Stroke Research Network (SRN)

Background

Academic input into portfolio development is facilitated through the SRN’s eight Clinical Studies Groups (CSGs). The groups have been meeting either by teleconference or face-to-face since December 2005. A number of the CSGs have held workshops with a wider audience of experts in the field to look at specific issues or jointly with other CSGs to work on cross-over issues, and identify priorities for future research.

At its November 2006 meeting, the UKCRC Research Funders Liaison Group requested that all topic network Clinical Studies Groups (CSGs) prepare a paper outlining the key research priorities in their specialist area, to be presented at their next meeting in May 2007. SRN Associate Directors co-ordinated the development of these priorities by involving CSG members and including the outputs from workshops where these had been held. This paper has been updated in the light of further workshops and events, for the next Funders Liaison Group in November 2007.

Identified priority areas of SRN CSGs:

Acute CSG

  • Process: Delivery of immediate investigation using established methods (MRI, CT perfusion) and of optimal (hyper)acute care with proven treatments (thrombolysis, intervention for carotid disease); research into practical aspects of the healthcare process such as emergency service protocols.
  • Methodological: Design and conduct of acute trials: selection criteria and outcome assessment.
  • Mechanistic: Better characterisation and understanding of natural history of subtypes of ischaemic and haemorrhagic stroke, to inform a) selection for future trials; b) predicted outcome for trial planning; and c) mechanisms and choice of interventional approach. This may include exploratory work with existing datasets. It implies considerable investment in research imaging support, especially because adequate imaging is not available through standard services, and into development of new imaging techniques. Reverse translational work is required, aimed at understanding and learning from failures of clinical trial programmes.

Biostatistics CSG

The Biostatistics CSG held its first meeting in April 2007, and will focus on methodological research.

Patient, Carer and Public Involvement CSG

  • Evaluation of the patient, carer and public involvement in stroke research: measuring costs and benefits.
  • Evaluation of different methods of involving patients, carers and the public in stroke research.
  • Seeking the experience of participants in SRN adopted trials in order to identify notable practice

Prevention CSG

  • Value of very early secondary prevention after stroke/TIA
  • Assessment of secondary prevention in specific subgroups, especially lacunar stroke (to prevent stroke and cognitive decline)
  • Use of basic and translational science to develop novel prevention strategies, e.g. based on haplotype (e.g. as deCODE have done with their antiplatelet)
  • Surgical/neuroradiological interventions for causes of haemorrhage, e.g. AVMs, cavernomas
  • Why do patients take or reject long term prophylaxis?

Primary Care CSG

  • Research demonstrating effectiveness of secondary prevention strategies in representative populations
  • Research on identification (including screening) and treatment of mood disorders in people with a past history of stroke
  • Research on strategies for providing late support/rehabilitation for stroke patients and carers (overlaps with Rehabilitation CSG)
  • The role of primary care in ensuring rapid treatment of transient ischaemic attack

Rehabilitation CSG

  • Research focused on improving participation and long term care after stroke (survivors and carers)
  • Investigation of cognitive and psychological factors that influence outcome after stroke
  • Applying advances in basic science and technology to develop new and improve existing rehabilitation interventions for people with stroke e.g. robotics, pharmacology.

Service Development and Training CSG

  • Can groups of smaller district general hospitals provide care for patients with acute stroke that is at least as efficient, cost-effective and acceptable to patients as sub-regional stroke specialist centres?
  • Can generic therapist and nurses provide the same care outcomes for people with stroke, as specialist stroke therapists and nurses, at equal cost?
  • What is the most effective way of teaching primary care clinicians about stroke?

Translational Research CSG

A joint Translational and Rehabilitation CSG workshop to discuss and plan a collaborative research programme was held on 29 March in London. This is to be followed up with another meeting in November 2007. A joint Translational and Acute CSG workshop on imaging in clinical and experimental stroke was held on14 and 15 May in Manchester.

Current partnerships SRN has with funders

SRN has a well-developed partnership with The Stroke Association (TSA), as evidenced by collaborative working for UK Stroke Forum, joint appointment of lay members to key committees (CSGs in SRN and Research Awards Committee in TSA) and funding of the SRN Patient, Carer & Public Involvement Manager. These arrangements are encapsulated in a Memorandum of Understanding between the two organisations.

SRN is developing working partnerships with the MRC on translational research, and the Department of Health HTA and SDO Programmes.

Joint working with the Alzheimer's Society, DeNDRoN and representatives from the major research funding bodies including the Stroke Association, Alzheimer's Research Trust, Wellcome Trust, Health Technology Assessment and the Medical Research Council, to discuss vascular dementia. An initial workshop in May 2007 has resulted in four workstreams to develop studies.

SRN Co-ordinating Centre

12 October 2007

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