Emerging infectious diseases (EIDs) constitute an important global health security problem. During EID outbreaks, patient centred research can play a significant role in informing evidence-based care for patients, in calibrating public health responses, and in directing effective policy and research. However, to date, this type of research has been limited in impact. This thesis sets out to improve the value of patient centred research in combating EID outbreaks. It provides a structured analysis of what has previously constrained efforts to rapidly accumulate high-quality evidence. It provides primary data from research conducted during an outbreak, and conducted in an outbreak vulnerable setting. And it provides recommendations that aim to facilitate high-quality data collection in future events. This thesis contains four results chapters. Chapter 2 systematically reviews elements of the research response to two EID outbreaks of public health importance. Chapter 3 provides findings of a phase II clinical trial of an investigational therapy for Ebola virus disease (EVD), contextualises the utility of this and comparable work in improving patient care, and discusses the operational feasibility of such work during an epidemic. Chapter 4 focuses specifically on improving one element - disease characterisation - during EID outbreaks. It achieves this through presenting a systematic analysis of bias in the characterisation of EVD and recommends how to prioritise data gathering for high-risk pathogens. Chapter 5 exemplifies how clinical data collection practices can progress between outbreaks. It is the first stage of work undertaken to improve the clinical characterisation of communicable diseases in the vulnerable environment of refugee camps. This thesis demonstrates progress towards having higher quality clinical research conducted during the time frame of an epidemic. Future work can focus on the most important barriers to accelerating research, now that these have been more clearly defined.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:736070 |
| Date | January 2017 |
| Creators | Rojek, Amanda |
| Contributors | Horby, Peter |
| Publisher | University of Oxford |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | https://ora.ox.ac.uk/objects/uuid:8a53052f-9585-4709-a06e-15586826efce |
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