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Three women's research is improving our lives; Women are at the forefront of health innovation across Wales. The award-winning Welsh Crucible scheme, which is funded by a consortium of Welsh universities, is the ideal platform for showcasing their ideas. Here, three outstanding Crucible members explain their pioneering research.

Byline: Dr Judith White

Dr Judith White is a researcher at Cedar at Cardiff and Vale University Health Board. She examines the clinical and cost-effectiveness of medical devices edical devices come in all shapes and sizes.

MExpensive equipment such as x-ray machines and MRI scanners may spring to mind, but bandages, catheters, mattresses, wheelchairs, blood pressure monitors, spectacles, and dentures are all examples of medical devices.

Clinical research often aims to answer questions about medical treatments, such as "is it safe?" and "does it work?" Drugs are tried and tested in several rounds of clinical trials before they can be prescribed in the NHS. Historically there has been less research conducted into the effectiveness of medical devices due to differences in the way they work. The research carried out at Cedar aims to improve this. Cedar, part of Cardiff and Vale University Health Board, is a health technology research centre.

We supply evidence on new and innovative medical devices and diagnostics to the National Institute for Health and Care Excellence (NICE).

The research is subsequently used to help the NHS adopt devices which will be both of benefit to patients and cost effective At Cedar we play two roles in providing evidence to enable NICE to make recommendations on whether the NHS should adopt a new device.

Firstly, we pull together and evaluate all of the work already published by examining previous studies to ascertain the reliability of existing evidence. Secondly, we look at clinical effectiveness and also assess the costs of using the new device in the NHS.

An example of my work is on the PLEURX catheter drainage system.

This device is designed to relieve the severe build-up of fluid in the abdomen that occurs in some people with cancer (malignant ascites) which causes pain, breathlessness, and reduced mobility.

Conventional treatment involves repeated hospital appointments to drain large amounts of fluid from the abdomen.

PLEURX is inserted in hospital but then patients or their carers drain small amounts of fluid at home.

Cedar evaluated the evidence for PLEURX and presented the results in a report to NICE.

We found that, although the evidence was limited, PLEURX was safe and effective and will likely reduce the time patients spend in hospital.

Importantly, by avoiding the massive build-up of fluid PLEURX could improve patients' quality of life. In 2012, NICE published medical technology guidance recommending that PLEURX should be considered for patients with recurrent malignant ascites.

The other important element of my work at Cedar is conducting new research to fill the gaps in our knowledge about a medical device.

For instance, I set up a clinical trial, in collaboration with Cardiff's wound healing research unit, on a wound healing device which uses ultrasound to help heal chronic wounds.

The study has been designed to shed light on whether this device delivers improvements in healing rates compared to standard NHS treatment. The results are due out soon.

I'm encouraged by Wales' strong medical device industry and feel passionately that we build a robust evidence base to support routine use of new effective devices within the NHS. We can use this evidence to drive improvements in patient care while also making the most of available resources to benefit more patients.

For details, email Judith.White3@wales.nhs.uk Dr Kate Langley is a lecturer at the School of Psychology at Cardiff University. She is interested in understanding why children develop ADHD (Attention Deficit Hyperactivity Disorder) As a researcher who investigates the causes of Attention Deficit Hyperactivity Disorder (ADHD), I am frequently asked if it is a real problem, or just something doctors and parents have made up because we no longer discipline children properly.

I usually reply that, although we can all have difficulties concentrating and can be impulsive at times, the levels of these behaviours experienced by those with ADHD and the problems these behaviours have on their lives (achieving in school, maintaining friendships) mean ADHD can be a real and impairing problem.

ADHD is not a new condition - there are reports of ADHD from medical journals as early as 1902.

Nor is it increasing. Studies show that, unlike some other mental health problems, the rates of ADHD have not changed over the past 50 years.

Instead, better awareness of the disorder has led to greater recognition and enabled more individuals with the disorder to be diagnosed. There is also a great deal of research indicating that genetics play a large role in the causes of ADHD.

It is these misrepresentations and the associated stigma suffered by many individuals and their families that spur my research on.

I believe that as we increase our knowledge of what causes ADHD, there will be greater understanding and acceptance of those with such problems.

I am especially interested in understanding the specific genes which may be involved. It is really complex. There is not a single gene for ADHD, there are likely to be hundreds involved, while many environmental factors are also important.

Finding these genes is only the beginning. Our group then aims to try and understand how they work and whether the genes involved differ between individuals with different presentations of the disorder.

The team at Cardiff University is internationally renowned for excellent ADHD research and organises the largest study of children and adolescents with ADHD and their families in the UK, with more than 1,000 families involved.

Without the contribution of such families, research would not be possible and we are grateful for their help. Hopefully we can return the favour by increasing our understanding of ADHD and helping individuals in the future.

It is a long road which is likely to take years before findings will be translated into clinical practice, but one I believe is extremely important.

In the mean time, it is my hope that by talking about ADHD and research into understanding the disorder, we will start to change people's minds.

As each new finding is discussed, we can chip away at the misconceptions about ADHD and research will help those with ADHD and their families in more ways than one.

For details, email langleyk@cardiff.ac.uk Dr Sharon Williams is a lecturer at Cardiff Business School at Cardiff University. In 2013 she was awarded a prestigious Improvement Science Fellowship by the Health Foundation. As part of her fellowship Sharon is currently investigating how techniques employed in other industries can be used to improve patient care Our healthcare systems, not only in Wales, but worldwide, are continually under pressure to deliver more services with the same or fewer resources.

My research aims to understand how current systems work that help to deliver the care for patients.

I am focusing on two chronic diseases: Chronic Obstructive Pulmonary Disease (COPD) and Huntington's Disease.

Improvement science is a relatively new academic discipline and it is developing the evidence base required for improvement in healthcare.

It is important when making an improvement we know how to measure the impact of the change and the difference this will make to patients and staff.

Healthcare improvement is now well established and some of the approaches used have been adapted from those tried and tested in other industries.

By talking with patients and staff I am now getting a real feel for how the pathways currently work and the information required to aid good decisionmaking.

This is important because if the right equipment or information is not readily available then healthcare staff end up spending time looking for things to enable them to do their job properly.

My research involves working with staff and patients to map out the existing pathways to help us to think about how the pathway might be redesigned in order to improve patient care.

One of the biggest challenges is working across different organisational boundaries such as hospitals and community providers.

My research in other industries, which has looked at the design of supply chains (moving from raw materials (such as wool) to finished goods (such as fabric), found that generally many of the issues were associated with how organisations work together.

Many companies are good at improving their own systems and processes but find it more challenging when they try to align these systems and processes with their customers and suppliers. Healthcare is no different and usually the supply chains are more complex.

Working across healthcare organisations will help us to shape the seamless care systems that patients and their carers require.

My research is examining which parts of the pathways can be standardised (meaning all patients receive the same treatment) and which need to be more person-centred or perhaps family-centred in the case of Huntington's Disease, where we need to be more flexible in our approach.

My project is being conducted in both NHS Wales and England.

Improving the design of COPD and Huntington's Disease pathways will have benefits for patients, staff and the wider healthcare economy.

For details, email Williamss78@cardiff.ac.uk

CAPTION(S):

Dr Judith White

Dr Kate Langley

Dr Sharon Williams
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Title Annotation:Features
Publication:South Wales Echo (Cardiff, Wales)
Date:Sep 9, 2015
Words:1501
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