11 A Researcher’s Perspective on Technology Collaboration in Palliative Care

despite let's get this going despite the logo we are very much researchers but the logo is just to give us an identity and what I want to talk about here today is our journey to date and the collaborations that we've had so far so I'm gonna talk a little bit about us our journey about our clinical need our collaborators our activities milestones and challenges and positives experience so that particularly to talk about the relationships that we've created along the way and and the challenges and positives from them so the core team is very much Michelle teeny and myself Michelle is a scientist and pharmacologist and she has a lot of experience in patient communication I run a product development company in the UK and have been a researcher in R&D in Medtronic for a number of years before start in the bio innovate program so we also have a support network of collaborators so under us we are with us we have clinicians in the u.s. in the Mayo Clinic we have clinicians in Cork University Hospital Gore University Hospital and shortly in Dublin and we're working very much with Steve over there in the health innovation hub and we won a competition last year in order to work with them to pull together patient engagement and clinician engagement we've also got a design partner we do development in-house in our lab in in Gore University Hospital but we have a specific expert in human factors that we work with specifically to get a consumer product at the end and we also have commercial expertise or external partners and we have consultants in intellectual property regulatory reimbursement and we have a number of mentors who are successful CEOs in Ireland already and specifically in the West Coast so so far we started myself Michelle we started in August 2017 on the bio Navy program and it's a need needs LED innovation program last in ten months the first eight weeks involve clinical immersion so we shadow doctors we shadow nurses we shadow anyone on the page pathway and we get to talk to patients as well our first clinical immersion of four weeks was in Gori University Hospital in Cork University Hospital and the second four weeks is in the Mayo Clinic in the US and we were fully immersed for the full four weeks there so the the program allows you to filter down these identified observations into needs and eventually you come to your top need and that's that's validated along the way by going back and forward to your clinicians through research and through general discussions and perhaps additional surveys and our top need was in the area of pleural effusions which I'll discuss a little bit about later so in June of that year we submit an application and to Oona and her colleagues in Enterprise Island and we got awarded that funding in September and we started proper with the company in October so last October so the area of malignant pleural effusions so effectively it's fluid on the lung so typically between your chest wall and your lung you have a space there which could be described as a balloon and there's only one to two teaspoons of fluid in there and it'll I allows the two to slide over each other with a malignant pleural effusion that can increase to anything up to around two to three liters so it's a significant weight on the person's body it affects around 15% of people with cancer so 15% of all cancer sufferers will get a recurrent pleural effusion and that increases up to 30% with those who lung cancer it is palliative and the predictive survival rate is between 3 and 12 months and the symptoms you get a shortness of breath feeling of fullness chest pain distress and exhaustion as you can imagine carrying that extra weight around with you so the aim of the treatment is to treat the symptom initially and to improve the patient quality of life and you do this by draining the pleural cavity and close in that space so it's close by a process called pleurodesis where there's an adhesion between the two layers so as soon as those two layers opposed they start an inflammatory response and and they no longer open up afterwards so the current treatment and the current creation experience is an indwelling catheter or an IPC some of the issues are you can see in the image here you have an invasive tunneling procedure so that image in the bottom left outlines where there's a catheter up under the skin and then it goes into the pleural cavity so it's quite traumatic for the patient when that goes in it can be very painful and it requires an anesthesiologist to be in the room you've also got an uncomfortable external tube you've got a long-term patient drainage so they can be draining for up to a year in the house and you've got home support which is absolutely required so when we look at the opportunity for us as a technology we look at our leading competitor and it does very well alleviate dyspnea and we will have to do the equivalent or better the only problem is that the average success rate of the pleurodesis through this treatment is only 50% so we aim to target at least 70% we're also looking at the time to the calf catheter removal so it's very unpredictable at the moment anything up to around about 434 days so we're trying to bring a predictability to it which means that the patient goes in on day zero they have the the catheter put in they go home for 30 days manage the treatment themselves and then they go back into the hospital the catheter gets taken out and then they go home and they no longer have any recurrent effusion on patient usability which certainly resonated with me with a lot of the speakers in the room today and it's not it is indicated for self use but it's a very very difficult thing to do we've all tried it and failed so we are trying to massively improve upon that and we have a number of ways identified through the engagement we've had with our clinicians and patients so onto our collaborations so we've got clinical collaborations technical collaborations and academic collaborations within the clinical collaborations we are partnering with patients so it's not just a voice it is very much the patient is on the journey all along with us and we are certainly having a core of that in Ireland through the health innovation hub whereby we set up focus groups with patients and we get access to clinicians who sit down with us who brainstorm and give feedback on possible ways of tackling things on the way that we're looking at changing the procedure on the way that we want to allow the patient to do the drainage at home themselves we have clinicians in the in goal University Hospital our lead clinician is there and we're working with clinicians down in Cork University Hospital very closely and we still maintain relationships with our main mayo clinic clinicians and there's a constant to and fro with them to ensure that we're capturing all the voices from the US as well and we also go in through a program with Trinity College again that's for patient access and clinician access and feedback and this is a very interesting one we recently went for a European funding to partner with an innovation agency in the NHS to get clinician and patient access to get the feedback for design inputs and we were unsuccessful but the agency got back to us and said we really want to work with you despite not have any funding in place come over on Friday so I flew over there last Friday and we discussed a way of moving the project forward and we've identified a way that we can fund it and that's going to be a massive bonus for us to get access to even more patients and access to the NHS system so from a technical collaboration point of view our design partner is an expert in human factors design and patient centric design saw empathic design process that the one that we're looking at so we're talking to patients their family the public health staff anyone that has any input to their treatment and anyone that can influence how the design should be so the aim is to get those insights and experiences and the outcome is to get an appropriate design and usability features and the clinic the clinician involvement and our partners very much work with us so they sit in on sessions and they want to get that firsthand feedback we find it very important that we run the sessions we know the most about the the area and we want to be able to have straight feedback for questions that come from the left field so it's important for us to have control over that but having them in the room and then hearing the voice firsthand is also very very powerful so they'll also the clinicians are also sitting on bench top testing and cadaveric testing and that way we can ensure we have a more effective procedure and a more effective device and with the Colet the academic collaborations because we are under the umbrella of Nu IG we do have a lot of support so we have clinician access in other therapeutic areas and our device can be indicated for other therapeutic areas along the way our first indication is in malignant pleural effusions but there are others we also got access to testing and build facilities within the university the Department of anatomy and allow us access to the cadavers so that we can do clinician validation activities and the School of Economics are currently looking at a healthcare technology assessment so that potentially for further funding or investment we've got a stronger argument about how much we're actually saving the system and the Mayo Clinic and this is kind of unrelated but it's very much related to the the way that we work and the relationships that we want to build along the way we continue the relationship relationships with the Mayo Clinic in the way that now we write in a paper on bedside collaboration and the influence a multidisciplinary team has with clinicians and the way they think innovatively and that paper we're writing on and aiming to have complete the end of this year so our product development timeline is we've completed Calavera tests and we are very early stage we are still researching but we have completed a number of activities in the bench and prototype work and we've submitted for one element of our device a patent which we know is going to stay the same and we're looking at having a final concept or a Minimum Viable Product concept completed by the end of the end of this year and all along that way we collect in patient and clinician feedback and validation so that is probably the most vital activity for us on this project and our aim is to then submit a full device patent and have potential to have FDA clearance in 2021 so when it comes to the the challenges that we've come across along the way certainly patient access and at the start it was amusing to see how we were going to get through it all but with the collaborations we had with the can-do attitude we've managed to really make strides with that and it's a testament to the buy-in that we get on this project clinician time that continues to be a challenge even when we do get clinician time it can be sporadic so it can be a half an hour here 20 minutes there all depends whether they pulled off something more important and academic systems so anyone in a large system like the like Nui G will know that it takes a long time to get through things but we look at that and we ensure that we build in enough in the time for him to get through those and those challenges I know budget our budget is it's reasonable but it is still challenging and it always will be challenging to anyone whatever budget they have I guess and the positives that we've seen along the way are certainly the link with the palliative care group going down into Limerick and doing a knowledge transfer event was a an eye-opener to the palliative care world and some of the relationships that we've created since has been very beneficial to us it is an open and collaborative Network in Ireland I see a lot of it in the West of Ireland being based there but it's it's island wide but it is exceptional in the West in particular so we see that the the hospitals are open to collaboration we've got academic Institute's the we've got Cork University we've got Dublin Trinity College everyone is open to working with them and what we always try to do when we get people involved is take time take time to tell them exactly what we're doing why we're doing it and get the buy-in right from the start to see is this a relationship that really work well and the multinationals I've worked in a multi a multinational and those relationships have really stood strong so when I need something it'll cost thousands to get from scratch or you can go up and ask a friend and they'll give you some parts that will help you out massively to to a design quicker the startup community is very very strong and very collaborative in Galway in particular and networking events however horrendous they can be at the start they always end up really good and there's always a connection with somebody and the can-do attitude it really is it's very much a positive right from the start and see how we can tackle this so it is a very thriving community of support and and I personally believe on genuine connections and you get that quite quickly with people and then you always want to you want to see them again you want to work with them and that's very important for me in my day to day job and with the project as a whole so much Michelle and myself we're very passionate about the area that we're working in and and I do believe we get a lot of buy-in from people because of that and for us it is about given the patient independence comfort and quality of life at a time that matters most to them so I've just put in a slide to outline a couple of the resources that we've used and I'd like to thank Enterprise Island for giving us the opportunity to spend two years proving out our technology and potentially making a big difference in the area of palliative care thank you very much

Glenn Chapman

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