èßäapp Research / èßäapp blog posts èßäapp Wild Apricot - membership management software and more en Fri, 27 Jun 2025 12:52:08 GMT Fri, 27 Jun 2025 12:52:08 GMT Mon, 02 Jun 2025 13:34:50 GMT PRAISE Trial - Pain Relief After Instrumented Spinal surgEry <p align="center"><strong><font><img src="/resources/Pictures/Research/PRAISE%20logo.png" alt="" title="" border="0"><br></font></strong></p> <p align="center"><strong><font>Pain Relief After Instrumented Spinal surgEry (PRAISE) trial</font></strong></p> <p align="center"><a href="https://www.sheffield.ac.uk/ctru/current-trials/praise" target="_blank"><font>https://www.sheffield.ac.uk/ctru/current-trials/praise</font></a></p> <p><font style="font-size: 15px;">An NIHR HTA funded randomised controlled trial and economic evaluation investigating the clinical and cost effectiveness of three approaches to postoperative pain relief following elective posterior lumbar instrumented fusion (+/- decompression) at 1-3 levels:</font></p> <ul> <li><font style="font-size: 15px;">Usual care&nbsp;</font></li> <li><font style="font-size: 15px;">Usual care + Intrathecal Opioids&nbsp;</font></li> <li><font style="font-size: 15px;">Usual care + Erector Spinae plane Block</font></li> </ul> <p><font style="font-size: 15px;">The primary outcome is back pain on movement around the bed (sitting up and/or turning) on a 0-100 VAS at 24 hours post-surgery.</font></p> <p><font style="font-size: 15px;">We are currently recruiting participants and setting up new sites. The Sponsor is Sheffield Teaching Hospitals NHS Foundation Trust.</font></p> <p><font style="font-size: 15px;">For more information or to express your interest in setting up as a recruiting site, please contact:</font></p> <p><strong><font style="font-size: 15px;">Sienna Hamer-Kiwacz</font></strong> <font style="font-size: 15px;">(s.a.hamer-kiwacz@sheffield.ac.uk) – Trial Manager</font></p> <p><strong><font style="font-size: 15px;">Prof Matthew Wilson</font></strong><font style="font-size: 15px;">(m.j.wilson@sheffield.ac.uk) – Chief Investigator/Featherstone Professor of Anaesthesia</font></p> <p><strong><font style="font-size: 15px;">Mr Ashley Cole</font></strong> <font style="font-size: 15px;">(Ashley.cole4@nhs.net) – Co-Chief Investigator/Consultant Spinal Surgeon</font></p> <p><br></p> /Research/13505704 /Research/13505704 Tue, 06 Dec 2022 15:17:00 GMT CSF Leak Incidence and Plan - CLIP Study <p>The èßäapp trainee committee would like to invite you to participate in the <strong>National Study - <u>C</u>SF <u>L</u>eak <u>I</u>ncidence and <u>P</u>lan - CLIP Study</strong>.<br> <br> The CLIP study is our new national prospective, multicentred, trainee-Initiative study. Building on the success of the MoveCom study we wish to create a model whereby the èßäapp members can collaborate to create a substantial work of research to answer clinically relevant and important questions.<br> <br> Please find details about the CLIP study below:<br> <strong>Name:</strong>&nbsp;CLIP - CSF Leak Incidence and Plan<br> <strong>Type of Study:</strong>&nbsp;National, prospective, observational study.&nbsp;<br> <strong>Aims:</strong> To assess current practice regarding managing dural tears throughout centres in terms of immediate surgical treatment, imaging and management within neurosurgical and orthopaedic units<br> <strong>Study duration:</strong>&nbsp;6 months, data collection to commence Jan 2023<br> <strong>Benefit for collaborators:</strong>&nbsp;All collaborators and data collectors shall be recognised with collaborator status / collaborative authorship on any presentation or publication</p> <ul> <li><a href="/resources/Documents/News/èßäapp%20CLIP%20Study%20Invitation.pdf" target="_blank"><font style="font-size: 16px;">Study Invitation (.pdf)</font></a></li> <li><a href="/resources/Documents/News/study%20design%20-%20CLIP%20FINAL.pdf" target="_blank"><font style="font-size: 16px;">Study Design (.pdf)</font></a></li> <li><a href="/resources/Documents/News/rules%20of%20engagement%20-%20CLIP%20FINAL.pdf" target="_blank"><font style="font-size: 16px;">Rules of Engagement (.pdf)</font></a></li> </ul> <p>All collaborators that sign up will receive a toolkit regarding the study providing future information. We are very excited to share this opportunity with you - our èßäapp members. We hope you will join us in making this a successful collaborative project. Please use the registration link below to join our study group.<br> <br> <strong>Registration form: <a data-cke-saved-href="https://forms.gle/YEt7jr6923gv6qe27" href="https://forms.gle/YEt7jr6923gv6qe27" target="_blank">https://forms.gle/YEt7jr6923gv6qe27</a></strong><br> <br> Best wishes,<br> CLIP Study Team -&nbsp;<a data-cke-saved-href="mailto:clipstudyèßäapp@gmail.com" href="mailto:clipstudyèßäapp@gmail.com" target="_blank">clipstudyèßäapp@gmail.com</a><br> èßäapp Trainee Committee</p> /Research/13113410 /Research/13113410 Thu, 19 May 2022 10:27:50 GMT The SunBurst trial on thoracolumbar burst fractures <p style="line-height: 27px;"><font style="font-size: 15px;" color="#000000">The treatment for patients with thoracolumbar burst fractures without neurological deficit or definite rupture of the posterior ligament complex is controversial and includes both surgical and non-surgical options. The aim of this study is to compare surgical to non-surgical treatment in patients with thoracolumbar burst fractures without neurological deficit and/or definite rupture of the PLC. &nbsp;</font></p> <p style="line-height: 27px;"><font style="font-size: 15px;" color="#000000">The SunBurst study is an international, multicentre, randomized controlled trial (<a href="http://clinicaltrials.gov">clinicaltrials.gov</a>:</font> <font style="font-size: 15px;" color="#333333">NCT05003180</font><font style="font-size: 15px;" color="#000000">). Currently all centres performing spine surgery in Sweden are involved and additional centres in Norway will join during 2022. Patients 18 to 66 years old with burst fractures from Th10 to L3 are eligible for the study. 202 patients will be randomized in a 1:1 relation to either surgical or non-surgical treatment. Patient-reported outcome measures (PROMs) and radiological data will be collected at the time of injury, after 3-4 months and after 1 year. &nbsp;</font></p> <p style="line-height: 27px;"><font style="font-size: 15px;" color="#000000">Additional centres are welcome to join and can contact: &nbsp;</font></p> <p style="line-height: 27px;"><font style="font-size: 15px;" color="#000000">Simon Blixt; <a href="mailto:simon.blixt@ki.se">simon.blixt@ki.se</a>, MD, PhD-student, Karolinska Institutet and Karolinska University Hospital&nbsp;</font></p> <p style="line-height: 27px;"><font style="font-size: 15px;" color="#000000">Paul Gerdhem; <a href="mailto:paul.gerdhem@ki.se">paul.gerdhem@ki.se</a>, MD, PhD, Professor, Karolinska Institutet and Karolinska University Hospital, +46-736-994409&nbsp;</font></p> <p><br></p> /Research/12785927 /Research/12785927 Tue, 14 Dec 2021 17:44:18 GMT The Modic Trial <p><img src="data:image/png;base64,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alt=""></p> <p><a href="/resources/Documents/Research%20Blog/TMF%202.2.6%20UK%20Persica%20002%20Recruitment%20Poster%2017%20Aug%202021%20UK%20T.pdf" target="_blank">Link to Leaflet HERE</a></p> <p><font color="#00B0F0">THE MODIC TRIAL</font> is open for recruitment for participants with moderate to severe Chronic Low Back Pain with Modic 1 or Modic 1 and 2.&nbsp;</p> <p>A First in Human study evaluating an intradiscal antibiotic formulation in the treatment of Chronic Low Back Pain with Modic 1 or Modic 1 and 2, <font color="#00B0F0">THE MODIC TRIAL</font> was set up following pioneering work by Dr Hanne Albert which demonstrated the efficacy of 100 days of oral antibiotics.&nbsp; The clinical evidence and associated side effects of oral antibiotic treatment was recently reviewed in <a href="https://www.thespinejournalonline.com/action/showPdf?pii=S1529-9430%2821%2900084-X" target="_blank">The Spine Journal</a></p> <p><font color="#00B0F0">THE MODIC TRIAL</font> is a multi-centre, randomised, double-blind, placebo-controlled trial taking place in the UK, Europe and New Zealand where Regulatory and Ethics approval have been obtained.&nbsp;</p> <p>All subjects will have Gd-enhanced MRI scans at baseline, 6 months and 12 months to assess the inflammation/Modic changes in the targeted disc. Efficacy will be assessed over 12 months using patient reported pain and disability scales.</p> <p>The key inclusion criteria are:</p> <p><font face="Arial, sans-serif">•<font style="font-size: 9px;" face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</font></font> Aged 18-70 years</p> <p><font face="Arial, sans-serif">•<font style="font-size: 9px;" face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</font></font> CLBP in the area L1 to S1 associated with vertebral body endplate bone oedema (Modic 1) or vertebral body endplate bone oedema and fat (Modic 1 and 2), at a single lumbar level</p> <p><font face="Arial, sans-serif">•<font style="font-size: 9px;" face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</font></font> CLBP has lasted <u>&gt;</u> 6 months</p> <p><font face="Arial, sans-serif">•<font style="font-size: 9px;" face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</font></font> Moderate-severe pain, back pain greater than leg pain</p> <p><font face="Arial, sans-serif">•<font style="font-size: 9px;" face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</font></font> Moderate-severe disability</p> <p><font face="Arial, sans-serif">•<font style="font-size: 9px;" face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</font></font> There is no clear alternative cause for back pain</p> <p><font face="Arial, sans-serif">•<font style="font-size: 9px;" face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</font></font> Failure of standard of care therapies</p> <p><font face="Arial, sans-serif">•<font style="font-size: 9px;" face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</font></font> The target lumbar disc must not have lost more than half its anticipated height at its centre</p><font style="font-size: 15px;" face="Calibri, sans-serif"><br></font> <p>If you have any patients who are suitable and would like to take part in a clinical trial, referrals can be made to research sites in the UK:</p> <table cellspacing="0" cellpadding="0" style="border-width: 1px; border-style: solid; border-color: initial; border-collapse: collapse;"> <tbody> <tr> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p><strong>City</strong></p> </td> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p><strong>Principal Investigator</strong></p> </td> <td width="227" valign="top" style="border-style: solid; border-width: 1px;"> <p><strong>E mail</strong></p> </td> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p><strong>Phone</strong></p> </td> </tr> <tr> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p><strong>Coventry</strong></p> </td> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p>Mr Robert Sneath</p> </td> <td width="227" valign="top" style="border-style: solid; border-width: 1px;"> <p><a href="mailto:robert.sneath@uhcw.nhs.uk" target="_blank">robert.sneath@uhcw.nhs.uk</a></p> </td> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p><span style="background-color: white;"><font color="#000000" face="Source Sans Pro, sans-serif">+44 2476965067</font></span></p> </td> </tr> <tr> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p><strong>Oxford</strong></p> </td> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p>Dr Matthew Scarborough</p> </td> <td width="227" valign="top" style="border-style: solid; border-width: 1px;"> <p><a href="mailto:Matthew.scarborough@ouh.nhs.uk" target="_blank"><font color="#0563C1">Matthew.scarborough@ouh.nhs.uk</font></a></p> </td> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"></td> </tr> <tr> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p><strong>Preston</strong></p> </td> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p>Dr Shiva Tripathi</p> </td> <td width="227" valign="top" style="border-style: solid; border-width: 1px;"> <p><a href="mailto:FIH@LTHTR.nhs.uk" target="_blank">FIH@LTHTR.nhs.uk</a></p> <p><a href="mailto:Shiva.Tripathi@lthtr.nhs.uk" target="_blank">Shiva.Tripathi@lthtr.nhs.uk</a></p> </td> <td width="156" valign="top" style="border-style: solid; border-width: 1px;"> <p><span style="background-color: white;"><font color="#000000" face="Source Sans Pro, sans-serif">&nbsp;+44 1772 524185 &nbsp;&nbsp;&nbsp;</font></span></p> </td> </tr> </tbody> </table> <p><font color="#00B0F0">THE MODIC TRIAL</font> is sponsored by Persica Pharmaceuticals Ltd.</p> <p>Further information can be found at <a href="http://themodictrial.com/" target="_blank">themodictrial.com</a>, <a href="https://clinicaltrials.gov/ct2/show/NCT04238676" target="_blank">clinicaltrials.gov</a> and at <a href="https://persicapharmaceuticals.com/" target="_blank">persicapharmaceuticals.com</a></p> <p><br></p> /Research/12192196 /Research/12192196 Thu, 28 Oct 2021 11:43:58 GMT Chymopapain Chemonucleolysis re-introduction Study <p><a href="/resources/Documents/Research%20Blog/Chymopapain%20Chemonucleolysis%20re.pdf" target="_blank">PDF Document Here</a></p> <p><strong><font style="font-size: 16px;">Background</font></strong></p> <p><font style="font-size: 16px;">Chymodiactin, the previously available product used widely in Europe, North America and many other countries obtained FDA approval in&nbsp; 1982 and also MHRA approval, ceased to be available in 2002.&nbsp; Abbott Laboratories&nbsp; had recently bought Knoll Pharma, a subsidiary of BASF, who owned the rights to the product, to gain access to the D2E7 molecule, which became the drug Humira. However Abbot decided not to continue with Chymodiactin and it ceased to be available.&nbsp; DisCure Medical has been set up with plans to re-introduce Chymodiactin which still has FDA and MHRA approval. However due to the time lapse, some relatively minor changes in the manufacturing process are likely to necessitate a reintroduction by means of a clinical trial as proposed.</font></p> <p><strong><font style="font-size: 16px;">Study Design</font></strong></p> <p><font style="font-size: 16px;">The study is a single arm prospective study.</font></p> <p><font style="font-size: 16px;">Patients with contained disc herniations at the L4-5 and L5-S1 levels will be randomized to injection of 1000 or 2000 pKat of Chymopapain.</font></p> <p><strong><font style="font-size: 16px;">Inclusion Criteria</font></strong></p> <p><font style="font-size: 16px;">A contained lumbar disc herniation at the L4-5 or L5-S1 level as determined by an MRI, and clinical symptoms corresponding to the location of the herniation.</font></p> <p><font style="font-size: 16px;">VAS Leg pain of 50 mm or greater and the ODI exceeding 30.</font></p> <p><font style="font-size: 16px;">Examination will have restriction of spinal movements and straight leg raising restricted to at least 45 degrees on the painful leg, with a positive bow string sign,&nbsp; with or without cross-over pain to the opposite leg.</font></p> <p><font style="font-size: 16px;">They will have adequate non-operative treatment for 6 or more weeks which may include medication (NSAIDs and/or analgesics), physical therapy, or spinal injection (epidural or root block), will be between 20 and 65 years of age and have had no previous spinal surgical intervention.</font></p> <p><strong><font style="font-size: 16px;">Exclusion Criteria</font></strong></p> <p><font style="font-size: 16px;">Disc herniations at more than one level.</font></p> <p><font style="font-size: 16px;">Disc herniation extruding through the posterior longitudinal ligament or sequestrated.</font></p> <p><font style="font-size: 16px;">Spinal Injection within 3 weeks of informed consent. (epidural or root- block)</font></p> <p><font style="font-size: 16px;">Previous spine surgery.</font></p> <p><font style="font-size: 16px;">Cauda equina syndrome or a severe rapidly progressing neurologic deficit.</font></p> <p><font style="font-size: 16px;">Lumbar spinal stenosis, spondylolisthesis, scoliosis, spinal tumor, spinal infection, ankylosing spondylitis.</font></p> <p><strong><font style="font-size: 16px;">Interested?</font></strong></p> <p><font style="font-size: 16px;">If you are interested in being involved in this study, please contact me ,</font></p> <p><font style="font-size: 16px;">Professor Douglas Wardlaw.&nbsp; Email <a href="mailto:dwardlaw@btinternet.com" target="_blank">dwardlaw@btinternet.com</a></font></p> <p><br></p> /Research/12071297 /Research/12071297 Mon, 14 Jun 2021 14:05:30 GMT POLYFIX <p><a href="/resources/Documents/Research%20Blog/POLYFIX%20DCM%20èßäapp%20summary.pdf" target="_blank">POLYFIX DCM èßäapp summary.pdf</a></p> <p><a href="/resources/Documents/Research%20Blog/POLYFIX%20-%20SBNS%20Update%20April%202021.pdf" target="_blank">POLYFIX - SBNS Update April 2021.pdf</a></p> <p><a href="/resources/Documents/Research%20Blog/POLYFIX%20-%20Trial%20Synopsis.pdf" target="_blank">POLYFIX - Trial Synopsis.pdf</a><br></p> /Research/10634583 /Research/10634583 Mon, 14 Jun 2021 14:02:51 GMT DENS <p><font style="font-size: 16px;"><span style="background-color: white;"><font color="#000000"><a href="/resources/Documents/Research%20Blog/DENS_StudyDiagram_protocol_newsletter%20May%202021.pdf" target="_blank">DENS_StudyDiagram_protocol_newsletter May 2021.pdf</a><br></font></span></font></p> <p><font style="font-size: 16px;"><span style="background-color: white;"><font color="#000000">The Duration of External Neck Stabilisation (DENS) study is a randomised controlled trial comparing early removal of a hard collar with treatment in a hard collar for 12 weeks in older or frail adults with odontoid (dens) fractures. The primary outcome measure is QoL&nbsp;assessed using the EQ-5D-5L at 12 weeks following injury.&nbsp;&nbsp;</font></span><font color="#000000">The aim of the study is to determine whether management without a collar improves outcome, compared to management with a collar. Cost efficiency will be assessed over the observed 12 months using standard NICE reference case methodology.</font></font></p> <p><font style="font-size: 16px;"><font color="#000000">We are currently awaiting&nbsp; REC approval and hope to begin site set up and recruitment from August 2021. If you are interested in taking part and have not already completed a feasiblity study for your site,&nbsp; please contact the Trial Manager, Angela Niven (</font><span style="background-color: white;"><font color="#000000"><a href="mailto:Dens.Trial@ed.ac.uk">Dens.Trial@ed.ac.uk</a>) or the Chief Investigator, Paul Brennan (<a href="mailto:paul.brennan@ed.ac.uk">paul.brennan@ed.ac.uk</a>)&nbsp;</font></span></font></p> <p><a href="https://www.ed.ac.uk/usher/edinburgh-clinical-trials/our-studies/all-current-studies/dens"><font color="#000000" style="font-size: 16px;">https://www.ed.ac.uk/usher/edinburgh-clinical-trials/our-studies/all-current-studies/dens</font></a></p> <p><br></p> /Research/10634578 /Research/10634578