Research interests
Dr George’s career project grant income (49 grants) exceeds £11,000,000, and he has held programme grants totalling another £7,000,000. Of his 94 peer reviewed papers (43 as principal author) 16 have appeared in either the BMJ or the Lancet (10 as principal author).
Dr George is known principally as a triallist, although about 25% of his published output has been in the area of outcome measurement. His work has often looked at changing systems of medical care, rather than individual patient treatment. Altogether he has undertaken, or is in the process of undertaking, fifteen large randomised controlled trials, all of complex interventions, and all of which so far have appeared in high profile journals. Over the 1990s his work looked at demand for medical care and ways to meet it. His work since then has aimed to improve cancer outcomes, whether by better organisation and delivery of cancer treatment or by earlier detection.
One current grant is for a trial aiming to start recruitment in late 2011/early 2012 and which will compare two diagnostic imaging methods to characterise solitary pulmonary nodules as malignant or not. The modalities being compared are Positron Emission Tomography combined with X-Ray Computerised Tomography (PET/CT – currently the gold standard recommended by NICE) and Dynamic Contrast Computerised Tomography (DCE CT - multiple CT images taken serially during the injection of X-ray contrast medium). The advantage of DCE CT, if it can be proved to be as sensitive to cancer as PET/CT, is that it is around one quarter to one third of the price, and thereby would allow imaging budgets to be used elsewhere or, conversely, would allow more people to have scans using the same budget.
Another current grant funds a systematic review comparing the effectiveness of local ablative methods for treating liver tumours not amenable to surgical resection. In recent years there has been increased interest in the use of local therapy for metastases, arising from improvements in systemic therapy. In the absence of effective systemic therapies, such local treatments have often been considered futile given both the difficulty in eliminating all sites of identifiable metastatic disease as well as realities regarding the rapid natural history of uncontrolled tumour dissemination. However, with a higher likelihood of patients surviving longer after effective systemic therapy, even if not cured, the eradication of residual metastases via potent local therapies may prove beneficial, and radiofrequency ablation plus chemotherapy has been shown to be superior in terms of survival to chemotherapy alone. Although surgical metastasectomy remains the most common and first-line standard among local therapies, nonsurgical alternatives, including various forms of thermal ablation, have become increasingly popular because they are generally less invasive than surgery and have demonstrated considerable promise in eradicating macroscopic tumour. This work is likely to lead on to an application to fund a definitive trial in this area in 2012. Dr George has also been working with interventional radiologists looking at the effectiveness of percutaneous cryoablation for renal carcinoma, again with a view to conducting a definitive trial.
Dr George is also a trial methodologist, and has published a series of papers on the use of quality of life measures in trials, in particular cancer trials. He is currently interested in the conduct of trials which involve a degree of operator expertise (e.g. surgical trials, trials of `therapies’) and in why correct methods for design and analysis of such trials are often not used.
Research group
Primary Care, Population Sciences and Medical Education
Affiliate research group
Population Health Sciences Research group
Research project(s)
Although effective medicinal treatment exists for asthma, many people continue to have distressing symptoms and impaired quality of life. People with asthma have expressed interest in non-drug asthma treatments, particularly in breathing exercises. Several recent studies have shown benefits from a short course of breathing exercises taught by a respiratory physiotherapist for people with asthma who remained symptomatic despite usual treatment. We believe that many NHS patients could potentially benefit from these exercises, but unfortunately, there is currently not enough access to suitable trained physiotherapists able to provide such a service. We propose to provide the same breathing training programme that we have previously shown to be effective when taught 'face-to-face' by a physiotherapist in the form of a DVD, or internet download. Patients will use this in their own home at times convenient to them, in addition to their standard treatment (e.g. with inhalers). We will find out whether this type of instruction is better than the 'usual care' that is currently provided, and whether it is as good as the 'face to face' physiotherapist instruction (which is more expensive and less convenient for patients).
