{"id":2961,"date":"2024-09-13T07:06:19","date_gmt":"2024-09-13T07:06:19","guid":{"rendered":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/?p=2961"},"modified":"2024-09-12T10:37:40","modified_gmt":"2024-09-12T10:37:40","slug":"my-pronto-journey-world-sepsis-day-2024","status":"publish","type":"post","link":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/my-pronto-journey-world-sepsis-day-2024\/","title":{"rendered":"My PRONTO Journey – World Sepsis Day 2024"},"content":{"rendered":"

-Blog by Julie Carman<\/p>\n

As World Sepsis day comes round again, I invite you to join me as I share my thoughts and observations as the Patient and Public Involvement (PPI) representative on working with the PRONTO trial research team.<\/em><\/p>\n

The PRONTO Trial<\/h2>\n

PRONTO<\/a> (PRO<\/u><\/strong>calcitonin and N<\/u><\/strong>EWS2 evaluation for T<\/u><\/strong>imely identification of sepsis and O<\/u><\/strong>ptimal use of antibiotics in the Emergency Department).<\/p>\n

My name is Julie and I have lived experience of sepsis. I am and have been a volunteer with UK Sepsis Trust for many years providing peer support online and at face-to-face UK Sepsis Trust Support Groups. This film<\/a> explains my story and this blog<\/a> highlights how I am using my lived experience to help improve patient health outcomes.<\/p>\n

As a sepsis survivor I have seen first-hand how important prompt treatment with intravenous (IV) antibiotics is once sepsis is confirmed. As a volunteer with the UK Sepsis Trust facilitating Support Groups and providing peer support to others, I am aware of the side effects of powerful lifesaving antibiotics and the ongoing issues they can cause, including hearing loss and gastric problems.<\/p>\n

The PRONTO trial aims to ensure that timely antibiotics are given appropriately, but not unnecessarily, leading to improved outcomes whilst playing an important part in reducing <\/strong><\/em>antibiotic resistance<\/em><\/strong><\/a>.<\/em><\/strong>\u00a0<\/em><\/strong><\/p>\n

The journey begins<\/h2>\n

I was first approached at a workshop to which patients and public were invited in August 2018. We discussed antibiotic resistance and its causes and why it would be beneficial to try and reduce antibiotic resistance. Explanations were given as to what is a biomarker, deferred consent, randomisation, how patients with suspected sepsis present to hospital, and how it was hoped that an additional blood test called Procalcitonin (PCT) would change current practice. It was explained that this would be a non-inferiority trial \u2013 to determine whether this new (additional) intervention is not inferior to another (established) intervention.<\/p>\n

We were asked to consider what outcomes were important to us as patients, our concerns, and how and when we felt patients would prefer to be contacted as the trial progressed.<\/p>\n

Some quotes from the day:<\/p>\n

\n

\u201cIt’s another diagnostic tool \u2013 why would you not use it?\u201d<\/em><\/p>\n

\u201cIt could help patients, reduce cost of hospital care and reduce cost of antibiotics.\u201d<\/em><\/p>\n

\u201cWould we be pioneering? Can we trust it?\u201d<\/em><\/p>\n

\u201cHow does the test differ from C-Reactive Protein (CRP)\/other biomarkers?\u201d<\/em><\/p>\n

\u201cMaybe if I’d had test earlier on it may have changed my outcome?\u201d<\/em><\/p>\n<\/blockquote>\n

We were given reassurance that if early interim analyses picked up harmful effects the trial would be stopped.<\/p>\n

After expressing my interest, I was invited to be the PPI representative for the PRONTO trial and our first Trial Management Group (TMG) kick-off meeting with the whole team was held in Liverpool in September 2019. The PRONTO journey had begun!<\/p>\n

\"Photo
PRONTO study team<\/figcaption><\/figure>\n

What we already know<\/h2>\n

Sepsis is a serious condition and is not always preventable. Currently, approximately 30% of patients who are diagnosed with severe sepsis die (approx 48,000 deaths per year in the UK). Sepsis is difficult to diagnose as it mimics other illnesses. Once diagnosed rapid treatment is crucial to survival and antibiotics are the first line treatment. PCT is a useful biological marker for assessing severity of infection and a PCT measurement from the patient, along with the routinely used NEWS2 score (a set of physiological measurements) could help clinicians in their diagnosis.<\/p>\n

Overuse of antibiotics is leading to Antimicrobial Resistance (AMR) \u2013 which means the antibiotics we have currently may not treat future infections and illnesses. AMR is a threat to both the NHS and patients worldwide. A system wide approach to the judicious use of antibiotics is needed to preserve future effectiveness.<\/p>\n

What we needed to know and why<\/h2>\n

The problem of AMR is not just relevant to the UK \u2013 it is global! Some of the questions we needed to ask to change current standard practice in the UK were:<\/p>\n