Reducing deaths among older patients with NSTEMI heart attacks through invasive management
Invasive procedures to treat a type of heart attack called non-ST elevation myocardial infarction (NSTEMI) include angiography (injecting
dye through a long tube into the heart’s blood vessels for x-rays to reveal blockages) and revascularisation (widening of narrow or blocked
arteries). Randomized trials showed that invasive procedures reduce deaths after NSTEMI, compared with non-invasive approaches.
However, the trials included few elderly patients. Lack of evidence in elderly patients means they may receive unequal access to life extending treatment.
What translational research was done?
The NIHR Health Informatics Collaborative (HIC) combines detailed linked electronic health record data across NHS Trusts. Analysing such data for translational research requires specialist expertise. The NIHR HIC started as a collaboration between the five largest BRCs,though not all contributed to the cardiovascular dataset, managed by Imperial BRC. Working closely with Information Management at University Hospitals Bristol and Weston NHS Foundation Trust, we created a detailed cardiovascular dataset that was combined with those from other Trusts. We developed methods to estimate the effect of invasive compared with non-invasive management of NSTEMI. We accounted for ‘confounding’ (presence of common causes of intervention and outcome) and ‘immortal time bias’ (where, during the period of observation, there’s some interval when the outcome can’t happen: a problem here because there’s no fixed time when invasive intervention happens).
Read the full story (pdf format)
Analysing CBT approaches for depression to inform a new integrated treatment
Cognitive behavioural therapy (CBT), a form of talking therapy, is an effective treatment for depression. However, some patients can’t get face-to-face therapy because it’s expensive and there’s a lack of therapists. Online CBT was designed to address this, but people haven’t tended to engage with it. Integrating face-to-face CBT with online materials could improve access, while costing less than face-to-face and being more effective than online alone.
What translational research was done?
The INTERACT study aimed to develop an integrated CBT approach, which would then be tested in a major trial. We developed new ways to combine and analyse data across randomized control trials (RCTs) on CBT treatments, to explore which aspects of the treatments are most effective. RCTs are the gold standard of research studies.
Read more about the translational research (pdf format)
An effective healthcare response to domestic violence and abuse
Domestic violence and abuse (DVA) is a major public health problem which needs a better response from healthcare. Most clinicians aren’t sufficiently trained to identify when patients are experiencing abuse or properly manage a disclosure.
What translational research was done?
We conducted studies on the prevalence and mental health impact of domestic abuse1 , alongside systematic reviews of DVA interventions. We showed that more effective support was needed,
particularly in primary care.
Read more about the research and work with DVA organisations (pdf format)