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2nd April 2024
The MPS Foundation is inviting healthcare professionals to register their interest and submit proposals for research grants focusing on patient safety and the wellbeing of healthcare professionals and teams, both medical and dental.
Applications for the grants – which are worth £5,000 to £200,000, or equivalent in local currency, depending on the scale, focus and duration of the proposal – are open to both Medical Protection Society members and non-members from countries including the UK and Ireland.
To be eligible, the research projects must be academically robust, evidence-based and address the MPS Foundation’s key research priorities, including:
Dr Graham Stokes, MPS Foundation chair, said: ‘We are delighted to launch our third grant programme to support research projects on patient safety and the wellbeing of healthcare professionals. Funding for research in this area has been limited but our grant programmes have been changing that. Projects that we have supported in previous years have shown great success in promoting best practise and wellbeing across several countries.‘
He added: ‘Our aim is simple: to fund research that improves safety for patients and the wellbeing of healthcare teams.
‘If you have a research project that you think is suitable, register your interest and join our growing community of grant recipients. I strongly encourage healthcare professionals to consider applying for support whatever the scale of the proposal and to make the most of the additional resources available to support applicants this year.’
Applicants can register interest for the grants and apply via the MPS Foundation online grant portal, which also includes a guide for applicants, frequently asked questions and tips on creating a good application.
Calls for expressions of interest are open until 5pm BST on 3 May 2024.
Projects awarded MPS Foundation funding in 2023 included a study aimed at improving safety in gastrointestinal endoscopy, research examining the effects of patient suicide on clinicians, and a project to better understand the role patients’ relatives play in ICU decisions and how the Mental Capacity Act can lead to better outcomes for patients, families and healthcare professionals.
The MPS Foundation is part of the Medical Protection Society – an organisation that aims to protect and support the professional interests of more than 300,000 doctors, dentists and healthcare professionals across the UK, Ireland, South Africa, New Zealand, Australia, Hong Kong, Singapore, Malaysia, the Caribbean and Bermuda.
28th March 2024
Having recently added a European Respiratory Society lifetime achievement award to her career successes, Dr Joanna Pepke-Zaba, consultant respiratory physician at Royal Papworth Hospital, talks to Saša Janković about the national chronic thromboembolic pulmonary hypertension service and her continuing commitment to this ever-evolving field of research and treatment.
Dr Joanna Pepke-Zaba graduated from Warsaw University School of Medicine in Poland before undertaking a fellowship in respiratory physiology at Royal Papworth and Addenbrooke’s Hospitals, University of Cambridge which resulted in a PhD.
Director of the Pulmonary Vascular Diseases Unit (PVDU) at Royal Papworth Hospital from 2003-19, she is currently a consultant respiratory physician at the hospital and has been instrumental in progressing many of the unit’s services over the years, as well as making significant contributions to research in pulmonary hypertension.
Dr Pepke-Zaba is also committed to training respiratory physicians and was a recognised teacher by the Clinical School of the University of Cambridge. As an honorary senior visiting fellow and affiliated associate professor of this institution since 2011, she has been able to run successful translational research programmes in the field of pulmonary hypertension.
With over 200 published papers, and an impressive h-index of 61, she’s certainly well positioned to be an inspirational mentor and support the next generation in elevating patient care in this fast-evolving field.
Citing a desire to develop ‘very close communication with the patient’, as well as ‘the possibility of doing applied research’ as her main reasons for specialising in respiratory medicine – and pulmonary hypertension in particular – Dr Pepke-Zaba says her early career in general internal medicine gave her ‘time to concentrate’ on choosing this specialism.
‘I wanted to be sure that this was the area which I would like to persevere with, and definitely the people I came across also encouraged me and pointed me towards areas for research’, she says.
She herself has consistently mentored postgraduate students, with most people working in pulmonary hypertension centres in the UK who have spent time at Papworth having been taken under her wing at one time or another, either as a registrar or as research fellows.
‘Mentors definitely played a significant role in my decision, and I think it’s very important to highlight that to stimulate junior doctors ]and demonstrate that] it’s vital to have mentoring alongside good clinical practice,’ she stresses.
Dr Pepke-Zaba’s objective of building strong relationships with patients hasn’t let up either. She is now leading the Pulmonary Hypertension Global Patients Survey in collaboration with patient associations across the world and Pulmonary Vascular Research Institute (PVRI).
This project, with over 3,700 responders, will provide the pulmonary hypertension clinical community with patient perspectives of their journey through the disease in order to help shape future research and enhance healthcare to benefit patients on a global scale.
As part of Cambridge University’s Medical School faculty, the PVDU at Royal Papworth Hospital is an internationally recognised centre for the investigation and management of pulmonary hypertension, with an established programme of clinical and basic science research.
It is a member of the European Reference Networks (ERN-Lung) and part of the working group of clinical research collaboration between the European Respiratory Society (ERS) and ERN-Lung, as well as the UK National Pulmonary Hypertension Service.
Based at the unit, Dr Pepke-Zaba’s main research has concentrated on the translational programmes in the field of pulmonary hypertension with specific interest in chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension.
She was instrumental in developing the UK’s national CTEPH programme in the mid-1990s at Papworth, which remains the UK’s only NHS centre commissioned to provide pulmonary endarterectomy (PEA) surgery and balloon pulmonary angioplasty (BPA).
‘At the beginning of the millennium, there were a lot of colleagues who, at that time, were very passionate about pulmonary hypertension, but there was no organisation behind it,’ says Dr Pepke-Zaba regarding the genesis of the programme.
‘We knew from programmes for other rare diseases like cystic fibrosis that if delivery can improve over a curve then commissioners will show an interest in developing a service, so we started to establish designated pulmonary hypertension centres in the UK, including at Papworth, and began introducing the pioneering surgery for CTEPH patients.’
As Papworth is the only centre that can carry out certain CTEPH procedures, it collaborates with other respiratory and cardiology teams across the country, as well as other pulmonary hypertension centres, who refer patients for consultation with Dr Pepke-Zaba’s multidisciplinary team (MDT) to assess their suitability for PEA surgery or BPA.
Since PEA surgery is a major operation and the level of risk versus benefit will vary from person to person, patients are invited to an all-day outpatient appointment to meet not only members of the MDT but also, if they wish, a patient who has already undergone the procedure. This means that they can ask them questions and make more informed choices about their own treatment.
‘Patients who have had the surgery tell us that they are really grateful to return to normal functioning so we really value the support that some of them volunteer to give to those who are considering the procedure,’ says Dr Pepke-Zaba. ‘But it’s not only about the surgery, it’s also relevant for people facing treatment for pulmonary hypertension as all the complex therapy with continuous intravenous infusion is very challenging.
‘Patients want to be put in touch with others who have been or are in that sort of clinical situation. We make sure we do everything we can to make the patient a partner in their discussions, since the idea is to make them better and to improve not only survival but also quality of life.’
As a result of this patient-centric approach, and Papworth’s expertise in pulmonary hypertension, the UK is considered ‘the best organised country in the world’ for these procedures, according to Dr Pepke-Zaba. This knowledge has subsequently been shared with clinical colleagues across Europe and seen Germany and France in particular become similarly proficient, she adds.
Dr Pepke-Zaba’s long-standing contributions to this field have garnered her a trio of lifetime achievement awards from the pulmonary circulation division of the Polish Cardiac Society, the PVRI, and, most recently, the ERS Lifetime Achievement Award in Pulmonary Vascular Diseases in October 2023.
Thankfully for her patients and colleagues, these distinguished accolades do not herald a wind-down for her career, since she sees continuing challenges and unmet needs in pulmonary vascular medicine to be addressed.
‘We have introduced several drugs and significantly improved survival for patients with pulmonary arterial hypertension, but these drugs are only slowing down progress of the disease. They are very expensive and unfortunately not all those which we would like are available to us in the UK, so further work on drug development is required. That’s one challenge’, she says.
‘As the pulmonary hypertension community, we are committed to improve treatments of patients with pulmonary hypertension associated with heart diseases and with lung diseases. This will be a long journey, but there is one positive study with a nebulised compound for patients with interstitial lung disease-associated pulmonary hypertension. If and when this will be approved by NICE we do not know, but we would like to have this drug in our portfolio to help these patients.’
And it’s not just treatments Dr Pepke-Zaba is interested in pursuing. ‘Another improvement we are desperate to introduce is a joint database that will work well for all of us in pulmonary hypertension centres across the NHS, but of course this is very expensive. All the individual trusts do their best with a limited amount of funds and we physicians have little to influence these sorts of decisions,’ she explains.
Nonetheless, Dr Pepke-Zaba sees much to be hopeful about on the horizon for pulmonary hypertension research and treatments.
‘The area of pulmonary vascular medicine is very dynamic with drug development for pulmonary arterial hypertension and interventions such as surgery and CTEPH procedures. What we are going to see next are more innovations related to digital endpoints in pulmonary arterial hypertension and the introduction of AI to imaging of pulmonary circulation and the heart’, she says.
‘We are also getting closer to personalised medicine treatments based on whether the patient has got a specific genetic mutation or not, which requires collaboration with clinical geneticists looking more into the genetic aspects of the disease. That is very exciting as it could truly help those patients benefit from specific treatments.’
In the meantime, Dr Pepke-Zaba says it’s still very important to acknowledge that ‘some patients with additional comorbid conditions do not respond to pulmonary hypertension medications as well as patients with only pulmonary arterial hypertension’. As such, she sees ‘the important challenge for me now is how to accommodate the progress of medicine into the reality of the service’.
How that will play out remains to be seen but having reached so many positive milestones in her career already, there’s no doubt she’ll make significant headway towards this goal with the support of her team, the pulmonary hypertension community and her patients.
16th February 2024
Introducing a national programme of weekend high-intensity theatre lists to reduce backlogs and offering hospital consultants protected time for research are among the recommendations outlined in a major new report.
In its ‘Report into the state of health and social care in Britain today’, the Times Health Commission called for high-intensity theatre lists to be launched once a month in 50 hospitals to get through a week’s worth of planned operations in a day and create seven-day surgical hubs.
It also outlined incentivising NHS staff to take part in research, and put the case for research to their patients, by giving 20% of hospital consultants and other senior clinicians 20% protected time for research.
These two recommendations form part of the report’s 10-point plan for the Government to transform the NHS.
To support the plan’s development, the Times Health Commission visited hospitals, care homes, GP surgeries and research laboratories in the UK, Japan, Denmark, Israel, Ireland and Spain to source examples of best practice.
The commissioners then established three core principles to underpin the report and recommendations, which they said are ‘pragmatic, practical, deliverable and could be taken up by any political party or government’.
The principles are rebalancing the health system away from hospitals and a putting greater emphasis on prevention and community care, reforming social care to reduce overcrowding in hospitals and give patients better support, and enabling the system to become more personalised and predictive through the use of technology.
The Commission called for doctors, nurses and midwives who stay in the NHS for three years to have their student debt cut by 30%, rising to 70% for those still working after seven years, and 100% after 10.
It said the health services must become a ‘much better employer’ in ways that go ‘beyond health settlements’, including affordable staff canteens, night transport and on-site childcare.
The requirement for junior doctors to rotate across the country must also end to better balance work and family, it said.
Other recommendations included creating digital health accounts or ‘passports’ for patients to book appointments; order prescriptions; view records, test results or referral letters; and contact clinicians.
And establishing a National Care System with the aim of giving everyone the right to appropriate support locally and in a timely fashion. This should be delivered by a mixture of the public and private sectors, the report said.
Chair of the Times Health Commission Rachel Sylvester said: ‘Despite its huge challenges, there is enormous cause for optimism for our health service. The NHS and social care system must seize the extraordinary opportunities on offer in the modern digital world to empower patients, liberate clinicians, improve services, drive efficiencies and create a healthier Britain. Other countries have done it and so could we.’
Commenting on the report, Royal College of Physicians president Dr Sarah Clarke said: ‘At a time when the NHS faces significant demands, we welcome the Times Health Commission’s report. Its 10-point plan places an important focus on increasing and supporting the medical workforce, fostering an environment where existing staff can flourish, and taking an important preventative approach to tackling health inequalities and ill health.
‘We also welcome the inclusion of social care within the report’s recommendations for reform – social care must be staffed and funded as an equal partner to the NHS to deliver optimal care for patients.’
Also responding to the report, Professor Philip Banfield, British Medical Association council chair, welcomed its focus on staff retention and supported the student loan write-off recommendation.
However, he said: ‘The Commission sadly fails to make the obvious recommendation of restoring doctors’ pay, which would have a real impact on retaining clinicians.
‘Without this, any meaningful hopes of addressing the near record-waiting lists will be dashed. Indeed, accelerated weekend theatre lists are all well and good, but the premium required to fund such activity risks detracting from essential investment elsewhere; doctors are already exhausted after working beyond their hours all week, already spread too thinly.’
Professor Banfield added: ‘There is a lot to unpack and consider in this report and its recommendations, but ultimately the ability to improve the state of the country’s health and services is bound by the Government’s will to act, and crucially, invest. This change must come from listening to the doctors and colleagues that give their all on the front line every day. We are the solution, not the problem.’
Matthew Taylor, chief executive of the NHS Confederation, who was a commissioner involved in the report, also called for greater Government funding to align with the report’s recommendations.
He said: ‘The NHS is recognised as one of the most efficient healthcare systems in the developed world, but we know that more can be done to improve productivity, and health leaders and their teams are always looking at ways to generate even greater efficiencies.
‘One of the crucial ways that this productivity challenge can be addressed is by providing the NHS with the capital investment it needs, which has not been covered in this comprehensive report. Specifically, in England, capital funding needs to increase to at least £14.1bn annually, a £6.4bn increase from the current level of £7.7bn. This is vital if we are to increase productivity and reduce waiting lists.’
In January 2024, a surgical workforce census report found that over half of the UK surgical workforce face problems accessing theatres, which is contributing to long waiting times for hospital treatment and excessive workloads.
12th October 2020
The discovery of an effective treatment will most likely bring huge financial gains for the organisation or company who succeed in finding the silver bullet. All research groups will be acutely aware of the rapid pace of change in COVID-19 research and the pressure to achieve and disseminate their findings. In their haste to get articles to press, scientists have literally inundated journals with manuscripts and ‘pre-prints’ have become much more readily available. In addition, many journals are now offering open access to their articles with the result that any initial positive results are widely disseminated in the lay media, spreading hope that these latest findings will bring salvation from the ravages of COVID-19. Moreover, a heightened desire to achieve success among the scientific community and the prospect of further grants based on positive research findings, serves only to increase the pressure upon those workers, with the attendant risk for not only an honest error but even blatant misconduct.
Nevertheless, utilising the findings of ‘pre-print’ COVID-19 research articles to aid clinical decision-making process is an inherently dangerous practice, especially as these findings have not been subjected to peer-review. In fact, the pre-print sites do caution that an article contains preliminary findings yet despite this cautionary note, clinicians sometimes appear to throw caution to the wind and seek to change clinical practice based on positive early data. This has been illustrated with the 4-aminoquinolones, hydroxychloroquine and chloroquine, mooted as treatments for COVID-19. Both drugs has been used for many years as anti-malarials and hydroxychloroquine has also proved to be of value a disease-modifying drug for the management rheumatic diseases. The original hope that hydroxychloroquine might represent a promising treatment for COVID-19, arose out of laboratory studies of its potential anti-viral activity. Animal studies showed that 4-aminoquinolones demonstrated anti-viral activity against both avian influenza A H4N1 and the Zika virus.1,2 Nonetheless, while chloroquine demonstrated in-vitro activity against influenza, it failed to provide protection against influenza in a large, randomised trial.3 At the outset of the pandemic, several small trials in China reported that hydroxychloroquine seemed beneficial and on 28 March 2020, the food and drug administration (FDA) in the US, approved the use of hydroxychloroquine for COVID-19 under its emergency use authorisation process. In May 2020, however, a large, registry-based analysis published in the Lancet that included 3016 patients receiving hydroxychloroquine, found that the drug increased the risk of death.4 Although the Lancet later retracted the paper after an independent review found that not all the necessary data was available, the FDA also revoked the emergency use authorisation for chloroquine and hydroxychloroquine on 15 June 20205. As noted by Kim et al,6 a rapid dissemination in the lay press and social media, combined with endorsement by prominent political figures, created a surge in demand for hydroxychloroquine despite an initial over-interpretation of the data and lack of direct supporting evidence of its value. This example serves to highlight our desperate need for an effective drug even where there is lack of credible evidence. A further issue which has not received much public attention is how in a number of cases, pre-print articles are never published and, in some cases even retracted.
Retracted publications
According to the US ClinicalTrials.gov site, there are currently 2548 COVID-19 clinical studies registered7 and over the last few months this has led to an enormous amount of pre-published material. Though it is inevitable that some studies fail to successful pass the peer-review process an increasing number are being retracted. According to the website ‘Retraction Watch’, currently 34 COVID-19-related publications have been retracted, three temporarily retracted, and for two articles there have been expressions of concern.8 The latter category (expression of concern) although not strictly a retraction, does alert readers that there are potential integrity issues with the paper. Although the reasons for a retraction are not always clear, it is invariably the authors themselves who instigate the retraction possibly due to more quality reporting. In fact, an analysis of COVID-19 treatment trials by researchers from the Oxford Centre for Evidence-based Medicine (CEBM) noted how too many of the current COVID-19 trials are open-labelled and too few double-blind, leading to biased results that can distort therapeutic decision-making.9
The vast number of research studies seeking approval has meant that ethics committees are deluged with COVID-19 study applications. Furthermore, these committees are unlikely to have members with the necessary specialist knowledge from key areas such as virology or immunology to critically appraise the applications. In a recently published communication in the Journal of Medical Ethics, Bramstedt10 has worryingly identified a large number of international COVID-19 studies that have been withdrawn as ‘pre-prints’ and some even after full publication.
It seems increasingly likely that the current pandemic will remain with us for several months and as new discoveries about the virus and possible treatments emerge, there will be a continued rush by researchers to publish their findings. However, it is important to avoid what has been termed ‘hot stuff bias’ in which investigators become less critical in their approach to researching a fashionable topic and journals more likely to publish findings on the topic.11
As COVID-19 continues to kill thousands of people across the globe, the research community has a duty to ensure that it undertakes high quality work that if used to inform clinical decision-making does not lead to either patient harm or provide a limited benefit. The ongoing UK RECOVERY trial demonstrates that large-scale, high quality research into COVID-19 is possible and likely to yield reliable results. Moving forward, this latter trial should serve as a template for future studies and hopefully reduce the amount of substandard research that is ultimately retracted.
References
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