Statistical Contributions to Medical Research in the South West Peninsula

Abstract

The papers on which this thesis is based are the result of original research work undertaken in collaboration with healthcare researchers in the South West Peninsula. Modern healthcare research involves large scale multidisciplinary projects and the Statistician's role In these projects, from concept through design and execution to the production of published papers, is crucial. Funding bodies, and in particular the Medical Research Council (MRC), expect a Statistician to be part of the project team and the statistical input and expertise included plays a key role in determining whether or not projects are funded and are subsequently successful. The selection of papers concentrates on work in the specialty of Neurology, which forms the major part of the thesis, a trial of a complementary therapy in General Practice, work in Primary Dental Care and work in the Anaesthetics and Histopathology departments in Plymouth. Some of the papers are the outcomes resulting from NHS researchers approaching the candidate for statistical advice and assistance to support their clinical work In the South West Peninsula. Funding in 1997 enabled a small group of Statisticians In Plymouth to set up a Statistical Support Service for researchers in health care across the South West Peninsula. Clinical researchers have taken the opportunity to consult a statistician with regard to the design, execution, analysis and reporting of their research work over the past eight years and, whilst many consultations progress the researcher's work but are not major undertakings, a sizeable proportion have developed into significant contributions to the body of knowledge In the clinical specialty. The paper reporting the results of. Phase I of a trial on the use of Cannabinoids in Multiple Sclerosis (CAMS) has become a major reference work In Neurology and also specialties where pain relief is important, such as cancer. This was a high profile project partly as a result of the nature of the treatment and partly because of the type of patients involved. Anecdotal reporting often suggests alternative therapy to treating physicians but many of these remain untested and. in the evidence-based and cost conscious world, are increasingly coming under scrutiny using a scientific approach. The nature of this particular treatment necessitated extreme caution at every stage of the trial and the candidate was part of the Thai Management Group from inception to completion. This submission also includes a paper reporting the Phase II results and a further paper on chemical markers relating to the treatment. With the emphasis on prevention in Health Care, more research is emanating from researchers in Primary Care and this is represented here by the results of a trial on the use of the common stinging nettle to treat arthritic pain in the thumb, and by work on anxiety in Dental Clinics. The remaining papers look at applications in radiology and histopathology, the laboratory based research on which clinical decisions so often depend but which frequently fails to grab the headline news. These papers represent just some of the output from my part in the developing role of the Medical Statistics group in the clinical research of the South West Peninsula.