Clinical Applications: A Medical Perspective

Guest: Dr Mairead Black
• Introduction to Dr Black and her research
• How does Dr Black use AMND in day-to-day practice?
• AMND research aiding clinical decision making
• Does clinical life influence AMND research?
• Extending AMND’s clinical applications across the UK

Show Notes

Episode 3: Clinical Applications: A Medical Perspective Guest: Dr Mairead Black Topics: Introduction to Dr Black and her research, How does Dr Black use AMND in day-to-day practice?, AMND research aiding clinical decision making, Does clinical life influence AMND research?, Extending AMND’s clinical applications across the UK

What is AMND in Focus?

A podcast series made in collaboration with the University of Aberdeen and the Aberdeen Maternity and Neonatal Databank (or AMND for short) aiming to act as an educational resource to engage the public in understanding what AMND is and why it’s so important to allow your data to be stored in this databank. We ultimately want people to feel proud to be part of such a unique and successful resource that we are so lucky to have in Aberdeen.

Welcome back to episode 3 of AMND in focus, a new podcast series made in collaboration with The University of Aberdeen and the Aberdeen maternity and neonatal databank (or AMND for short). This podcast aims to act as an education resource to engage the public in understanding what AMND is and why it is so important to allow your data to be stored in this databank.

If you are new here and have missed our previous episodes, we recommend you start from the beginning in order to gain an understanding of AMND and make the most out of the information from this podcast series. My name is Shauneen, and today myself and Grace will be leading this episode from a medical student's perspective.

In today's episode, we will be focusing on how the work and research that AMND does influences the day to day clinical practice within the Aberdeen Maternity Hospital.

Our guest speaker for this episode is Dr Mairead Black, interviewed by Dr Heather May Morgan. Dr Black is a senior clinical lecturer in obstetrics at the University of Aberdeen, as well as an honourary consultant obstetrician at NHS Grampian, with leadership roles in labour ward and the obstetric risk management services.

Her research interests include the role of caesarean birth, informed and supported decision-making in maternity care, multimorbidity in pregnancy, the impact of the COVID-19 pandemic in pregnant women and the role of outpatient induction of labour.

So, how does Dr Black use AMND in day-to-day practice?

Health research has an incredibly high value to society and healthcare. It can provide important information on disease trends and risk factors, outcomes of public health interventions and patterns of care.

Research and clinical trials are an everyday part of the NHS, and the information that we gain from research can eventually be implemented into the everyday practice of healthcare professionals, and allows patients to benefit from this research. Within the Aberdeen Maternity Hospital, healthcare professionals are constantly using research from the AMND. Let's now hear from Dr Black on how she uses the data in her clinical work.

In your work, obviously working very closely with pregnant women in Aberdeen, and doing research around the AMND as well, could you tell us a bit about, in the first instance how you use the AMND in terms of your clinical work on a sort of day-to-day basis in terms of data capture or input of information, what that looks like when you’re actually hands on at work.

So, ever since I arrived in Aberdeen back in 2006, I was aware that the records that we keep when we see women would eventually frame what data is put into AMND. So it has been kind of integral to my practice, and as time has gone on that has become more relevant in terms of knowing that the AMND research that we’ve done has actually given us answers to some questions that women will ask, or will give us information that we will want to provide to women, and that has been really helpful.

I can think of an example being, women who have a haemorrhage after their first birth, and it is a study from the AMND that really gives me confidence in answering their questions and helping them plan for their next pregnancy, because it was such a robust study looking at what happens to women who previously had a haemorrhage at time of birth.

We tend to think of data, I suppose as, big data with individual data in it but I suppose the value of collecting all those individual sets of data the research that is then done can then inform decisions not just to give an oversight of what’s going on but actually can help individuals in decision making in their own personal care as well.

As Dr Black discussed, AMND research is essential in aiding clinical decisions, for both the practitioner and the patient. Shared decision making is an essential component in the modern day doctor-patient relationship, in which the health care professional works together with the patient to reach a decision on their care.

This involves choosing tests and treatments based on both the evidence and the individual's personal preferences, beliefs and values. However, a patient can't make decisions on their care without an understanding of the risks, benefits and consequences of the options available.

This is where the AMND comes in. Discussing the previous research and studies that are relevant to the patient's individual outcomes, women gain a greater understanding of their situation and can be empowered to take an active role and make decisions about the care that is right for them.
So how does patient contact frame AMND research?

Well now that we have an understanding of how AMND research influences clinical life, let's take a look at the opposite question: does clinical life also influence AMND research?

In terms of your own research as well, does that help you to frame questions for your own research because of the close contact you have with patients, their kinds of concerns are they then things that you can use the database to research yourself or think about what data needs to be collected for answering future questions as it were.

Yes, that has very much been the case. As you can imagine there are antenatal clinics, we spend an awful lot of time talking to women about their very individual situations and their individual concerns.

So, one of the issues is that we need to think about what’s happened in their family. For example, if their mum had complications during pregnancy how that might affect them this time, or their own personal history such as previous miscarriage and previous emergency section. Women really want to know, women often ask us what does that mean for next time and we want to be able to give a really evidence based response rather than just experience based.

So it has been really helpful for that kind of issue and has helped us frame research questions, for student projects and for our own projects. So there is a very clear link from the questions that patients ask to the questions that we can answer through the research using the AMND.

That’s really reassuring for women coming into the hospital in Aberdeen and having that connection between research and practice all happening under one roof, and them having some say on what research gets done as well.

It is clear from Dr Black's experience, that patient interaction is a key source and inspiration for potential new research questions. The whole overriding aim of medical research is to eventually improve patient care and outcomes, and so it is obvious that unanswered questions patients may have can give rise to new and exciting research ideas.

As medical students here at the University of Aberdeen, it is exciting to think of our teaching hospital as such a forefront of maternal and neonatal research, and that there is the opportunity for us to also be involved with the AMND in addressing these research gaps.

How does patient contact frame the future of AMND?

So we know that currently, clinical experience and patient contact is essential in the development of new research. Will this extend to the future of the AMND?

So just picking up on that point on future, the data collection is ongoing it continues and the database builds, are there any future intentions around the AMND or any developments that you are aware of that we should be watching out for in the future.

So the thing that really comes to mind is that women have a strong interest in long term complications or even consequences of birth related events, so I think it’s really worth emphasising that the data that we’ve collected from say the year 2000 to the year 2010 where practice was changing all the time, that could lead to different consequences for women 20 or 30 years later. So it’s certainly our intention to do a number of studies looking at long term outcomes of events that happened around that time.

So it could be another 10 years before we do some of those studies, things like pelvic floor function, need for surgery etc might be another 10 years before the numbers of women affected are high enough to make it be useful research. But that’s certainly something that we are planning to do and I’m sure there are many other examples like that where you need time to pass before you get that useful follow up data.

But we can link AMND to Scottish data so even if women have left Aberdeen we could potentially follow up their hospital related outcomes even elsewhere in Scotland.

Great and this really taps into what Shantini was saying about the data linkage side of things and how that can be done to answer these questions that are really important and make use of additional databases to be able to create enough data and follow up data as well to make it useful in research
It is clear that the doctors of NHS Grampian have a strong awareness and usage for the AMND, both presently and hopefully for the future, but can the same be said for our patients? Dr Black and Dr Morgan will now consider how the Aberdeen Maternity Hospital, and those working there, help create an understanding of the AMND in the general population.

I just wonder how, you know obviously in conversations with patients you can raise the existence of the AMND or perhaps refer to research that’s being done with it. But how aware are patients of the fact that their data is being collected for their own records but also for use in research as well?

So that’s something that I’ve become more aware of in recent times, mainly because you see posters up in the waiting rooms and women are often a bit more interested now in how their data is used particularly because it’s now electronic.

However, in saying that even before we became electronic, the paper records that women held actually had a clear statement in them about their records being used for research, and women did spend a lot of time reading their hand held notes so I suspect the knowledge was relatively wide spread although it wasn’t something that we specifically measured, but the information was there in their hands to see which was reassuring.

How is AMND shaping evidence based practice?

The AMND has a crucial clinical application within NHS Grampian, but does this role extend beyond Aberdeen? Let's hear Dr Black talk through her personal role in extending AMND's clinical application to the entirety of the UK.

But the value of the research that’s going on and the data that’s been collected in Aberdeen and indeed been collected for decades, it has wider reach doesn’t it, it’s not just useful here in Aberdeen and the Grampian region but has wider application.

That’s right, so I think a really nice example of that for me is that I’ve spent the last three years on a national guideline committee writing the UK’s antenatal care guideline, and it became clear that there were questions which only studies from AMND could answer, and these were studies which were looking at what happens to women who have a specific complication of pregnancy, what does it mean for their pregnancy outcome, what does it mean for future pregnancies.

So seeing AMND papers used to inform that guideline was fantastic and really highlighted again that it is a unique dataset that’s answering questions that other groups and other data sets can’t answer so that was really good.

Yeah absolutely to see that wider reach and the media coverage of some of the stories but also that policy application, you mentioned the guidelines there, it’s not just the awareness and research but actually its creating that evidence based guideline.

The term evidence based practice was introduced into medical literature in 1991, and is a key medical principle that states the importance of applying the best current and available research into clinical practice.

It is incredibly exciting to know that some of the best current and available research on antenatal care, are studies based on data from the AMND, and that this is being used to create nationwide guidelines. This means that doctors across the UK will be basing their management decisions on evidence that the AMND has a part in.

Overall, the work and research based from the AMND data has considerable clinical applications: in patient understanding and decision making, framing research for the benefit of future patients and in nationwide management guidance for doctors.

Without data collection and research, there is simply no impactful healthcare or treatment options, and here at NHS Grampian, we are proud to be part of something that contributes to maternal and neonatal healthcare, in Aberdeen and beyond.

Thanks again for joining us for our third episode of AMND in focus. We would also like to extend our thanks to Dr Heather May Morgan for carrying out this interview, and to Dr Mairead Black for enlightening us on her personal clinical and research experience, and how closely linked to clinical practice the AMND truly is.