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31st Bradford Hill Memorial Lecture

Beyond 'Standard-of-Care': novel trial designs for old problems

Professor Sarah Walker, MRC Clinical Trials Unit at UCL and Nuffield Department of Medicine at the University of Oxford 

In conjunction with the Royal Statistical Society, the London School of Hygiene & Tropical Medicine is pleased to host Professor Sarah Walker, who will deliver the 31st Bradford Hill Memorial Lecture. 

Randomised trials provide the most robust evidence about new interventions, because they control known and unknown confounders. Over the last 50 years, huge advances in healthcare have been made by systematically and iteratively improving a “standard-of-care” regimen through a series of generally two-arm, randomised controlled trials vs tightly controlling Type I error (false-positive rate). Over the last 10 years, “platform” designs, comparing multiple new interventions vs this “standard-of-care”, have speeded up delivery of effective new interventions. 

However, despite the huge threats to delivery of safe healthcare posed by antimicrobial resistance, advances in antibiotic treatment have been very limited. Reasons include the need for and reality of huge diversity in prescribing, counter to the single “standard-of-care” paradigm and requiring more challenging non-inferiority designs, together with other innovative approaches to addressing the unique problems posed by bacterial infections. 

Speaker 

Sarah Walker (FMedSci, NIHR Senior Investigator) is Professor of Medical Statistics and Epidemiology at the Medical Research Council Clinical Trials Unit at University College London (MRC CTU at UCL) (40%) and at the Nuffield Department of Medicine at Oxford University (60% FTE).

At UCL she has responsibility for the statistical design, management and analysis of a portfolio of randomised controlled trials and other interventional and non-interventional studies in the field of infectious diseases, particularly HIV, Hepatitis C, the acutely sick child in Africa and bacterial infections, including as Trial Statistician for 15 randomised trials in high-, middle- and low-income countries over the last 10 years. She has a track record in applying efficient but complex and challenging designs, including factorial and multi-arm multi-stage, to address multiple questions within each trial.

At Oxford, she has been at the forefront of translating advances in genetic sequencing into microbiology services and linking this sequence data to electronic health records for large-scale epidemiology, including as Director of the National Institutes of Health Research Health (NIHR) Protection Research Unit on Antimicrobial Resistance and Healthcare Associated Infections, and co-Lead of the NIHR Biomedical Research Centre Antimicrobial Resistance and Modernising Medical Microbiology Theme.

Most recently she is the Chief Investigator and Academic Lead for the UK’s COVID-19 Infection Survey, a partnership between the Office for National Statistics, Oxford University and the Department of Health and Social Care. The survey is the largest study of COVID-19 infection and immunity across all four nations of the UK, swabbing ~180,000 participants every fortnight and taking blood from ~150,000 participants every month.

She has co-authored over 440 publications (H-index 88).

 

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