Future Funding and Projects
Prof D. Menon,
Cambridge
At the Oxford meeting of NccNet stakeholders, we addressed the issue of finding funding to underpin the collaborative network. In the long run, we would hope that the data collection for risk adjustment would be recognised by the Department of Health as a clinical governance need (as with ICNARC at the moment). However, we need to show that such data effectively aid robust risk adjustment. The research that underpins this demonstration is the basis of a collaborative study currently being considered for funding by the Health Technology Assessment (HTA) Program – RAIN.
Risk Adjustment in Neurocritical Care (RAIN)
The HTA application, which is entitled Risk Adjustment in Neurocritical care (RAIN) seeks to evaluate and refine existing models of risk adjustment in Traumatic Brain Injury (TBI). The study is based at ICNARC, and NccNet is a key stakeholder. The project seeks to collect clinical and imaging data on 3,400 patients with TBI who require ICU admission, either in District General Hospitals, or in Neurosciences centres. All recruited patients will have a postal Glasgow Outcome Score at follow up. The planned start date for the project is September 2008, with the first patients recruited in January 2009, and follow up completed June 2010. Publications are expected to emerge in early 2011.
The collaboration that is activated by RAIN will provide the data collection framework on which further studies will be built. The aim is to maximise clinical audit and research in neurocritical clinical populations, so as to ensure that the best available evidence is being translated into clinical practice, and where such evidence is not available, we try our best to acquire it through high quality multicentre studies. We envisage applying for additional funding for such subsequent studies in an open and collaborative manner, which will replicate the success enjoyed by the Canadian Critical care Network. Individual members of NCCnet would propose ideas for research which will be discussed openly, refined and then submitted as funding proposals, lead by the centre or individual that was responsible for their development. We hope that the mechanisms by which these proposals reach maturity will maximise our chances of funding success:
• Topics for research will emerge from analyses of existing data, or through analyses specifically undertaken to underpin proposed studies.
• An additional underpinning will be provided, wherever appropriate, by a systematic review of the available evidence – in some instances this will be undertaken as a preparatory publication by an NCCnet member.
• We would use the NCCnet collaboration to drive the collection of pilot data or epidemiological data which strengthened the case for the study.
•The grant proposal would be developed accounting for ongoing competing studies, thus ensuring timely completion of projects, but also ensuring equity of access to patient populations.
•Wherever possible we would try to make the best use of patient populations, by interleaving studies that are complementary and synergistic. This would allow for simultaneous observational studies.
Other ongoing trials
We will also keep members informed about current or emerging multicentre studies which they may wish to participate in. To address this in the current context, there are two interventional studies either currently running or on the horizon:
RESCUEicp : A randomised trial of decompressive craniectomy for refractory intracranial hypertension in TBI. (www.rescueicp.com; Funded by MRC, PI: Peter Hutchinson, Cambridge). Study ongoing, target 600 subjects, currently recruited 146 patients.
EuroTherm: A planned randomised trial of hypothermia in TBI (funded by ESICM; PI Peter Andrews, Edinburgh). Protocol being finalised; details will appear on the NCCnet website.
