Conducting a project from start to finish

1
Conducting a project from start to finish

• An example of a successful small project
• run in Primary Care
• Dr David Memel

2
(No Transcript)
3
The idea

• Came from everyday clinical practice
• Does ear syringing actually help people or is a
  ritual that is easy and satisfying for both
  doctors and patients
• Does ear syringing improve hearing (objective
  measurement)
• Does ear syringing help other symptoms

4
The team

• Talk to colleagues doctors and nurses
• Assemble a team
• Researcher
• GPs from three practices
• Statistician
• Academic ENT Surgeon
• Audiologists

5
Funding

• RCGP Scientific Foundation Board

6
Things that helped made the trial feasible

• Able to have patients in a special clinic where
  researcher, nurse and audiologist all present
• The trial rotated round the three practices
• Intervention was acceptable to patients, nurses
  and ethics committee

7
The intervention

• Intervention Group
• Saw nurse who decided the ear(s) to be syringed
• Had first hearing test with Audiologist
• Had ear(s) syringed
• Waited for ears to dry and filled out
  questionnaires
• Had second hearing test
• 1 week later were sent another symptom sheet by
  post

• Control Group
• Saw nurse who decided the ear(s) to be syringed
• Had first hearing test with Audiologist
• Waited same time as syringing would take. Filled
  out questionnaires
• Had second hearing test
• Had ear(s) syringed
• 1 week later filled out another symptom
  questionnaire

8
Results

• 185 patients had ears syringed in 12 week period
  in combined population of 33,000
• Equivalent to 25,000 in UK every week
• 116 patients took part in the trial

9
Results

• 34 of intervention group hearing (tested before
  and after syringing) improved by 10 dBs or more
• Only 1 person (1.6) of controls hearing(no
  syringing between tests) showed this level of
  improvement.
• NNT 3.1
• Other symptoms as well as hearing improved on
  symptom questionnaires
• particularly pain and feeling of blocked ears

10
(No Transcript)
11
Publication

• Rejected at first post by BMJ
• Academic ENT surgeon said quality of audiology
  measurement was inadequate
• Accepted by British Journal of General Practice

12

• Ear syringing
• There is consensus that ear syringing is
  effective, but we found no RCTs comparing ear
  syringing alone versus no treatment.
• One RCT compared oily drops plus syringing
  versus oily drops alone and assessed improvement
  in hearing.18 The RCT did not relate
  improvements in hearing to amount of wax removed.
  It found that oily drops plus syringing
  significantly increased the proportion of people
  with improved hearing compared with oily drops
  alone.18 However, oily drops may impair
  baseline hearing level, which may have biased the
  results in favour of intervention. This makes the
  RCT difficult to interpret.
• Memel D, Langley C, Watkins C, et al.
  Effectiveness of ear syringing in general
  practice a randomised controlled trial and
  patients' experiences. Br J Gen Pract
  200252906911. PubMed