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Background: Most people with a stoma are anxious about stoma-related leakage., Aims: To investigate the impact of a novel digital leakage notification system on worry related to stoma leakage, and to evaluate the effect on overall stoma care management., Method: A 12-week interventional, single-arm, multicentre study was conducted in the UK to evaluate the novel digital leakage notification system, including a telemedicine-based support service (=test product), as part of routine stoma care in patients with a recent stoma formation (ClinicalTrials.gov: NCT05135754). Patients completed questionnaires at baseline and at other time points throughout the study period. Study nurses evaluated the test product on individual patient completion of the trial., Findings: The intention-to-treat-population consisted of 92 patients. At baseline, 39% of patients worried to a high or very high degree about leakage, which fell to 14% at the final evaluation ( P <0.001), at which point patients also reported significantly fewer baseplate changes due to leakage-related worry ( P <0.001). The vast majority of nurses reported that the test product helped patients (82%) improve their stoma-care routines ( P <0.0001)., Conclusion: The use of a digital leakage notification system reduced leakage-related worry and improved stoma self-care.

Background: Identifying clusters of multiple long-term conditions (MLTCs), also known as multimorbidity, and their associated burden may facilitate the development of effective and cost-effective targeted healthcare strategies. This study aimed to identify clusters of MLTCs and their associations with long-term health-related quality of life (HRQoL) in two UK population-based cohorts., Methods: Age-stratified clusters of MLTCs were identified at baseline in UK Biobank (n = 502,363, 54.6% female) and UKHLS (n = 49,186, 54.8% female) using latent class analysis (LCA). LCA was applied to people who self-reported ≥ 2 LTCs (from n = 43 LTCs [UK Biobank], n = 13 LTCs [UKHLS]) at baseline, across four age-strata: 18-36, 37-54, 55-73, and 74 + years. Associations between MLTC clusters and HRQoL were investigated using tobit regression and compared to associations between MLTC counts and HRQoL. For HRQoL, we extracted EQ-5D index data from UK Biobank. In UKHLS, SF-12 data were extracted and mapped to EQ-5D index scores using a standard preference-based algorithm. HRQoL data were collected at median 5 (UKHLS) and 10 (UK Biobank) years follow-up. Analyses were adjusted for available sociodemographic and lifestyle covariates., Results: LCA identified 9 MLTC clusters in UK Biobank and 15 MLTC clusters in UKHLS. Clusters centred around pulmonary and cardiometabolic LTCs were common across all age groups. Hypertension was prominent across clusters in all ages, while depression featured in younger groups and painful conditions/arthritis were common in clusters from middle-age onwards. MLTC clusters showed different associations with HRQoL. In UK Biobank, clusters with high prevalence of painful conditions were consistently associated with the largest deficits in HRQoL. In UKHLS, clusters of cardiometabolic disease had the lowest HRQoL. Notably, negative associations between MLTC clusters containing painful conditions and HRQoL remained significant even after adjusting for number of LTCs., Conclusions: While higher LTC counts remain important, we have shown that MLTC cluster types also have an impact on HRQoL. Health service delivery planning and future intervention design and risk assessment of people with MLTCs should consider both LTC counts and MLTC clusters to better meet the needs of specific populations., Competing Interests: Declarations. Ethics approval and consent to participate: All participants gave informed consent to data provision. UK Biobank has full ethical approval from the NHS National Research Ethics Service (16/NW/0274). The University of Essex Ethics Committee has approved all data collection on UKHLS main study and innovation panel waves. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Late side effects of head and neck cancer treatment commonly affect swallowing function. Late radiation-associated dysphagia (late-RAD) often presents years post-treatment when patients have been discharged from their multidisciplinary team. Timely symptom management may provide important physical and emotional support, potentially reducing the overall healthcare burden. Speech and language therapists (SLTs) are key in the assessment and management of dysphagia but there is no current guidance in the late-RAD setting., Aims: The primary objective was to establish how late-RAD is assessed in both existing literature and by UK SLT. The study also aimed to explore UK SLT approaches to management., Methods: A dual methodology approach was taken. A scoping review (SR) of PubMed, Scopus, CINAHL, Web of Science and Embase databases was conducted between November and December 2022. Eligibility criteria included studies reporting dysphagia outcomes >2 years post-treatment with narrative data synthesis. Also, a survey of SLTs working in the United Kingdom was conducted between November 2023 and February 2024. Respondents were questioned about their current pathways and service provision for patients with late-RAD., Main Contribution: The SR included 39 studies. Dysphagia was assessed using three different toxicity grades; five patient-reported outcome measures (PROMs) and five clinical assessments. Five studies were multidimensional in their approach to data collection, whilst nine used PROMs alone and four used a toxicity grade alone. The survey received 56 responses. Only six respondents reported an existing late effect clinic (all tumour sites) in their region. A wide range of measures were used to assess dysphagia including 12 different PROMs. Instrumental assessments were used by most (98% Videofluoroscopy; 82% Fibreoptic Endoscopic Evaluation of Swallowing). Rehabilitation was offered by 86% and this was intensive in 34%. Late-RAD patient information was routinely provided by 35 respondents and usually within 1 year of treatment completion., Conclusion: A wide range of assessment methods and outcome measures were used to report dysphagia in existing literature but often in a unidimensional approach. In the United Kingdom, SLTs also use a variety of assessment tools and regularly offer intensive rehabilitation. Without consensus on how we measure late-RAD, synthesising evidence to guide service provision is challenging., What This Paper Adds: What is already known on the subject Late-RAD significantly affects swallowing function, often necessitating enteral feeding which in turn impacts emotional and health-related quality of life. There is no existing guidance on optimum pathways, assessment methods or effective treatment options. What this paper adds to existing knowledge This study highlights the lack of consensus in the evidence base regarding how to assess and measure late-RAD. In the United Kingdom, referral pathways are not well defined and there is wide variation on provision of information and specialist assessment and management of late-RAD. What are the potential or clinical implications of this work? Challenges in synthesising existing studies translate to variations in practice due to a lack of guidelines. Without a robust evidence base, patients will experience geographical variation in how they are supported with their late-RAD symptoms., (© 2025 Royal College of Speech and Language Therapists.)

There is limited evidence to support optimal patient-centered management for compromised first permanent molars (cFPM) in children. Based on an online discrete choice experiment (DCE), this study elicits UK adult general population preferences and calculates willingness to pay (WTP) for pathways to manage cFPM. The DCE was designed with information from semistructured interviews and literature reviews, as well as focus groups with an expert panel of dentists, citizens, and policy makers. A statistically optimal D-efficient design generated 18 choice tasks, split across 2 blocks. Each respondent answered one block of 9 tasks to reduce survey fatigue. Choice tasks varied across 5 attributes: type of treatment, provider of care, who makes the management decision, number of future visits avoided, and cost. An opt-out was included (no treatment). Conditional logit models (fixed effects) were used for data analysis, and marginal WTP for each attribute level was calculated. An overall 430 respondents completed the DCE. Respondents valued children receiving care as compared with not. Restoring a cFPM was valued equally to spontaneous or orthodontic gap closure. In contrast, having a partial gap, prosthetic replacement with a bridge, or a full unit gap was valued less than restoration or full gap closure. General dentists were preferred to dentists with enhanced skills, but there was no evidence of a preference for general dentists over specialists in pediatric dentistry. Respondents preferred to be wholly or partly involved in the decision-making process as opposed to the dentist making the decision alone. Respondents preferred less costly treatments and the avoidance of future dental work. Dental care service providers must consider service user preferences for health and nonhealth outcomes in any service redesign. Furthermore, the results provide marginal WTP estimates that can be used to value dental care services., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Food insecurity (FI) is associated with increased mortality risk, depression, and obesity in females in high-income countries, but causal mechanisms remain unclear. FI is often assumed to lead to increased levels of hunger. However, quantitative evidence describing daily experiences of hunger in FI is lacking. Our pre-registered study used ecological momentary assessment to capture experiences of hunger in two groups of UK-based females: those experiencing FI (N = 143) and those experiencing food security (FS; N = 149). Participants self-reported hunger hourly (0900-2100) for one week (Monday-Sunday). There was no difference between groups in mean hunger (t(290) = 0.17, p = .866, d = 0.02) nor within-day standard deviation in hunger (t(290) = 1.31, p = .193, d = 0.15). However, both quantities fluctuated more from day to day in the FI group. Compared to the FS group, participants in the FI group had a larger day-to-day variation in mean hunger (t(284) = 2.43, p = .016, d = 0.29) and a larger day-to-day variation in the within-day standard deviation of hunger (t(284) = 2.90, p = .004, d = 0.34). In exploratory analyses, we found that the hunger of the two groups patterned differently across the day. Our findings suggest that experiences of hunger are less stable in those experiencing FI, which may reflect associations between FI and greater uncertainty in food access, higher variability in meal timings or the increased likelihood of chaotic home and work lives., Competing Interests: Declaration of competing interest There is no conflict of interest for any of the authors., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The long-term health-economic consequences of acute stroke are typically extrapolated from short-term outcomes observed in different studies, using models based on assumptions about longer-term morbidity and mortality. Inconsistency in these assumptions and the methods of extrapolation can create difficulties when comparing estimates of lifetime cost-effectiveness of stroke care interventions., Aims: To develop a long-term model consisting of a set of equations to estimate the lifetime effects of stroke care interventions to promote consistency in extrapolation of short-term outcomes., Methods: Data about further admissions and mortality were provided for acute stroke patients discharged between 2013 and 2014 from a large English service. This was combined with data from UK life tables to create a set of parametric equations in a model that use age, sex, and modified Rankin Scores to predict the lifetime risk of mortality and secondary care resource utilization including ED attendances, non-elective admissions, and elective admissions. A cohort of 1509 (male 51%; mean age 74) stroke patients had median follow-up of 7 years and represented 7111 post-discharge patient years. A logistic model estimated mortality within 12 months of discharge, and a Gompertz model was used over the remainder of the lifetime. Hospital attendances were modeled using a Weibull distribution. Non-elective and elective bed days were both modeled using a log-logistic distribution., Results: Mortality risk increased with age, dependency, and male sex. Although the overall pattern was similar for resource utilization, there were different variations according to dependency and gender for ED attendances and non-elective/elective admissions. For example, 65-year-old women with a mRS at discharge of 1 would gain an extra 6.75 life years compared to 65-year-old women with a mRS at discharge of 3. Over their lifetime, 65-year-old women with an mRS at discharge of 1 would experience 0.09 less ED attendances, 2.12 less non-elective bed days, and 1.28 additional elective bed days than 65-year-old women with an mRS at discharge of 3., Conclusions: Using long-term follow-up publicly available data from a large clinical cohort, this new model promotes standardized extrapolation of key outcomes over the life course and potentially can improve the real-world accuracy and comparison of long-term cost-effectiveness estimates for stroke care interventions., Data Assess Statement: Data are available upon reasonable request from third parties., Competing Interests: Declaration of Conflicting InterestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: P.M., S.M., A.M., J.P., M.A., A.L., and L.S. report no conflicting interests. P.W. reports receiving institutional unrestricted educational grants from Stryker, Penumbra, and Metronic and participation on a Data Safety Monitoring/Advisory Board for MR CLEAN NO IV, TENSION, PROTECT U (all unpaid). M.J. reports being an unpaid Trustee for the Stroke Association. G.A.F. reports that his organization receives payments from other NIHR grants, consulting fees from CSL Behring stroke trial design and Astra Zeneca interview on stroke management, payment for lectures from Bayer Cardiovascular, meeting with Primary Care Cardiovascular Society, and meeting expenses from Novartis. G.A.F. also participated on a Data Safety Monitoring Board or Advisory Board for CSL Behring Stroke Advisory Board (personal payment), Bayer Stroke trial advisory Board (payment to institution), and Advance Accelerator Applications round table event on radioligand services (personal payment). C.I.P. reports that they receive salary support from the NIHR Program Grant for Applied Research.

Background: Despite an urgent need for multi-domain lifestyle interventions to reduce dementia risk, there is a lack of interventions which are informed by theory- and evidence-based behaviour change strategies, and no interventions in this domain have investigated the feasibility or effectiveness of behaviour change maintenance. We tested the feasibility, acceptability and cognitive effects of a personalised theory-based 24-week intervention to improve Mediterranean diet (MD) adherence alone, or in combination with physical activity (PA), in older-adults at risk of dementia, defined using a cardiovascular risk score., Methods: Participants (n = 104, 74% female, 57-76 years) were randomised to three parallel intervention arms: (1) control, (2) MD, or (3) MD + PA for 24 weeks and invited to an optional 24-week follow-up period with no active intervention. Behaviour change was supported using personalised targets, a web-based intervention, group sessions and food provision. The primary outcome was behaviour change (MD adherence and PA levels), and the secondary outcomes included feasibility and acceptability, cognitive function, cardiometabolic health (BMI and 24-h ambulatory blood pressure) and process measures., Results: The intervention was feasible and acceptable with the intended number of participants completing the study. Participant engagement with group sessions and food provision components was high. There was improved MD adherence in the two MD groups compared with control at 24 weeks (3.7 points on a 14-point scale (95% CI 2.9, 4.5) and 48 weeks (2.7 points (95% CI 1.6, 3.7)). The intervention did not significantly change objectively measured PA. Improvements in general cognition (0.22 (95% CI 0.05, 0.35), memory (0.31 (95% CI 0.10, 0.51) and select cardiovascular outcomes captured as underpinning physiological mechanisms were observed in the MD groups at 24 weeks., Conclusions: The intervention was successful in initiating and maintaining dietary behaviour change for up to 12 months which resulted in cognitive benefits. It provides a framework for future complex behaviour change interventions with a range of health and well-being endpoints., Trial Registration: ClinicalTrials.gov NCT03673722., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval for the study was given by the National Research Ethics Committee Northern Ireland (18/NI/0191). Participants provided initial consent for the 24-week study intervention during the online screening and written consent during the in-person screening. During the initial 24-week intervention, participants were invited to take part in the 24- to 48-week behaviour maintenance phase, and further written consent was obtained. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: People living at home with dementia are often cared for by family members, especially those from minority ethnic groups. Many people living with dementia from minority ethnic communities face barriers to accessing formal care. However, there is a paucity of dementia research, which foregrounds diversity within minority ethnic populations. This study, conducted between July 2024 and August 2026, will explore the diverse care experiences of South Asian people living with dementia. Conducted across four sites (Newcastle, Nottingham, Birmingham and London), it aims to understand how inequalities related to ethnicity intersect with other factors (eg, gender, age and class) to shape the dementia care experiences of people living in South Asian communities and apply this learning to explore how public policy and care systems could be improved to reduce health and social inequalities., Methods and Analysis: In Newcastle, ethnographic research will be undertaken with up to 20 people living with dementia (or with memory concerns) in South Asian communities for a period of 12 months. The lengthy research period will enable a deep understanding about how experiences change as dementia progresses over time. In Nottingham and Birmingham, semi-structured interviews and/or focus groups will be conducted with up to 30 people living with dementia (or with memory concerns) in South Asian communities. This will enhance the data generated via the ethnographic research. Analysis will follow the principles of reflexive thematic analysis and will involve identifying themes and synthesising and theorising the data. Following this, findings will be reflected upon in 4-6 task groups convened in London, Nottingham and Newcastle with practitioners from health and social care, voluntary organisations or faith groups involved in dementia care. Task groups will focus on developing practical goals based on the research findings., Ethics and Dissemination: Ethical approval for this study has been granted by Newcastle University Faculty of Medical Sciences Ethics Committee (Reference: 2773/43721). Findings will be disseminated to academics, practitioners, policymakers and members of the public via a range of channels including conferences, peer-reviewed publications, lay reports, leaflets and non-written formats such as animated videos., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Poor social connectedness has been identified as a risk factor for poor mental health but there is a lack of standardisation in how it is measured. This systematic review aimed to identify suitable measures of social connectedness for use in UK adult general populations., Methods: Searches were undertaken in two stages to identify: (1) measures of social connectedness from review articles and grey literature and (2) studies reporting on the psychometric properties of the identified measures. Grey literature and five databases were searched: MEDLINE, Embase and PsycINFO; CINAHL and Web of Science. Studies based on UK adult general populations (16-65 years) or other English language speaking countries with similar cultures (US, Canada, Ireland, Australia and New Zealand) were included. Psychometric evidence was extracted relating to six general domains: conceptual model, content validity, reliability, construct validity, scoring and interpretability, and respondent burden and presentation. A narrative synthesis summarised these psychometric properties., Results: Stage (1) 2,396 studies were retrieved and, 24 possible measures of social connectedness were identified; stage (2) 6,218 studies were identified reporting on psychometrics of identified measures and 22 studies were included. These studies provided psychometric evidence for 10 measures, and we did not find psychometric studies for the other identified measures. Six measures (6/10, 60%) reported assessing loneliness and four (4/10, 40%) reported assessing social support but there was a degree of overlap between the assessments of each concept. There was good evidence of reliability across measures, 90% (9/10) had adequate internal consistency, but evidence of content validity was only available for one scale. Five measures (5/10, 50%) reported on at least half of the psychometric criteria, and these were: UCLA-3 (for loneliness), and MSPSS, F-SozU K-6, SPS-10 and SPS-5 (for social support)., Conclusions: This review identified ten social connectedness measures, and identified UCLA-3, MSPSS, F-SozUK-6, SPS-10, and SPS-5 as having the most robust psychometric properties for the UK adult population. Further testing is required to establish content validity, and to clarify the definition and conceptualisation of social connectedness, to enable standardisation in the approach to measuring social connectedness., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Depression and anxiety are common in dementia, with a devastating impact. However, there remains a lack of evidence-based psychological therapies for this clinical group. Compassion-focused therapy (CFT), a talking therapy which addresses feelings of shame and stigma, has shown benefits in other clinical populations. This study is a mixed-methods feasibility randomised controlled trial (RCT) of group CFT for people with dementia and symptoms of anxiety and/or depression, to determine if a future definitive RCT is feasible., Methods and Analysis: 50 people with mild-to-moderate dementia and symptoms of anxiety and/or depression will be randomised to either the intervention arm (12 sessions of group CFT plus treatment as usual (TAU)) or the control arm (TAU). Primary outcome measures include the feasibility of conducting an RCT in terms of recruitment, acceptability, suitability of secondary outcome measures and fidelity. Blind assessments will be conducted at baseline, approximately 16 weeks and 6 months follow-up, to collect data on depression, anxiety, quality of life, quality of the carer-patient relationship, cognition, self-compassion and carer burden. Qualitative interviews will be used to gather participant, carer/supporter and clinician perspectives on the value, acceptability and feasibility of the intervention., Ethics and Dissemination: This study has been approved by the London Riverside REC (Ref: 23/LO/0535) and the Health Research Authority (HRA) ethical approval process through the Integrated Research Application System (IRAS ID: 327086). We plan to publish the results in open-access peer-reviewed journals, present data at conferences and provide feedback to the study participants, sponsors and funders., Trial Registration Number: ISRCTN20868432., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

The Iowa Test of Consonant Perception is a single-word closed-set speech-in-noise test with well-balanced phonetic features. The current study aimed to establish a U.K. version of the test (ITCP-B) based on the Southern Standard British English. We conducted a validity test in two sessions with 46 participants. The ITCP-B demonstrated excellent test-retest reliability, cross-talker validity, and good convergent validity. These findings suggest that ITCP-B is a reliable measure of speech-in-noise perception. The test can be used to facilitate comparative or combined studies in the U.S. and U.K. All materials (application and scripts) to run the ITCP-B/ITCP are freely available online., (© 2024 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).)

Background: Patient complaints in healthcare settings can provide feedback for monitoring and improving healthcare services. Behavioural responses to complaints (e.g., talking or apologising to a patient) can influence the trajectory of a complaint for instance, whether a complaint is escalated or not. We aimed to explore healthcare professional (HCP) and service user (patient and carer) views on complaints' management and the perceived factors influencing responses to complaints within a healthcare setting by applying behavioural frameworks., Method: A qualitative study was conducted using online or phone-based interviews with eleven HCPs and seven patients or carers. All participants (N = 18) had experience responding to or submitting a formal complaint in secondary and tertiary public healthcare settings in the United Kingdom. The interviews were structured using the Capability-Opportunity-Motivation-Behaviour (COM-B) Model. We analysed the transcripts using inductive thematic analysis. Then, themes were deductively mapped onto the COM-B Model and the more granular Theoretical Domains Framework (TDF)., Results: Ten themes were generated from the analysis representing the influences on HCPs' responses to complaints from HCP and patient/carer perspectives. This included (with TDF/COM-B in brackets): 'Knowledge of complaint procedure' (Knowledge/Capability), 'Training and level of skill in complaints handling' (Skills/Capability), 'Regulation of emotions associated with complaints' (Behavioural regulation/Capability), 'Confidence in handling complaints' (Beliefs about capabilities/Motivation), 'Beliefs about the value of complaints' (Beliefs about consequences/Motivation) and 'Organisational culture regarding complaints' (Social influences/Opportunity). Staff highlighted strong support systems and open discussions as part of positive organisational cultures regarding complaints (Social influences/Opportunity), and a lack of certainty around when to treat issues raised by patients as a formal complaint or informal feedback (Knowledge/Capability)., Conclusion: Our study findings highlight the importance of strong support systems and organisational openness to patient feedback. These findings can be used to design targeted interventions to support more effective responses and enhance patient-centred approaches to complaints management in healthcare settings., Patient and Public Contribution: Patient and public involvement (PPI) was integral in this research. The NIHR PRU in Behavioural and Social Sciences had a dedicated PPI strategy group consisting of six external representatives from the patient and public community (Newcastle University, 2024). These six PPI members actively participated in shaping the research by reviewing and providing feedback on all questionnaire items before the data collection. They were actively involved in supporting participant recruitment by advertising this study on their PPI platform, The Voice R,1 and through their online social networks. During the analysis stages of the research, preliminary findings were discussed with the PPI group to support 'sense checking' and interpretation of the results., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Background: Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people., Objectives: To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people's access to, navigation of, and engagement with mental health support., Method: This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people., Results: Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an intersectional, youth-rights approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the right to freedom of safe self-expression to be upheld. The model that we have produced contains 13 principles that are necessary to the provision of mental health support, and to improve access to, engagement with, and navigation of mental health services., Conclusions: In the United Kingdom, a rights-based approach to mental health service provision is not prominent. In addition, at the time of writing, lesbian, gay, bisexual, trans, queer/questioning, plus young people are facing active legislative and policy attacks on their human rights. This study provides the first large-scale theory-led evaluation of early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with common mental health problems. The resulting intersectional, youth-rights approach provides evidence on ways of improving lesbian, gay, bisexual, trans, queer/questioning, plus young people's mental health. Further research on the implementation of an intersectional, youth-rights approach to early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with mental health problems is required., Study Registration: This study is registered as PROSPERO CRD42019135722., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/04) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 47. See the NIHR Funding and Awards website for further award information.

Objective: To explore how it feels to be a burnt out GP in the NHS., Design: In depth qualitative interviews with 16 UK GPs with self-declared 'lived experience' of burnout., Setting: United Kingdom Primary Care., Results: Seven male and nine female GPs described their experiences of burnout to a peer researcher. Themes identified were exhaustion and depersonalisation, mental and physical illness, identity and existential crises, and finally tenacity and resilience. Participants were self-reflective and described distress, shame, stigma, and guilt, including times of suicidal behaviour and isolation due to their burnout., Conclusions: Burnout threatens a GP's sense of identity, purpose, and functioning in their lives, and ultimately can be life-threatening. Active listening to GP distress and a system wide approach to managing distress and burnout is urgently required.

Background: Evidence and External Assessment Groups (EAGs) assist in the National Institute of Health and Care Excellence's Technology Appraisal programme by either critiquing evidence provided by companies on different health technologies, or by carrying out an independent search and evaluation of the published evidence. Historically, there has been little patient and public involvement within the work of EAGs., Objective: To identify key barriers and facilitators to patient and public involvement in EAG Reports feeding into the National Institute for Health and Care Excellence's Health Technology Appraisal process., Methods: A primary qualitative study consisting of one-to-one interviews with EAG researchers and focus groups with members of the public. From anonymised transcripts, data were deductively coded using a framework analysis against the Theoretical Domains Framework and translated to the COM-B model. Coding was triangulated through inductive thematic analysis, guided by the principles of Braun and Clarke., Results: Ten researchers were interviewed and four focus groups with a total of 26 members of the public were undertaken. Both EAG researchers and the public felt they did not have enough knowledge, time and money to be able to embed patient and public involvement; researchers suggested that patient and public involvement might not be relevant to the scope of their Reports. Members of the public highlighted a lack of awareness of the Technology Appraisal process and that jargon may stop them being involved. Both researchers and members of the public said having specific guidance on how to embed patient and public involvement in EAG Reports would be helpful, including guidance on how to write plain language summaries., Conclusion: The perspectives of both EAG researchers and members of the public suggest work needs to be conducted to produce frameworks for patient and public involvement and plain language summaries within EAG Reports specifically. Additionally, that further awareness-raising of Technology Appraisals and the role of EAGs would help members of the public to contribute effectively to EAG Reports., Patient or Public Contribution: Two members of the public were part of the research team and governed all stages of the research in accordance with the UK Standards for Public Involvement., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Aim: Locally advanced and recurrent colorectal cancer represents a complex clinical entity, which requires multidisciplinary decision-making and management. The aim of this work is to understand the provision of clinical services in this cohort of patients across Great Britain and Ireland (GB&I) as a key essential step to help facilitate future service development and improvement., Method: A cross-sectional, organizational survey was sent to all colorectal cancer multidisciplinary teams (MDTs) across GB&I. It consisted of 12 key questions addressing the provision of specialist services and advanced surgical techniques. Results are reported in line with the CHERRIES guideline., Results: One hundred and seventy-five MDTs across GB&I participated, with 142 English, 13 Welsh, 14 Scottish, 3 Northern Irish and 3 Irish MDTs. The overall response rate was 93.5% (175/187). Ninety (51.4%) hospital sites reported having a specialist dedicated or subsection MDT. Specialist advanced nursing support was available in 46 (26.2%) hospitals, with a dedicated advanced colorectal cancer outpatient clinic available in 31 (17.7%) hospitals. One hundred and thirteen MDTs (64.5%) offered surgery for advanced colonic cancer, 82 (46.8%) for recurrent colonic cancer, 58 (33.1%) for advanced rectal cancer and 39 (22.2%) for recurrent rectal cancer. A variable number of MDTs offered specialist surgical techniques, including distal sacrectomy [33 (18.9%)], high sacrectomy [16 (9.1%)], complex vascular resection ± reconstruction [33 (18.9%)] and extended lymphadenectomy (pelvic sidewall or para-aortic) [44 (25.1%)]., Conclusion: The IMPACT organizational survey highlights the current variation in the delivery and provision of clinical services for patients with advanced and recurrent colorectal cancer across Great Britain and Ireland., (© 2024 Association of Coloproctology of Great Britain and Ireland.)

Over the past decade, single mothers have experienced increasing work requirements both in the UK and in other developed countries. Our aim was to examine if increasing job hours are associated with mental health of single mothers compared to partnered mothers. Using 13 waves of the Understanding Society Survey (2009-2023), we estimated the relationship between changing job hours and mental health using difference-in-difference event study design, accounting for differential treatment effects across time and individuals. We also investigated the role of potential mechanisms, including role strain and additional income. Our findings suggest that increasing job hours from part-time to full-time is associated with an instantaneous decrease in mental health of 0.19 standard deviations for single mothers [95% CI: -0.37;-0.01], with no effect for partnered mothers. Further analyses suggest increased role strain for single mothers as a mechanism helping explain these differences. The negative effects of increasing job hours and increased role strain should be considered when developing future welfare policies for single mothers, to ensure that greater work requirements do not undermine the mental health of the already vulnerable population group., (© 2024 The Author(s). Health Economics published by John Wiley & Sons Ltd.)

Aim: To identify research priorities regarding the effectiveness of interventions for children and young people (CYP) with childhood neurological conditions (CNCs). These include common conditions such as epilepsies and cerebral palsy, as well as many rare conditions., Method: The National Institute for Health and Care Research (NIHR) and the James Lind Alliance (JLA) champion and facilitate priority setting partnerships (PSPs) between patients, caregivers, and clinicians (stakeholders) to identify the most important unanswered questions for research (uncertainties). A NIHR-JLA and British Paediatric Neurology Association collaboration used the JLA PSP methodology. This consisted of two surveys to stakeholders: survey 1 (to identify uncertainties) and survey 2 (a prioritization survey). The final top 10 priorities were agreed by consensus in a stakeholder workshop., Results: One hundred and thirty-two charities and partner organizations were invited to participate. In survey 1, 701 participants (70% non-clinicians, including CYP and parent and caregivers) submitted 1800 uncertainties from which 44 uncertainties were identified for prioritization in survey 2; from these, 1451 participants (83% non-clinicians) selected their top 10 priorities. An unweighted amalgamated score across participant roles was used to select 26. In the final workshop, 14 health care professionals, 11 parent and caregivers, and two CYP ranked the 26 questions to finalize the top 10 priorities. Ten top priority questions were identified regarding interventions to treat CYP with CNCs and their associated comorbidities, for example, sleep, emotional well-being, and distressing symptoms., Interpretation: The results of this study will inform research into the effectiveness of interventions for children with neurological conditions., (© 2024 The Author(s). Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.)

Purpose: Previous cross-sectional research suggests self-compassion may mediate associations between autistic traits and mental health in autistic and non-autistic adults. However, no research to date has examined these relationships longitudinally. In this study, we used a cross-lagged panel analysis to examine correlations over time between autistic traits, self-compassion, and anxiety/depression., Methods: Participants were from the UK and included autistic (n = 228 at T1, n = 156 at T2, and n = 165 at T3) and non-autistic adults (n = 228 at T1, n = 122 at T2, and n = 124 at T3) without intellectual disability. Participants were recruited through an online participation platform and completed demographics, the Autism Spectrum Quotient (AQ), the Self-Compassion Scale (SCS), and the Hospital Anxiety and Depression Scale (HADS) at baseline (T1), 6 months (T2), and 12 months (T3)., Results: In the autistic sample, negative correlations were observed between self-compassion and subsequent anxiety/depression across all models and timepoints, and these relationships were not reciprocal (i.e., earlier depression and anxiety did not predict future self-compassion). In the non-autistic sample, the findings generally suggested bi-directional relationships between self-compassion and anxiety/depression. In both groups, an indirect pathway between T1 autistic traits and T3 anxiety/depression via T2 self-compassion was confirmed., Conclusion: Considering the high prevalence of anxiety and depression among autistic people, and that self-compassion can be cultivated through practice, these findings suggest that self-compassion could be a useful therapeutic target to promote mental health in the autistic population., (© 2023. The Author(s).)

Purpose: Lower-grade gliomas (LGG) are mostly diagnosed in working-aged adults and rarely cured. LGG patients may face chronic impairments (e.g. fatigue, cognitive deficits). Self-management can improve clinical and psychosocial outcomes, yet how LGG patients self-manage the consequences of their tumour and its treatment is not fully understood. This study, therefore, aimed to identify and understand how LGG patients engage in the self-management of their condition., Methods: A diverse group of 28 LGG patients (age range 22-69 years; male n = 16, female n = 12; mean time since diagnosis = 8.7 years) who had completed primary treatment, were recruited from across the United Kingdom. Semi-structured interviews were conducted. Informed by a self-management strategy framework developed in cancer, directed content analysis identified and categorised self-management types and strategies used by patients., Results: Overall, 20 self-management strategy types, comprising 123 self-management strategies were reported; each participant detailed extensive engagement in self-management. The most used strategy types were 'using support' (n = 28), 'creating a healthy environment' (n = 28), 'meaning making' (n = 27), and 'self-monitoring' (n = 27). The most used strategies were 'accepting the tumour and its consequences' (n = 26), 'receiving support from friends (n = 24) and family' (n = 24), and 'reinterpreting negative consequences' (n = 24)., Conclusions: This study provides a comprehensive understanding of the strategies used by LGG patients to self-manage their health and wellbeing, with a diverse, and substantial number of self-management strategies reported., Implications for Cancer Survivors: The findings will inform the development of a supported self-management intervention for LGG patients, which will be novel for this patient group., (© 2023. The Author(s).)

Introduction: The evolving landscape of inflammatory bowel disease (IBD) necessitates refining colonoscopic surveillance guidelines. This study outlines methodology adopted by the British Society of Gastroenterology (BSG) Guideline Development Group (GDG) for updating IBD colorectal surveillance guidelines., Methods and Analysis: The 'Grading of Recommendations, Assessment, Development and Evaluation' (GRADE) approach, as outlined in the GRADE handbook, was employed. Thematic questions were formulated using either the 'patient, intervention, comparison and outcome' format or the 'current state of knowledge, area of interest, potential impact and suggestions from experts in the field' format. The evidence review process included systematic reviews assessed using appropriate appraisal tools. An extensive list of potential outcomes was compiled from literature and expert consultations and then ranked by GDG members. The top outcomes were identified for evidence synthesis in three key areas: utility of surveillance in IBD, quality of bowel preparation and use of advanced imaging techniques in colonoscopy for IBD. Risk thresholding exercises determined specific risk levels for different surveillance strategies and intervals. This approach enabled the GDG to establish precise thresholds for interventions based on relative and absolute risk assessments, directly informing the stratification of surveillance recommendations. Significance of effect sizes (small, moderate, large) will guide the final GRADE assessment of the evidence., Ethics and Dissemination: Ethics approval is not applicable. By integrating clinical expertise, patient experiences and innovative methodologies like risk thresholding, we aim to deliver actionable recommendations for IBD colorectal surveillance. This protocol, complementing the main guidelines, offers GDGs, clinical trialists and practitioners a framework to inform future research and enhance patient care and outcomes., Competing Interests: Competing interests: MG is an editor for Cochrane, supporting clinical truth and unbiased synthesis since 2017 (ongoing). GBN, VS, IAB, AB, SDO, OF, BH, JM, MN, NS, VSU and JEE have no competing interests to declare related to the manuscript. SD is a committee member of the BSG IBD Section (2019–2025) and National Lead for IBD Colorectal Cancer Surveillance for the Scottish Government's National Centre for Sustainable Delivery (2020–2025). AD has received speaker fees and honoraria from AbbVie (2023–present), with his department receiving advisory fees, speaker fees and consultancy support from Tillotts UK (since 2022) and speaker fees, honoraria and advisory support from Takeda (since 2022). CH is employed as a JAG assessor, with JAG using standards to guide the assessment of endoscopy units for accreditation. CL has received research support and/or fees for non-promotional education from Janssen, Takeda, AbbVie, AstraZeneca, Eli Lilly, Orion, Pfizer, Roche, Sanofi Aventis, Ferring, UCB, Nordic Pharma, Dr Falk and Biogen (2019–present), as well as research support from Genentech Inc. (2012–present); he is also the Secretary of the IBD Section for the British Society of Gastroenterology (2021–present). AH has received lecture and advisory board fees from Janssen, Takeda, Celltrion, Galapagos, AbbVie and Lilly (2017–present), and her department has received sponsorships for meetings from Janssen, Takeda, Celltrion, Galapagos and AbbVie (2020–present); she is also a Governing Board member of ECCO (since 2018) and a Scientific Board member of Crohn's and Colitis UK (since 2011). TR has undertaken paid consultancy work for Abbvie, Arena, Aslan, AstraZeneca, Boehringer-Ingelheim, BMS, Eli Lilly, Ferring, Galapagos, Gilead, GSK, Heptares, LabGenius, Janssen, Pfizer, Roche, Takeda, UCB and XAP Therapeutics (since 2020), and he is a director of Endoread Ltd. (since 2022); he serves on the Scientific Committee of ECCO (since 2022) and United European Gastroenterology (since 2021). MR is a Regional Endoscopy Advisor for NHS England (since 2021) and Chair of JAG (since 2023). NT serves on the advisory board for Dr Falk UK concerning EoE and Jorveza (current), and his department receives research support, speaker fees and conference support from Dr Falk UK (research support is current). LW has served on advisory boards for Pfizer (May 2023), BMS (June 2023), Celltrion (June 2023) and Dr Falk (June 2023); she has received a speaker’s honorarium from Takeda (February 2023) and conference attendance support from Dr Falk (June 2023); she also receives editorial royalties for the Inflammatory Bowel Disease Nursing Manual (2019). RW is an employee of Crohn’s & Colitis UK (since October 2019) and Crohn’s & Colitis UK receives funding from various sources, as detailed in their annual accounts (published online)., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To explore stakeholders' perceived barriers and facilitators to the inclusion of dental services in the Great North Care Record (GNCR) by identifying the stakeholders, exploring their perspectives and using the findings to inform integration of dental services in GNCR., Methods: Qualitative online interview study with inductive thematic analysis., Results: Twelve stakeholders identified through purposive sampling participated. Five key themes were identified: information accuracy, efficiency, safety and security, value of records and optimal GNCR design. Inclusion of dentistry in GNCR was favoured to improve information accuracy and efficiency. However, participants raised concerns about how information accessed would be handled safely and worries about intraprofessional criticism within dentistry. Others saw a real value in including dentistry in the GNCR., Conclusions: This study demonstrates support for the inclusion of primary care dentistry in the GNCR, provided that the data are used responsibly, and that the system aids information safety and efficiency., (Copyright© 2024 Dennis Barber Ltd.)

Purpose and Scope: The aim of this position statement is to provide recommendations regarding the delivery of genomic testing to patients with rare disease in the UK and Ireland. The statement has been developed to facilitate timely and equitable access to genomic testing with reporting of results within commissioned turnaround times., Methods of Statement Development: A 1-day workshop was convened by the UK Association for Clinical Genomic Science and attended by key stakeholders within the NHS Genomic Medicine Service, including clinical scientists, clinical geneticists and patient support group representatives. The aim was to identify best practice and innovations for streamlined, geographically consistent services delivering timely results. Attendees and senior responsible officers for genomic testing services in the UK nations and Ireland were invited to contribute., Results and Conclusions: We identified eight fundamental requirements and describe these together with key enablers in the form of specific recommendations. These relate to laboratory practice (proportionate variant analysis, bioinformatics pipelines, multidisciplinary team working model and test request monitoring), compliance with national guidance (variant classification, incidental findings, reporting and reanalysis), service development and improvement (multimodal testing and innovation through research, informed by patient experience), service demand, capacity management, workforce (recruitment, retention and development), and education and training for service users. This position statement was developed to provide best practice guidance for the specialist genomics workforce within the UK and Ireland but is relevant to any publicly funded healthcare system seeking to deliver timely rare disease genomic testing in the context of high demand and limited resources., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The Newcastle Sjogren's Stratification Tool (NSST) stratifies Sjogren's disease patients into four subtypes. Understanding the stability of the subtypes is vital if symptom-based stratification is to be more broadly adopted. In this study, we stratify patients longitudinally to understand how symptom-based subtypes vary over time and factors influencing subtype change., Methods: 274 patients from the United Kingdom Primary Sjögren's Syndrome Registry (UKPSSR) with data permitting NSST subtype assignment from two study visits were included. The French Assessment of Systemic Signs and Evolution of Sjogren's Syndrome (ASSESS) cohort (n=237) acted as an independent comparator. Group analyses of significant differences were performed, with logistic regression models used to assess covariates of subtype stability., Results: UKPSSR and ASSESS cohorts showed a broadly similar proportion of subjects in each subtype and similar baseline clinical characteristics except body mass index (BMI). Several baseline characteristics differ significantly between the subtypes, most notably anti-Ro status and BMI. Subtype membership was reasonably stable in both cohorts with 60% and 57% retaining subtype. The high-symptom burden subtype was the most stable over time with 70% and 67% retaining subtype. Higher baseline probability score was the greatest predictor of subtype stability with higher C4 levels, antidepressant use, and a higher CCI score also predicting increased stability., Conclusion: NSST subtype membership remains stable over time in a large proportion of patients. When subtype transition is associated with factors at baseline, it is most strongly associated with an uncertain subtype allocation. Our findings support the hypothesis that symptom-based subtypes reflect genuine pathobiological endotypes and therefore maybe important to consider in trial design and clinical management., Competing Interests: Competing interests: XM received consultant fees from BMS, Galapagos, GSK, Novartis and Pfizer. W-FN has undertaken clinical trials and provided consultancy or expert advice in the area of Sjögren’s syndrome to the following companies: GlaxoSmithKline, MedImmune, UCB, Abbvie, Takeda, Resolves Therapeutics, Sanofi, Novartis, Bain Capitals and Argenx. No other potential conflict of interest relevant to this article was reported., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: X-linked agammaglobulinaemia (XLA), caused by mutations in BTK, is characterised by low or absent peripheral CD19 + B lymphocytes and agammaglobulinaemia. The mainstay of treatment consists of immunoglobulin replacement therapy (IgRT). As this cannot fully compensate for the immune defects in XLA, patients may therefore continue to be at risk of complications., Objectives: To describe the clinical outcomes of XLA patients in the United Kingdom and Hong Kong and evaluate current treatment strategies., Methods: Patients with a definitive diagnosis of XLA were included in this cross-sectional and retrospective analysis of clinical health outcomes. Data pertaining to diagnosis, infection incidence, IgG trough levels and lung function were collected and analysed., Results: 99 patients with a median age of 29.02 years (IQR 12.83-37.41) and a total follow up of 1922 patient years, were included this study. The median age at diagnosis was 3.30 years (IQR 1.04-8.38) which decreased over time (p = 0.004). 40% of the cohort had radiological evidence of bronchiectasis. Risk of bronchiectasis was not significantly associated with clinical infection incidence (p = 0.880) or IgG trough levels (p = 0.407). Two patients demonstrated novel complications, namely persistent norovirus infection, leading to haemopoietic stem cell transplantation (HSCT)., Conclusions: Despite modern therapy, most XLA patients continue to experience complications, most notably bronchiectasis, likely due to absence of IgA/M in current therapies, but lack of B lymphocytes may also lead to additional sequalae. These data strongly support the need for further research, particularly that of curative modalities including HSCT and gene therapy., Competing Interests: Declarations Competing Interests Ben Shillitoe has received travel grants from Pharming and speaker fees from TakedaTomaz Garcez has Consulting, advisory work and educational support from BioCryst, CSL Behring, KalVista, Novartis, Octapharma, Pharming and Takeda.Jaime S Rosa Duque received a conference sponsorship from Merck Sharp & Dohme in 2023Yu Lung Lau chairs the Scientific Committee on Vaccine Preventable Diseases of the Hong Kong Government. The remaining authors have no COIs to delcare., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Material disadvantage is associated with poor health, but commonly available area-based metrics provide a poor proxy for it. We investigate if a measure of material disadvantage could be constructed from UK primary care electronic health records., Methods: Using data from Clinical Practice Research Datalink Aurum (May 2022) linked to the 2019 English Index of Multiple Deprivation (IMD), we sought to (1) identify codes that signified material disadvantage, (2) aggregate these codes into a binary measure of material disadvantage and (3) compare the proportion of people with this binary measure against IMD quintiles for validation purposes., Results: We identified 491 codes related to benefits, employment, housing, income, environment, neglect, support services and transport. Participants with one or more of these codes were defined as being materially disadvantaged. Among 30,897,729 research-acceptable patients aged ≥18 with complete data, only 6.1% (n=1,894,225) were classified as disadvantaged using our binary measure, whereas 42.2% (n=13,038,085) belonged to the two most deprived IMD quintiles., Conclusion: Data in a major primary care research database do not currently contain a useful measure of individual-level material disadvantage. This represents an omission of one of the most important health determinants. Consideration should be given to creating codes for use by primary care practitioners., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Importance: Lengthening waiting lists for organ transplant mandates the development of strategies to expand the deceased donor pool. Due to concerns regarding organ viability, most organ donation organizations internationally wait no longer than 1 to 2 hours for potential donation after circulatory death (DCD), possibly underutilizing an important organ source; UK policy mandates a minimum 3-hour wait time., Objective: To assess whether time to death (TTD) from withdrawal of life-sustaining treatment (WLST) is associated with kidney transplant outcomes., Design, Setting, and Participants: This population-based cohort study used data from the prospectively maintained UK Transplant Registry from all 23 UK kidney transplant centers from January 1, 2013, to December 31, 2021; follow-up was until the date of data extraction (October 2023). Participants comprised 7183 adult recipients of DCD kidney-alone transplants., Exposure: Duration of TTD, defined as time from WLST to donor mechanical asystole., Main Outcomes and Measures: Primary outcome was 12-month estimated glomerular filtration rate (eGFR; for the main eGFR model, variables with significant right skew [histogram visual assessment] were analyzed on the log2 scale), with secondary outcomes of delayed graft function and graft survival (censored at death or 5 years)., Results: This study included 7183 kidney transplant recipients (median age, 56 years [IQR, 47-64 years]; 4666 men [65.0%]). Median donor age was 55 years (IQR, 44-63 years). Median TTD was 15 minutes (range, 0-407 minutes), with 885 kidneys transplanted from donors with TTD over 1 hour and 303 kidneys transplanted from donors with TTD over 2 hours. Donor TTD was not associated with recipient 12-month eGFR on adjusted linear regression (change per doubling of TTD, -0.25; 95% CI, -0.68 to 0.19; P = .27), nor with delayed graft function (adjusted odds ratio, 1.01; 95% CI, 0.97-1.06; P = .65) or graft survival (adjusted hazard ratio, 1.00; 95% CI, 0.95-1.07; P = .92). These findings were confirmed with restricted cubic spline models (assessing nonlinear associations) and tests of interaction (including normothermic regional perfusion). In contrast, donor asystolic time, cold ischemic time, and reperfusion time were independently associated with outcomes. Compared with a theoretical 1-hour maximum wait time, the UK policy (minimum 3-hour wait time) has been associated with 885 extra DCD transplants compared with 6298 transplants (14.1% increase)., Conclusions and Relevance: In this cohort study of DCD kidney recipients, donor TTD was not associated with posttransplant outcomes, in contrast to subsequent ischemic times. Altering international transplant practice to mandate minimum 3-hour donor wait times could substantially increase numbers of kidney transplants performed without prejudicing outcomes.

In comparison to the efforts required to bring a new drug or formulation to the clinic, bestowing a name on a medicine is relatively simple. However, if the name we choose causes confusion-by making its contents ambiguous or if it is too alike another drug-it can precipitate clinical errors. This prompted the World Health Organization to set up the International Nonproprietary Naming Committee in the 1970s to select unambiguous names for drugs. Unfortunately, multidrug products-which are becoming increasingly popular-do not fall under the remit of conventional International Non-proprietary Nomenclature. We have identified 26 combination formulations that have been historically named with the co-drug format in the United Kingdom. Most of them have also been prescribed in the United Kingdom in the past year, and although several of them are not prescribed very often, 11 were prescribed more than 2000 times. In this paper, we have explored the literature to identify prescribing errors with co-drug products and found several idiosyncrasies that have caused drug errors in the past. We advocate for a standard nomenclature (state the international nonproprietary name [INN] of each component followed by dose information in the x + y format) for these products on the box and in prescribing resources. We hope that this will enhance clarity and safety during prescribing and administration, particularly for high-volume drugs like paracetamol + codeine (co-codamol), amoxicillin + clavulanic acid (co-amoxiclav) and trimethoprim + sulfamethoxazole (co-trimoxazole)., (© 2024 The Author(s). British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)

Diagnosis of urinary tract infections (UTI) is a routine part of medical work and yet is well recognised to be an area of high clinical uncertainty. Meanwhile, diagnosis of UTI is becoming increasingly important to policymakers globally due to concerns about antibiotic over-prescription. Drawing on Mol's concept of ontological multiplicity in clinical work, I explore how diagnostic uncertainty is co-ordinated into certainty by a UK national diagnostic algorithm for UTI. The diagnosis of UTI is produced or withheld as a post hoc rationalisation of a prior decision whether to prescribe antibiotics or not. Work in the sociology of diagnosis has already noted that diagnostic steps are often re-ordered by health-care professionals taking diverse actions in the best interest of their patients. This article contributes an argument that ordering diagnostic work around antimicrobial stewardship agendas has the effect of narrowing possible actions. Exploring the consequences and effects of doing diagnosis in this way for different groups, I argue that a greater creativity about what could be done to care for painful bladders could be found in a return to more clinical ways of working., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Introduction: Localisation methods for surgical excision of impalpable breast lesions have advanced in recent years, with increasing utilization of new wire-free technologies. The Hologic LOCalizer™ radiofrequency identification (RFID) tag is one such device; however, as is the case when new technologies are first introduced, little is known about clinical experiences, potential complications, and learning used to overcome perioperative challenges when changing from guidewires to RFID tags. This study reports shared learning experiences of clinicians using the LOCalizer™ as part of the national iBRA-NET localisation study., Methods: This mixed-methods study captured shared-learning themes relating to LOCalizer™ usage as part of a multicentre prospective registry study, which collected data on each LOCalizer™ placement. Prospective, anonymized clinical and demographic data were collected and managed using a Research Electronic Data Capture (REDCap) database. Shared learning was captured prospectively as part of the registry study between January 2021 and July 2022, combined with a virtual qualitative webinar-style focus group. Learning events were then coded, grouped by theme, and suggestions for practice were produced., Results: Twenty-four UK breast units submitted data on 1188 patient records pertaining to RFID-guided localisation between January 2021 and July 2022, of which 59 (5.0%) included a shared-learning event. The virtual webinar was attended by 108 healthcare professionals, including oncoplastic breast surgeons and breast radiologists. Shared-learning themes were categorized into preoperative, intraoperative, and postoperative events., Conclusions: By sharing learning outcomes associated with localisation techniques in this paper, the aim is to shorten the learning curve and potential for adverse events for users new to the LOCalizer™ technique., (Copyright © 2024. Published by Elsevier Ltd.)

The use of uncrewed aerial vehicles (drones) has increased over the last decade. However, their application in healthcare has not been fully examined, in part, due to regulations preventing flight beyond the visual line of sight. This prospective randomised controlled laboratory study aimed to determine whether the in vitro quality of packed red blood cell components is maintained when transported by drone, beyond visual line of sight. Ten identical pairs of packed red blood cell units were randomly allocated to transport by drone or by ground vehicle (1:1, allocation concealment) 68 km between two hospitals in Northumbria, UK. Markers of blood component quality were compared at 8, 14, 28 and 35 days following blood unit manufacture. There was no statistical difference in haemolysis, potassium concentration, total haemoglobin, glucose and lactate, haematocrit and mean cell volume, between the two groups, up to the date of unit expiry. The temperature of the packed red blood cell units did not deviate outside the recommended 2-10°C for transportation, regardless of the allocated group. Blood component transport was faster by drone, but did not reach statistical significance. This study demonstrates the feasibility and safety of flying blood components by drone between hospitals in the United Kingdom., (© 2024 British Society for Haematology and John Wiley & Sons Ltd.)

Background: Of the neurodegenerative diseases, Parkinson's disease is recognised to have the fastest growing prevalence. It is unclear whether this is due to the ageing global population alone, with several environmental factors increasingly implicated in changing prevalence rates. Large data sets have been used nationally and globally to help predict future disease burden. However, the reliability of such sources is yet unknown for Parkinson's disease., Summary: This review discusses the methods used in all published UK prevalence studies conducted to date. Direct comparison between prevalence figures obtained from the 10 to discussed prevalence studies is precluded due to differences in methodology for case ascertainment and diagnosis. Age adjusted estimates vary from 105/100,000 to 168/100,000., Key Messages: These studies demonstrate no overall trend in changing prevalence figures between 1961 and 2007. No difference in prevalence trends were seen for those living in rural or urban areas. Differences between ethnic groups, for example, remains an under explored area., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The agonal phase can vary following treatment withdrawal in donor after circulatory death (DCD). There is little evidence to support when procurement teams should stand down in relation to donor time to death (TTD). We assessed what impact TTD had on outcomes following DCD liver transplantation., Methods: Data were extracted from the UK Transplant Registry on DCD liver transplant recipients from 2006 to 2021. TTD was the time from withdrawal of life-sustaining treatment to asystole, and functional warm ischemia time was the time from donor systolic blood pressure and/or oxygen saturation falling below 50 mm Hg and 70%, respectively, to aortic perfusion. The primary endpoint was 1-y graft survival. Potential predictors were fitted into Cox proportional hazards models. Adjusted restricted cubic spline models were generated to further delineate the relationship between TTD and outcome., Results: One thousand five hundred fifty-eight recipients of a DCD liver graft were included. Median TTD in the entire cohort was 13 min (interquartile range, 9-17 min). Restricted cubic splines revealed that the risk of graft loss was significantly greater when TTD ≤14 min. After 14 min, there was no impact on graft loss. Prolonged hepatectomy time was significantly associated with graft loss (hazard ratio, 1.87; 95% confidence interval, 1.23-2.83; P  = 0.003); however, functional warm ischemia time had no impact (hazard ratio, 1.00; 95% confidence interval, 0.44-2.27; P  > 0.9)., Conclusions: A very short TTD was associated with increased risk of graft loss, possibly because of such donors being more unstable and/or experiencing brain stem death as well as circulatory death. Expanding the stand down times may increase the utilization of donor livers without significantly impairing graft outcome., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: To compare the experiences of people with dementia living alone or with others and how these may change over two years., Design: We analysed longitudinal data from three assessment waves, one year apart, in the British IDEAL cohort., Setting: Participants with mild-to-moderate dementia were recruited through National Health Service providers, where possible with a family caregiver, and interviewed at home., Participants: The current analyses include 281 people with dementia living alone and 1,244 living with others at baseline; follow-up data were available for 200 and 965 respectively at time 2 and 144 and 696 respectively at time 3. For those living alone, 140 nonresident caregivers contributed at baseline, 102 at time 2 and 81 at time 3. For those living with others, 1,127 family caregivers contributed at baseline, 876 at time 2 and 670 at time 3., Measurements: Assessments covered: cognitive and functional ability; self-reported perceptions of health, mood, social engagement, quality of life, satisfaction with life and well-being; use of in-home and community care; and transitions into residential care., Results: People living alone tended to have better cognitive and functional ability and were more frequent users of in-home care. However, they experienced poorer physical, social, and psychological health and reduced quality of life, satisfaction with life, and well-being. These differences persisted over time and rates of transition into residential care were higher., Conclusions: To facilitate continuing in place for people with dementia living alone, a dual focus on supporting functional ability and add ressing psychosocial needs is essential in the context of an enabling policy framework., Competing Interests: DISCLOSURES The authors declare no conflicts of interest. ‘Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study’ was funded jointly by theEconomic and Social Research Council (ESRC)and theNational Institute for Health and Care Research (NIHR)through grantES/L001853/2. Investigators: L. Clare, I.R. Jones, C. Victor, J.V. Hindle, R.W. Jones, M. Knapp, M. Kopelman, R. Litherland, A. Martyr, F.E. Matthews, R.G. Morris, S.M. Nelis, J.A. Pickett, C. Quinn, J. Rusted, J. Thom. ESRC is part of UK Research and Innovation (UKRI). ‘Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study’ is funded by Alzheimer's Society, grant number 348, AS-PR2-16-001. Investigators: L. Clare, I.R. Jones, C. Victor, C. Ballard, A. Hillman, J.V. Hindle, J. Hughes, R.W. Jones, M. Knapp, R. Litherland, A. Martyr, F.E. Matthews, R.G. Morris, S.M. Nelis, C. Quinn, J. Rusted. This report is independent research supported by the National Institute for Health and Care Research Applied Research Collaboration South-West Peninsula. The views expressed in this publication are those of the authors and not necessarily those of the ESRC, UKRI, NIHR, the Department of Health and Social Care, the National Health Service, or Alzheimer's Society. The support of ESRC, NIHR and Alzheimer's Society is gratefully acknowledged., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The evidence underpinning caries management for children has progressed dramatically over the past 20 years. Anecdotally, this is not reflected in the teaching provided to undergraduate dental students, with the ongoing teaching of outdated methods within some dental schools., Aim: To capture the current undergraduate teaching provision and clinical treatment experience requirement relative to caries management in paediatric dentistry in UK dental schools., Design: Cross-sectional analysis of current teaching methods on paediatric caries management was obtained using a piloted online data collection form. Question content included current caries teaching methods, assessment of student exposure and competence. The results were analysed descriptively., Results: Of the 16 UK dental schools, 14 participated. Discrepancy in teaching content was apparent. Many schools (n = 9) taught biological caries management through therapeutic fissure sealants, yet this was not reflected in assessment and clinical requirements. Some schools (n = 4) taught amalgam placement in children, and most (n = 12) operatively taught treatments that would no longer be routinely provided in general dental practice in the UK, including primary tooth pulpotomy., Conclusion: There is substantial variation in the paediatric caries management techniques that are taught across UK dental schools, demonstrating a need for a national consensus to address these disparities., (© 2024 The Authors. International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

The COVID-19 pandemic had a disproportionate impact on ethnically minoritised and other marginalised communities, yet little is known about the impacts of long COVID-19 (LC) on this group. Living with LC takes its toll both physically, emotionally and financially and even more so when a diagnosis is hard to come by. By using qualitative interviews centring the view of undiagnosed and marginalised communities already classed as 'underserved' in the medical literature, we show the range of barriers and impacts faced by these groups in the UK, and the strategies of resilience they use. Whether trapped on a 'diagnostic odyssey' at the level of primary care, struggling to maintain employment and businesses, or managing family commitments, we argue many minoritised communities are caught in a liminal space of misrecognition, invalidation and ambiguity. We show how these impacts are generated by tensions and challenges in the process and categorisation of diagnosis, and how this effects the daily lives of many individuals already on the receiving end of health inequity. We also offer some examples and suggestions for best practices., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Background: There remains a lack of diversity among those pursuing clinical academic careers. Structural inequalities, discrimination and a paucity of relatable role models can disadvantage minoritised students, hindering their educational experiences and career opportunities. Innovative and effective approaches are needed at an undergraduate level to address this problem, ensuring the pipeline is representative, diverse and inclusive., Approach: To help address this challenge, in 2021, we developed a free online 'medical education masterclass series' for 250 UK medical students, with students from minoritised backgrounds particularly encouraged to apply. The masterclasses explored topical themes in medical education through seminars and workshops featuring diverse guest speakers., Evaluation: To evaluate the programme, students were invited to submit an anonymised reflection and complete a semi-structured interview exploring how their perceptions of medical education may have changed following attendance of the masterclasses. A total of 18% responded, and data were thematically analysed., Results: Students reflected on how the sessions broadened their understanding of medical education beyond their own curriculum experiences. Students described acquiring skills and building networks to further develop their interest in medical education. The desire to make medical education more inclusive was identified as a key priority for students, and students felt empowered to advocate for positive change within their own institutions., Implications: Providing students with opportunities to explore medical education through such masterclasses has the potential to raise awareness and address some of the barriers experienced by minoritised students. We would advocate for similar initiatives to be developed in other clinical academic areas to increase diversity., (© 2024 The Author(s). The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Objective structured clinical examinations (OSCEs) are used globally to assess health professional learners' clinical skills and applied knowledge. Despite innovations with simulated participants, manikin technology and real patient involvement, there remains a gap between 'real-life' practice and 'OSCE experience'. For example, although mobile phone use is increasingly common in clinical practice; however, it would represent a significant disruption to established assessment practices in OSCEs. We aimed to explore student use of mobile phones during OSCE assessment, with a focus on exam security, equity and relevance to practice., Methods: Cultural Historical Activity Theory (CHAT) allows us to conceptualise and analyse complex systems such as those of OSCE assessment. We recruited a range of stakeholders in a UK medical school setting to participate in focus group interviews exploring our stated aim. Transcripts were analysed using CHAT as a theoretical lens to construct an activity system of assessment and identify emerging tensions around the use of a potentially disruptive technology: students' own mobile phones., Findings: Seven examiners, 13 medical students, and two simulated participants participated in three focus groups. Three sources of tension were identified: between the tools of assessment and practice, of exam security and exam relevance, and of medical students as people and professionals., Discussion and Conclusion: This study exemplifies how a seemingly small disruption in a complex system (introducing a mobile phone-a tool used in everyday practice) can help us understand and describe the unwritten rules of assessment., (© 2024 The Author(s). The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Ganglioneuroblastoma intermixed (GNBi) and ganglioneuroma (GN) represent benign variants of peripheral neuroblastic tumours. While historically surgical resection was recommended, watchful active observation has become the accepted management for a subset of patients., Objectives: To review clinical features, biology, natural history and management of a retrospective UK CCLG study cohort of GN and GNBi, and compare outcomes of patients treated with surgical resection or watchful active observation., Methods: Retrospective review of histologically confirmed non-metastatic GN and GNBi diagnosed between 1990 and 2020., Results: A total of 259 patients were identified (163 GN, 93 GNBi, median age 62 months). In all 201 (78%) had initial surgery and 58 (22%) were observed. Overall survival was 98%. Twenty-one of 58 observed (36%) required subsequent surgery due to progressive tumour growth (52%). Gross total resection (GTR) was achieved in 79% of patients with a 19% complication rate. GTR was obtained in a similar proportion of patients having initial surgery (65%) and delayed surgery (76%). Patients obtaining GTR were more likely to have complete symptom(s) control (43% vs. 24%). In 45 cases (39%), surgical pathology was different from pathology at biopsy, and in 14 (12%) the pathology changed from GN/GNBi to neuroblastoma/GNB nodular., Conclusion: Watchful active observation can be a safe approach, with surgical resection reserved for symptomatic patients. However, a small proportion of patients in the observation group had their diagnosis revised to malignant at surgery. Careful assessment of surgical risk and expected benefits, after considering an initial period of observation, will allow clinicians to make optimal decisions for patients and their families., (© 2024 The Author(s). Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

Background: Social Media (SoMe) as a learning tool, though ubiquitous in society and popular within medical education, is often criticised as superficial. Its limitless output has been blamed for encouraging shorter attention spans and shirking in-depth reflection. The evidence base is itself superficial and lacking rigour or meaning. We aimed to consider a theoretical basis for how 'quality' learning may happen on such platforms. Our findings then informed the construction of a taxonomy for SoMe learning., Methods: We conducted a qualitative interview study of United Kingdom (UK) medical students using a theory-informed inductive study design. The research question was: 'How do medical students conceptualise quality of learning on social media?'. We purposively sampled participants from responses to a short survey collecting demographic and SoMe usage data. Interview data were analysed using framework analysis and informed by Blooms taxonomy, connectivism and communities of practice (CoP) theories., Results: We received survey responses from 118 medical students across 25 UK medical schools. From these, 13 participants were recruited to individual semi-structured interviews. We constructed three themes through framework analysis of interview data: cognitive hacking, professional identity reflection and safety, control and capital., Discussion: Quality SoMe learning may be conceptualised as a socially connected process, built upon constantly evolving networks but inexorably influenced by fluctuating hierarchy within learner-centric CoP. Educators and institutions may support high-quality learning for students through engagement which promotes community development, and safe, listening environments which foster professional identity formation., (© 2024 The Author(s). The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Objective: Evaluate knowledge and beliefs about dietary nitrate among United Kingdom (UK)-based adults., Design: An online questionnaire was administered to evaluate knowledge and beliefs about dietary nitrate. Overall knowledge of dietary nitrate was quantified using a twenty-one-point Nitrate Knowledge Index. Responses were compared between socio-demographic groups., Setting: UK., Participants: A nationally representative sample of 300 adults., Results: Only 19 % of participants had heard of dietary nitrate prior to completing the questionnaire. Most participants (∼70 %) were unsure about the effects of dietary nitrate on health parameters (e.g. blood pressure, cognitive function and cancer risk) or exercise performance. Most participants were unsure of the average population intake (78 %) and acceptable daily intake (83 %) of nitrate. Knowledge of dietary sources of nitrate was generally low, with only ∼30 % of participants correctly identifying foods with higher or lower nitrate contents. Almost none of the participants had deliberately purchased, or avoided purchasing, a food based around its nitrate content. Nitrate Knowledge Index scores were generally low (median (interquartile range (IQR)): 5 (8)), but were significantly higher in individuals who were currently employed v . unemployed (median (IQR): 5 (7) v . 4 (7); P < 0·001), in those with previous nutrition education v . no nutrition education (median (IQR): 6 (7) v . 4 (8); P = 0·012) and in individuals who had heard of nitrate prior to completing the questionnaire v . those who had not (median (IQR): 9 (8) v . 4 (7); P < 0·001)., Conclusions: This study demonstrates low knowledge around dietary nitrate in UK-based adults. Greater education around dietary nitrate may be valuable to help individuals make more informed decisions about their consumption of this compound.

Despite significant progress in cardiovascular pharmacotherapy and interventional strategies, cardiovascular disease (CVD), in particular ischaemic heart disease, remains the leading cause of morbidity and mortality among women in the UK and worldwide. Women are underdiagnosed, undertreated and under-represented in clinical trials directed at management strategies for CVD, making their results less applicable to this subset. Women have additional sex-specific risk factors that put them at higher risk of future cardiovascular events. Psychosocial risk factors, socioeconomic deprivation and environmental factors have an augmented impact on women's cardiovascular health, highlighting the need for a holistic approach to care that considers risk factors specifically related to female biology alongside the traditional risk factors. Importantly, in the UK, even in the context of a National Health Service, there exist significant regional variations in age-standardised mortality rates among patients with CVD. Given most CVDs are preventable, concerted efforts are necessary to address the unmet needs and ensure parity of care for women with CVD. The present consensus document, put together by the British Cardiovascular Society (BCS)'s affiliated societies, specifically portrays the current status on the sex-related differences in the diagnosis and treatment of each of the major CVD areas and proposes strategies to overcome the barriers in accessing diagnoses and treatments among women. This document aims at raising awareness of the scale of the current problem and hopes to stimulate a multifaceted approach to address sex disparities and enable future comprehensive sex- and gender-based research through collaboration across different affiliated societies within the BCS., Competing Interests: Competing interests: VK is an associate editor for Heart BMJ and is NIHR National Cardiovascular Research Lead, Research Delivery Network., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those identified as 'at risk' may help reduce malnutrition risk and associated healthcare use, and improve quality of life. The aim of this study is to explore how primary care practitioners (PCPs) and older adults perceive, use and respond to an intervention to support those identified as 'at risk'., Methods: We developed and optimised an intervention (screen and treat protocol, online tools and printed materials) to support primary care practitioners to identify malnutrition risk among older adults, and intervene where necessary. We recruited older adults (described as 'patients' here) taking part in a feasibility study, and carried out semi-structured interviews to assess PCPs' and patients' engagement with the intervention, and identify any contextual issues that supported or undermined their engagement., Results: Four themes were developed, encompassing patients' and PCPs' perceptions of undernutrition, study measures and appointments, constraints on PCPs' enthusiasm to make a difference, and patients' expectations of nutritional appointments. Key findings included patients commonly not accepting advice for undernutrition/malnutrition but welcoming support for their nutritional needs; checklists potentially distracting patients from recalling discussions about their nutritional needs; a tension between PCPs' desire to recruit less-well patients and logistical difficulties in doing so; and patients compromising their nutritional needs to suit others., Conclusions: Diverse factors influence whether an intervention succeeds in primary care. PCPs learn about an intervention/study in different ways, vary in how they understand and accept its aims, and desire to make a difference to their patients. Patients bring perceptions and expectations about the study's aims, coloured by their habits and preferences, prior experience of research and healthcare, and pressure from social expectations. Each aspect must be considered when developing a successful primary care intervention that is viewed as relevant and meaningful, and presented using language that aligns with participants' values and goals. Our findings suggest that references to 'malnutrition risk' should be avoided in any patient-facing materials/interactions as participants do not accept or identify with this label., (© 2024. The Author(s).)

Background: The COVID-19 pandemic changed the way many industries work, including contact centres, with some employees working from home and new on-site restrictions/measures in place representing even greater challenges for employers around staff engagement and wellbeing. This study aimed to understand the interplay of individual, social, environmental and organisational factors influencing physical activity and sedentary behaviour in UK contact centre employees, how the pandemic impacted these factors, and their relevance for the future of hybrid working., Methods: Individual interviews (n = 33) were conducted with participants (staff working full and part time, on site and from home) from four UK contact centres. A topic guide based on the ecological model was developed to understand current barriers and facilitators to physical activity and (reducing) sedentary behaviour during and outside of working hours. Thematic analysis was carried out using a codebook and a deductive coding approach to identify themes., Results: Three key insights are provided. First, participants felt they were generally sitting more and moving less since the first UK-wide lockdown. Second, factors which negatively impacted on these behaviours were evident across all levels of the ecological model. These included individual and social barriers (e.g., lack of motivation and preferable physical activity options) as well as environmental and organisational barriers (e.g., poor home office setup, back-to-back virtual meetings). There were a mix of new and existing barriers (exacerbated by the pandemic) and several of these were linked to homeworking. Third, organisational support requirements (e.g., homeworking ergonomic support) and existing facilitators (such as the provision of informational support and flexible working arrangements) were identified., Conclusion: Solutions to reduce sedentary behaviours and increase physical activity in contact centres need to address barriers from the individual to the organisational level. Whilst the study was undertaken in the UK, the results are like to be applicable globally., Trial Registration: Clinical trial registration: The trial for the wider project has been registered on the ISRCTN database: http://www.isrctn.com/ISRCTN11580369., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Manner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: We evaluated the clinical safety and performance of the ultrathin strut biodegradable polymer-coated Supraflex Cruz (Sahajanand Medical TechnologiesLtd., Surat, India) sirolimus-eluting stent (SES) in an all-comer patient population requiring coronary stent implantation., Study Design: The study was a prospective, observational, multicentre, single-arm registry., Study Settings: The study was conducted at 19 NHS Hospitals across the UK, from March 2020 to September 2021., Study Participants: A total of 1904 patients with symptomatic coronary artery disease (age ≥18 years) who underwent percutaneous coronary intervention with at least one Supraflex Cruz SES were enrolled., Primary and Secondary Outcomes Measure: The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (TV-MI) and clinically indicated target lesion revascularisation (CI-TLR), at 12 months. Safety endpoints were stent thrombosis, all-cause death and any MI. Prespecified subgroups analysis included patients with diabetes mellitus, bifurcation lesion, type B2/C lesion defined as per ACC/AHA (American College of Cardiology/American Heart Association) lesion classification and long coronary lesions (>20 mm)., Results: A total of 2973 Supraflex Cruz SES were implanted in 1835 patients (mean age: 65.20±11.03 years). Of these, 404 patients had diabetes mellitus (491 lesions), 271 had bifurcation lesions (293 lesions), 1541 had type B2/C lesions (1832 lesions) and 985 had long coronary lesions (>20 mm, 1139 lesions). Among the overall population, device success was achieved in 98.2% of lesions. TLF occurred in 12 (0.7%) patients (0.3% cardiac death, 0.2% TV-MI, 0.2% CI-TLR) at 30 days and in 43 (2.3%) patients (0.8% cardiac death, 0.8% TV-MI, 0.8% CI-TLR) at 12 months follow-up. The rate of definite stent thrombosis was 0.3% in the overall population at 12 months. The incidence of TLF and stent thrombosis was 6.2% and 1% in the diabetic, 1.8% and none in bifurcation lesion, 2.5% and 0.3% in type B2/C lesion, and 2.7% and 0.3% in long coronary lesions (>20 mm) subgroups, respectively. at 12 months follow-up., Conclusion: The S-FLEX UK-II registry confirms the clinical safety and performance of the ultrathin Supraflex Cruz SES in an all-comer population with complex coronary artery disease, demonstrating low rates of TLF and stent thrombosis., Trial Registration Number: ISRCTN39751665 (https://doi.org/10.1186/ISRCTN39751665)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Clinical trials are fundamental to healthcare, however, they also contribute to anthropogenic climate change. Following previous work to develop and test a method and guidance to calculate the carbon footprint of clinical trials, we have now applied the guidance to 10 further UK and international, academically sponsored clinical trials to continue the identification of hotspots and opportunities for lower carbon trial design., Methods: 10 collaborating clinical trial units (CTUs) self-identified and a trial was selected from their portfolio to represent a variety of designs, health areas and interventions. Trial activity data was collated by trial teams across 10 modules spanning trial setup through to closure, then multiplied by emission factors provided in the guidance to calculate the carbon footprint. Feedback was collected from trial teams on the process, experience and ease of use of the guidance., Results: We footprinted 10 trials: 6 investigational medicinal product trials, 1 nutritional, 1 surgical, 1 health surveillance and one complex intervention trial. Six of these were completed and four ongoing (two in follow-up and two recruiting). The carbon footprint of the 10 trials ranged from 16 to 765 tonnes CO 2 e. Common hotspots were identified as CTU emissions, trial-specific patient assessments and trial team meetings and travel. Hotspots for specific trial designs were also identified. The time taken to collate activity data and complete carbon calculations ranged from 5 to 60 hours. The draft guidance was updated to include new activities identified from the 10 trials and in response to user feedback., Discussion: There are opportunities to reduce the impact of trials across all modules, particularly trial-specific meetings and travel, patient assessments and laboratory practice. A trial's carbon footprint should be considered at the design stage, but work is required to make this common place., Competing Interests: Competing interests: JG, LF, JB and PRW have received NIHR funding to undertake this study (support for the manuscript). FA is the paid chair of the Sustainable Healthcare Coalition. RA-SS reports clinical study grants from the British Heart Foundation and Chief Scientist Office Health Improvement, Protection and Services Research Committee Project Grant; consulting fees from Recursion Pharmaceuticals and Bioxodes, and payment from European Stroke Masters (European Stroke Organisation). RA-SS participates on the Novo Nordisk NN9931-4553 and NN9931-4554 endpoint adjudication committee and is the clinical director of the UK Clinical Research Collaboration network of registered Clinical Trials Units. CA is the Vice President of the World Stroke Organisation, Editor-in-chief of Cerebrovascular Diseases and Associate Editor of International Journal of Stroke; reports grants or contracts from National Health and Medical Research Council (NHMRC) of Australia, Medical Research Council (MRC) of the UK, Medical Research Foundation (MRF) of the UK, Penumbra and Takeda; consulting fees from AstraZeneca Advisory Board and participation on Dutch DIST trial. CG is supported by the NIHR CTU efficiency call. KG receives consulting fees from Boehringer & Ingelheim (unrelated to this work) and is Chair of the ICTMC 2024 Scientific Committee. KH is the Deputy Chair of the NIHR Research Professors panel and was previously a member of the NIHR HTA General Committee. CN is an unpaid information specialist in a priority setting partnership for adults living with type 1 diabetes. SP reports grants or contracts from ViiV Healthcare, Gilead Sciences, NIH, MRC, EDCTP and Janssen-Cilag and is a DSMB member for the academic NIHR–funded trial TIPAL. SO’R, LM and JM are supported by funding from Health Research Board (HRB) Ireland MRSy is an independent unpaid member of many Independent Data Monitoring Committees for academic sponsors; reports grants or contracts from Astellas, Clovis Oncology, Janssen, Pfizer, Novartis and Sanofi-Aventis; consulting fees from Eli Lilly; speaker fees from Janssen and AstraZeneca, and payment from Eisai, all unrelated to the topic of this comment. EM, AB, DC, FY, LW, XC, CM, PD, NM, AP, KM, EB, FD and CK report no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: In June 2021, high-profile testimonials in the media about pain during intrauterine device (IUD) procedures in the UK prompted significant discussion across platforms including Twitter (subsequently renamed X). We examined a sample of Twitter postings (tweets) to gain insight into public perspectives and experiences., Methods: We harvested tweets posted or retweeted on 21-22 June 2021 which contained the search terms coil, intrauterine system, IUD or intrauterine. We analysed the dataset thematically and selected illustrative tweets with the authors' consent for publication., Results: Following deduplication and screening, we included 1431 tweets in our analysis. We identified testimonials with descriptions of varied pain experiences. Twitter users reported that clinicians had not warned them that pain could be severe or explained the options for pain relief. Some raised concerns about pain being minimised or dismissed and linked this to the management of women's pain in medicine more broadly. Twitter users described connecting to an online community with shared experiences as validating and used this as a springboard for collective action., Conclusions: While we acknowledge the limitations of our sample, this study highlights important perspectives and accounts relating to pain during IUD procedures. Our findings attest to the need for strategies to improve the patient experience for those opting for IUD as a clinical priority. Further research should explore IUD users' experiences, expectations and wishes around pain management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Within traditional drug and alcohol (D&A) treatment services, the majority of those accessing support are of white ethnicity, with only a small percentage of people from the British South Asian (BSA) and Muslim community engaging in treatment services. This paper aims to explore perceived barriers to accessing traditional D&A services within the British South Asian and Muslim communities, based on qualitative data from interviews with family members and a practitioner. Qualitative data were obtained via 11 semi-structured interviews involving a practitioner (n = 1), and family and friends (n = 10) of those with historic and current D&A use in the community. Reflexive thematic analysis revealed four themes: (1) awareness of drug and alcohol use in the community, (2) drug and alcohol use as a taboo topic and the impact of admitting use, (3) knowledge of services for treatment, (4) how to increase awareness and accessibility of treatment. There was an increasing awareness of D&A use in the BSA and Muslim community. Despite this, limited conversations and misconceptions around D&A use and recovery led to those using D&A and their family members feeling stigmatised within their community and unable to seek support. This paper concludes by recommending increased communication between the BSA and Muslim communities and D&A treatment services to ensure accessibility of treatment by improving cultural competency.

Background: Internationally, there has been a move towards fostering diverse healthcare workforces that are representative of the patient populations they serve. Selection criteria for academic-clinicians often aim to capture skills and attributes that demonstrate both clinical and academic excellence. Currently, it is not known whether the selection criteria for early academic-clinical careers advantage or disadvantage certain ethnic or socioeconomic groups. The UK has a structured route of integrated clinical academic training with entry level training for newly qualified doctors administered through the 'Specialised Foundation Programme' which provides protected time for research within the first two years of postgraduate clinical training. In this study, we aim to identify what selection criteria are used within the UK Specialised Foundation Programme, and how these relate to demographic factors., Methods: We will perform a mixed methods study consisting of a document analysis of person specifications and selection criteria used in the 2024 UK Specialised Foundation Programme, and a national cross-sectional survey of current medical students in the UK. We will obtain the person specifications, selection criteria, white space (open ended questions used during shortlisting) and interview questions and mark schemes from each Specialised Unit of Applications via information available on their websites or through Freedom of Information requests. Our survey will collect information relating to demographic data, selection criteria, and perceptions of specialised foundation programme selection., Discussion: International literature has demonstrated inequity in academic markers used in selection of post-graduate clinicians and that disadvantages caused by selection can compound over time. As such it is important to understand what inequity exists within the selection of early academic-clinicians, as this can help inform more equitable selection practices and help nurture a more diverse academic-clinical workforce., (© 2024. The Author(s).)

Since the term AI (artificial intelligence) was first coined, it has become embedded in modern life, with debate focusing on its challenges. In dentistry, AI is being used in clinical and education practice; however, many educators have limited knowledge or skills in its use. The British Alliance of Researchers in Dental Education and Scholarship hosted an AI-themed conference in November 2023. The conference organisers set out to initiate discussion on the use of AI in UK dental education, including a focused workshop to develop a consensus opinion. Before the conference, potential opportunities and threats associated with AI were determined, and through a pre-conference questionnaire, these were prioritised for in-depth discussion. During the workshop, personalised learning, support for learning, educator resources and equality were all identified as opportunities presented by AI, while digital literacy, misuse and safety were seen as potential threats. Two key overarching concepts emerged at the end of the conference: recognition that AI is here to stay and that dental schools must engage with it now to realise its potential; and recognition that educators do not know enough about how students are using AI and need to collaborate with our students in future development and research., (© 2024. The Author(s).)