trial, which is a platform study that examines community-acquired pneumonia. When COVID-19 appeared and the impact on lungs became clear, the study was modified to gather data on treatment approaches. 

We quickly had three new domains introduced into the study – the immune modulation domain, convalescent plasma and varying doses of anticoagulation. Similar to the drugs trialled in the RECOVERY study out on the wards, we were looking at whether their effectiveness changes depending on the stage of the disease.

Because of this overlapping of my work, I’m now visible to so many more people who see the significance of my role. I also feel like I’m part of a much bigger team now, working across so many departments has been a real positive to have come from such a difficult time. It’s also been incredible to see the difference that my work makes – because of the results that came out of RECOVERY after the first wave, we were able to see the impact that Dexamethasone made on patients during the second wave. 

Katrina James:  Pre-COVID-19 I managed the 10 bed respiratory high-care unit for patients with type 1 and 2 respiratory failure at the QA Hospital in Portsmouth. At the start of the pandemic we had to move our unit upstairs to a private patient unit that had individual rooms due to infection control needs. The only equipment we took with us were our ventilators and we expanded from 10 beds to 18. 

Because of the quick expansion, we merged with a team of surgical nurses which involved an element of rapid teaching, as we had to train staff to use the ventilators and to look after patients on them which normally takes around 18-24 months. 

We faced so many challenges that we took for granted working on our normal ward. Individual rooms made it harder to keep an eye on patients, so we had to ensure that there was always someone going from bed to bed to assess each patient's condition. We also had to get creative with how we communicated with patients as many of the rooms were double chamber which limited our face to face contact with them. 

We began teaching staff how to write backwards on the windows, and then we started using bits of paper before we got whiteboards and pens and then iPads to create better communication with them. These parts of our job are so important – moving units and being limited with patient contact made us reassess so many things that we take for granted. We also created “Face Behind the Mask” videos to put up on the hospital website so that relatives and patients could see the faces behind the mask caring for their loved ones. 

Having research nurses working side-by-side with us was really different. We had to learn quickly what they needed and were taken through the research to understand the different arms of studies and how to identify suitable patients and recruit them into trials. I learnt a lot about research in a very short space of time. 

Initially the research team would administer any trial drugs but after some training and teaching that role was handed over to us, so that we could get senior staff to administer them. 

We have had to adapt so many of our normal processes and nursing techniques so quickly – in a normal year we would see 600-700 patients come through the high-care unit but this year we have had 1,500. It’s been incredibly hard. 

But we’re seeing the impact of the research being done and the difference our work is making. Patients are getting better, we can now use high-flow nasal cannulas which we couldn’t use in the first wave because of worries about the spread of the virus. These make a difference to patients and are much more effective. Drugs like Tocilizumab and Dexamethasone are helping to reduce some of the effects of the virus. 

Together we’ve learnt a lot about the virus but also about each other. How we can work together and learn from each other to grow what we do.