Barts and The London School of Medicine and Dentistry • Queen Mary, University of London • Winter 2010/11
raising education to new heights of excellence Anthony Warrens, Dean for Education on why Barts and The London School of Medicine and Dentistry is the place to study page 8
Preventing prostate cancer: a major breakthrough page 4
www.qmul.ac.uk
Loving lipids: an interview with Professor Carol Shoulders page 10
Helping London’s trauma patients: a research network in action page 12
1
news
A word from the Warden Welcome to the latest edition of BLnews. We’ve had a busy few months and there is much to report. A visit to New Delhi in November by our Dean for Education to discuss opportunities for increased partnerships between Queen Mary, University of London and Indian HEIs has been an exciting development for the School, one we look forward to progessing. Our research achievements include a major breakthrough in the prevention of prostate cancer, and a revolutionary new technique of diagnosing sexually transmitted infections, plus we trial – together with our NHS partner Barts and The London NHS Trust – a surgical solution to hypertension which is proving a highly effective alternative to medical therapy alone. Professor Anthony Warrens discusses how we are building on our excellent student support system here at Barts and The London School of Medicine and Dentistry by introducing a new academic mentoring scheme, and Professor Carol Shoulders is interviewed about her cutting-edge research into lipidology. Our talented researchers have as ever been recipient of further awards, recognition and accolades. Read about them…and much more, in the following pages. As always we welcome any comments, or contributions for future editions. Professor Sir Nicholas Wright, Warden Barts and The London School of Medicine and Dentistry
If you have any comments or ideas for BL news please contact Alex Fernandes at a.fernandes@qmul.ac.uk
2
WINTER 2010/11
Barts and The London School of Medicine and Dentistry to lead £4.7million Policy Research Unit Barts and The London School of Medicine and Dentistry is to lead a £4.7million Policy Research Unit dedicated to research on cancer screening, symptom awareness and early diagnosis. The funding is provided over 5 years by the Department of Health’s Policy Research Programme. The Unit – to be led by Professor Stephen Duffy – will undertake research to underpin earlier diagnosis of cancers, so enabling more successful treatment and ensuring better survival rates. The research Unit has been commissioned to provide evidence to support the development, implementation and evaluation of Department of Health policy. Its outputs will also assist the work of the NHS Cancer Screening Programme and of the National Awareness and Early Diagnosis Initiative (NAEDI). The remit of the Policy Research Unit will include:
• Studies of cancer awareness and survival • Studies of GP response to cancer symptoms • Studies of the benefits of the NHS cancer screening programmes (cervix, breast and bowel) designed to identify good practice • Assessment of interventions to enhance cancer awareness, improve access to screening and promote diagnosis at an earlier stage Professor Duffy said: “It is a big responsibility to be awarded this programme, but it is also a great opportunity to help develop policies to improve outcomes for cancer patients.” Collaborating in the Unit – and joint recipients of part of the funding – are Kings College London; University College London; the London School of Hygiene and Tropical Medicine; Hull York Medical School; Peninsula College of Medicine and Dentistry, and the University of Durham
Funding boost for health innovation in NE London
Following the news that Barts and The London School of Medicine and Dentistry is to lead a new Health Innovation and Education Cluster (HIEC), the initiative has recently secured new funding for innovation and education in maternity services and lung disease. The HIEC is a collaboration between health and higher education designed to revolutionise patient care and benefit more than six million people in North East London, North Central London and Essex. The new investment, worth £50,000, is via two Regional Innovation Funding
grants for diffusion of innovation. The first is for promoting normal childbirth within maternity units. This project – already up and running across North East London – is partnership with the NHS Institute of Innovation and Improvement and the Innovation Unit. The second is to develop training in the primary care of patients with chronic obstructive pulmonary disease (COPD). In addition HIEC won four pilot projects from the Lung Improvement Program and these are already active across the region with the key goal of reducing hospital admissions for patients with the disease. “We’re also running an event that is looking at creative ways to solve long-standing challenges within the health service – this time looking at the ‘Missing Millions in COPD’,” said Managing Director of the North East London HIEC, Robyn Hudson. HIEC can be found at www.necles. org.uk. Those wishing to get involved should contact Robyn Hudson on robynhudson@hiec.org.uk
news
Surgical solution to hypertension goes on trial A treatment for hypertension involving minor kidney surgery, shown to be more effective in reducing high blood pressure than medical therapy alone, is being trialed at Barts and The London NHS Trust, and Barts and The London School of Medicine and Dentistry.
Together the Trust and School are providing one of the international trial sites – and one of only three in the UK – for the catheter-based treatment whose primary results, published in The Lancet in November demonstrate a substantial and sustained blood pressure reduction.
The study forms part of the Barts and The London’s National Institute of Health Research Unit (NIHR) programme to bring novel treatments into the clinic. It is being conducted through the European Society of Hypertension Centre of Excellence and the William Harvey Research Institute. The first patient in the UK received the innovative procedure at the London Chest Hospital in December 2009. Volunteer patients were recruited from the hypertension clinic at Barts Hospital and from the William Harvey Research Institute’s Clinical Research Centre, part of Barts and The London School of Medicine and Dentistry.
Joint-leaders of the trial were Dr Mel Lobo, Consultant Physician and Clinical Hypertension Specialist and Professor Mark Caulfield, Director of the William Harvey Research Institute and the NIHR Cardiovascular Biomedical Research Unit. Professor Caulfield said: “I am delighted that this study facilitated by Barts and The London National Institute for Health Research Biomedical Research Unit has shown substantial falls in blood pressure in patients with severe uncontrolled hypertension on multiple medicines. It offers a novel route to reduce blood pressure and cardiovascular risk in people who have exhausted conventional treatment. The long term effects will be assessed over the coming years in this and other studies but we are delighted to have had the opportunity to involve our patients in this study which may accelerate transfer of this therapy into the National Health Service.” Professor Caulfield is also President of the British Hypertension Society.
India trip yields joint working opportunities Professor Anthony Warrens, and other senior academic staff from professor anthony warrens and david universities willlets mp throughout the UK met the Right Honourable David Willets, MP at a briefing session at the British High Commission in New Delhi in November. The session marked the conclusion of an international conference at which representatives from HEIs, government and industry debated ways to increase partnerships between Indian HEIs and overseas institutions that would support strategic development of the sector for all partners. Dr Willetts set out three
challenges; firstly to increase the number of UK students studying in India as part of student exchange initiatives; secondly to engage with the Indian government’s commitment to expand HE capacity, with particular reference to the planned new ‘innovation universities’; and finally to support leadership development by collaborative development of innovative education and training programmes for tomorrow’s Vice Chancellors in the sub-continent. He undertook to work with the sector to enable bilateral recognition of academic credit and to remove, wherever possible, other bureaucratic barriers to joint working. During the six day trip to India Professor Warrens also visited Bangalore to meet representatives of Narayana Hrudayalaya hospitals, with which Barts and The London School of Medicine
and Dentistry has a memorandum of understanding. Recalling the trip he said: “One of the most exciting aspects of our week in India was the opportunity to meet with groups of highly motivated, energised individuals in the Indian institutions we visited. Above all, they were driven by a desire to pursue excellence in whatever field of endeavour they were working in. These are people Queen Mary could certainly do business with!”
WINTER 2010/11
3
research highlights
Major breakthrough in prevention of prostate cancer Scientists may have found the key to preventing prostate cancer, according to promising new research, published in the journal Cancer Research in November. One man dies every hour from prostate cancer – the second most common cause of death in men after lung cancer. Now, a research team at Barts and The London School of Medicine and Dentistry has discovered that a high level of ‘androgens’ – chemically related male sex hormones that help the male reproductive system to function properly – trigger a specific genetic change in the prostate that can cause cancer to develop. This genetic change is the fusion of an androgen-driving gene, with a tumour causing ‘oncogene’ gene. When these two genes fuse together they activate cancer development. This gene fusion
dr yong-jie lu
is a major cause of prostate cancer and has been found in more than half of all prostate cancers. Funded by the male cancer charity Orchid and the Medical Research Council (MRC), this new discovery reveals a critical understanding in the way prostate cancer develops but also presents an opportunity to prevent prostate cancer occurrence by learning how to control androgen levels. Lead researcher Dr Yong-Jie Lu, from the School’s Institute of Cancer comments: “This is a significant discovery and a major breakthrough in the future prevention of the disease. If we can learn how to control and manage androgen levels, there is a strong possibility that we may be able to help thousands of men, especially those known to be at high risk from a family history of prostate cancer, from developing the condition all together.”
Link between paracetamol and asthma strengthened Research led by Seif Shaheen, Professor of Respiratory Medicine at Barts and The London professor seif School of Medicine shaheen and Dentistry has found evidence suggesting the risk of childhood asthma associated with prenatal paracetamol exposure may depend on antioxidant genes in the mother. The results of a study published in the Journal of Allergy & Clinical Immunology in November strengthen the argument for a causal link between paracetamol exposure in early life and later childhood asthma. Researchers examined data from the British Avon Longitudinal Study of Parents and Children which has followed 14,000 children since birth – beginning with their mothers’ pregnancies – and continuing into the children’s 8th year.
4
WINTER 2010/11
They searched for evidence of interaction between paracetamol use during pregnancy or infancy and antioxidant genes in the mother or child. Variants in such genes may influence the toxicity of paracetamol. Participating mothers reported on their use of paracetamol during pregnancy, as well as their child’s exposure to the drug during infancy. Histories of wheezing and any asthma and allergy symptoms and diagnoses in the children were recorded, along with details of environmental exposures and family lifestyles. Between ages seven and eight the children had allergy skin and blood tests and lung function tests. Both mothers and children had genetic testing performed. Professor Shaheen and researchers found evidence suggesting that the risk of childhood asthma associated with prenatal paracetamol exposure depended on which variants of various antioxidant genes were present in the mother.
“Our latest findings add further weight to the evidence implicating prenatal paracetamol exposure in the development of childhood asthma. However, ultimately a cause and effect relationship can only be confirmed through randomised clinical trials,” he said.
research highlights
Protein link to pancreatic cancer
A protein known to regulate cell proliferation and survival has been linked for the first time to pancreatic cancer by researchers from Barts and The London School of Medicine and Dentistry. The protein could provide a target to develop new treatments for the disease – the UK’s fifth most common cause of cancer death – or enable early diagnosis. Pancreatic cancer has the lowest survival rate of all cancers due to its lack of symptoms in the early stages, late diagnosis and its resistance to chemotherapy and radiation therapy. The research – led by Professor of Molecular Pharmacology Marco Falasca and funded by the Pancreatic Cancer Research Fund – found that nearly three quarters of pancreatic cancer tumours had high levels of a protein known as P110γ. In laboratory experiments, when production of this protein was blocked, the cancer cells stopped growing. The findings were published online in September in Clinical Cancer Research. “It is a striking number of patients who present with high levels of P110γ,” said Professor Falasca. “The fact that P110γ is needed for pancreatic cancer cells to grow shows that it is likely to have a critical role in the progression of the disease, which makes it a potential target for developing new treatments.”
New technology revolutionises diagnosis of STI’s Mobile phones could revolutionise the diagnosis of sexually transmitted infections (STIs) dr claudia estcourt by using new technology to give instant results and recommend treatment options. A new £5.7 million project is developing self-test devices that can plug directly into mobile phones and computers, immediately identifying infections. The Medical Research Council – and the UK Clinical Research Collaboration – has given a £4 million grant to a consortium of academic and industrial researchers to improve sexual health through the use of new technology. The consortium, which includes Queen Mary, University of London, St George’s,
UCL, Brunel University, University of Warwick, the Health Protection Agency and industrial partners, made up the remaining £1.7 million. The project – called eSTI² (electronic self-testing instruments for STIs) – is being led by Dr Tariq Sadiq at St George’s, University of London. Queen Mary’s contribution is being coordinated by Dr Claudia Estcourt from the Blizard Institute of Cell and Molecular Science. Dr Estcourt said: “Here at Barts and The London we’re leading all the crucial initial stages of the program which will work through the complex regulatory, ethical and clinical barriers to implementing such novel diagnostic and communication technologies from development to patient care. This work will influence not just eSTI² but should set up recommendations for mainstreaming future complex technological advances across the NHS.”
Beetroot beats way to naturally lowering bp The nitrate content of beetroot juice is the underlying cause of its blood pressure lowering benefits, research from Barts and The London School of Medicine and Dentistry has revealed. In a study published online in the American Heart Association journal Hypertension in June it was revealed that blood pressure was lowered within 24 hours in people who took nitrate tablets, and people who drank beetroot juice. Study author Amrita Ahluwalia, Professor of Vascular Biology at the School’s William Harvey Research Institute said the investigation was able to demonstrate that the nitrate found in beetroot juice was the cause of its beneficial effects upon cardiovascular health and worked
by increasing the levels of the gas nitric oxide in the circulation. She said: “We gave inorganic nitrate capsules or beetroot juice to healthy volunteers and compared their blood pressure responses and the biochemical changes occurring in the circulation. “We showed that beetroot and nitrate capsules are equally effective in lowering blood pressure indicating that it is the nitrate content of beetroot juice that underlies its potential to reduce blood pressure. We also found that only a small amount of juice is needed – just 250ml – to have this effect, and that the higher the blood pressure at the start of the study the greater the decrease caused by the nitrate. “Our previous study two years ago found drinking beetroot juice lowered blood pressure; now we know how it works.” The results of the study could pave the way for a natural approach to lowering blood pressure that ultimately may help reduce the currently massive burden of cardiovascular disease on the NHS.
WINTER 2010/11
5
research highlights
yearly mammograM
screening for women with a family history of cancer could
save lives
Giving women younger than 50 with a family history of breast cancer a mammogram every year will detect more cancers and could save lives, according to an article published online in The Lancet Oncology in November.
6
WINTER 2010/11
research highlights Women with several relatives with breast cancer, or with relatives who had breast cancer diagnosed early in life, can be professor duffy more than three times as likely to get the disease. It has been suggested that these women might benefit from more frequent mammogram screening or from starting screening at an earlier age than recommended by the UK National Health Service Breast Screening Programme, which currently offers 3-yearly mammography to all women aged 50 to 70 years. The Family History 01 (FH01) study was designed to assess the effect of yearly mammography screening on disease stage at presentation and likelihood of death of women younger than 50 years with a significant family history of breast cancer.
6,710 women at intermediate familial risk were recruited from 76 centres across the UK and given yearly mammography for an average of 4 years. The size, node status, and histological grade of tumours were recorded and risk of death within 10 years of diagnosis calculated using a prognostic score. The findings were compared with two independent groups of women who had not received screening, using data from the UK Age Trial and a Dutch Study of women with a family history of breast cancer. Findings showed that tumours were significantly smaller, less likely to be node positive, and were of a more favourable grade in women who were given screening compared with those in the UK Age Trial, and were significantly less likely to be node positive than tumours in the Dutch study. Lead author Stephen Duffy, Professor of Cancer Screening said: “Tumour size, node status, and grade are highly
predictive of future death from breast cancer, and we showed that these characteristics were significantly more favourable in tumours in the FH01 cohort than were those in the two independent comparison groups.” Additionally, the researchers predicted that women who received screening were significantly more likely to be alive 10 years after a diagnosis of invasive cancer than women from the two control groups. To prevent two breast cancer deaths within 10 years of diagnosis, 10,000 screens would have to take place, compared with 0.56 deaths prevented per 10,000 screens over 7–9 years in the UK Age Trial. Professor Duffy concluded: “Our data suggest that, in women younger than 50 years who are at medium or greater familial risk of breast cancer, mammographic surveillance could increase cancer detection, reduce the risk of advanced stage disease, and decrease predicted mortality.”
HPV vaccine could cut cervical screening to twice in a lifetime
Women who have had the human papillomavirus (HPV) vaccine could need only two HPV screening tests for the rest of their lives according to new research presented at the NCRI Cancer Conference in Liverpool in November. Professor Peter Sasieni, a Cancer Research UK scientist at Barts and The London School of Medicine and Dentistry, believes the vaccine may mean women will no longer have to go for screening every three to five years as is the current practice. Research suggests that the HPV vaccine will prevent at least seven out of 10 cervical cancers and new vaccines currently being evaluated should prevent even more. It typically takes over 10 years for a
cancer to develop after HPV infection. Research shows that cancer caused by HPV types not prevented by the current vaccines take even longer. This could allow the first cervical screen to be safely offered much later then at age 20 or 25. Professor Sasieni will also outline how testing for cervical cancer-causing strains of the HPV could be a more accurate method of detecting the disease than the current method, the smear test which is designed to look for abnormal cells. He will urge the UK government to consider making HPV testing the main method of cervical screening across the health service as a priority. Professor Sasieni said: “The UK cervical screening programme has done a fantastic job in reducing cervical cancer, but it is based on an old screening test. HPV testing could prevent an even greater proportion of cervical cancer with just half the number of screens over a lifetime. If testing were to be rolled out from next year, it could be used nationally by 2015. “With continued high coverage of HPV vaccination and targeting of screening resources towards unvaccinated women,
cervical cancer should become a truly rare disease.” Cervical cancer is the second most common cancer among women under the age of 35, and the majority of cases are caused by two strains of HPV, types 16 and 18. In the UK, girls aged 12 to 13 are offered the HPV vaccine. Girls have three injections over six months given by a nurse. A two year catch up programme also started in autumn 2008 to vaccinate girls aged between 13 and 18. Dr Lesley Walker, Cancer Research UK’s director of cancer information, said: “HPV vaccination has been a huge step towards reducing the number of women that will be diagnosed with cervical cancer in future years. And the high uptake of the vaccine in the UK has been a real success story. “This exciting research poses interesting questions for the screening programme in terms of the best way to screen women in the future who have been vaccinated. But for now it remains vitally important that all women continue to take up the invitation to go for screening when they receive it.”
WINTER 2010/11
7
education
taking education
to the
highest heights
8
WINTER 2010/11
education
professor anthony warrens
Anthony Warrens is a man enthused. Four months into his tenure as Dean for Education at Barts and The London School of Medicine and Dentistry, he has already been mightily impressed by what he’s seen.
“It’s great,” he beams, “I’m having a fantastic time. It’s a great institution, I like the people I’m working with, I think the series of issues I’m trying to deal with are fascinating, and I’m up for it.” I’ve come to Professor Warrens’ Whitechapel-based office to learn of his planned review of the MBBS programme, and it’s clear from the start that his vision is as expansive as his mood. “We have to be competitive in everything we do,” he tells me. “We have to be out there attracting the best students. We have to make sure that Barts and The London School of Medicine and Dentistry is one of the schools that they consider as a very high priority choice for them, and I think we’ve got very attractive selling points that we need to be trumpeting – and indeed have been – to make that happen.” So what, I ask the Dean, does he recognise as being those attractive selling points. “One,” he says quickly, raising a thumb; “clinical experience. If you are serious about getting the best clinical training then you need to make sure you put yourself in a place during your student years where you see as much clinical medicine as possible, because you never have as much time to focus
in on individual patients with individual problems as you do during these years. “I would argue,” he continues; “that we have a wider range of pathology than you’ll see almost anywhere else in the country. We have in St Bartholomew’s a hospital situated in one of the most affluent parts of the UK and, sadly, we know that here at the Royal London we are in one of the most deprived parts of the country.
‘ Giving students the skills to function as professionals is a major contribution that will help people for the rest of their careers.’ A student who is really commited to using his or her years as a medical student to gain maximum exposure to the widest range of pathology will not find a better institution.” “Number two,” he goes on, “we’ve got fantastic scientists – you just have to look at the results of the 2008 RAE and you can see external validation of the quality of the science at Barts and The London School of Medicine and Dentistry and these are people who are really interested in being engaged in the education of our medical students. So on the one hand you’ve got fantastic clinical opportunities, on the other hand you’ve got fantastic scientific opportunities – so Unique Selling Points numbers 1, 2, 3, 4 and 5 are a first class medical education.” Warrens joins Barts and The London School of Medicine and Dentistry from Imperial College – where he led the Graduate-Entry Programme since establishing it there in 2005. When he joined the School in June 2010, its Warden, Professor Sir Nicholas Wright, said he looked forward to the new Dean taking our already high level of excellence in education to new heights. I ask him about his plans for achieving that.
He tells me: “We’re building on the already excellent student support system here by introducing a system that deals with people who have the potential to excel. The idea behind the new ‘academic mentoring scheme’ is to pick up people who are really at the top of the class and give them a bit more. Our first 6 students are recruited to the scheme, we’re pairing them with two tutors – one who’s a scientist, one who’s a practising clinician – and the idea is then to give them the opportunity to get connected to a research programme, and move forward with that. “We’ve also taken further the idea of having an intercalated masters degree – we’re very fortunate here in that as well as having our Graduate-Entry Programme, on our 5-year Undergraduate-Entry Programme we actually have a lot of graduates, so we’re looking at what we can do by way of giving them an additional qualification – a masters qualification. We’re not there yet but the premise has so far been very positively received.” Anthony Warrens found the experience of setting up the GEP at Imperial College ‘hugely enjoyable’ and, he says, it was the potential for doing other things in education that prompted his move to an ‘equally prestigious medical school,’ Barts and The London. I ask what he considers a medical education should seek to achieve. “There is a danger that a medical education can be seen as just the acquisition of a very large number of facts and a new vocabulary. But, that’s not all there is to a medical education. The student needs to acquire a set of skills that are transferable – both in terms of the very technical skills of being a doctor, but also in managing problems and communicating. One of the things I’m absolutely committed to is that our students get a very good scientific grounding because I do strongly believe that that will serve them forever in good stead. But giving students the skills they’ll need to function as professionals – the communications skills, an understanding of the NHS, and of society’s expectations of them as doctors – is a major contribution that Barts and The London School of Medicine is making that will help people for the rest of their careers.”
WINTER 2010/11
9
research
For the love of lipids
Carol Shoulders is Professor of Lipidology at the William Harvey Research Institute. Bridget Dempsey interviews her for BLnews. BD: Tell me about some of the research you’re undertaking at the moment. CS: We look at genetic disorders where blood cholesterol and fats (lipids) are perturbed. We use genetics as a tool to understand the basic molecular processes that are involved in determining blood lipid levels. High lipid levels are a major risk factor for coronary heart disease. BD: How has some of the research affected the way people think about the way they eat? How is your research translated? CS: We look at patients who come to medical attention because of heart attacks at an unusually young age and turn out to have high lipid levels. We then look at their medical histories, and their families to see whether any close relatives also have a particular type of high lipid level – called combined hyperlipidemia, involving high levels
10
WINTER 2010/11
of cholesterol and high levels of another fat called triglyceride. We particularly make enquiries about their dietary habits and study those families who have high levels of triglyceride and high levels of cholesterol, even though they are relatively slim and have normal blood glucose levels. These people have primary hyperlipidemia, which is partly genetic. Early detection of familial forms of combined hyperlipidemia helps make sure people get the right dietary advice and treatment before the clinical symptoms of cardiovascular disease develop. Another area of our research that has affected the way people eat is a more strongly, but fortunately very rare, genetic condition that manifests very early in infancy and can be treated. In this condition, babies fail to thrive because they cannot absorb cholesterol and triglyceride. BD: What sort of treatment would they be getting if they have that genetic component?
CS: The high blood fat levels of combined hyperlipidemia are treated, rather than necessarily the cellular defect. Lipids are so important. What you’re actually seeing is a readout of what is happening in your adipose tissue, what is happening in your skeletal muscle, what is happening in your liver, so all your body parts which are handling lipids will actually contribute to what is in your bloodstream. BD: How many people are you seeing with this type of genetic disorder? CS: Combined Hyperlipidemia the most common cause of lipid disorders. BD: How many people would have a lipid disorder? CS: The estimate is per cent of the population. Because the processes that regulate blood lipid levels are rather complicated there are many different reasons why your lipids might become high. At the genetic level some people may have a combination of four or five suboptimal variants of a gene that predispose them to developing high lipid levels. BD: How many are in your research team?
research
CS: We currently have a very tight knit team of seven investigators. We are very fortunate in having some excellent collaborators across the world, as well as within our Centre and Institute. BD: What have been some of the highlights of your research career? CS: Cloning the gene which causes abetalipoproteinemia. This is a very serious condition which if left untreated can cause patients to become blind and wheelchair bound by their third decade – it results because the defective gene stops dietary lipids and fat-soluble vitamins from being absorbed. Lipids are so important for so many cellular processes. Also establishing that the gene that causes that condition – a microsomial triglyceride transfer protein – is very similar to the egg yolk protein. When you eat your eggs and see the yellow in the middle that’s vitellogenin and this protein and the microsomal triglyceride transfer protein are related – they’re cousins. BD: It sounds extremely interesting. Are you going to conduct genomic DNA sequencing?
CS: We have been using that technology in a variety of ways over many years, and are just about to start using the latest and hugely more powerful technology for doing so. There are many genes which have now been implicated in controlling blood lipid levels and we do not know what functions these genes perform – so we are also doing the functional analyses. BD: What are some of the things you hope your research will lead to? What is your ultimate aim? CS: The educational goal is to spread awareness of just how crucial lipids are for every cell of the body. The ultimate medical goal has to be to understand more about the causes of high blood cholesterol and triglyceride levels in order to develop more effective therapies for ensuring wellbeing. BD: What would you say to someone who would be interested in studying in lipids? CS: Their importance has been underrated for too many years. There have been huge technological advances that have made their study so much easier and more exciting! I have talked about two
of the main lipids in blood, we now know there of thousands of them. Working out their medical importance is now not only possible but crucially important. This line of research will almost certainly lead to unexpected clinical benefits; in particular disease prevention. BD: Are there many researchers coming through who want to concentrate on lipids? CS: I’ve had more people wanting to do Phds in lipids than ever before which I think is due to our move over to the William Harvey Institute. Carol Shoulders joined the William Harvey Research Institute in August 2009. She is an expert professor carol panel member shoulders for the Finnish Academy Research Council for Health, a committee member of the Heart-UK Research Board, a scientific advisor for the American Society of Biochemistry and Molecular Biology Today Journal and an Associate Editor for the Journal of Lipid Research.
WINTER 2010/11
11
research
Trauma research: a network in action Barts and The London School of Medicine and Dentistry conducts world-leading research that uniquely covers the entirety of trauma disciplines, from injury prevention through to patient rehabilitation and outcomes.
Coordinated from the Royal London Hospital (RLH), the UK’s flagship Major Trauma Centre, a network of civilian and military partners performs fundamental and translatable research across the whole of the Trauma patient journey (see figure right).
Barts and The London School of Medicine and Dentistry trauma research network is focused upon the continuous development of ideas and experimental models to deliver new diagnostic tools and therapeutic interventions for the care of trauma
Complex Outcomes & Trauma Healthcare Systems Research • develop & validate impactful means for measuring short- & long-term trauma patient outcomes • v alidate indicators of performance in pre-hospital, trauma centre & rehabilitation care to ensure the optimal standard of patient treatment within regional trauma systems • provide health economic evidence to support the adoption of such enhancements to trauma patient care Karen Hoffman Senior Research Occupational Therapist, Barts and The London NHS Trust
Karen collects data on short and long term functional and psychological outcome – as well as quality of life data enabling a holistic analysis of the impact improved trauma care and research has made on patients. Outcome data and rehabilitation input is collected along the recovery pathway for patients on discharge, at 3, 6 and 12 months. The data will be used to measure the trauma system effectiveness, patient satisfaction, patient outcome and overall quality of life after a traumatic injury.
12
WINTER 2010/11
patients. The trauma network is developing laboratory, translational and clinical programmes in several key research streams. As the major trauma centre for the North East London & Essex Trauma Network, the RLH is ideally placed to continue nurturing and instigating focused collaboration between groups within the medical school, the university and with UK and international civilian & military partners. Barts and The London School of Medicine and Dentistry has strong links with industry and is a world-leading institution in recruitment for trauma multi-centre clinical trials. As such the School is ideally placed to continue to lead large collaborative networks, which include the International Trauma Research Network and the London Trauma Research Group, that translate research between the bench and bedside thereby ensuring the continuous improvement of trauma patient care.
Innovations in the Management of Traumatic Injury • develop predictive, decision analysis models for the management of traumatic injury • apply profound hypothermia to enhance survivability & outcomes of trauma patients • evolve techniques for the regeneration & reanimation of tissue post-traumatic injury Dr William Marsh School of Electronic Engineering and Computer Science Queen Mary, University of London
Dr Marsh is collaborating with Mr Nigel Tai at Barts and The London NHS Trust on the problem of determining criteria for deciding to amputate an injured lower limb. He is part of a research group that specialises in risk assessment and decision analysis whose approach is to build decision systems combining both data and human expertise. Two PhD students, one medical, the other a computer scientist, are working together to apply this approach to the problem of limb amputation. As well as using the extensive data gathered by the Trauma team over 10 years, they plan to use the clinicians’ understanding of the interaction of the relevant factors to create useful decision criteria.
research
London Ambulance Service
Trauma
Emergency department
Operating room
Critical Care Unit
Trauma Ward
Repatriation
Helicopter Emergency Medical Service
Neurotrauma & Traumatic Brain Injury • develop enhanced and novel neuroprotective strategies in neurological trauma • therapeutic application of omega-3 polyunsaturated fatty acids in spinal cord injury Professor Adina Michael-Titus Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry Adina’s research has included working on various neuroprotective strategies in neurological trauma, with a particular focus on polyunsaturated fatty acids. The work of her laboratory has shown that omega-3 polyunsaturated fatty acids have a significant therapeutic effect in spinal cord injury. These findings are highly important, as the potential for translation to the clinic is very significant. In parallel, she and her team are exploring the role of retinoid signaling, which can be activated by fatty acids in aging, spinal cord injury and motor neurone disease.
Orthopaedic Trauma • collect & analyse trauma-patient tissues to identify robust indicators of injury severity, response to treatment and long-term outcomes of severe musculoskeletal trauma • enhance patient outcomes by manipulating the injury and healing environments of hard and soft musculoskeletal tissues to optimise current & novel biological and drug therapeutics • evolve minimally invasive techniques for accessing and treating injured bones & joints whilst developing novel measures of patient outcomes in order to assess their efficacy Manoj Ramachandran Consultant Paediatric and Young Adult Orthopaedic and Trauma Surgeon, Barts and The London NHS Trust Honorary Senior Lecturer, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry Mr Ramachandran’s interests are in all aspects of young adult and paediatric orthopaedics and trauma including; the young adult – hip and knee; children’s orthopaedics – with a particular interest in the lower limb, and injuries/traumatic disorders of children’s bones and joints.
Trauma-Induced Coagulopathy & Transfusion • understanding the body’s response to injury and traumainduced dysfunction of blood clotting (i.e coagulopathy) • developing techniques for the rapid diagnosis of coagulopathy and prediction of transfusion requirements • studying patient treatment and resulting outcomes to improve transfusion practice in trauma Karim Brohi Professor of Trauma Sciences, Barts and The London School of Medicine and Dentistry Consultant Trauma & Vascular Surgeon, Barts and The London NHS Trust Professor Brohi is lead for research for the Trauma Clinical Academic Unit at Barts and The London NHS Trust. A strong focus of that research has been the identification and characterisation of Acute Traumatic Coagulopathy, a defect in the body’s mechanism for blood clotting, and the development of experimental models to explore new diagnostic tools and therapeutic interventions.
WINTER 2010/11
13
awards
Awards and achievements Professor Finbarr Cotter elected President of the British Society of Haematology Finbarr Cotter, Professor of Haematology at Barts and The London School of Medicine and Dentistry, was elected President of the British Society of Haematology in August. This year celebrating its 50th anniversary, the Society, which has over 1500 members, is the representative professor cotter organisation for all UK Haematologists. Professor Cotter is also Editor-in-Chief of the British Journal of Haematology, and the
website for haematology research and training run in conjunction with the Society, www.bloodmed.com Professor Cotter said; “It is a real honour to be appointed the President of the British Society for Haematology. I have been involved with the Society for over a decade as it has developed into an important representative organisation for all haematologists in the UK with input into both education and clinical
practice, including its internationally recognised guidelines. During my time as President I aim to further promote the advance of academic haematology and the modernisation of haematology within the health service. The website, Bloodmed, for which I am Editor-in-Chief is part of this development. Globally the BSH is fostering a relationship with the developing countries to improve haematological care in poorer economic areas of the world. It is a real pleasure to take up this appointment and the support from the Medical School and Queen Mary has been appreciated in catalyzing this important appointment.”
Five feature in list of UK’s top docs
professor maffulli
14
professor reznek
WINTER 2010/11
Finbarr Cotter is one of five specialists at Barts and The London School of Medicine and Dentistry and Barts and The London NHS Trust to have been named in a recent list of Britain’s top doctors published by The Times. Introduced by the newspaper’s Dr Mark Porter, the A-Z of the UK’s ‘top docs’ includes: • Finbarr Cotter, Professor of Haematology at Barts and The London School of Medicine and Dentistry’s Institute of Cancer • Dr Paul Telfer, Senior Lecturer and Haematologist, Barts and The London School of Medicine and Dentistry’s Blizard Institute of Cell and Molecular Science, and Royal London Hospital • Rodney Reznek, Professor of Diagnostic Imaging at Barts and The London School of Medicine and Dentistry’s Institute of Cancer
• Neil Barnes, Professor of Respiratory Medicine at Barts and The London and Head of Respiratory Illnesses at the London Chest Hospital and the Royal London Hospital • Nicola Maffulli, Professor of Sports and Exercise Medicine at Barts and The London School of Medicine and Dentistry’s Institute of Health Sciences Education. Dr Mark Porter said: “Over the past six months a team of Times researchers asked charities, specialists and professional bodies and associations to come up with a list of leaders in their particular field. Some names appeared on everyone’s lists and it is these names that we have recommended…they are not just extraordinary doctors, but extraordinary people.”
awards
Guardian Public Service Award for School widening participation scheme
front row l-r: cathy baker
–
barts and the london
school of medicine and dentistry, michaela morris
– interim
chief executive of newham university hospital, sandra brighton
–
learning and development manager, newham
university hospital, with students past and present
A pre-medical school work placement scheme aimed at widening-participation for local A-level students considering a career in medicine, has been awarded the Guardian Public Service Award 2010 in Diversity and Equality. The Newham Doc Scheme – run in partnership between Barts and The London School of Medicine and Dentistry and Newham University Hospital NHS Trust – helps students whose social and economic circumstances may have prevented them achieving the required A-Level grades to enter medical school. The award was announced at a ceremony in Old Billingsgate in November. Students are selected by Barts and The London School of Medicine and Dentistry
and Newham University Hospital NHS Trust who work in partnership with local schools and Colleges to identify potential candidates. The scheme runs for an academic calendar year during which students rotate through three placement areas with a focus on patient experience, basic science and working within a clinical team. They undergo regular performance and development meetings and their progress is formally assessed at intervals before recommendations are made to Barts and The London School of Medicine and Dentistry regarding their place on the MBBS programme. The scheme has so far seen 18 students benefit from a year of training, intensive support and learning opportunities within a clinical setting. Two of them have since graduated from medical school and have now completed their first year working as doctors. Dr Cathy Baker head of graduate entry at Barts and The London School of Medicine and Dentistry added; “The scheme has shown that with hard work and support students from social and educational backgrounds that are not traditional for medical students can achieve a career that was once not even imaginable.”
Jass prize for best paper in the Journal of Pathology The research team of Denise Sheer, Professor of Human Genetics has been awarded the Jass prize by the Pathological Society and the Journal of Pathology. The annual prize was instituted in memory of the late Jeremy Jass and is awarded to the authors of the paper judged by the editorial team to have been the best published in the Journal of Pathology in the prior calendar year. The team received the Jass award for their paper Activation of the ERK/ MAPK pathway: a signature genetic defect in posterior fossa pilocytic astrocytomas. It describes the results of an international collaboration between the researchers at Queen Mary, University of London, St Jude Children’s Research Hospital, Memphis, Tennessee and the Royal Victoria Infirmary, University of Newcastle. The award was formally made at the winter meeting of the Pathological Society on 6 January. All authors received certificates whilst the joint first authors, Tim Forshew and Ruth Tatevossian, also received commemorative medals.
Royal College of GP’s honours Professor Trisha Greenhalgh Professor Trisha Greenhalgh OBE was awarded the prestigious George Abercrombie Medal from the Royal College of GPs at its annual award ceremony in November.
professor greenhalgh (right) with dr iona heath and professor amanda howe
The medal is for outstanding contribution to the literature of general practice. The award was given by the College’s President, Dr Iona Heath, and its Honorary Secretary, Professor Amanda Howe. It was the first time in the College’s history that the award was both given and received by female doctors. Professor Greenhalgh said: “Receiving this award was an iconic moment because
this is the first time ever there have been three women in those roles.” At the ceremony, Professor Howe highlighted Professor Greenhalgh’s unique contribution to GP research, including her work in managing chronic conditions – such as diabetes – in minority ethnic groups. She also highlighted her efforts to make studying medicine more accessible and her work with medics in low-income countries. Professor Greenhalgh was also recently made a Fellow of the newly formed Society of Biology for her contribution to public debate about science.
WINTER 2010/11
15
BLnews is written and compiled by Alex Fernandes. Contributions to this issue have been made by Bridget Dempsey, Deborah James and Kerry Noble.
Queen Mary, University of London Mile End Road, London E1 4NS Tel: +44 (0)20 7882 5555