Evidence-Based Health Care

Professor Kamal Mahtani continues his interview with Professor Carl Heneghan, discussing where your motivation as a leader comes from, succession planning, seeking mentoring, how leaders can engage with the wider world. Plus strategies for managing your work life balance.

Professor Kamal Mahtani interviews Professor Carl Heneghan, exploring his leadership; how it all started, the challenges he has faced, emotional intelligence, the importance of clear communication and being a tortoise rather than a hare as a leader.

Dr Rob Salguero-Gomez, Associate Professor in Ecology, Department of Zoology, gives a talk on lessons for a longer, better human life for the EBHC podcast series.

Recent results of the NELSON Lung Cancer Screening Trial reports reductions in lung-cancer survival but not overall survival - The desire to detect disease even earlier means Overdiagnosis is on the rise. However, the interpretation of screening trial results is problematic and often gives rise to significant uncertainties that go unanswered.

Carl Heneghan, Professor of Evidence-Based Medicine, employs evidence-based methods to research diagnostic reasoning, test accuracy and communicating diagnostic results to a wider audience.

This talk was held as part of the Evidence-Based Diagnosis and Screening module which is part of the MSc in Evidence-Based Health Care and the MSc in EBHC Medical Statistics.

Dr Jamie Hartmann-Boyce discusses a case study of systematic reviews of electronic cigarettes for smoking cessation, looking across meta-analyses in this area. Dr Jamie Hartmann-Boyce is Senior Researcher, Health Behaviours team at the Nuffield Dept of Primary Care Health Sciences.

Should doctors with commercial interests lead research on their products? Should we forget ‘conflicts’ and discuss ‘declarations of interest’ instead? Who should hold and maintain conflicts of interest registers for doctors? Should practicing doctors work with the pharma industry as well as serve on guideline committees? Should researchers with extensive financial interests be disqualified from studies of their own products?

The Physician Payments Sunshine Act requires US manufacturers to collect, track and report all financial relationships with clinicians and teaching hospitals. Professor Heneghan will discuss the failings with the current system of reporting of conflicts in medicine, what’s been tried so far, and why it is time for a UK Sunshine Act.

Carl Heneghan, Professor of Evidence-Based Medicine, employs evidence-based methods to research diagnostic reasoning, test accuracy and communicating diagnostic results to a wider audience.

This talk was held as part of the Practice of Evidence-Based Health Care module which is part of the MSc in Evidence-Based Health Care and the MSc in EBHC Systematic Reviews. Members of the public are welcome to attend.

 

Professor Karla Hemming discusses using evidence-based policy in the evaluation of policy interventions and answers the question 'how useful is the stepped-wedge study as an evaluation design? Professor Karla Hemming is the Professor of Biostatistics at the Institute of Applied Health Research, University of Birmingham.

Professor Bruno Marchal gives a talk illustrating the principles of realist evaluation using the case of the development of a new Tuberculosis control policy in Georgia. The talk focuses specifically on the central role of the programme theory, how this theory was developed and how it informed not only the policy, but also the study design.

Professor Bruno Marchal is Associate Professor at the Health Systems and Equity unit, Department of Public Health, Institute of Tropical Medicine, Antwerp.

The logic and principles behind the drive for evidence-based health care are so compelling that often the limitations of evidence go unacknowledged. Despite a strong evidence base demonstrating the health risks associated with higher body weights, and health professionals routinely instructing patients to lose weight to improve their health, the incidence of obesity is predicted to continue to rise. Calling on his research into the relationships between obesity, inequality and health, Oli Williams - a fellow of The Healthcare Improvement Studies Institute - will argue that when it comes to reducing the burden on, and improving, health care a more critical approach to the way we generate, select, apply and communicate evidence is needed.

Oli Williams completed his PhD in the Department of Sociology at the University of Leicester. He was subsequently awarded the NIHR CLAHRC West Dan Hill Fellowship in Health Equity which he held at the University of Bath. He later re-joined the University of Leicester in the Department of Health Sciences working in the SAPPHIRE Group and is now based at King's College London after being awarded a THIS Institute Postdoctoral Fellowship. His research focuses on health inequalities, the promotion of healthy lifestyles, obesity, weight stigma, equitable intervention and co-production. He co-founded the art collective Act With Love (AWL) to promote social change. The Weight of Expectation comic is one example of their work, view others at: www.actwithlove.co.uk In recognition of his work on weight stigma the British Science Association invited Oli to deliver the Margaret Mead Award Lecture for Social Sciences at the British Science Festival 2018.

This talk was held as part of the Qualitative Research Methods course which is part of the Evidence-Based Health Care Programme.

The increased reliance of health systems on the digital record as the primary mechanism for storing data on consultations and other health interactions has opened new opportunities for research, healthcare innovation, and health policy. The electronic health record (eHR) is now ubiquitous in many countries, in hospital and primary care settings, and in some countries their health systems in terms of reporting patient care activity are essentially 'paperless'.

Health systems globally are also facing accelerating challenges as they seek to deliver better value healthcare against the background of increasing levels of chronic disease, ageing populations, financial pressures and demands on public spending. Digital health tools and services are held up to be part of the solution to these challenges, potentially offering low-cost and patient-centred solutions.

There has been huge investment in Big Data research in health, particularly in relation to digitised imaging and automated reporting and predictive modelling using phenotypic and increasingly genetic data. There have also been similar gains in more applied research that explores the potential of accessing the huge quantum of data held in the eHR, and linkage of these data to other national or regional databases, such as mortality records or cancer data. This session will explore some of the applications for routine data research, illustrated by projects that have resulted in research success and better healthcare.

This will include the exemplars of using large eHR platforms and prescribing data platforms to create infrastructure for i) common disease surveillance, such as the UK RCGP RSC; ii) generation and validation of disease risk assessment tools, such as QRisk scores; iii) pragmatic electronic follow up trials; iv) within practice systems dashboard feedback reports, eg data normalised to regional and national rates on prescribing and investigation physician activity; v) traditional epidemiological linkage studies; and vi) linkage to long term phenotypic follow up of established disease cohorts.

Richard Hobbs is Nuffield Professor of Primary Care at the University of Oxford, and Head of the Nuffield Department of Primary Care Health Sciences. He has served a decade as National Director of the National Institute for Health Research’s School for Primary Care Research and was Director of the NHS Quality and Outcomes Framework (QOF) Review panel from 2005-09. He has served many national and international scientific and research funding boards in UK, Ireland, Canada, and WHO, including the BHF Council, British Primary Care Cardiovascular Society, and the ESC Council for Cardiovascular Primary Care. He currently chairs the European Primary Care Cardiovascular Society, a WONCA Special Interest Group.

He is one of the world's leading academics in primary care, and has developed at Oxford one of the largest and most highly ranked centres for academic primary care globally. He has also made major contributions to growing primary care academic capacity, in terms of people development and research networks. A highly cited primary care clinical scientist, he has authored over 450 peer reviewed publications, has an h-index of 90, with over 63000 citations (36000 since 2013) and 81 papers cited over 100 times, 14 papers cited over 1000 times and 7 papers with over 2000 citations. He has an outstanding track record in cardiovascular research, delivering trials that changed international guidelines and practice, especially in the areas of stroke prevention in atrial fibrillation (BAFTA, SAFE, and SMART trials), heart failure burden and diagnosis (ECHOES and REFER trials), and hypertension self-management (TASMINH series). He is only the fifth ever recipient of the RCGP Discovery Prize in 2018 (an occasional award made since 1953) and received an inaugural Distinguished Researcher Shine Prize plus Best Presentation Prize at the WONCA World Congress in 2018. He was awarded a CBE for services to medical research in the 2018 New Year's Honours.

This talk was held as part of the Big Data Epidemiology course which is part of the Evidence-Based Health Care Programme.