Artificial pancreas an international success

Cambridge researchers from the Metabolic, Endocrinology and Bone research theme collaborated with our Women’s Health and Paediatrics theme to develop a world-leading artificial pancreas system (a continuous glucose monitoring device) for people with type 1 diabetes. The system uses smartphone technology to communicate with an insulin pump and a continuous glucose monitor.

The system calculates and delivers the correct amount of insulin needed at any particular time, therefore cutting out the need for injections, improving glucose control and reducing the risk of hypoglycaemia (low blood sugar). The continuous glucose monitor is worn 24/7 meaning that blood sugar levels are continuously measured including through the night leading to less disturbed sleep patterns.

More than 150 children and adults have trialled the device and compared it with the best available therapy in diabetes clinics internationally, including the UK, Germany and Austria. Longer-term trials are ongoing, testing the artificial pancreas in newly diagnosed children and adolescents and young children aged 1 to 7 years old.

Families have their questions answered

These genes were either not previously identified or more commonly changes in the DNA of these genes have been identified as causing a specific rare disease.

More than 400 patients and families have directly benefitted from this research as individual mutations or change in these genes have been identified in the participating families. However, the research contribution has been wider as these gene tests are now available to all clinicians across the NHS who can now offer patients a test for these known genes, if appropriate. Cambridge researchers continue to work with partners to understand rare diseases.

Prostate Cancer Diagnostic Pathways

Clinicians at Cambridge University Hospitals have been working with imaging researchers to carry out Magnetic Resonance Imaging (MRI) targeted prostate biopsies (needles into the prostate to retrieve samples), using MRI-Ultrasound image fusion software.

In 2011, Cambridge was the first centre in the UK to use this technique routinely in the clinical setting, for repeat biopsy in high-risk patients. This practice was subsequently adopted in the 2014 update of the NICE guidelines for prostate cancer. Cambridge researchers developed the Ginsburg group guidelines on how to perform targeted ‘transperineal biopsy’ to allow standardisation of the technique.

The traditional diagnostic pathway of prostate cancer has been changed since 2015; prior to intervention, men now have the MR imaging before undergoing a biopsy.

This pathway has provided clinicians an improved way to identify cancerous tumours in the prostate and has reduced the number of invasive samples being taken and in some cases avoiding a biopsy altogether.

This has allowed clinicians to “get it right first time” and is helping men to be diagnosed faster and start treatment earlier. The Anglian Network Cancer Group has adopted this practice as its Prostate Best Practice Pathway, and NICE have suggested that this practice will form part of their updated 2018 guidelines for prostate cancer diagnosis and management.

Genetic variants found that determine severity of Crohn’s disease

One of the biggest challenges that doctors face in treating Crohn’s disease is that the behaviour of the disease can vary considerably between people, with some experiencing very aggressive disease and others having a much milder form. It was previously thought that the more variants people had, the more likely they would be to have a more aggressive form of Crohn’s disease, but Cambridge researchers have shown that this is not the case.

By comparing the genomes (the complete set of all the genes) of more than 2,700 people who have either mild or aggressive Crohn’s disease, the researchers showed that while there were variants that influenced prognosis, these were different from the variants that caused the disease to develop in the first place.

Finding that the genes involved in determining disease course differ from those that cause Crohn’s disease to develop has wide-ranging and important implications. It suggests, for example, that the best targets for new therapies might not be the pathways that have previously been thought to be important in Crohn’s disease, but rather new pathways in which the prognosis-associated genes are involved. This work – to better understand how these genes might alter prognosis – is ongoing and should provide better ways of treating Crohn’s disease in the future.

New ways to manage vasculitis

B-cells are a type of white blood cells that can produce harmful auto-antibodies which attack the body tissue. This can lead to conditions such as vasculitis, when the immune system attacks blood vessels and it can be serious in some people.

Cambridge researchers have looked at the effect of depletion of B cells with a drug called Rituximab.

Through pilot and controlled studies, researchers have looked at the long-term benefit of Rituximab and how this drug would suit patients with vasculitis. This has led to rituximab being accepted into the NHS commission guidance and national guidelines.

Do I upload recruitment activity in Edge or CPMS?

Unless your study is an EXCEPTION, all your recruitment activity should be uploaded into Edge only – there should be no duplication of data entry.

If you are working on an exception study, you should already be aware and know where and to whom you should be sending recruitment activity. If you need assistance with whom you should be sending recruitment activity to for an exception study, please email: cuh.edge@nhs.net

Not sure if your study is an exception study? Please click on this spreadsheet (updated 09.12.19), which lists the studies currently open at Cambridge University Hospitals and whether their recruitment activity needs to be uploaded to Edge (LPMS) or CPMS.

This spreadsheet is not accurate by status of study, but raw data only to indicate the method that recruitment activity needs to be uploaded (EDGE or CPMS). This list will be updated monthly.

If the study you are looking for does not appear on the list, or you need further assistance, please email cuh.edge@nhs.net.

REMINDER:

  • You should upload recruitment activity for portfolio studies to Edge
  • Unless your study is listed as an exception (see spreadsheet)
  • Do NOT duplicate data by entering it into both Edge and CPMS

Edge seminar updates

New dates will be confirmed soon.

Click on the link to register your interest.

These are informal sessions that last no more than an hour and include:

  • Short introduction to the changes
  • Video Presentation
  • Key FACTS: What you need to know
  • Q&A Session
  • Details of how to book further Edge training

All research staff must attend one of these drop-in sessions, if they haven’t already done so. The sessions apply to all research staff.

If you have any questions or would like to find out more please contact the email below.

Edge Learning Resources

  • What is research activity data? (5:58 mins)

  • Watch the short video below to find out about changes to the way the CRN captures research activity data through LPMS/CPMS (4:08 mins)

Please note that the bitly links (which we use to shorten URL links) in the below resources are case sensitive.

Useful links and additional information

Events and films

Events / presentations

Presentations by event organisers or NIHR representatives taking place within NIHR-hosted events must be on the correct NIHR slide template. For all NIHR fully- or part-funded or sponsored events, you should notify the BRC Communications team at least 28 days prior to the event. All promotional materials for these events should include the correct NIHR / sub-logo. Any promotional materials must be sent to the BRC Communications team for sign off.

Films

If you produce a film which features research funded or supported by NIHR Cambridge BRC, CRF or BioResource, the title page should include the appropriate NIHR logo. It should also include an acknowledgement and a disclaimer (see above drop-down section for sample text).

The BRC Communications team should be notified at the start of the filming project and kept up-to-date with progress. They will also need to see the final version of the film and notify NIHR Central Commissioning Facility (CCF) for sign-off.

Consent

If you wish to film, photograph or interview research participants or members of staff to use on communication materials, they must first give their written consent.

Please contact your organisation’s communications department for the required consent forms or contact the BRC Communications team. The participant must also receive a copy for their records so they know who to get in touch with if they wish to withdraw their consent.

Press releases

Your press release must include an acknowledgement of NIHR support, notes to editors and a disclaimer. See below for example wording.

NIHR Cambridge BRC Acknowledgement

If the NIHR Cambridge BRC has supported a research project, it should be named in the first or second paragraph of a press release and spelt out in full at the first mention (after which abbreviations may be used, eg:

      1. “Researchers supported by the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre (BRC) have…” or
      2. “National Institute for Health and Care Research (NIHR)-funded researchers at…”

Notes to editors:

Notes to editors are included after the press release and provide information that may be of relevance/interest to journalists.

Please cut and paste the following:
    • About the National Institute for Health and Care Research The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

      • Funding high quality, timely research that benefits the NHS, public health and social care;
      • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
      • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
      • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
      • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
      • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

      NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.

    • About the NIHR Cambridge Biomedical Research Centre Based within the most outstanding NHS and University partnerships in the country, the Biomedical Research Centres are leaders in scientific translation. They receive substantial levels of funding from the National Institute for Health and Care Research (NIHR) to translate fundamental biomedical research into clinical research that benefits patients and they are early adopters of new insights in technologies, techniques and treatments for improving health.

Disclaimer:

Always include the following:

    • The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Patient data use:

If you have used patient data in your research, you must also include in your Notes to editors a statement on patient data use:

    • This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. www.nihr.ac.uk/patientdata

Attachments:

If a research paper or report is the subject of the press release, a copy of the research paper/ report must be included, as well as suitable images.

If you are representing an NHS Trust or university check their templates for example wording on what to include for their respective organisations in Notes to Editors.

Displaying the NIHR identity correctly

Logos

The NIHR logo is the most important element of the revised NIHR identity. It now appears on the top left of all NIHR materials and no longer carries the NHS lozenge: NIHR infrastructures now have an individual logo (a ‘sub-logo’) which carries the NIHR abbreviation and name of site in full on the right-hand side (see below). alt=""

When to use the main NIHR logoalt=""

  • All NIHR logos now appear in the top left-hand side of the publication / webpage
  • You work for an NIHR organisation but the materials you are producing represent a collaboration between two or more NIHR organisations (e.g. NIHR Cambridge BRC and NIHR Cambridge CRF)
    • Refer to individual parts of the NIHR in your body copy

When to use the NIHR sub-logo

  • You work for an NIHR organisation and the materials you are producing promote research that the NIHR organisation you are representing has fully or partly supported or funded
  • Other partners’ logos (provided they are not also part of the NIHR) may be included if applicable, but cannot be bigger than the NIHR sub-logo
  • The sub-logo must appear in the top left-hand side of the publication / webpage

When to use the NIHR logos in partnership with other organisations 

  • The NIHR logo should be in equal proportion to the logo of its partners, but its position will depend on whether:
    • NIHR is a leading partner (i.e. the main single funder). The NIHR templates should be used with the NIHR logotype positioned top-left on the front page of corporate communication materials, OR:
    • The NIHR is a secondary partner (i.e. not the main funder). The logo can be positioned preferably bottom left on the front page

When to use the NIHR Funded/ Supported logos

  • You do not work for or are paid by the NIHR, but the research that you are promoting in your materials has been wholly or partly funded or supported by the NIHR (including Cambridge BRC)
  • Use your host institution’s templates such as posters, powerpoint presentations etc
  • Mention NIHR Cambridge BRC in the body of the text
  • Use either the NIHR Funded / Supported logo as appropriate towards the bottom
  • Include a relationship statement and disclaimer (see acknowledgement section, above) in the bottom half of your material
  • NEVER use the Funded / Supported logos in document headers or to displace the leading brand on materials
  • Examples of where these logos can be used include: study recruitment materials, communications and research dissemination materials, websites, social media, presentations, consent forms and patient questionnaires

Templates

NIHR templates should only be used if you are representing the NIHR and include posters, presentations, banners, business cards and letters.

To find out more about how to access templates, download logos and read more on the NIHR brand identity guidelines, contact our comms team at: cuh.brccomms@nhs.net

Download the NIHR Cambridge BRC poster template:

Acknowledgement statement and disclaimer

***IMPORTANT: You must send a copy of the paper/article/output to BRCcomms@addenbrookes.nhs.uk 14 days before it is due to be published so it can be recorded and sent to NIHR for review.***

If you are publishing research findings:

When submitting a paper, article or report for publication you must include:

  • The relationship statement:
    • The NIHR Cambridge Biomedical Research Centre (BRC) is a partnership between Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge, funded by the National Institute for Health Research (NIHR), AND:
  • The relevant funding acknowledgement:
    • This research was funded by the NIHR Cambridge Biomedical Research Centre (BRC)
    • This research was co-funded by [insert name of co-funder] and the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre (BRC)
    • This paper presents independent research funded [and/or] supported by the NIHR Cambridge BRC, OR:
    • [Insert name of author(s)] is / are supported by the NIHR Cambridge Biomedical Research Centre (BRC)
      • Please note this will apply to you if:
        • You are a PhD student supervised by a BRC Theme / Programme Lead
        • You have used BRC infrastructure but no BRC funding
  • The following disclaimer must also be included: The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

These statements may be placed in either the acknowledgement or funding section of a publication. It can also be placed in supporting information provided there is a linking statement in the main publication. It is not sufficient to place only in author’s affiliations.

Other research outputs (for example, posters, presentations):

Include the appropriate funding acknowledgement shown above and the disclaimer. If you are representing an NHS Trust or university, use their templates and the NIHR ‘funded’ or ‘supported’ stamps. If you are representing the NIHR please use their own templates for marketing materials.

Please also refer to the ‘Displaying the NIHR identity correctly’ section below.

Need help?

Please email the final draft of all publications to us so we can check the acknowledgements prior to submission.

Acknowledgement audits

The NIHR Cambridge BRC management team undertakes regular audits of publications from researchers who have used NIHR facilities to ensure that appropriate acknowledgements have been included.

In circumstances where we have not been appropriately acknowledged when support has been provided/utilised, we may ask researchers to issue errata at their own cost to relevant papers in order to ensure that NIHR acknowledgements are always included where necessary.

When do I need to acknowledge NIHR Cambridge BRC?

Research outputs can include publications, press releases, newsletter articles, websites, presentations, posters and participant materials.

Acknowledgement of BRC funding is an important contractual requirement and a condition of your funding. We maintain regular reports on publication acknowledgements and this information may be used to guide future funding decisions.

Furthermore, acknowledgements are used as a metric by the Department of Health & Social Care to justify future budgets and therefore help ensure continued funding to support clinical research projects and infrastructure.

The NIHR Cambridge BRC not only directly funds projects and staff: we also support essential clinical research infrastructure at Cambridge University Hospitals, including technology platforms, key NHS support services, research nurses, administrators, clinical trials infrastructure and governance support.

Therefore, if your research is translational or clinical in any way, it is supported – either directly or indirectly – by the NIHR and you MUST acknowledge this is all your peer-reviewed publications, press releases and promotional materials.

Evidence-based web tool aims to help inform treatment options in early prostate cancer

Vincent GnanapragasamPREDICT Prostate has been developed by researchers at the University of Cambridge, led by Mr Vincent Gnanapragasam (pictured, right), University Lecturer and Honorary Consultant at Cambridge University Hospitals, and undertaken by Dr Thurtle, both of the Academic Urology Group in Cambridge, and in collaboration with Professor Paul Pharoah of the Department of Cancer Epidemiology.

The tool brings together the latest evidence and mathematical models to give a personalised prognosis, which aims to empower patients as they discuss treatment options with their consultant.

Mr Gnanapragasam said: “We believe this tool could significantly reduce the number of unnecessary – and potentially harmful – treatments that patients receive and save the NHS millions every year.”

Risk classification

Progression of prostate cancer is variable: in most cases, the disease progresses slowly and is not fatal. But in a significant number of men, the tumour will metastasise (spread to other organs in the body), threatening their health.

When a patient is diagnosed with prostate cancer, they are currently classified as low, intermediate or high risk, according to guidelines provided by NICE (the National Institute for Health and Care Excellence).

Depending on the patient’s risk group, clinicians will recommend either an ‘active monitoring’ approach or treatment. Treatment options include radiotherapy or surgery and can have potentially significant side-effects, including erectile dysfunction and urinary incontinence.

But the risk classifications have been shown to be only 60-70% accurate – meaning many men may elect for treatment when it is not necessary.

What PREDICT Prostate does is take routinely available information including PSA test results, the cancer grade and stage, the proportion of biopsies with cancerous cells, and details about the patient including his age and other illnesses.

It then gives a 10-15 year survival estimate. Importantly, the tool also estimates how the patient’s chance of survival differs depending on whether he opts for monitoring or treatment, providing context of the likelihood of success of treatment and risk of side effects.

  • In a randomised study of almost 200 prostate cancer specialists, those clinicians given access to the PREDICT tool were less likely to recommend treatment in good-prognosis cancers
  • The tool is recommended for use only in consultation with a clinician. It is not suitable for men with very aggressive disease or who have evidence of disease spread at the time of diagnosis
  • Every year, tens of thousands of men are diagnosed with prostate cancer. But what should they do? Listen to Vincent Gnanapragasam’s interview with the Naked Scientists

New device could improve safety of routine testing for prostate cancer

Clinicians currently diagnose patients using a technique called trans-rectal ultrasound, which is where a small ultrasound probe inserted into the back passage. However, this method can be unpleasant, and have side effects such as urinary infections or risk of sepsis.

Cambridge researchers have devised a new tool, called the CamProbe, that allows biopsies to be taken via the transperineal route (under the scrotum) where a sample of tissue is removed from the prostate for examination under a microscope. This can be done under local anaesthesia.

No infections were detected using this technique in the pilot studies, compared with the 5-12% using the standard method, and most trial participants preferred the CamProbe test.

Now with further funding, clinical trials are underway to test the device on larger numbers of patients. If the results are positive, it will substantially improve the safety of routine testing for prostate cancer, reduce the risk of sepsis and antibiotic resistance and potentially save the NHS millions every year.

Detecting cancer with a ‘pill on a string’

Early detection of this type of cancer requires a referral for an endoscopy, where a camera is fed through your mouth to your stomach, which can be uncomfortable for some people and is expensive for the health service.

However, researchers in Cambridge have come up with a new way to collect cells from the oesophagus to test for cancer, which is easier and less uncomfortable than an endoscopy and importantly can be performed in the GP surgery. The device, known as the cytosponge or ‘pill on a string’, only takes a few minutes to use and can be done outside of a hospital setting.

Patients are asked to swallow a small capsule (about the size of a multivitamin pill) which is attached to a string. When it gets to the stomach the capsule disintegrates and releases a small sponge. The sponge is then pulled back using the string, collecting cells as it comes up the oesophagus which can be sent off for testing. The team have also devised the laboratory test to make the testing as fast and accurate as possible.

The cytosponge is now in its third stage of trials at GP practices and results are expected within a year. Early tests have shown them to be effective at detecting Barrett’s oesophagus. If trials continue to show positive results, the device could provide more patients to be tested for the possibility that they have Barrett’s oesophagus.

This means testing can take place in the community, identifying those who have suspected Barrett’s oesophagus faster and reducing the number of those who require an endoscopy. The cytosponge could revolutionise testing and save the NHS money.

Find out the journey of the timeline from an idea to now a a new diagnostic tool to detect Barrett’s oesophagus.

 

Looking at lung cancer without surgery

The standard way to assess how far lung cancer had spread involved invasive surgery to count the number of chest lymph nodes that the cancer had spread to. This approach was not very sensitive and required the patient to undergo surgery.

Cambridge cancer researchers led the international NIHR Cambridge BRC and NIHR Health Technology Assessment ASTER trial. Using an alternative, non-surgical approach called endosonography (an endoscopy combined with ultrasound to obtain images of the internal organ), the procedure was found to be more accurate, a safer way to assess the spread of the lung cancer and also gave patients a much better quality of life.

Not only are the results to using endosonography more accurate, but is also much cheaper than a surgical procedure. As a result this new approach has replaced surgery as the front line test for lung cancer spread and over 100 centres now provide this service in the UK, cutting the rate of surgical lymph node staging in the UK from 3,020/year in 2010 to 1,854 in 2015.

Improving dialysis for kidney patients

People with end-stage kidney disease require a kidney transplant but as there is a waiting list for suitable kidneys, they also need regular dialysis treatment.

Haemodialysis, where you are hooked up to a machine which flushes the excess fluid and toxins from your blood, it is the most common form of dialysis and one of the ways to receive it is via an AVF.

This is created by joining a small artery to a vein in the patient’s arm. It is less risky than inserting lines into bigger veins, reduces infection and is more popular amongst patients.

But nearly half of all AVF surgeries fail in the first year – and researchers want to investigate what causes them to fail.

The SONAR trail will use ultrasounds to scan patients, who have recently had the AVF surgery, over 10 weeks to find out more about how AVF grow and also to see if problems can be detected earlier, potentially reducing the failure rate and also the need for further surgery.

Increasing the number of organs available for transplantation

Previously it was believed that organs from circulatory death donors were inferior to those from brain death patients.

This has enabled clinicians to address the severe shortfall in organs available for transplantation, and now circulatory death kidneys account for one-third of all kidney transplants performed in the UK.

BRC researchers have also introduced the practice of sampling kidneys taken from older donors prior to transplantation, allowing them to be examined under the microscope to assess the health of the organ. This helps clinicians decide whether to use these kidneys, potentially reducing the number unnecessarily discarded. This practice is now being examined in a national trial.

Could biopsies of donor kidneys help reduce waiting lists?

A lot of kidneys are often rejected as they are seen as unsuitable for transplantation, due to the donor’s age or the fact that they had a serious health condition.

To address the shortage, researchers have developed a new tool to analyse kidneys to see if they are suitable for transplantation – including those which have been initially rejected because the donors were too old or too ill.

In the largest study of its kind, researchers showed that conducting pre-implantation biopsies to assess the quality of the kidneys can help surgeons determine whether they are suitable for surgery.

There are now proposals to bring these biopsies into routine practice for kidney transplants, so more procedures can be carried out, reducing the number that are discarded. This could lead to reducing waiting times for kidney transplants and save hundreds of lives.

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