Cardiothoracic Interdisciplinary Research Network (CIRN)
NAHP Lead: Professor Julie Sanders
Cardiac Surgery aSSL: Mr Luke J. Rogers & Mr Ricky Vaja
Thoracic Surgery aSSL: Mr Edward Caruana & Mr Askshay Patel
The Cardio-Thoracic Interdisciplinary Research Network, or CIRN for short, is a collaborative research group of healthcare professionals (HCPs) in Cardiac and Thoracic Surgery that have an interest in research. It has developed from funding provided by the Royal College of Surgeons (England) through the Surgical Specialty Lead (Professor Gavin Murphy) program and Surgical Trials Initiative in response to a growing need for high-quality, high-impact clinical research within surgery (Horton 1996). It has been supported by the Society of Cardiothoracic Surgery (SCTS) through the collaborative’s inception and continued development.
The United Kingdom is currently the world leader in the high-quality science it produces; accounting for 15% of all top-rated scientific outputs with only 7% of the world’s researchers. To build on this the UK government plans to double investment in Life Science research over the next 10 years. This is likely to see a significant increase in the funding available for clinical trials. The CIRN is perfectly positioned to bring all those involved in the care of individuals undergoing Cardiac and Thoracic Surgery together to take advantage of these opportunities and undertake truly transformative high-quality research.
UK cardiothoracic surgery has produced some of the highest impact Cardio-Thoracic research across the world, with the NIHR supporting numerous high impact clinical trials including ERICCA, TITRE2, UK-TAVI, MAVRIC, UK Mini-Mitral and VIOLET. Increasingly, funding is awarded to research grant applications that demonstrate engagement of multidisciplinary healthcare professionals and public and patient involvement throughout the entire research process including the formulation of research goals, identification of relevant outcome measures and dissemination of results to name but a few stages. In a number of other surgical specialities successful research networks are already well established, producing high impact research and attracting significant grants.
Mr Ricky Vaja (ricky.vaja@gmail.com) and Mr Luke J Rogers (lukerogers1@nhs.net) were initially appointed as associate Surgical Specialty Leads (aSSLs) in 2018, and have more recently been bolstered with the appointment of Mr Edward Caruana (edwardcaruana@nhs.net) and Mr Akshay Patel (a.patel.2@bham.ac.uk) in 2019 as Thoracic aSSLs.
The premise of the CIRN is threefold:
- To develop a UK and Ireland wide infrastructure to deliver high-quality, high-impact clinical trials in Cardiac and Thoracic Surgery across all centres providing these services.
- Provide opportunities for HCPs, whatever profession, to get involved with clinical research and develop the skills necessary to deliver Point 1. (Link to Associate PI scheme)
- To recognise the fact that collaboration in research is essential and requires individuals to be recognised for the work they have contributed, however small. (Link to Terms of Reference)
If you are interested in getting involved with any of the ongoing projects please email CIRNetwork@outlook.com with your name, occupation (including level if appropriate), place of work and interest. Alternatively, feel free to contact any of the aSSLs directly (emails above). Completion of Good Clinical Practice (GCP) and SCTS membership is required.
Patient and Public Involvement (PPI)
PPI has demonstrated repeatedly over the years to improve the quality of research. From its origin in 1969 with the 10-page document produced by Sherry Arnstein leading to the Arnstein Ladder of Public Participation, to the adoption by the research community of patient and public participation in research, the role of PPI has never been more necessary.
We are all potential patients and those of us who work with PPI do so with a vested interest and desire to see the patient put front and centre of all research. Our role is not only advisory, we are consulted at every level and on many occasions steer the path of research.
We are independent consultees motivated by a concern that the best interests of the patient are represented from the patient perspective.
We are critical friends bringing our knowledge and experience of being patients, carers and informed individuals, in the healthcare sector to bear on medical research.
We challenge from a standpoint of wanting to achieve the best we can for patients, a better future, better outcomes and a better quality of life.
Within the current context of adding a public voice to cardiac research projects, we are fully supportive of the initiatives being made and look forward to making a valued contribution.
Thank you to Sarah Murray, Jeremy Dearling and Keith Wilson for writing this section.
NIHR associate Principal Investigator Scheme
The NIHR associate Principal Investigator (aPI) scheme was proposed by the West Midlands Research Collaborative (WMRC) as a mechanism to encourage, train and recognise trainees, nurses & allied health professional involvement in high-quality research.
The scheme involves ensuring a trainee, nurse or allied health professional will work alongside a principal investigator to deliver a clinical trial at their Trust. This will then be formally recorded both within the trial documents and the individuals personal NIHR account following ratification by the local PI, Chief Investigator and a minimum commitment of 6 months’ work. When this is combined with a project being delivered by the CIRN individuals will be named as per the outline of corporate authorship within the Terms of Reference (hyperlink) with clear identification of each individuals duties and responsibilities as a PI in the Appendix of all subsequently published work.
Associate Principal Investigator (PI) Scheme (nihr.ac.uk)
Associate PI Scheme - Study Registration Form (google.com)
Associate PI Scheme List of Registered Studies - Google Sheets
Priority Setting Partnership – Key Projects for Cardiac Research
Projects
Since the CIRNs inception in March 2018 it has included over 100 HCPs including consultant surgeons, nurses and allied health professionals (NAHPs), and surgical trainees both those with national training numbers (NTNs) and those without (non-NTNs) leading on projects and assisting in the delivery of even more.
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Cochrane Review proposal (published), final manuscript (under review)
National Variation in Practice Survey (published)
NIHR Program Development Grant (successful application)
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COVIDSurg Studies
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COVIDSurg–Cohort Cardiac (manuscript under review)
COVIDSurg–Cohort Thoracic
COVIDSurg–Cancer Lung
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Antithrombotic treatment following Coronary Artery Bypass Surgery
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Cochrane Review (proposal under review)
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Major Aortic Surgery
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Preliminary survey (data collection)
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Vitamin D Supplementation in Surgical Patients
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Systematic Review (protocol in writing)
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The first NIHR funded CIRN project; “A Surgical Site Infection Risk Prediction Tool to Enable Targeted Infection Prevention Strategies in Adult Cardiac Surgery” is a program development grant (PDG) to investigate:
- the predictors of wound infection (Work Package 1),
- barriers and facilitators to surgical site infection (SSI) prevention strategies (Work Package 2) and
- barriers and facilitators to SSI surveillance systems (Work Package 3).
This has been underpinned by a Cochrane Review exploring the interventions implemented to reduce SSI in the adult cardiac surgery population (CIRN 2019) and a national survey illustrating the variation in practice that exists both in which interventions are utilised, and in how many of them are implemented (CIRN 2020).
Not only has this work already included over 100 HCPs, including nurses, infection prevention specialists and surveillance experts but is has also be carried out in close collaboration with the National Cardiac Benchmarking Collaborative (NCBC) and Public Health England (PHE).
We are hopeful that this program of work will lead to a successful Program Grant for Applied Research in two years’ time.
Supporting Projects
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UK Mini-Mitral Trial
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Clinical Trial involving aPI’s (ongoing)
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Redo-Aortic Valve Treatment Study
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National audit (ongoing)
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Multicentre Evaluation of Renal Impairment in Thoracic Surgery (MERITS)
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National audit (complete)
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Evaluation of postoperative atrial fibrillation in Thoracic Surgery (EPAFT)
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National audit (complete)
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Represented Centres
Centres marked with an X still need representation. If you work in any of these centres and want to get involved please email CIRNetwork@outlook.com
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Region
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Hospital
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Consultant
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SSI Lead
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NAHP
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Surgical Junior
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Scotland
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Aberdeen Royal Infirmary
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X
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Royal Infirmary Edinburgh
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X
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Golden Jubilee National Hospital
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X
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X
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X
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North East
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Newcastle Upon Tyne Hospitals NHS FT
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X
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X
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X
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X
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South Tees Hospitals NHS FT (James Cook)
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X
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Yorkshire
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Hull and East Yorkshire Hospitals NHS Trust (Castelhill)
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X
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X
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Leeds Teaching Hospitals Trust
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X
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X
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Sheffield Teaching Hospitals NHS FT
(Northern General)
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X
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X
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North West
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Blackpool Teaching Hospitals NHS FT
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Central Manchester University Hospitals NHS FT
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University Hospital of South Manchester NHS FT (Wythenshawe Hospital)
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Liverpool Heart & Chest NHS FT
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X
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X
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East Midlands
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Nottingham University Hospitals NHS Trust
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X
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X
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University Hospitals of Leicester NHS Trust (Glenfield)
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X
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X
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X
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West Midlands
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Royal Wolverhampton NHS Trust
(New Cross)
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University Hospital of North Midlands NHS Trust (Royal Stoke)
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X
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X
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X
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University Hospitals Birmingham NHS FT
(Queen Elizabeth)
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X
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University Hospitals Coventry & Warwickshire NHS Trust (Walsgrave)
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X
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Wales
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Morriston Hospital (Swansea)
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University Hospitals of Wales (Cardiff)
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X
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X
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East of England
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Royal Papworth Hospital NHS Trust
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X
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X
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X
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X
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Basildon & Thurrock University Hospital NHS FT
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X
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South East
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Brighton & Sussex University Hospital Trust
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X
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X
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South Central
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Oxford University Hospitals NHS Trust
(John Radcliffe)
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X
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X
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X
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X
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University Hospital Southampton FT
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X
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X
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X
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South West
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University Hospitals Bristol NHS FT
(Bristol Heart Institute)
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X
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X
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X
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X
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University Hospitals Plymouth NHS Trust (Derriford)
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X
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X
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X
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London
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Guy's & St Thomas' NHS FT
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X
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X
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X
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Barts Health NHS Trust
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X
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X
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X
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St Georges Healthcare NHS Trust
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X
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X
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Imperial College Healthcare NHS Trust (Hammersmith)
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Kings College Hospital NHS FT
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X
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Harefield Hospital
(Royal Brompton & Harefield NHS FT)
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X
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X
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X
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Royal Brompton
(Royal Brompton & Harefield NHS FT)
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X
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X
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X
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Publications
Cochrane Review Proposal
Cardiothoracic Interdisciplinary Research Network, Rogers L, Vaja R, Bleetman D, Ali JM, Rochon M, Sanders J, Tanner J, Lamagni TL, Talukder S, Quijano-Campos J, Lai F, Loubani M, Murphy G, Cardiothoracic Interdisciplinary Research Network. Interventions to prevent surgical site infection in adults undergoing cardiac surgery. Cochrane Database of Systematic Reviews 2019, Issue 5. Art. No.: CD013332. DOI: 10.1002/14651858.CD013332
https://www.cochrane.org/CD013332/VASC_interventions-prevent-surgical-site-infection-adults-undergoing-cardiac-surgery
Variation in Practice Survey
Cardiothoracic Interdisciplinary Research Network, National Cardiac Benchmarking Collaborative; Public Health England. National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland. J Hosp Infect. 2020 Dec;106(4):812-819. doi: 10.1016/j.jhin.2020.09.016. Epub 2020 Sep 19. PMID: 32956785.
https://www.journalofhospitalinfection.com/article/S0195-6701(20)30431-X/fulltext
COVIDSurg – Cohort Cardiac
Cardiothoracic Interdisciplinary Research Network and COVIDSurg Collaborative. Brief communication. JTCVS (under review).
References
Horton R. Surgical research or comic opera: questions but a few answers. Lancet, 1996;347 (9007)984-985.
Terms of Reference. Cardiothoracic Surgery Interdisciplinary Research Network (CIRN). Society for Cardiothoracic Surgery (SCTS) in Great Britain & Ireland. Dec 2018.
Associate Principle Investigator Scheme. National Institute for Health Research. West Midlands Research Collaborative, Birmingham Surgical Trials Consortium. Birmingham Clinical Trials Unit & West Midlands NIHR CRN. Version 1.4. Nov 2018.
A Systematic Review & Meta-Analysis of Interventions to Prevent Surgical Site Infection (SSI) in Cardiac Surgery Protocol. 20th July 2018. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=104219
Interventions to prevent surgical site infection in adults undergoing cardiac surgery. Cochrane Database of Systematic Reviews. Cardiothoracic Interdisciplinary Research Network. Cochrane Systematic Review - Intervention – Protocol. Published: 15 May 2019. https://doi.org/10.1002/14651858.CD013332.