Closed loop control systems for optimisation of treatment

A treatment that is optimised and personalised to the individual patient can significantly improve outcomes across a range of medical conditions. The closed-loop control approach involves continuously monitoring key clinical parameters and, informed by mathematical models, adapting treatment. The advent of massive computer power, highly sensitive, specific and flexible sensors, and finely-titratable treatments has finally allowed closed-loop control systems to offer a revolutionary leap in medical treatment. Examples of challenges that might now be met include: the delivery of treatment to cancer patients, the moment-to-moment management of critically ill (or injured) patients, and the accelerated healing of chronic wounds. We propose the formation of a multidisciplinary team comprising academics, clinicians and industrialists, supported by stakeholders, to address these challenges.

The first year of the network involves bringing together the community in a series of Grand Challenge Workshops to establish a roadmap. Areas where there are gaps in technology or knowledge will be addressed by eight feasibility studies or secondments that will run during years 2 and 3 and will provide proof of concept data for grand challenge funding applications. These larger funding applications will be developed in parallel to the feasibility studies.

Beneficiaries
This network will work directly with beneficiaries to ensure that feasibility studies funded by the network are of relevance to a range of stakeholders, and have the potential for implementation in a healthcare context. These will include;

1) The healthcare sector, in particular the NHS through improved patient care (more efficient, better outcomes).
2) The general public will benefit through personalised models of healthcare
3) A range of commercial private sector beneficiaries small and medium sized enterprises and larger companies who participate in network meetings.

Healthcare Impact
Critical care patients and their relatives would benefit from improved critical care. Over 100,000 patients are admitted to intensive care units (ICU) in the UK per year. Over the 5 years following an ICU admission there is an excess mortality for these patients there is now a substantial body of evidence to show that significant numbers of survivors of critical illness experience reduced cognitive function and longer term physical and psychological impairments (Griffiths et al, Critical Care 2013, 17:R100). Survivors of critical illness in the UK face a negative impact on employment and commonly have a care requirement after discharge from hospital.

Cancer patients would benefit from optimised treatment. About 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world (Jemal et al, CA Cancer Journal for Clinicians, 2011, 61:69019). A substantial proportion of the worldwide burden of cancer could be prevented with one of the major factors being early detection and treatment.

People with chronic wounds would benefit from improved treatment. 200,000 patients in the UK have a chronic wound with the cost to the NHS conservatively estimated at £2.3bn-3.1bn per year (at 2005-2006 costs), around 3% of the total estimated expenditure on health (£89.4bn) for the same period. With proper diagnosis and treatment, much of this burden should be avoidable (Posnett, J, Franks, PJ, Nursing Times 2008, 104:3, 44-45)

Commercial Impact
Industry partners will benefit from the partnerships with clinicians, academia, public and patients. They will also benefit from intellectual property that will be generated during the feasibility studies and future funding streams. A protocol will be established to govern aspects such as confidential information, IPR and associated benefits. Appropriate contractual arrangements will be put in place, including a collaboration agreement, to ensure compliance with all UK Research Council terms including Clause GC 21 Exploitation and Impact.