Happy New Year and a TERN update.
Happy new year to all our colleagues in the emergency care community. We hope this finds you well and coping with current working conditions. Although work is challenging at the moment, we feel there is still plenty to be optimistic about in the world of emergency care research and hope the activities of TERN, amongst others, can help to keep you inspired. This a long(ish) but overdue update on TERN activities. Grab a drink, take a breather, and have read about what we’ve been up to and what plans are brewing.
There are a couple of new faces to introduce you to at this end of the TERN email addresses. I (Fraser) have taken over from Rob as TERN Fellow. I am an ST6 trainee in the Severn Deanery who has long had an interest in research alongside full-time clinical training. I see TERN as a network aimed at people just like me until recently - interested and keen to contribute, but needing to make significant effort to fit involvement around the other demands of our work. TERN is here to help, and would love to involve all of you in an accessible way. The introduction of EDT and the emphasis on research and critical appraisal under SLO 10 in the 2021 curriculum will hopefully make this easier for the trainees amongst us.
The network is now also supported by our fantastic administrator, Alice. Alice has an academic background in Translation Studies and in 2020 she left her academic role to pursue a career in research management and administration. She also has roles with the NIHR Emergency Care Incubator and the UWE Emergency Care Research Team so is fast becoming an expert in the field! Please include her in any email communication about study setup and delivery, and in fact just about anything. Alice can be reached at tern.administrator@rcem.ac.uk
TERN has gone from strength to strength since its inception in 2018 thanks to the efforts of its members, the dedication of previous TERN fellows Tom and Rob, and the college professors, who continue to offer invaluable guidance and support. Our challenge is to keep the network delivering important research, engage yet more trainees and emergency care staff in research activity, and build a sustainable structure to support a growing range of activities.
Research
ACS:ED - Acute Coronary Syndrome in the Emergency Department.
ACS:ED will run in March 2023. It’s TERN’s next big study looking at chest pain presentations to the Emergency Department. The methodology will be similar to that of SHED with an observational opt out consent model. The recruitment period is short and sweet, only one week long, but we are hoping for big numbers given the frequency of chest pain presentations to every emergency department across the UK. We have received expressions of interest from over 70 sites so far and there is still time to get involved - get in touch ASAP if you want to know more or are interested in running the study at your site. It’s another perfect opportunity for someone without much research experience to run a study so we welcome contact from all staff groups.
The ACS:ED protocol can be found here.
SHED - Sudden onset Headache in the Emergency Department
SHED is in its final few months of recruitment and will stop in February 2023. Recruitment is at over 3500 patients and continuing at a healthy pace. SHED is TERN’s first patient facing study and aimed at one of the 2017 James Lind Alliance emergency medicine research priorities. We’re delighted with progress so far and we’d like to offer a heartfelt thanks to everyone involved and encouragement to keep recruitment going over the winter months until the study ends. Every data point counts! The new NICE guidelines for the diagnosis and management of aneurysmal SAH were published this week including some research recommendations to which the results of SHED will be directly relevant. We’re very excited to start analysing the results and communicating them to our collaborators and beyond.
SEED- UK - An observational Study of E-scooter impacts upon Emergency Departments in the UK.
SEED-UK ran in the Autumn of 2021 and the results have now been written up and submitted for publication. You may have seen Tom and Rob talking about them at the RCEM ASC and EUSEM. SEED-UK is a great example of the power of TERN as a network - an idea that went from design to delivery in a short timeframe, captured useful data about a relatively new clinical area, and has already attracted interest from important decision makers. Congratulations to all involved.
TERN Delphi
The results of the TERN Delphi were published in the EMJ at the end of September. They can be found here. They give a great insight in to the research priorities of members of the TERN network. Have a read, along with the refreshed James Lind Alliance priorities, and get in touch if it sparks some inspiration for a future TERN project.
Next……?
We’d love to hear from you. We see the TERN network as a collaborative community of clinicians and researchers and would be delighted if the idea for TERN’s next big project came from someone reading this email. However small or well-formed your idea might be, whatever your previous experience in research, don’t hesitate to get in touch.
TERN Education
The TERN Education team, tirelessly led by Raj Chatha, continue to work on content for RCEM Learning, the TERN section of which can be found here. We have read with interest and some dismay the results of the EMTA survey which show a clear issue with access to research involvement and critical appraisal activity. We’re currently working on plans to create some regular TERN Education content to help remove barriers to journal club provision at local and regional levels. For this to be a reliable and sustainable process, we will be regularly involving the TERN regional reps in content production, and are also looking to recruit more members to the TERN Education central team. If you are interested in getting involved, please contact us at both tern@rcem.ac.uk and tern.education@rcem.ac.uk
TERN Committee
We will be looking to recruit members to a central TERN committee in the near future, so watch out for an email with more details. We’d love to hear any and all suggestions about how the TERN committee could be structured to best serve it’s members.
Regional Reps
Thank you very much to our regional reps who have worked so hard to make the network a success over the past few years. We have refreshed our list of who is in post across the UK and the time has come to appoint some new people in the regions listed below. This is a great opportunity to help with the network’s activities on a regional level, have some input into how TERN research is delivered, and coordinate regional contributions to the TERN Education output. Although responsibilities are not too onerous, there’s plenty of opportunity to make a meaningful contribution.
- Kent Surrey and Sussex
- London North Central and East
- London North West
- London South
- North West
- Northern Ireland
- Scotland North
- Scotland West
- South West - Peninsula
- Wessex
- West Midlands
- Yorkshire and Humber North and East
- Yorkshire and Humber West
Please get in touch if you’d like to be involved or have any questions!
The SHED leaderboard is live!
SHED Leaderboard
TIRED 2
I am so pleased to be able to contact you with the link to the second paper from the TIRED study ‘Need for recovery and physician well-being in Emergency Departments: national survey findings’ paper published in the European Journal of Emergency Medicine.
All contributor names will appear at the end of the article and the article should be able to be accessed through local institutional logins but if you have any issues then please let us know.
Your hard work in sharing and spreading the message of the original TIRED study paper in BMJ Open was brilliant and resulted in the article having an Altmetric of 214, featuring as a 60 second piece in the BMJ in print and is still being picked up with citations and a recent infographic.
So we would encourage you to do the same with this paper and increase the impact on this still very important topic by sharing the paper and results with your colleagues as widely as possible through email and on social media using the hashtag #TIREDSTUDY and feel free to tag in @ternfellow and @lauracottey too. We have attached a document containing the Top 5 outcomes which can be used for social media.
Top tips for increasing engagement with the paper:
- Add the article link to your signature block
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Share with colleagues that may have taken part by sharing the link/QR code through email, local whatsapp groups and on social media
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If on platforms like Linkedin or ResearchGate add the paper on there using the DOI
Once again, I cannot thank you all enough for your support of this study and for all the hard work you put in to make it a success. If you have any comments, further requirements or questions please don’t hesitate to contact tern@rcem.ac.uk. TIRED 2!
Laura
The SHED Protocol Is Online!
The SHED Protocol is Online
Study Protocols
Study protocols are a core component of a research studies. They document a study’s rationale, methodology, and planned analyses, and adherence to a protocol is now a part of research legislature (1). These have not always been publicly available, and inconsistencies between protocol and publication have been reported with selective presentation of outcomes (2), inconsistent reporting on methodology (3), and adverse events (4). Trial registries provide a platform for detailing the core components of a study (SHED’s can be found here), but protocols provide additional information beyond what is commonly available on most trial registries (5).
Protocol Publishing
As a result, there has been a move towards publication of study protocols, with entire journals now devoted to the publication of study protocols. Making protocols publicly available informs researchers and participants of upcoming trials and novel research methods, provides greater transparency, and reduces selective publication and reporting of research outcomes, although there is always work to be done (6).
However, there is a problem. Publishing protocols costs money. So how do you adhere to best research practice when you can’t afford it?
As far back as 1999 the internet has been seen as providing a solution to these problems (7). As part of a trend towards greater transparency, the use of preprint publications has grown rapidly over the last twenty years (this wonderful graph tracks the rapid growth in preprints over time). Pre-print publications are presented prior to peer review, with the caveat that it has not been peer-reviewed. During the COVID-19 pandemic the use of preprints increased exponentially as a means of rapidly reporting findings related to this new and novel disease. This image below shows the dramatic rise of preprints.
Image courtesy of Nicholas Fraser
Subarachnoid Haemorrhage in the Emergency Department (SHED)
We are choosing to publish the SHED study protocol as a preprint.
Pre-prints are normally a step towards full publication, a tool to speed up the availability of important research data. However, we are not planning on submitting SHED to a peer-reviewed journal for publication.
We believe that publishing the study protocol is vital for research transparency. Importantly, it will allow our members know more about the study, how it will be run, and get people excited for SHED. It will allow free and open-access to our methodology and ensure that we are held up to the highest research rigor without having to pay for the privilege. We want everyone to be able to read the SHED Protocol.
Despite not submitting for journal peer-review, our study has been reviewed during both the funding and ethical approval process. Indeed, many journals would take these two reviews and accept the protocol for publication – after the open-access payment of course.
Research funding is not infinite, and we have a duty to patients and those sponsoring this study to use the money wisely. We would rather use this limited resource to run the study and increase local research engagement than pay to publish the protocol on a particular journal website rather than a preprint server. Whilst many large studies will not suffer from the thorny dilemma of where best to allocate a limited research budget, many do not have this luxury.
We’re looking forward to running SHED with you all, and getting down to some non-COVID related research. Recruitment will be starting in September / October 2021. Email us here with your questions / comments / suggestions. Tweet about the study and tag us @ternfellow.
References
- European Medicines Agency. International Council for Harmonisation (ICH) E6 – Good Clinical Practice (GCP) (R2) addendum [Internet]. 2016 [cited 2021 Jun 1]. Available from: https://www.ema.europa.eu/en/documents/scientific-guideline/ich-e-6-r2-guideline-good-clinical-practice-step-5_en.pdf
- Al-Marzouki S, Roberts I, Evans S, Marshall T. Selective reporting in clinical trials: analysis of trial protocols accepted by The Lancet. The Lancet. 2008 Jul;372(9634):201.
- Chan A-W, Hrobjartsson A, Jorgensen KJ, Gotzsche PC, Altman DG. Discrepancies in sample size calculations and data analyses reported in randomised trials: comparison of publications with protocols. BMJ. 2008 Dec 4;337(dec04 1):a2299–a2299.
- Scharf O, Colevas AD. Adverse Event Reporting in Publications Compared With Sponsor Database for Cancer Clinical Trials. JCO. 2006 Aug 20;24(24):3933–8.
- Skogvoll E, Kramer-Johansen J. Publication of clinical trial protocols – what can we learn? Scand J Trauma Resusc Emerg Med. 2013 Dec;21(1):12, 1757-7241-21–12.
- Cro S, Forbes G, Johnson NA, Kahan BC. Evidence of unexplained discrepancies between planned and conducted statistical analyses: a review of randomised trials. BMC Med. 2020 Dec;18(1):137.
- Chalmers I, Altman DG. How can medical journals help prevent poor medical research? Some opportunities presented by electronic publishing. Lancet. 1999;353(9151):490–3.
TERNEd Mailing List
What's the TERNED Mailing List? you ask.
First of all: hello. You may have noticed us producing a lot more educational content recently. That is thanks to the sterling efforts of our new Education Reps - Raj Chatha and Celestine Wegeenaar. We want to make sure you never miss out on a post or a podcast from us, so are producing a second mailing list, separate to the usual TERN Mailing list (which can be found here). This one will be focusing on the TERN Educational content we produce, so we will endeavour to keep the two different streams of content separate. If you want to find out more, you can join our TERNEd mailing list here:
https://tinyurl.com/TERNEDMailingList
Here's a nice pretty picture to go with it.
CERA 5
CERA 5 is here!
Good evening everyone. The COVID-19 Emergency Responsiveness Assessment study is in its fifth phase. The first three phases looking at the acceleration, peak, and deceleration of the first wave of the COVID-19 pandemic in the UK in 2020. The fourth phase (for which we now have results!) looked at the impact of the third wave. A finding observed in the deceleration phase of the pandemic was a high degree of persisting distress & trauma. Given the impact of the third wave of the pandemic, we are looking to find out how people are feeling, three months after the first survey.
If you completed the first survey, you will have received an invite to this phase of the survey. This phase of the survey - CERA 5 - is open for two weeks. We will then collect the data and send it off to the R-factory. This will allow us to assess the impact of this third wave of the pandemic in the UK, the impact of which persists for many. Our heart goes out to all those affected by the scenes of devastation seen in India.
Hope you're staying safe.
Rob
TERN April Update
Good morning everyone; time for a TERN April Update!
I just wanted to write a little post updating people on a few things that were going on.
CERA 1
The results of the first, acceleration phase of the CERA study has now been published. It can be found on the EMJ and if you're a collaborator and eager to see your name in lights - can be found here on PubMed. Please tweet and share about it! We'll be posting an infographic to boot.
CERA 4
The results from the fourth iteration of the study looking at the third wave of the pandemic this winter have come back from the R factory, and we will be getting them into a publishable form and will be releasing it to you all. Watch this space.
Delphi
The Delphi study is in full-swing, and we are now rounding out the second round of the questionnaire, attempting to produce a list of research priorities. This will come out and will then go on to identify research priorities for the network. Stay tuned!
SHED
We are going ahead for a September / October start for SHED; we will be releasing a survey next week asking people to tell us where they will be next year in order to start working out where we will be recruiting for the sites. Keep an eye out!
Educational Work
With our new Education leads, Raj & Celestine, we've started producing more educational / research-orientated content on our home on RCEMLearning. This includes two new features - TERN's Top Papers and the TERN Virtual Journal Club.
TERN's Top Papers
Trainees do not always have time to read the most recent papers. We want to help trainees stay abreast of the evidence base. We have started by producing a monthly summary of important articles. Teams of trainees from each region (with the assistance of the TERN Education Leads) will produce a summary each month. These will be comprised of a selection of the most important articles to trainees based around that month’s theme published from the past year.
This summary will be written by trainees for trainees. Participation will help EM trainees evidence the research specialty learning outcome (SLO10) and will help aspiring EM trainees demonstrate commitment to specialty. If you are interested in getting involved email us at tern.education@rcem.ac.uk with your name, grade, and deanery.
TERN Virtual Journal Club
Now, as you will likely know, the new curriculum has removed the critical appraisal exam, moving towards a portfolio-process. We at TERN are keen to introduce evidence-based practice into our everyday working practice. The previous college focus on critical appraisal (by way of making it an exit examination) has meant that this has become the step of evidence-based practice we focus on. The most crucial of the five steps of evidence-based practice, and the one the literature suggests is the most neglected, is the actual application of the evidence to the patient in front of us.
We are planning to meet a number of needs through creating the Virtual Journal Club. Practically, trainees can demonstrate engagement with the new curriculum (and the SLO10 research outcome) and develop skills at appraising the evidence. We want to centre the application of evidence to clinical practice to the forefront of everyone's mind. Too long we look at a guideline and follow it blindly - we want to go behind the evidence, behind the guidelines, and really get to know the evidence-base behind our practice.
Find our articles on RCEMLearning - we'll also have a section where they will be linked to on this website.
This has been your TERN April Update!
Thanks,
Rob
CERA 4 Update - First Week
CERA 4 Update time!
Many thanks for all your amazing efforts with CERA.
We have had 1945 responses which is a tremendous amount. A quirk that had not been anticipated last March (amongst other things, such as us even having to do this iteration of the survey...) had been the transition to an entirely different email set-up in Scotland. I very smartly* changed all of the bounced Scottish emails to nhs.scot which, amazingly, didn't fix the problem for everyone.
So, I'd like to extend sincere, heartfelt, big big thanks to Leia Kane and Rachel McLatchie who have painstakingly gone through their contact lists to update basically all of the bounced Scottish emails. The next round of updates will be going out to everyone tomorrow, which will hopefully give everyone a bit of time to have their say. There's the TERN equivalent of a Blue Peter badge waiting for them both if they want to claim it.
So, the moment you've been waiting for - the league table.
(Link available at www.datawrapper.de)
CERA Is Online
CERA is online!
Good morning everyone, and many thanks for all your hard work with CERA - CERA is online. The study has gone live and the full preprint can be found here: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3760472. As you may have seen, the press release has been picked up by a few places. I'm going to share with you where you can find our work.
Press
These articles are directly about the findings of the CERA Study:
and these articles reference the findings:
- Metro
- WalesOnline
- Belfast Telegraph (paywalled)
- Daily Mail (apologies. They don't even reference who did the study. Typical.)
Interview
Listen to Tom Roberts, former TERN Fellow, discussing the CERA study on LBC. It can be found on our new Soundcloud.
Infographic
You can find our infographic here. Let me know what you think!
Journal Club Facilitation
If you've got a Journal Club coming up or simply want a little more detail than the infographic but can't sit down to the paper, you can read the Journal Club facilitation document. If you want to run it as a journal club, instructions are found within the document. Big shout out to Laura Cottey & Leia Kane for their work on TIRED for 'inspiring' this format. The document is here.
Thank you again for all of your sterling efforts & enthusiasm. TERN is the result of all of your work & ardour.
Thank you.
Rob
A SHED Update
SHED Update here.
Good morning everyone,
Many thanks, again, for all of the time and effort you have put into the Subarachnoid Haemorrhage in the Emergency Department (SHED) study. We have been delighted to see so much enthusiasm and engagement for this study, especially after delays due to the first peak of the pandemic.
However, this new viral variant and resultant third wave of COVID-19 is a further challenge to observational research. A new national lockdown has been enacted. Patients from Kent are being transferred to intensive care units in Devon for capacity. The urgent public health research prioritisation template has been recirculated and it is clear that any level 3 studies will receive little or no R&D support regarding set up, governance, oversight and recruitment.
As a consequence, we have discussed again with the sponsor to review delivery of the SHED study. Unfortunately, we all feel it will be difficult to proceed; the majority of sponsor R&D staff are working from home and are being prioritised to support urgent public health COVID-19 research. Your local R&D departments are likely facing similar challenges. Redeployment of nursing & clinical staff is happening, which will affect both research nurse support and clinical delivery of the study. It appears untenable to proceed at present and we remain concerned about the validity of the research within the current NHS pandemic setting.
We are therefore proposing a further deferral for SHED. We plan to defer until September 2021 for the earlier sites and October 2021 for the majority of sites.
We share your disappointment and can only apologise if rotational placement means you will now struggle to participate. However, we now have a 6-month opportunity to develop research opportunities at further sites, make the necessary amendments and ensure the protocol is deliverable in the context of any recent local changes. We have over 110 sites signed up, so chances are the ED you move to will already be involved. If it isn’t, let us know, and we can work with you to get local approvals set-up so you can hit the ground running.
It is a very difficult decision to have to do this, especially a second time, but we are certain this is the right thing to do. In addition to the above, we will be using the next 6 months to work on our website and consolidate & publish the outputs from recent TERN projects. We will also press ahead with the recently commenced Delphi project, as discussed at the December EMTA conference. You'll receive a SHED update confirming details regarding SHED nearer the time, and we'll work with you throughout.
The infrastructure and funding behind TERN provided by RCEM means that background work can continue and our administrative team can take the hit on paperwork, rather than this falling on the shoulders of enthusiastic individual researchers. This remains a big step forward for EM network research and should help us to deliver on the ideas you put forward, even if there are future hurdles to navigate.
For now, good luck, stay safe and get in touch if you have any queries.
Robert Hirst & Dan Horner