Respiratory Registrar in West of England recognised for contributions to research

Dr David Arnold, Respiratory Registrar, North Bristol NHS Trust, has been awarded the British Thoracic Society (BTS) and NIHR Clinical Research Network (CRN) Early Career Researcher Award 2023.

The BTS and NIHR CRN research awards celebrate the outstanding contributions from the respiratory clinical research community. This award recognises Early Career Researchers and those new to research showing a significant contribution to recruitment into NIHR portfolio studies. The award specifically recognises contribution to: 

• Increased research recruitment and/or developed new pathways to recruitment
• The successful delivery of NIHR portfolio studies
• Engagement with patients to inform them of new opportunities to participate in NIHR CRN clinical research

Research journey

Following the announcement of his award, we talked with David to find out more about his career in research.

After medical school David was part of the Specialised Foundation Programme. At that time he approached the respiratory team in Southmead Hospital, Bristol. “I had heard they did a lot of good research and that they had a big bank of pleural fluid, a fluid that lubricates the thin tissue that lines the chest cavity and surrounds the lungs, in their freezer. Slightly odd, but that sort of attracted me to the team. I’ve been here ever since.” 

In the 12 years since David joined the team, he has become an Academic Clinical Fellow, then a Doctoral Research Fellow and is currently an Academic Clinical Lecturer, following the Health Education England (HEE) / NIHR Integrated Clinical Academic Programme.

“The NIHR has supported every single step of my research pathway and given me the time and funding I need to do it. I wouldn't be where I am today without NIHR funding.”

Removing barriers to recruitment

David is the joint lead for the Aspirin after hospitalisation with Pneumonia to prevent cardiovascular Events randomised Controlled Trial (ASPECT) which will be the largest NIHR interventional respiratory trial ever, recruiting 22,600 patients across 60 UK hospitals. The trial is currently in the pilot phase and has already opened in 25 UK hospitals.

In order to meet these ambitious recruitment targets, David is working hard to make it as easy as possible for everyone involved.

“I think what we learnt from COVID is that if we put our minds to it, the NHS is very well set up to do research. You've just got to make it as easy as you can and remove as many barriers as possible for the physicians, the research team and also for the patients.”

David advocates for healthcare professionals who are starting out in their research careers to join the associate principal investigator (PI) and trainee network schemes. “I’m really passionate about championing non-medical professionals being PIs, for example we’ve got several nurse PIs who are recruiting to the ASPECT trial.”

Other ways that David and his team are removing barriers to recruitment involve having “a razor sharp focus on trying to keep things as simple as possible, trying to minimise things like loads of questionnaires and repeat hospital visits.” 

Making studies and findings accessible

David was part of the AERosolisation And Transmission Of SARS-CoV-2 in Healthcare Settings (AERATOR) study, in which he and his team were working with the physicists from the aerosol science department in Bristol to try work out how much virus or how much aerosol was produced from medical procedures. The results of the study facilitated the safe resumption of NHS services during the pandemic.

David worked with a medical illustrator to translate the results of the study into a digestible comic strip. The team are hoping to use the same illustrator in every part of the research process, including co-designing illustrations with PPI representatives to help convince funders that respiratory is an important area of research.

“If you can present them with any sort of illustration about their condition, they’ll learn a little bit more about it and then understand the study much better. It's a much better way of getting informed consent”

Involving patients in the process

David spoke about another study that came from Emma Samms, a PPI representative for the DISCOVER study.  She had contracted COVID in the first wave and then developed long COVID symptoms. “She noticed from a lot of her chats with patients with long COVID that they were really reticent about getting vaccinations.”

David co-developed a study with Emma and set up a case control study as the vaccine was rolled out to see whether the vaccine worsened or improved COVID symptoms. Emma was a co-author on the study paper, which was published in Annals of Internal Medicine and cited in NICE vaccine guidance.

“It is a fantastic example of patient involvement from an idea all the way through to publication.”

This is not the only example of David going above and beyond to ensure that the patient's voice is a priority.

“A lot of the time research is done on patients, more than for patients. We are trying especially in this department to involve patients more and more at the early stage.”

David is co-leading an upcoming James Lind Alliance Priority Setting Partnership on the topic of pneumonia and its complications with Dr Fergus Hamilton. “This will ensure that the patient voice is represented in future research funding in the UK and worldwide for at least the next decade.”

Could respiratory research be for you?

We asked David about the benefits of being involved in research as part of his career.

“It’s using your mind in a different way. I love being on the ward and talking to patients and that’s where you get a lot of research ideas. But you very quickly realise what is the limit of knowledge about a lot of the interventions that we are performing so it’s great to have time to think about how to improve outcomes for patients.”

“Should ASPECT be successful then that will be the first real advancement in your pneumonia treatment in decades. Almost since the invention of antibiotics, the treatment of pneumonia hasn't really changed so it's fantastic to be at the cutting edge of that.”

“You need to have a really supportive mentor, which I have had in Nick Maskell, and a great team around you, and the Bristol team is that. If you can build those things from the start, then you've got every chance of really being successful in research.”