JOB DESCRIPTION – CARDIOTHORACIC ADVISORY GROUP CLINICAL
AUDIT FELLOW (3 year fixed term appointment based at Golden Jubilee
National Hospital, Glasgow & NHS Blood and Transplant, Bristol)
JOB TITLE:
Cardiothoracic Advisory Group Clinical Audit Fellow
REPORTING TO:
Prof Nawwar Al-Attar, Consultant Cardiac & Transplantation
Surgeon, Golden Jubilee National Hospital, Glasgow, Dr Nick
Banner, Consultant in Cardiology, Transplant Medicine and
Circulatory support, Harefield Hospital (Chair CTAG Audit
Group) and Dr Jenny Lannon, Principal Statistician, NHS
Blood and Transplant
SALARY:
According to qualifications and experience
CONTRACT:
Three years full-time
LOCATION:
The Golden Jubilee National Hospital, Glasgow and NHSBT,
Bristol.
SUMMARY:
The Research Fellow will join a national programme of audit and clinical research in
heart transplantation coordinated by the CTAG Audit Group. The Fellow will conduct
a series of studies building on previous work carried out by the Group which involved
an observational UK multi-centred modelling study on the incidence of Primary Graft
Dysfunction.
The post will be suitable for doctor training in either cardiac surgery or cardiology,
ideally with a NTN and a special interest in the treatment of Heart Failure. The
successful candidate will be expected to register for a higher degree at the University
of Glasgow. In addition, the post holder will be encouraged to maintain their clinical
skills (either in cardiac surgery or cardiology). Training and support will be provided
in clinical research methodology, audit and statistics by NHSBT and at the University
of Glasgow.
The post holder will also work in conjunction with all UK cardiothoracic transplant
centres.
BACKGROUND:
The high incidence of primary graft dysfunction after heart transplantation in the UK
and consequent risk-averse donor-selection is the most pressing problem facing the
cardiothoracic transplant community. If we are to achieve our goal of a sustainable
increase in UK cardiac transplant activity, it will be essential to address this issue.
The CTAG audit group has a proven track record in this area. The high incidence of
PGD events makes the project of national interest. The recent ISHLT consensus
definition of PGD, and its grading, will necessitate modification of the UK audit
database. This post is intended to support development of the audit database and
clinical research in this area
16th June 2014
MAIN TASKS FOR THE CLINICAL RESEARCH FELLOW:
The main aims for the Research Fellow will cover areas of literature review, auditing
and practice change, and research developments around management of primary
organ dysfunction. These will provide the Research Fellow with a comprehensive
exposure to and understanding of clinical research
The audit fellow will be involved in four streams of work which will form a coherent
basis for a research thesis and are likely to result in several peer review publications.
Stream One: Modelling the incidence of PGF
Work to-date has been carried out looking at the univariate impact of individual risk
factors on the incidence of PGF. The fellow will extend this work and construct a
multivariate model which takes in to account the combined effects of these factors
and looking in more detail at the grading of PGD and its impact on clinical outcome.
Stream Two: Impact of the implementation of new ISHLT guidelines for
defining cardiac PGD
The research fellow would be involved in retrospective data collection and validation
from individual centres. Data would be collected in order to grade PGD as defined by
ISHLT. This will allow us to compare the ISHLT definition to previous definitions
and explore the relationship of this new definition to clinical events.
Stream Three: Supporting the development of heart and lung allocation
protocols
The CTAG Zonal Allocation Working Group has recently been established to review
the existing zonal arrangements for heart and lung allocation zones which are
currently shared between the two organs, and to define new arrangements as
necessary. The research fellow would support the Group in the development of heart
and lung allocation protocols in general, including support for computer intensive
simulation studies, for example. The fellow would help inform multivariate modelling
of outcomes and waiting times.
Stream Four: Pilot Clinical Trial on the use of remote preconditioning in cardiac
donors
This is a national study which aims to determine whether remote ischaemic
preconditioning (RIC) reduces PGD after heart transplantation and improves heart
transplant outcome. The fellow would directly contribute to setting up the design of
the trial, initiate a pilot study (in Glasgow) to establish feasibility of the technique in
donors. This entitles working with an industry partner who provides devices that
would blind operator to intervention making the trial a randomised double blinded
placebo-controlled trial.
References
Botker, H. E., Kharbanda, R. K., Schmidt, M. R., Bottcher, M, Kaltoft, AK,
Terkelsen, CJ, Munk, K, Anderson, NH, Hansen, TM, Trautner, S, Lassen, JF,
Christiansen EH, Krusell, LR, Kristensen, SD, Thuesen, L, Nielsen, SS, Rehling, M,
Sorensen, HF, Redington, AN, and Nielsen, TT. Prehospital remote ischaemic
16th June 2014
conditioning increases myocardial salvage in acute myocardial infarction. Lancet .
2010.
Thielmann M, Kottenberg E, Kleinbongard P, et al. Cardioprotective and prognostic
effects of remote ischemic preconditioning in patients undergoing coronary artery
bypass surgery: a single-center randomized, double-blind, controlled trial. Lancet
2013; 382: 597-604.
Ericca.lshtm.ac.uk protocol accessed 24 August 2013.
Rogers, C. Primary Graft Dysfunction – updated analysis. Oral presentation to the
NHSBT CTAG Heart Advisory Group. 18/09/2013.
Banner N R, Thomas, H.L, Curnow, E, Hussey, J C, Rogers, CA., Bonser, RS. The
importance of cold and warm ischemia for survival after heart transplantation.
Transplantation 2008;86: 542-547
Kobashigawa, J, Zuckermann A, Macdonald, P, Leprince, P, Esmailian, F, Luu, M,
Mancini, D, Patel, J, Razi, R, , Reichenspurner, H, Russell, S, Segovia, J, Smedira, N,
Stehlik, J, Wagner, F. Report from a Consensus Conference on Primary Graft
Dysfunction After Cardiac Transplantation. Downloaded from ISHLT website.
APPROPRIATE SKILLS:
The successful candidate will have a postgraduate qualification in medicine.
Preferably a cardiothoracic surgical or heart failure cardiology trainee who is highly
numerate with strong statistical and programming knowledge. An interest in clinical
research, inter-personal skills and an ability to work within a team are essential.
PLACES OF EMPLOYMENT
Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
NHS Blood and Transplant, Oak House, Reeds Crescent, Watford, WD24 4QN
CONTRACT
A three year fixed contract will be offered.
APPLICATION
Application is by NHS Application Form including current CV which should be
submitted with a statement of support indicating the applicant’s interest in clinical
research. Short-listed candidates will be invited for interview.
Informal enquiries about the post are encouraged and should be directed to Prof
Nawwar Al-Attar (Nawwar.Alattar@gjnh.scot.nhs.uk; Tel 0141 951 5853) Dr
Nicholas Banner (n.banner@rbht.nhs.uk; 01895828556).
16th June 2014
EMPLOYEE SPECIFICATION
REQUIREMENT
ESSENTIAL
DESIRABLE
Qualifications

Hold MB, ChB or equivalent
Postgraduate qualification e.g.
MRCS or MRCP
Clinical
Experience

Experience of cardiac surgery or
cardiology


Clinical Audit experience
Interest in management of
heart failure or organ
transplantation

Clinical trial and/or other
research experience
Presentations at external
clinical
or
research
meetings
Publications
in
peerreviewed journals
Management and 
Administrative
Experience

Teaching
Experience

Research
Experience

Ability to work within and , when
appropriate, lead a multi-disciplinary
team
Understanding of and ability to
institute clinical governance measures
Ability to teach junior medical and
nursing staff


Other
Attributes






Ability to communicate effectively 
and work with/influence senior
colleagues across a range of
specialities.
Ability to write reports and papers in
the medium of English
Good interpersonal skills
Commitment to Continuing Medical
Education and the requirements of
Clinical Governance and Audit
Willingness to undertake additional
professional responsibilities at local,
regional or national levels
Highly numerate with strong statistical
knowledge (including use of statistical
software)
Long-term commitment to
transplantation’