Research in this group is informed by expertise in midwifery and obstetrics, social science, epidemiology and public health. The strategy is currently focusing on two main areas of Health Services Research which include inequalities and disparities in health outcomes and quality and safety in maternal health care, conducted in a range of low, medium and high income countries, and with regard to:
This work is underpinned by a programme of work on evidence synthesis and knowledge translation to inform maternal and infant health care.
This research stream focuses on the three inter-related areas of maternal health, fetal wellbeing and pregnancy outcomes at delivery, with the aim to improve the management of medical problems in pregnancy (antiphospholipid syndrome, pre-eclampsia, obstetric cholestasis, diabetes); fetal congenital abnormality, preterm labour, and dysfunctional labour.
The overarching goal is to implement a research strategy that will deliver new diagnostic tools, novel therapies and clinical management guidelines to improve overall outcomes for pregnant women and their children. Our strategy is centred on translating good basic science research related to parturition, inflammation, obesity and nutrition, reproductive ageing and preterm birth into novel and successful clinical outputs.
Our strengths include large multidisciplinary research team that has access to two of the largest and most socially and ethnically varied and complex populations of pregnant women in the UK that exhibits high rates of pregnancy-associated complications and social deprivation.
We have an excellent track record of developing first trimester screening tools, implementing clinical trials in pregnancy and proven experience in integrating science research goals with clinical need. Our research approach is further enhanced by cross-linking with the researchers with an interest in 'Women's Health Policy, Services and Public Health'. Collaboration will facilitate rapid evaluation of knowledge transfer, and effectiveness and safety of our research outputs in a monitored health care setting. The impact of mental health on pregnancy outcomes will also be a focused area for expansion in our research programmes.
Modern assisted reproduction technology offers both infertile women and men the potential to have a healthy child. In addition, Assisted Reproductive Technology (ART) with pre-implantation genetic diagnosis (PGD) has allowed detection in the early embryo of life threatening single gene related disorders, which through selection of unaffected embryos has enabled the delivery of healthy children to gene carrying or affected parents.
The Reproductive Medicine Unit located at the Guy's Campus comprises the Reproductive Medicine Clinic (RMC), the Assisted Conception Unit (ACU) and the centre for Pre-implantation Genetic Diagnosis (PGD). Together these provide a highly rated comprehensive fertility and reproductive medicine service with over 2000 new patients seen per annum and substantial research potential. The Unit provides the UKs largest and most successful PGD programme and has a pioneering human embryonic stem cell (hESC) research unit. It is also one of the key units for subspecialty postgraduate training in reproductive medicine in the UK.
The recent build on the 11th floor of the Guy's Tower provides state of the art clinical facilities fully compliant with the European Tissue and Cells Directive (EUTCD), as well as full GMP facilities for the production of clinically grade hESC. The Unit has a good network of collaboration between Guy's and St Thomas' NHS Foundation Trust and other national research centres (Birmingham Women's Hospital, Aberdeen, St Mary's Hospital) and other sources in the private sector for recrtuitment of patients for studies (e.g. The Lister Hospital, London). International partners include groups in Belgium, Spain and Italy.
The focus on research is improvement in the outcome of fertility treatment, developing novel efficient techniques for PGD and providing materials for establishing stem cell lines from embryos affected by clinically relevant genetic disorders, under GMP conditions.
The Urogynaecology Unit at Kings College Hospital NHS Foundation Trust is the largest tertiary referral centre in London and has an established national and international reputation for active clinical research, clinical practice, teaching and training. It currently employs three full-time Consultant Urogynaecologists (Cardozo, Robinson, Bidmead), one subspecialty trainee, two clinical research fellows, two senior urogynaecology nurse specialist, one specialist nurse and two women's health physiotherapists.
Current research funding is from industry grants, competitive grants and private sponsorship. Grants and funding pay for the salaries and overheads of research fellows and specialist additional equipment.
The Menopause Research Unit was established in 1991 by Professor Rymer and commenced with a collaborative study with the Guy's Osteoporosis Unit to investigate the first "nonbleeding" hormone replacement therapy (HRT), the primary outcome being bone density. This 15-year follow up study was the longest running HRT trial in the UK. The Unit collaborates with many other disciplines in GSTFT: radiology, nuclear medicine, neuropharmacology, cardiology, cytology, histopathology, breast medicine, oncology, biochemistry and psychiatry. Research fellows in the unit have focussed on the following areas: HRT and osteoporosis, HRT as add back therapy with GnRH analogues, and cardiovascular effects of different nonbleeding HRTs. A major collaboration with the Institute of Psychiatry is ongoing, investigating the effect of sex hormones on brain function. The Unit has been involved in many pharmaceutical multicentre trials.Current research includes a trial on women who have had premature ovarian failure (POF). If the women choose to have treatment they are randomised to HRT or the oral contraceptive pill. The primary outcome measure is bone density. We are also collaborating with the Daisy Network (a support group for POF sufferers). The research fellow responsible for the trial (her MD project) has also started up an innovative NHS Premature Ovarian Failure Clinic with support from the Guy's & St Thomas' Charity and has established a database. This is an example of a research idea evolving into the delivery of a specialty clinic that is both service and research-orientated.
In the laboratory setting, Professor Kevin O'Byrne is studying the neural mechanisms underlying hot flushes, using a radio-telemetry system to monitor rat tail skin temperature (TST); a relevant animal model, which has been extensively validated. His is the only unit in Europe with this capability and are currently studying the effects of selective ER-alpha and ER-beta agonists and antagonists on the vasomotor disturbances that underlie hot flushes. We are also interested in the potential use of phytoestrogens as "alternative" therapies for hot flushes.
Perinatal mental health has a major impact on women and their families, including maternal morbidity and mortality, obstetric complications, neonatal and infant death, and adverse outcomes for both mother, child and the family. We use mixed methods, including epidemiological and qualitative research, systematic reviews, development and evaluation of therapies, development of clinical management guidelines to improve outcomes for pregnant women and their children, analysis of the biological correlates of perinatal mental disorders, and investigation into the impact on parenting skills and long-term offspring development.
In addition we are carrying out a number of research projects on domestic violence, including examining the response of mental health services to domestic violence (LARA), carrying out systematic reviews on the prevalence of domestic violence experienced by mental health users, and epidemiological research investigating the impact of antenatal domestic violence on women's mental health antenatally and postnatally and the impact this has on child development using the ALSPAC cohort.
We evaluate complex interventions for women with mental health problems including women's crisis houses (CHOICES), mother and baby units (ALTERNATIVES study; ESMI study) and health visitor delivered non-directive counselling RESPOND. We lead on gender aspects of the South London and Maudsley NHS Foundation Trust /Institute of Psychiatry Biomedical Research Centre Stakeholder Participation Theme and are investigating the impact of stigma on women's mental health (SAPPHIRE).
Current research includes: co-leading organisational case studies in Birthplace in England, a national study of birth outcomes in home, midwife led, and obstetric led units; investigating the relationship between measures of safety climate and health care quality in A and E and intrapartum care; and conducting nested process evaluations of two trials of obesity in pregnancy behavioural interventions.
I am programme director in the NIHR King's Patient Safety and Service Quality Research Centre leading a programme of work on innovations in service quality and health technologies. The programme of work on patient safety looks at both the translation of novel technologies into health care and innovative ways of organising services differently to bridge 'gaps' in care and improve quality and safety for patients. Current research includes: a) the exploration of the management of 'failure to rescue' in medical and maternity settings b) exploration of the development, diffusion, governance and patient experience of technique-centred and clinical innovation.