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2020 NIHR ACF PES Leeds Acute Care



2020 NIHR Academic Clinical Fellowship in Priority Research Themes

HEE Local Office: Yorkshire and Humber
Medical School: University of Leeds
Research Theme: Acute Care
Specialty Options: Anaesthetics or General Surgery or Vascular Surgery

Plain English Summary

This NIHR Academic Clinical Fellow (ACF) post is about understanding why patients who are frail suffer more complications following major surgery and what can be done to reduce the risks. Although surgery is safe for the majority of patients, around 10% of patients are at particular risk of complications and even death. In addition to the suffering patients experience from a complication, there are increased costs from additional care, including hospital care and community care for rehabilitation and support.

It is increasingly recognised that the patients most vulnerable to surgical complications are physically frail. They have less muscle, decreased strength and energy, and are less able to fight infection. Our academic programmes offer clinical trainees the opportunity to research what makes frail patients vulnerable to surgical complications. The link between frailty and poor surgical outcomes can be explored using the latest molecular biology techniques, health informatics, or clinical trials.

A key requirement for improving surgical outcomes in the high-risk frail population is to improve early identification of those at greatest risk. Previous research undertaken by the team has looked at the genes and other cell processes that are involved in muscle regulation to identify patients at high risk of surgical complications. This has been performed using laboratory studies and tissue from patients undergoing surgery. We have also explored medicines that have the potential to improve muscle function. In addition, we have used an electronic frailty index (eFI), developed from patient records in Leeds, to identify high risk patients. We have demonstrated that exercise before surgery is possible even in frail patients. The next stage will be to perform a clinical trial to determine if exercise programmes can prevent surgical complications and improve outcomes.

The ACF will undertake clinical training in either general surgery, vascular surgery or anaesthetics and develop research and publish peer-reviewed papers to enable a highly competitive PhD Fellowship application, leading to a future Clinical Lecturer (CL) post and clinical academic career; the post will be embedded within a dynamic research environment linked to our well-established NIHR Integrated Academic Training programme at Leeds which includes 4 ACFs and 1 CL, supported by 3 senior academics, a tenure track University Academic fellow, 9 externally funded research fellows and 3 laboratory technicians. Leeds Teaching Hospitals NHS Trust is one of the largest Trusts in the UK. It is host to a NIHR MedTech Co-operative in Surgical Technologies (2018, £1.34M over 5 years), which will provide access to clinicians, academics, public and patients and industry partners as necessary to develop the research towards clinical translation. There is also access to the Leeds In Vitro Diagnostics and Medical Technologies Co-operative and RCS Eng. Surgical Trials Centre, further bolstering access to translational expertise. Numerous clinical educational opportunities are available with regular weekly teaching sessions for trainees, in addition to departmental CPD events. Clinical departments have an excellent track record in preparing candidates for fellowship examinations.

Key contacts
Academic leads: Professor David Jayne (General Surgery), Professor Julian Scott (Vascular Surgery) and Professor Phil Hopkins (Anaesthetics).