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Lesley Wilson Senior Vascular Research Nurse Newcastle upon Tyne

ACST 2. Lesley Wilson Senior Vascular Research Nurse Newcastle upon Tyne. The key importance of research staff to ensure successful recruitment in to ACST-2 . Aims. Background to Newcastle upon Tyne. Recruitment problems with ACST2. Study set up to optimise recruitment. Barriers

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Lesley Wilson Senior Vascular Research Nurse Newcastle upon Tyne

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  1. ACST 2 Lesley Wilson Senior Vascular Research Nurse Newcastle upon Tyne

  2. The key importance of research staff to ensure successful recruitment in to ACST-2

  3. Aims • Background to Newcastle upon Tyne. • Recruitment problems with ACST2. • Study set up to optimise recruitment. • Barriers • Solutions • Conclusion

  4. Newcastle upon Tyne • Large teaching hospital-2 sites • Population- 900,000 80-100 CEA per year 25-40 CAS per year • 6 vascular surgeons • 2 interventional radiologist • 3 research nurses

  5. Asymptomatic carotid disease • From 2008 to end 2012 • CEA 425 – 64 asymptomatic (15%) • CAS 163 – 67 asymptomatic (41%) • More than one treatment option available • Decisions regarding management opinions often vary • Many referral pathways

  6. Referrals

  7. Barriers for ACST - 2 • Small numbers - (1st year(2008) 22pts • Lack of awareness of ACST2 • Randomisation options not available in many centers- recruitment restricted • Logistics initially seemed problematic!

  8. Study set up • Establish links with regional hospitals • Set up meeting to discuss ACST-2 • Each site had different requirement. • Involve research staff wherever possible • Seek NHS approvals • Agree referral mechanism • Clear patient pathway

  9. Freeman & RVI Sunderland Durham Bishop Auckland Middlesbrough

  10. “ Hub & Spoke ”: Catchment Area 3 Million Recruitment from 6 centres n=114 : Sunderland Royal Hospital James Cook University Hospital, Middlesbrough CAS AT THE FREEMAN HOSPITAL Royal Victoria Infirmary, Newcastle North Durham University Hospital Bishop Auckland Hospital, Cumberland Infirmary, Carlisle

  11. ACST 2 Hub and Spoke • Referring centre: Potential eligible patient Imaging ( duplex) Patient interested in treatment/trial Confirmatory imaging ( MRA/CTA) • Phone – interventional radiology Imaging sent via PAC system + clinical history • MDT • Plan for treatment

  12. Weekly -Multi-disciplinary team meeting (MDT) • Consultant Vascular Surgeons • Stroke physicians • Interventional Radiologists • Medical Physics Laboratory • Research Nurses

  13. Hub and Spoke recruitment by year *Only 17 asymptomatic cases performed out of the trial

  14. Barriers !

  15. Time ! • Out patient clinics : • Inadequate referral information. • Imaging not available • Referral template currently being devised

  16. Patient unclear of reason for referral • Early mention of ACST-2 + information sheet • Clear explanation- reduce risk of bias. • Time to answer questions

  17. Patients perspective. • Expectation • New treatment better • Patient choice • Procedural differences • Dr should know best! • Trial – delays? • Randomisation • Follow up

  18. Attribution of research activity • ACST-2 was adopted by the stroke research network (SRN) of the UK (HTA sponsored trial) • Funding for this studies follows recruitment • Important to agree how this will be calculated amongst centers as this funds research staff

  19. Conclusion What has been key to success? • Commitment to research • Communication • Team work • Research Nurses working within the department • Hub and Spoke • Increase recruitment by 100% • Regular number of referrals

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