James Lind and the RCEM needs you (and you, and you). St.Emlyn’s


You probably already know of James Lind as he is rather famous in medical research. If not then you will know his work. As a Scottish physician working with the Royal Navy he conducted the first clinical trial using citrus fruits to prevent scurvy, and made great strides to improve basic hygiene and thus prevent typhus. He is arguably one of the most important figures in the history of medical research.

So why are we talking about him now?

Today could be a watershed day for emergency medicine in the UK. The James Lind alliance is a non-profit making initiative which was established in 2004. It brings patients, carers and clinicians together to identify and prioritise the unanswered questions about the effects of treatments that they agree are most important. 
This week the first process for finding the top research priorities starts with a meeting at the Royal College of Surgeons of England.

The team is guided by Richard Morley who brings a wealth of experience to the process having run several priority exercises in the past. We will be working over the next 12-18 months to set the research priorities that matter for patients, carers and clinicians. It’s going to be highly influential and we need your help to make it work.

You can hear more about the work of the JLA in this short video from the recent RCEM conference in Manchester.

Why do we need to do this?

Emergency medicine in the UK has a huge scope of practice and it is therefore difficult to determine where the priorities exist for research. In the last 20 years we have seen UK emergency medicine research make huge strides forward with many centres of excellence and an increasing number of large scale trials answering what we believe to be important clinical questions. However, the ideas on what to research are largely led by the interests of individual researchers and teams. In other words research on patients is largely led by clinicians and whilst I have no doubt that those clinicians have the best interests of patients at heart we could not defend a charge that patients and their families are not involved in setting research priorities.

If you need convincing about that, consider that some esteemed colleagues believe that up to 85% of research is wasted.

The JLA seeks to bring patients, carers, families and clinicians together to set the priorities for research and it is this a powerful tool to then take those priorities forward to funding organisations for subsequent clinical trials.

1st steering group
First meeting of the JLA EM steering group (sadly I missed the photo)

The advantage of the JLA is that they provide a framework, with a reproducible process, and advisers who guide the process along the way. They are recognised by large grant-awarding bodies as the gold standard in research prioritisation. If you are applying for a research grant, and can map your application to one of the research priorities, then this adds considerable weight to the application.

In other words the JLA process is designed to find the right questions, to prioritise the right questions and then to publicise and promote answers to those questions. It is hosted within the National Institute for Healthcare Research (NIHR) and it’s findings are considered highly influential to research funding bodies. In other words the peoploe with the cash take notice of what JLA partnerships find. If we are to deliver important, relevant and great research in emergency medicine we need to do this.

If you are involved in emergency medicine in any way it must be obvious why this is important. Most importantly this is not just for academics and researchers. It’s for everyone who works in emergency care.

How does it work?

Today marks the first meeting of the steering group that will set up the EM priority setting partnership (PSP).

PSPs comprise patients/carers and their representatives, and clinicians. The JLA process is designed to bring about this sort of collaboration which is otherwise rare in research priority exercises which are typically influenced by clinician preference or industry.

The basic process looks a bit like this.


Over the next 18 months the PSP will identify topics that are important, and yet to be answered using a variety of mechanisms akin to systematic reviews, listening exercises and priority setting groups.

At the end of the process we should have a top 10 list of research questions that need answering and a whole range of other questions linked to the UK DUET (Database of Uncertainties about the Effects of Treatments). http://www.library.nhs.uk/duets/

The St.Emlyn’s team are involved so that we can help engage with as wide a community as possible through social media and also because of the team’s expertise in critical appraisal and the BestBets system which we can use as a system to test the evidence base for any questions that arise.

Who’s funding it?

The EM PSP is being generously funded by the Royal College of Emergency Medicine.

What’s the time scale?

The steering group met for the first time today to begin agree the process for EM, to identify stakeholders and to get started. We expect the process to take about 18 months to complete. The key date for you (and me) is the end of January 2016 which is the closing date for submitting your questions.

We need you to get involved!

We absolutely need you to get involved in the process. This is a way for us to identify and prioritise really important questions for our speciality and a way for us to drive research funding into those areas. So what can YOU do?

  1. Submit your suggested research question or topic now!  We want to hear from everyone and gather as many ideas as possible.  Submit your suggestion 30 Sept 2015 – 31 Jan 2016. This is the most important responsibility for you and everyone else involved in emergency care. Without great questions we will not have much to work on so itis absolutely vital that we hear from everyone. Social media is one route to this engagement but please get out there and speak to your colleagues, your patients and any local interest groups that might have a great research question for emergency medicine.
  2. Download the flyer to display in your ED
  3. Follow the team on Twitter at @JLAEMPSP
  4. We need volunteers to act as Local Champions across all relevant stakeholder groups: clinicians of all levels (including doctors and nurses), patients and carers. If you’re interested in becoming a Local Champion for this project, please contact Jason Smith. Local Champion applicants – it would be helpful if you could explain in a short statement why you think you would be suitable.

Screenshot 2015-10-23 09.34.20

We particularly want to hear from people with the following skills and/or experiences.

  • Allied health professionals who work in emergency departments
  • Clinicians of all levels
  • Data analysts
  • Devolved nation representatives
  • Experience of patient involvement in research
  • Nurses who work in emergency departments
  • Patients and lay representatives
  • Systematic reviewers

What if I don’t work in an emergency department, or don’t live in the UK?

It does not matter. If you have a great idea or question let us know. If a question is important and relevant we will use it in the priority setting exercise.

So what should you do right now?

Get interested, get involved, get others involved and share your ideas. Together we will make a real difference For more information on the JLA please visit www.jla.nihr.ac.uk. You can follow the JLA on Twitter at www.twitter.com/lindalliance and there is a specific twitter account for the emergency medicine group




Before you go please don’t forget to…

Cite this article as: Simon Carley, "James Lind and the RCEM needs you (and you, and you). St.Emlyn’s," in St.Emlyn's, October 23, 2015, https://www.stemlynsblog.org/james-lind-and-the-rcem-needs-you-and-you-and-you-st-emlyns/.

4 thoughts on “James Lind and the RCEM needs you (and you, and you). St.Emlyn’s”

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