Trust researchers, in collaboration with partners including Imperial College, the Northwick Park Institute for Medical Research, King's College London, Brunel University and local GPs, are engaged in more than 400 projects addressing important diseases like cancer, inflammatory bowel disease, coronary heart disease and stroke, sickle cell disease, TB and HIV/AIDS, with support from a number of prestigious funding bodies including the Medical Research Council, Cancer Research UK, the Wellcome Trust and the Department of Health. Between 250 and 350 scientific papers are published by Trust researchers each year, and their work continues to lead to improvements in healthcare both locally and nationally.
Individual projects are funded by competitive grants and they generally involve working closely with our academic partners outside of the units. We are working closely with the Education Department at the Trust to contribute to health service research training for undergraduates.
The Trust is committed to undertaking high quality research and development that addresses issues of concern to the population of Brent and Harrow, and to the NHS as a whole, and leads to improvements in health care and in the health and wellbeing of the local community.
Our current portfolio
Our portfolio of research at the moment is wide and focuses on specific areas. The delivery of these projects and programmes is informed by methodological research which is governed by the research governance framework. Over the years some of our units have managed to obtain successful grants worth over £12 million.
This programme is directed towards the diagnosis and treatment of the following bowel diseases:
- Inflammatory Bowel Disease, including ulcerative colitis and Crohn's disease
- Painful anal conditions, such as fistula and haemorrhoids
- Functional bowel disorders, including faecal incontinence, constipation and irritable bowel syndrome.
This major focus of this programme is on colorectal cancer research within St Mark's Hospital, but there is also significant research effort on lymphomas, leukaemias, bladder and prostate cancer. The programme includes:
- Clinical research into colorectal and anal cancer, concentrating on the early diagnosis and treatment of malignancy, and in the detection and management of individuals with premalignant adenomas, particularly mass population screening studies
- Assessment of optimal endoscopic strategies for surveillance of "high risk" individuals for colorectal cancer
- Development and evaluation of endoscopic and radiological techniques for of virtual colonography
- Development of tumour vaccines and immunotherapy
- Participation in non-commercially funded multicentre cancer clinical trials.
This programme involves clinical, basic and health services research in coronary heart disease, acute coronary syndromes, acute myocardial infarction and heart failure, using therapeutic, nuclear cardiac imaging, echocardiography, contrast myocardial echocardiography and epidemiological approaches. The main objectives of the programme are:
- The development and evaluation of new methodologies for non-invasive cardiac imaging (nuclear cardiac imaging and echocardiography) to improve diagnosis
- The practical application of these imaging methodologies in a District General Hospital and community setting
- The evaluation of the impact of redesign of cardiology services
- Participation in multicentre clinical trials.
Stroke is the commonest cause of disability in the UK. Research has been increasing rapidly and with a comprehensive stroke unit we are well placed to contribute to this. It is well known that people who take part in clinical trials tend to have a better outcome from their condition so we encourage as many of our patients as possible to help with our research.
Northwick Park has always been active in stroke research. We are currently running studies in acute stroke, stroke genetics, and stroke prevention. We are shortly going to be investigating a new drug for acute stroke treatment and opening trials in rehabilitation and TIA treatment as well.
This programme comprises research on the pathogenesis, immunology, diagnosis and management of tuberculosis, and on HIV and Genitourinary Medicine. In tuberculosis there are four main areas of research:
- Immunology: investigating the immune response to TB in providing protection for the host and in leading to disease
- Vitamin D: the role of vitamin D in protection, involving both in vitro and in vivo studies
- Diagnosis: continuing development of new tools for diagnosis of tuberculosis
- MDR -TB: investigation of multi-drug resistant disease, a major new problem in tuberculosis.
In sexual health, the research focuses on six main areas:
- Management of HIV in an affected population that is largely made up of ethnic minorities (especially African)
- The epidemiology of HIV and STDs, especially as it affects the local population
- New models of care tailored to the needs of our local population
- Basic science to underpin the understanding of HIV disease in women and HIV immunisation
- Understanding the clinical and immunological interactions between HIV/TB and HIV/ JC virus coinfections
- Management of metabolic complications of HIV therapy.
This programme is concerned with multi-professional health services research undertaken in four main areas:
Rehabilitation: harnessing clinical governance mechanisms in order to develop and evaluate systems to improve the quality and standard of health services offered, including gathering of patient and consumer perspectives; systematic reviews; exploration of the barriers to implementing research findings in clinical practice; the use of guidelines, protocols, and integrated care pathways to enhance implementation of research evidence in routine clinical practice; and analysis of outcome and variance data to confirm whether clinical trial evidence is borne out in real-life NHS practice
- Service evaluation: evaluation of service development and innovation, particularly in the area of process redesign
- Emergency care: development and evaluation of the role of Emergency Nurse Practitioners and Minor Injury Nurse Practitioners; and telemedicine.
- Diabetes: the local epidemiology of diabetes, including changes in the prevalence of (and mortality and morbidity associated with) diabetes in the different ethnic groups in Harrow over time, and the prevalence of and risk factors for coronary calcification in patients with Type 2 diabetes; and re-engineering diabetic services, including mechanisms of reducing unnecessary referrals from primary care to secondary care.
This programme relates to clinical and psychosocial research on sickle cell disease and the thalassaemias. The main areas of activity are:
Reviewing the evidence for clinical/management interventions (International Cochrane Collaboration activities)
Improving psychosocial outcomes for patients and their families
Understanding the psychosocial issues and dynamics underlying genetic decisions
Development of a patient register to improve clinical care and research the natural history of SCD in the UK and the long-term patient outcomes of patients with SCD taking hydroxyurea (PhD students).
Improving clinical care: National survey of Perioperative transfusion practice relating to SCD patients as a pre-cursor to an application for an RCT transfusion versus no transfusion pre-operatively, and developing a joint application (with Dr Kirkham, Institute of Child Health, London) to test the CMH hypothesis "that nocturnal hypoxemia is a major risk factor for CNS damage in SCD"
Participation in an NIH (USA) led from Oakland , California (study on the National History of E-beta thalassaemia and the impact of hydroxyurea therapy in these patients.
Research in the Paediatrics and Child Health area falls into four main areas:
Infection - funded support for infection rapid diagnostic test development/roll out to support acute intermediate care (procalcitonin and TB) in association with Imperial College
Child Public Health including Health Services Research - support for development of national public health measurement tool for ascertaining health and wellbeing at school entry funded by London Region NHS R&D in association with the Research Division of the Royal College of Paediatrics and Child Health; and international development of child health indicators across 17 countries in the EU, funded by the EC; and health status of Looked After Children, funded by Brent and Harrow HA, CHIC and the Local Authority.
Mechanisms underlying premature birth, fetal growth restriction and sudden infant death syndrome
Participation in multicentre trials of intervention in a variety of acute and chronic children's disease, including asthma, Kawasaki's disease, infantile spasms, status epilepticus, Down syndrome, and hearing screening in the newborn.
There are pockets of research within the Trust covering ethnic minority research. We are currently developing this aspect of our remit and will be working in collaboration with our primary care colleagues and academic partners. Further information will be posted when it becomes available.