Clinical Innovation
New technological and clinical advancements have the potential to not only improve patient outcomes, but to reduce pressures on the health system. PIHR researchers are working on the cutting edge in many areas of practice with respect to clinical innovation, from hospital-based/specialist care through primary care and community services.
Cancer

As well as investigating the underlying mechanisms by which cancers are initiated and propagate (Frontiers in Discovery Science), our researchers are involved in the development of new approaches for the early diagnosis, screening, treatment and prevention of a variety of cancers and understanding the impact and effectiveness of frontline treatments on practice.

Highlights include the identification of biomarkers which will help predict patient response to treatment (Hanemann, Hutchinson); novel therapeutics for lymphoma (Hutchinson); and the prevention and treatment of oral and skin cancers (Bing Hu).

Although effective drug protocols exist for some cancers, many cancers remain untreatable. Researchers in The Jarvis Lab are developing a novel cancer vaccine that targets ‘universal’ tumor-associated antigens (TAAs) as a therapeutic vaccine against cancer for both humans and canine companion animals.

Diabetes

Research supporting the evidence based management of people with diabetes is an important focus of the Rehabilitation Research Group. The Balance Enhancement and Ulcer Prevention (BEUP) group is an academic/NHS multidisciplinary collaboration, which aims to translate the results from our published research to influence and inform everyday clinical practice with respect to diabetes and neuropathy.

Applying specialist knowledge of diabetic foot self-care and education and ulcer prevention and management with focus onfoot pressure analysis, orthotic design and balance problems the team is developing and testing a battery of interventions to make walking safer for people with diabetes.

Highlights in applied research include an automated 3D-printed insole, a novel balance enhancement insole and a clinical trial testing pressure data guided insoles (Paton, Marsden, Collings).

Co-Chief Investigators Plymouth's Professor Jonathan Pinkney and Exeter's Dr Mark Tarrant are exploring how treatment outcomes for people with severe obesity can be ImPROved by GROUP-based behavioural intervention (PRO-GROUP). This work, funded by the NIHR and supported by PenARC, investigates the experiences of those who have been unable to lose weight using other services but are not ready or prefer not to have bariatric surgery and examines how Tier 3 services can be optimised.

Dietetics in primary care

As part of the Dietetics, Human Nutrition and Health group, Professor Mary Hickson, Dr Avril Collinson and Dr Jenny Child have explored new ways of working to manage malnutrition and frailty and childhood allergy in GP surgeries. They have also explored how dietitians can successfully take on a first contact practitioner role.

Find out more about the work of the group

Intensive care medicine

Professor Daniel Martin’s main research interest is oxygen physiology, in particular how humans adapt to low levels of oxygen and the potential harm caused by excessive oxygen. In the NIHR-funded UK-ROX trial, he is evaluating whether giving a little less oxygen than usual to critically ill patients on a mechanical ventilator will improve their survival. The EXAKT study investigates the accuracy of pulse oximeters in critically ill patients with different skin tones, to answer a very important question about these essential oxygen monitoring devices. Daniel is also exploring the use of exercise to improve clinical outcomes, including in patients awaiting liver transplantation and bariatric surgery.

Liver disease

The Hepatology Research Group works with the South-West Liver Unit, at Plymouth Hospitals NHS Trust, providing a full range and secondary, tertiary and community Hepatology services to the South West region, including assessment for liver transplantation, TIPS and liver cancer therapy. The research team runs several commercially sponsored clinical trials in hepatitis C therapy, non-alcoholic steatohepatitis (NASH), primary biliary cholangiopathy (PBC), alcoholic liver disease and liver failure amongst others, through the clinical research facilities of The Lind Research Centre at Derriford Hospital.

Paediatric health

PIHR has significant research expertise in paediatric nursing, streams including child and family centred care (International Network for Child and Family Centred Care, co-Chaired by Neill), patient and family witnessed resuscitation, end-of-life care, paediatric sepsis, patient and family reported outcome measures and clinical care improvement (Latour); and the presentation and management of acute childhood illness in children under five years of age, predominantly in the home and in first contact health services, such as primary care and urgent and emergency care (Neill).

We host ASK SNIFF, a programme of research developing video based information resources to help families with young children understand signs and symptoms of acute illness so that they can spot when their child is sick.

The Dietetics, Human Nutrition and Health group researches the nutritional management of disease in childhood. Prominent projects include the CORE-KDT study which aims to identify a list of the most important outcomes to measure for children with epilepsy treated with the ketogenic diet.

Research often uses seizure control and the side effects of a ketogenic diet as the main way of assessing ketogenic diet therapy (these are known as ‘outcomes’). However, we also think it is vital to consider outcomes that are important to the children receiving treatment and their parents. Other outcomes may include measurements of physical health, mental health and quality of life, to name a few.

The institute also incorporates multi-disciplinary research into children with long term and acquired neurological conditions including Down Syndrome, Cerebral Palsy, Ataxia and Posterior Fossa Tumour (Marsden, Bunn). NIHR funded research, partnering with Alder Hey (the ASPECT trial) has acted to validate outcome measures for use in rehabilitation of balance (Bunn) and evaluate a ‘hospital to home’ exergaming intervention (collaborating across 5 NHS sites before and during the COVID19 pandemic). A large multi-disciplinary team are currently engaged in co-producing guidelines for allied health and nursing care of children with a rare neurological condition called Ataxia Telangiectasia (Bunn).

Mental health

The Community and Primary Care Research Group carries out a range of mental health research in community-based settings. Examples include: Partners 2, an NIHR funded Programme designed to help primary care and community based mental health services work more closely together by developing a system of collaborative care based in GP surgeries for people with schizophrenia and bipolar disorder (Byng, Williams, Hobson-Merrett); the evaluation of community pilots designed to provide more effective care to the client group who do not meet the threshold for secondary mental health services but are deemed inappropriate for primary care services such as IAPT; PHASED, a study examining research on physical activity in relation to alcohol and substance use disorders (Thompson); and Flourish in Nature, a project supporting alcohol and drug use recovery through volunteer opportunities in natural environments (Thompson).

Rehabilitation

The Rehabilitation Research Group specialises in clinical trials evaluating a range of physical rehabilitation interventions, typically delivered within the NHS, and aimed at improving the function and wellbeing of people with multiple sclerosis (Freeman, Marsden, Gunn, Andrade), balance enhancement and ulcer prevention in diabetes (Paton, Collings); and orthotic management (Freeman).