Search

Background: Enhancing long-term support for post-stroke cognitive impairment is a top research priority. Addressing current gaps in UK post-stroke cognitive care provision requires a pragmatic and scalable intervention that can be integrated within the existing stroke care pathway. This study aimed to develop consensus on an initial set of core features for a UK-based monitoring and psychoeducational intervention for cognitive changes after stroke. Methods: An expert panel of UK healthcare professionals and researchers participated in an online modified Delphi survey. Candidate intervention features were identified from clinical guidelines, existing literature, research team/collaborator expertise, and PPI group lived experience. Survey participants indicated whether they agreed/disagreed/had no opinion about including each candidate feature in the intervention and free-text responses were invited. We analysed responses for consensus (≥ 75% agreement) using descriptive statistics, with items not reaching consensus carried into subsequent rounds. Template analysis was used to identify similarities/differences in viewpoints for items that did not reach consensus. Results: Three survey rounds were completed by 36, 29 and 26 participants, respectively. Participants agreed reviews should include a stroke-specific cognitive screen (97% agree) and assessment of other psychological changes (low mood, anxiety, fatigue: 94%, 90%, 89% agree, respectively). They agreed stroke survivors should be offered at least one review, regardless of their cognitive profile in hospital. They agreed on the importance of various cognition-focused psychoeducation topics, and formal (100% agree) and informal (79% agree) training for those conducting reviews. Consensus was not reached on the review mode (in person/remote options: 67% agree), offering reviews one-year post-discharge to patients without acute cognitive impairments (68% disagree), or including a dementia screen (63% disagree) and/or neuropsychological assessment battery (58% disagree). However, there were similarities in participant viewpoints. For example, participants emphasised the importance of onwards referral where clinically indicated. Conclusions: The UK-based post-stroke monitoring and psychoeducation intervention was originally conceptualised as a cognitive care pathway, but expert participants agreed on the importance of simultaneously addressing related psychological changes (e.g. low mood, anxiety). There was clear consensus on a minimum set of intervention features. Recommendations outlined here may usefully inform local service improvements. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic put unprecedented pressure on weight management services. These services were required to adapt to continue to provide care for people living with obesity. This study sought to develop consensus recommendations on the best practice solutions adopted by weight management services in the United Kingdom during the COVID‐19 pandemic. Methods: This study utilised a semi‐structured interview and a modified Delphi methodology to develop a consensus of best practice recommendations identified by specialist weight management services during the pandemic. Results: Twenty‐three healthcare professionals working in weight management service across the United Kingdom participated in the study. Analysis of interview transcripts identified four key thematic domains: outpatient, patient education and support, perioperative care and team working. Of the initial 43 unique recommendations, 30 reached consensus agreement. Outpatient recommendations focused on communication strategies, patient self‐monitoring and remote patient tracking. Patient education and support recommendations addressed the development of online educational resources and support groups. Perioperative care recommendations emphasised case prioritisation, waiting list support and postoperative care. Team working recommendations targeted the use of digital collaboration tools and strategies for effective teamwork. Conclusion: Developing consensus recommendations on best practice is a critical step for weight management and outpatient services to achieve higher standards of care. These recommendations provide a springboard for departmental discussions, paving the way for improved experiences for individuals living with obesity as they progress along their weight management journey. Key points: During times of crisis, healthcare providers in weight management services can rapidly adopt innovative digital solutions to support good patient care.Thirty expert consensus recommendations relating to outpatient management, patient education and support, perioperative care and team working were found.Collaborative research is key to further guideline development on obesity management in areas of outpatient care, patient education, perioperative care and team working. [ABSTRACT FROM AUTHOR]

Strength training recommendations have been embedded within the UK's Chief Medical Officers' physical activity guidelines since 2011. There is limited evidence that these recommendations are used by exercise instructors in the community to underpin strength training prescription in the older adult population. This study aimed to explore exercise instructors' awareness and utilisation of the guidelines when prescribing strength training to older adults. Fifteen exercise instructors working with older adults in the UK participated in one online interview. A general inductive approach was conducted and thematic analysis allowed for major themes to be identified from the raw data. We found that most exercise instructors (n = 9), but not all (n = 6), were aware of the guidelines. Only one instructor (n = 1) had reportedly implemented the guidelines into their practice; other instructors reported that the guidelines were irrelevant. Instead, each of the instructors had their preferred sources of information that they relied on to underpin their exercise prescription, and each had their own interpretation of 'evidence-based strength training.' This individualised interpretation resulted in exceptionally varied prescription in the community and does not necessarily align with the progressive, evidence-based prescription known to build muscular strength. We suggest that (i) more detail on how to build muscular strength be embedded within the guidelines, (ii) a handbook on how to implement the guidelines be made available, (iii) theoretical and practical teaching materials and courses be updated, and/or (iv) a re-(education) of exercise instructors already in the field may be necessary to bring about a consistent, evidence-based strength prescription necessary for the best possible health and longevity outcomes for our ageing population. [ABSTRACT FROM AUTHOR]

Background Older people are often explicitly or implicitly excluded from research, in particular clinical trials. This means that study findings may not be applicable to them, or that older people may not be offered treatments due to an absence of evidence. Aims The aim of this work was to develop recommendations to guide all research relevant to older people. Methods A diverse stakeholder group identified barriers and solutions to including older people in research. In parallel, a rapid literature review of published papers was undertaken to identify existing papers on the inclusion of older people in research. The findings were synthesised and mapped onto a socio-ecological model. From the synthesis we identified themes that were developed into initial recommendations that were iteratively refined with the stakeholder group. Results A range of individual, interpersonal, organisational, community and policy factors impact on the inclusion of older people in research. A total of 14 recommendations were developed such as removing upper age limits and comorbidity exclusions, involving older people, advocates and health and social care professionals with expertise in ageing in designing the research, and considering flexible or alternative approaches to data collection to maximise opportunities for participation. We also developed four questions that may guide those developing, reviewing and funding research that is inclusive of older people. Conclusion Our recommendations provide up to date, practical advice on ways to improve the inclusion of older people in health and care research. [ABSTRACT FROM AUTHOR]

Hailed as an international human rights innovation, the UN Human Rights Council's Universal Periodic Review ("UPR") is a peerreview mechanism that assesses the protection and promotion of human rights in all 193 UN Member States, including intergovernmental and civil society input. Importantly, within the UPR, other Member States provide recommendations to each state under review on how it can improve human rights on the ground. States can decide to accept or note recommendations and should then go on to implement those that are accepted. The recommendations are a fundamental part of the UPR process, yet they are not always formulated in a way that leads to positive change. Using the case study of domestic abuse in the UK, this article seeks to add to the current literature through an analysis of the formulation of UPR recommendations, providing five practical suggestions for how recommendations can be improved to ensure action is taken on the ground: (1) use consistent terminology, (2) be specific when discussion aspects of violence against women and girls, (3) UPR recommendations should be fluid and adapt to the changing human rights landscape, (4) utilize recommendations provided by civil society organizations in their stakeholder submissions, and (5) consider applying an intersectional approach when making recommendations. [ABSTRACT FROM AUTHOR]

Investment consultants market their services by claiming their fund manager recommendations add significant value. Using nonpublic data sourced from investment consultants and the UK regulator, we find no such evidence, but identify several practices that explain their exaggerated claims: comparisons to benchmarks instead of peers, inclusion of simulated and backfilled returns, use of investment horizons that allow losers to be forgotten, and unexplained exclusions of products from the analysis. Consultants do not fully disclose their methodology to investors, who therefore cannot verify or reliably compare their performance. This paper was accepted by Haoxiang Zhu, finance. Supplemental Material: Data and the internet appendix are available at https://doi.org/10.1287/mnsc.2021.4218. [ABSTRACT FROM AUTHOR]

Domestic Homicide Reviews (DHRs) are a statutory requirement in England and Wales, conducted when somebody aged 16 and over dies from violence, abuse or neglect by a relative, intimate partner or member of the same household. While key aims of DHRs are to identify recommendations and lessons learned to eventually prevent further domestic homicides, there is limited evidence globally regarding the extent to which these are followed up or make a difference. This paper explores the barriers and facilitators to the conduct and impact of DHRs to enhance their learning potential. It is based on nineteen qualitative interviews with professionals involved in the DHR process across five Safeguarding Boards in Wales and fourteen Community Safety Partnerships in the North‐West of England, UK. Findings are presented thematically under four section headings: upskilling and democratising the review process; family and friends' involvement; negotiating organisational blame to foster learning; and actioning and auditing recommendations. It is suggested that organisational learning cannot be achieved without accepting organisational responsibility, which could be interpreted as blame. The role and skills of the Chair are perceived as key to ensure a safe, evidence‐based, transparent and learning‐focused DHR process. Developing and actioning recommendations may challenge longstanding prejudices. Promoting the role of families/survivor networks and professionals on an equal footing would support a more democratic process. Learning could be enhanced by thematising recommendations and proactively using lessons from one area to inform another. Participants called for appropriate central regulation and accountability to support the action of recommendations. [ABSTRACT FROM AUTHOR]

Reducing inequalities in preconception health and care is critical to improving the health and life chances of current and future generations. A hybrid workshop was held at the 2023 UK Preconception Early and Mid-Career Researchers (EMCR) Network conference to co-develop recommendations on ways to address inequalities in preconception health and care. The workshop engaged multi-disciplinary professionals across diverse career stages and people with lived experience (total n = 69). Interactive discussions explored barriers to achieving optimal preconception health, driving influences of inequalities and recommendations. The Socio-Ecological Model framed the identified themes, with recommendations structured at interpersonal (e.g. community engagement), institutional (e.g. integration of preconception care within existing services) and environmental/societal levels (e.g. education in schools). The co-developed recommendations provide a framework for addressing inequalities in preconception health, emphasising the importance of a whole-systems approach. Further research and evidence-based interventions are now needed to advance the advocacy and implementation of our recommendations.

Optimal thromboprophylaxis in orthopaedic procedures is crucial in an attempt to lower the risk of venous thromboembolism, including deep vein thrombosis and pulmonary embolism. We aim to: 1) identify clinical practice guidelines (CPGs) and recommendations (CPRs) on thromboprophylaxis in adult patients undergoing orthopaedic procedures, and 2) assess the methodological quality and reporting clarity of these guidelines. The study was conducted following the 2020 PRISMA guidelines for a systematic review and has been registered on the international prospective register of systematic reviews (PROSPERO) under the registration number (CRD42023406988). An electronic search was conducted using Medline, Embase, Cochrane, Web of Science, Google Scholar and medRxiv. The search terms used were ""adults", "orthopedic surgery", "orthopedic surgeries", "orthopedic surgical procedure", "orthopedic surgical procedures" "english language", "venous thromboembolism", in all possible combinations (January 2013 to March 2023). The eligible studies were evaluated by four blind raters, employing the Appraisal of Guidelines for Research & Evaluation II (AGREE-II) analysis tool. The literature research resulted in 931 studies. Finally, a total of 16 sets of guidelines were included in the current analysis. There were 8 national and 8 international CPGs. Eight CPGs made specific recommendations for orthopaedic surgery and referred mostly to joints; one guideline focused on pelvi-acetabular trauma, while the rest were more inclusive and non-specific. Four guidelines, one from the American Society of Hematology (ASH), two from the United Kingdom (UK) and one from India were found to have the highest methodological quality and reporting clarity according to the AGREE-II tool. Inter-rater agreement was very good with a mean Cohens Kappa 0.962 (95 % CI, 0.895–0.986) in the current analysis. So, the reliability of the measurements can be interpreted as good to excellent. Optimal thromboprophylaxis in orthopaedic procedures is crucial. The available guidelines were found to be mostly of high methodological quality and inter-rater agreement was very good, according to our study. [ABSTRACT FROM AUTHOR]

Many types of guidance documents inform conservation by providing practical recommendations for the management of species and habitats. To ensure effective decisions are made, such guidance should be based upon relevant and up‐to‐date evidence. We reviewed conservation guidance for mitigation and management of species and habitats in the United Kingdom and Ireland, identifying 301 examples produced by over 50 organizations. Of these, only 29% provided a reference list, of which only 32% provided reference(s) relevant to justify the recommended actions (9% of the total). Furthermore, even this guidance was often outdated, lacked a methodology for production, or did not highlight uncertainty in the key evidence that supported the recommendations. These deficiencies can lead to misguided and ineffective conservation practices, policies, and decisions, and a waste of resources. Based on this review and co‐design by experts from 14 organizations, we present a set of principles for ensuring sufficient and relevant evidence is transparently incorporated into future conservation guidance. Producing evidence‐based guidance in line with these principles would enable more effective conservation outcomes. [ABSTRACT FROM AUTHOR]

Pediatric acute‐onset neuropsychiatric syndrome is a clinical concept used to describe a subgroup of children with sudden onset of psychiatric and somatic symptoms. The diagnostic term and especially management of children differs depending on the clinical setting to which they present, and the diagnosis and management is controversial. The aim of this paper is to propose a clinical guidance including homogenous diagnostic work‐up and management of paediatric acute onset neuropsychiatric syndrome within the Nordic countries. The guidance is authored by a Nordic‐UK working group consisting of paediatric neurologist, child psychiatrists and psychologists from Denmark, Norway, Sweden and Great Britain, and is the result of broad consensus. Conclusion: Consensus was achieved in the collaboration on work‐up and treatment of patients with paediatric acute‐onset neuropsychiatric syndrome, which we hope will improve and homogenise patient care and enable future collaborative research in the field. [ABSTRACT FROM AUTHOR]

Recruitment to oral and maxillofacial Surgical (OMFS) specialty training was centralised in 2010. The 'flexibility' for OMFS to respond to specialty specific recruitment issues is reducing and many Specialty Trainees' (ST) posts are left unfilled. The National Institute for Health and Care Research (NIHR) appointment process designed to address the problem of recruiting and appointing academic surgeons with local selection with national benchmarking has worked. Using a database of all UK OMFS consultants/trainees, an electronic questionnaire was shared by e-mail, WhatsApp, and other social media. Of 306 replies, 125 (41%) were Consultants/post-certificate of completion training (CCT) individuals, 66 (22%) ST, 61 (20%) second degree students, 27 (9%) pre-second degree, 26 (9%) dual degree pre-ST trainees, and one did not indicate their status. A total of 249 (76%) studied dentistry first and 230 (75%) were male. Of those replying, 147 (48%) had no direct experience of national selection. 120 (39%) had experience as a candidate, 20 (7%) as a selector only, 17 (6%) as a candidate and selector, and two did not record their experience. Of 250 expressing an opinion, 156 (62%) supported local selection with 140 (56%) supporting local selection and national benchmarking, which is a process used for research training posts by the NIHR. Geographical continuity was most important for 78% of pre-second-degree trainees, 45% of STs, and 54% of second-degree students. A total of 57 respondents completed free text comments. There is support for changes in OMFS ST selection including creating OMFS posts which include Foundation and second-degree training in NIHR style locally recruited nationally benchmarked posts., (Copyright © 2024 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Despite widespread evidence of the effectiveness of lipid modification for the reduction of cardiovascular disease (CVD) risk, lipid modification goals are commonly underachieved in the United Kingdom (UK). In order to understand current UK lipid management guidance and the corresponding attainment of recommended lipid lowering goals relating to treatment with statins and ezetimibe, a literature review was conducted using PubMed focusing on publications between January 2017 and February 2020 in order to capture the most up-to-date literature. Identified publications were reviewed against key clinical guidelines for lipid management in relation to CVD risk from the National Institute for Health and Care Excellence (NICE, CG181), the Scottish Intercollegiate Guidelines Network (SIGN, 149) and European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS). Cholesterol lowering goals are central to current lipid lowering therapy guidance, although specific goals vary depending on the guideline and patients' individual risk profile. Current guidance by NICE and SIGN specifies that treatment should achieve a greater than 40% reduction in non-high-density lipoprotein cholesterol (non-HDL-C) at 3 months of treatment, while the ESC/EAS place emphasis on the lowering of low-density lipoprotein (LDL-C) and total cholesterol. Yet, despite widespread availability of guidance and consistent messaging that lipid lowering goals should be ambitious, current evidence suggests a significant proportion of UK patients have sub-optimal reductions in cholesterol/non-HDL-C/LDL-C. The reasons for this are reported to be multifactorial, including a lack of compliance with guidelines, particularly regarding high-intensity statin prescribing, patient adherence, statin intolerance and statin reluctance as well as wider genetic factors. A number of possible strategies to improve current lipid management and attainment of lipid-lowering goals were identified, including improving the patient-healthcare professional partnership, conducting audits of local prescribing versus guidance, implementing plans for the refinement of current services and considering alternative options such as cost-effective single pill combinations for improving adherence. [ABSTRACT FROM AUTHOR]

Introduction: This paper provides a critical reflection from both the researcher and public contributor (PC) perspective on the benefits and the learnings taken from involving PCs in research related to Parkinson's. APPROACH TO PATIENT AND PUBLIC INVOLVEMENT (PPI): This paper reports on how PCs shaped the design and development of the PRIME-UK research programme study materials through input into information leaflets, consent forms and other patient-facing documents used across three studies within the PRIME-UK research programme. The PRIME-UK research programme is designed to improve the quality of life of people with Parkinson's and this project included three studies: a cross-sectional study, a randomised control trial and a qualitative study. We captured these impacts using Public Involvement Impact Logs, which provide a framework allowing researchers and PCs to report on the learnings, immediate outcomes and impacts from PPI. For this project, the impact logs enabled us to provide reflections from PCs and researchers on the process of involving 'the public' in Parkinson's research., Findings: This paper builds on existing evidence of the range of benefits and challenges that emerge from working with patients and the public in Parkinson's research; this includes reflecting on the changes made to the study materials and benefits for the people involved. Four themes emerged from the reflections that were common to the researchers and PCs; these were the importance of providing a supportive environment; recognition of the benefit of the evaluation of the impact of PPI; acknowledgement that engagement of PPI can make a positive difference to the research process and that timely communication and the use of face-to-face communication, where available, is key. Furthermore, we demonstrate how impact logs provide a useful and straightforward tool for evaluating public involvement practices and supporting the feedback process., Conclusion: We offer key recommendations for involving patients and the public in Parkinson's research and suggest approaches that could be implemented to capture the impacts of public involvement., Public Contribution: Public contributors (PCs) were involved in the design and development of the participant information leaflets, consent forms and other patient-facing documents used for studies within the PRIME-UK research programme. In addition, PCs evaluated their involvement using impact logs and co-authored this paper., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Objectives To develop evidence-based recommendations on the use of MRI in the diagnosis of axial SpA (axSpA). Methods A working group comprising nine rheumatologists and nine musculoskeletal radiologists with an interest in axSpA was established, with support from the British Society of Spondyloarthritis (BRITSpA). Two meetings were held. In the first meeting, research questions were formulated. In the second meeting, the results of a systematic literature review designed to inform the recommendations were reviewed. An anonymized Delphi process was used to formulate the final set of recommendations. For each recommendation, the level of evidence and strength of recommendation was determined. The level of agreement was assessed using a 0–10 numerical rating scale. Results Two overarching principles were formulated, as follows: The diagnosis of axSpA is based on clinical, laboratory and imaging features (overarching principle 1), and patients with axSpA can have isolated inflammation of either the sacroiliac joints or the spine (overarching principle 2). Seven recommendations addressing the use of MRI in the assessment of patients with suspected axSpA were formulated, covering topics including recommended sequences, anatomical coverage, acquisition parameters and interpretation of active and structural MRI lesions. The level of agreement for each recommendation was very high (range 8.8–9.8). Conclusion A joint rheumatology and radiology consensus on the acquisition and interpretation of MRI in axSpA diagnosis was achieved, and a research agenda formulated. This consensus should help standardize practice around MRI and ensure a more informed, consistent approach to the diagnosis of axSpA. [ABSTRACT FROM AUTHOR]

The follow-up care of people diagnosed with early breast cancer varies across the world. In the UK, services have evolved in an ad hoc way, with no standardized approach nationally. Some people are seen face to face at regular intervals, others are discharged at two years, while others are followed up over the telephone. This is creating confusion for patients as to what is best practice. The lack of evidence to support intensive surveillance is frequently cited as the main reason to reduce or indeed review the benefits of face to face clinical consultations in the hospital/community setting. In addition, a lack of specific recommendations in current guidelines compounds this. Although primary disease stage and treatment are strong indicators of survival, and time to recurrence (both local and distant) is extending, patterns of follow-up care in the UK differ depending on where you live. Yet, European and American guidelines, where survival is frequently reported as being better than the UK, continue to recommend follow-up at regular intervals as part of their overall management approach; to ensure new and changing ways of treating early breast cancer are initiated, managed and monitored accordingly. Indeed their guidelines are increasing rather than decreasing follow-up. While their health systems may differ, survival outcome reporting is not adjusted to reflect these differences. This paper provides an overview of breast cancer follow-up guidance across the world and opens up a debate about whether patterns of follow up care will affect survival outcomes into the future. • Breast cancer guidelines across the world differ in relation to follow-up practice. • There is a lack of consensus globally as to how, when and by whom, follow up care is provided. • The treatments available for early breast cancer require long-term monitoring. • Patients receive different follow-up approaches dependent on where they live. [ABSTRACT FROM AUTHOR]

This paper concerns recommendations for intervention in honour-based violence (“HBV”) as recommended by individuals who face such violence in their everyday lives. Utilising data extracted from interviews conducted with 30 key agents and 8 South-Asian female survivors in the UK, this paper will argue that UK public agencies are struggling to cope with how to respond to HBV. This is despite the UK government recognising shortcomings in the support for victims in the House of Commons Home Affairs Committee report in 2008. In particular, participants identified that (a) the police, healthcare, and social services are particularly poor at supporting victims; (b) public sector workers require appropriate training and awareness on HBV; (c) education on HBV and forced marriages is absent in schools, colleges, and universities; and (d) more needs to be done to engage and educate communities about HBV and where victims can access support. [ABSTRACT FROM AUTHOR]

In July 2017, a landmark report Review of Nutrition and Health Research (80 pages) was published following a strategic review commissioned by The Office for Strategic Coordination of Health Research (OSCHR). The review sets out a future vision for nutrition research and offers recommendations designed to capitalise on UK strengths, tackle weaknesses and thus strengthen and revitalise the UK research base. Traditionally, the UK has benefited considerably from research funding from the European Union, and the report stresses the window of opportunity that exists to galvanise the research community at a time when the future of UK research funding is at a crossroads. Unusual for reviews of this type, the report emphasises the vital need for partnership with industry, not least because the sector is key to ensuring translation of research advances into healthier products and improved nutrition support for those who are ill. The strategic review calls for an agreed code of practice to facilitate open, transparent and effective partnerships. In response to the review, the Medical Research Council has identified three pillars of activity for nutrition research: building the UK research base; developing plans for global nutrition research; and working with the food industry. [ABSTRACT FROM AUTHOR]

This article provides an overview of a project undertaken by the Queen's Nursing Institute (QNI) and funded by The Department of Health, to identify the barriers and challenges that prevent effective discharge from hospital to home. Unnecessary delays in discharging patients from hospital to home is an ongoing problem and for older people this can lead to worse health outcomes, which can increase their long-term care needs. Findings from the project illustrates that while there are challenges in achieving excellent practice in the transfer of a patient's care from hospital to home, there is a significant willingness and commitment from nurses based both in the community and hospital to improve the patient experience. Key recommendations are cited in the article that will enhance an improved discharge experience for patients, carers and their families. [ABSTRACT FROM AUTHOR]

Background: Adolescents are a population group at high risk of low vitamin D status, yet the evidence base for establishing dietary vitamin D requirements remains weak. Objective: The aim was to establish the distribution of vitamin D intakes required to maintain serum 25-hydroxyvitamin D [25(OH)D] concentrations above proposed cutoffs (25, 30, 40, and 50 nmol/L) during winter in white males and females (14-18 y of age) in the United Kingdom (51°N). Design: In a dose-response trial, 110 adolescents (aged 15.9 ± 1.4 y; 43% males) were randomly assigned to receive 0, 10, or 20 mg vitamin D3 supplements/d for 20 wk during winter. A nonlinear regression model was fit to total vitamin D intake and postintervention serum 25(OH)D concentrations, and regression-predicted values estimated the vitamin D intakes required to maintain serum 25(OH)D concentrations above specific cutoffs. Results: Mean ± SD serum 25(OH)D concentrations increased from 49.2 ± 12.0 to 56.6 ± 12.4 nmol/L and from 51.7 ± 13.4 to 63.9 ± 10.6 nmol/L in the 10- and 20-μg/d groups, respectively, and decreased in the placebo group from 46.8 ± 11.4 to 30.7 ± 8.6 nmol/L (all P # 0.001). Vitamin D intakes required to maintain 25(OH)D concentrations >25 and >30 nmol/L in 97.5% of adolescents were estimated to be 10.1 and 13.1 μg/d, respectively, and 6.6 μg/d to maintain 50% of adolescents at concentrations >40 nmol/L. Because the response of 25(OH)D reached a plateau at 46 nmol/L, there is uncertainty in estimating the vitamin D intake required to maintain 25(OH)D concentrations >50 nmol/L in 97.5% of adolescents, but it exceeded 30 μg/d. Conclusion: Vitamin D intakes between 10 and ~30 μg/d are required by white adolescents during winter to maintain serum 25(OH)D concentrations >25-50 nmol/L, depending on the serum 25(OH)D threshold chosen. This trial was registered at clinicaltrials. gov as NCT02150122 and as International Standard Randomized Controlled Trial Number ISRCTN40736890. [ABSTRACT FROM AUTHOR]

This study explored associations between free sugars intake (using non-milk extrinsic sugars as proxy) and nutrient intakes among children aged 1·5–18 years in the UK National Diet and Nutrition Survey 2008–2012. Dietary records were completed by 2073 children (95 % completed 4 d). Mean free sugars intakes (% energy) were 11·8, 14·7 and 15·4 % in the 1·5–3, 4–10 and 11–18 years age groups, respectively. Nutrient intakes and nutrient density were compared across quintiles (Q1–Q5) of free sugars intake (% energy) within each age group. Energy intake rose from Q1 to Q5 of free sugars, whereas percentages of energy intake from fat, SFA and protein dropped. Associations with micronutrients (mg/d or mcg/d) were mostly non-significant, but among 11–18-year-olds there were significant negative associations with Zn, Se, Fe, Cu, and vitamin A and D. There were stronger negative associations with micronutrient density (mg/mcg per 4·18 MJ) for most nutrients in all age groups. Associations with vitamin C were positive. Results were similar after excluding misreporters. Children aged 4–18 years who consumed average amounts of free sugars or above (>13 % energy or Q3–Q5) had lower diet quality than those consuming <10 % free sugars (Q1), but there were insufficient data to assess diets with 5 % free sugars. High consumers obtained a higher proportion of free sugars from soft drinks, fruit juice and sugar confectionery and less from breakfast cereals. Ultimately, nutrient intakes depend on the total dietary pattern; however, reducing overconsumption of sugary foods and drinks with low nutrient density may help improve diet quality. [ABSTRACT FROM PUBLISHER]

Purpose: We sought to identify exemplars of high quality care provision from established stroke vision services.Methods: We identified areas of high quality services across the UK, judged as having integrated stroke/vision care provision for stroke survivors. Healthcare professionals were selected to participate in 1:1 interviews or focus groups. A strengths–weaknesses–opportunities–threats (SWOT) framework was used to lead the discussion in a semi-structured format. Thematic analysis was undertaken.Results: Interviewees (n = 24) from 14 NHS Trusts included eye clinic managers, nurses, orthoptists, occupational therapists and physiotherapists. Identified strengths of their services included established communication, training provision for stroke team staff, “open access” for referrals, use of standardised screening/referral forms, provision of lay summaries and information sheets, patients assessed on the stroke unit with continued follow-up and initial visual assessments made within 1 week of stroke onset. Weaknesses included lack of funding, insufficient orthoptic cover, and time consuming retraining of stroke staff because of staff rotation and changes. Opportunities included increasing the number (or length) of orthoptic sessions and training of stroke staff. Perceived threats related to funding and increased appointment waiting times.Conclusions: Practical elements for improved stroke and vision care provision are highlighted which can be implemented with relatively little financial inputs.Implications for RehabilitationIntegrated vision services within stroke units can improve the detection of visual problems in stroke survivors leading to earlier visual rehabilitation.Orthoptists within core stroke teams are beneficial to the delivery of a high quality service.This study illustrates clear practical elements to support the provision of high quality integrated stroke and vision services. Relatively little financial inputs are required to fund such services but with larger potential to improve patient care. [ABSTRACT FROM PUBLISHER]

Objective. There are unique challenges to designing and carrying out high-quality trials testing therapeutic devices in OA and other rheumatic diseases. Such challenges include determining the mechanisms of action of the device and the appropriate sham. Design of device trials is more challenging than that of placebo-controlled drug trials. Our aim was to develop recommendations for designing device trials. Methods. An Arthritis Research UK study group comprised of 30 rheumatologists, physiotherapists, podiatrists, engineers, orthopaedists, trialists and patients, including many who have carried out device trials, met and (using a Delphi-styled approach) came to consensus on recommendations for device trials. Results. Challenges unique to device trials include defining the mechanism of action of the device and, therefore, the appropriate sham that provides a placebo effect without duplicating the action of the active device. Should there be no clear-cut mechanism of action, a three-arm trial including a no-treatment arm and one with presumed sham action was recommended. For individualized devices, generalizable indications and standardization of the devices are needed so that treatments can be generalized. Conclusion. A consensus set of recommendations for device trials was developed, providing a basis for improved trial design, and hopefully improvement in the number of effective therapeutic devices for rheumatic diseases. [ABSTRACT FROM AUTHOR]

One in five people in the UK is known to have a low serum vitamin D level (25-hydroxy vitamin D below 25 nmol/l) according to the National Diet and Nutrition Survey. The Summer of 2015 saw publication of a draft report from the government's Scientific Advisory Committee on Nutrition ( SACN), which proposes introduction of dietary reference values ( DRVs) for all age groups (not just those considered as vulnerable). The health outcome identified as the basis for setting DRVs for vitamin D was musculoskeletal health (based on rickets, osteomalacia, falls, risk of falling and muscle strength). The data were not sufficient to establish a distribution of serum 25( OH)D concentrations or a clear threshold serum 25( OH)D concentration to support musculoskeletal health outcomes, but the evidence overall suggests that the risk of poor musculoskeletal health is increased at serum 25( OH)D concentrations below 25 nmol/l. Therefore, SACN selected a serum 25( OH)D concentration of 25 nmol/l, on a precautionary basis, as the target concentration to protect all individuals from poor musculoskeletal health. This concentration was considered to be a 'population protective level' ( i.e. the concentration that 97.5% of individuals in the UK should be above, throughout the year, in order to protect musculoskeletal health). After establishing the health outcomes linked with low vitamin D status, the next step in estimating DRVs for vitamin D was translation of the serum 25( OH)D concentration of 25 nmol/l into a dietary intake value that represents the reference nutrient intake ( RNI) for vitamin D [ i.e. the average daily vitamin D intake that would be sufficient to maintain a serum 25( OH)D concentration of at least 25 nmol/l in 97.5% of individuals in the UK]. The average vitamin D intake refers to the mean or average intake over the long-term and takes account of day-to-day variations in vitamin D intake. It was not possible to quantify the sunlight exposure required in the summer months to maintain a winter serum 25( OH)D concentration of at least 25 nmol/l because of the number of factors that affect endogenous vitamin D synthesis, storage and utilisation. Instead, use was made of a series of three randomised controlled trials, conducted in the winter months, to estimate directly the amount of vitamin D required daily to achieve a serum threshold of 25 nmol/l throughout the year. The RNI proposed by SACN for all people aged 4 and above is 10 μg/day. For younger children, a Safe Intake of 8.5-10 μg/day (depending on age) is proposed. These recommendations bring alignment with many other countries of the world. As dietary intakes from food are typically well below the 10 μg/day proposed by SACN for most age groups, media reports speculated on how this advice might be achieved in practice. [ABSTRACT FROM AUTHOR]

In its report on Carbohydrates and Health, the Scientific Advisory Committee on Nutrition ( SACN) has recommended increases in the dietary reference values for fibre to 30 g/day for adults and 15-30 g/day for children, depending on their age. Intakes are currently much lower than this, at an average of 18 g/day in adults, less in children, and there are socio-economic differences, with lower intakes in the lowest income quintile compared to the highest. Dietary modelling shows that achieving these recommendations is possible but will require substantial changes to dietary patterns for many, with meals based around fibre-rich starchy foods (such as wholegrain and high-fibre options of bread, breakfast cereals, pasta and rice, and jacket potatoes), supplemented by inclusion of high-fibre snacks such as unsalted nuts and considerable amounts of vegetables and fruit, daily. This article discusses the challenges associated with communicating these new recommendations, in the context of current labelling legislation. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report and review the legislative and regulatory responses to the global financial crisis (GFC) from within the United Kingdom (UK). Design/methodology/approach – The paper observes aspects of the effect of the GFC within the UK, using economic statistics and institutional case studies. It summarises the laws that the European Union (EU) and the UK have produced in the wake of the crisis and recommends approaches to be taken from this point. Findings – The regulators are putting in place a comprehensive, integrated framework, much of which is sensible in its content. However, this structure will be insufficient to re-establish the effective operation of the financial sector, unless firms comply with the rules and a “relationship culture” is developed. Research limitations/implications – It is not yet clear how the Prudential Regulation Authority (PRA) and the Financial Conduct Authority (FCA) will perform and coordinate. Originality/value – The paper presents a comprehensive review of relevant EU and UK legislation, thereby bringing readers up to date with the situation in the UK. [ABSTRACT FROM AUTHOR]

Strength recommendations have been embedded within the UK's Chief Medical Officers' physical activity guidelines since 2011. In 2019, they were given a more prominent position in the accompanying infographic. However, there is limited evidence that these recommendations have been successful in their population-wide dissemination. This study aimed to explore the engagement of community-dwelling older adults with the guidelines to date and to gain a nuanced understanding of the awareness, knowledge, and action that older adults take to fulfil strength recommendations. A total of fifteen older adults living in the UK participated in one online interview. A general inductive approach was used to generate themes from the data. There were four major themes that were found. 1. The strength component of the physical activity guidelines, 2. Barriers, 3. Motivators, and 4. Solutions. No participants were aware of the strength guidelines. When they were asked what activities they used to fulfil the ' build strength on at least two-days-per-week' criteria, walking, yoga, and Pilates were the most common responses. Ageism and strength training misconceptions were major barriers to participation in strengthening exercise. Older adults were much less aware of the benefits of building strength and strength training participation when compared to aerobic activities, so motivators to participation were generally not specific to strength training. Finally, there are several ways that practitioners can overcome the barriers to strength training participation. Solutions to improving the uptake and adherence to strength training participation are likely to be more successful when they include opportunities for social interaction, ability-appropriate challenge, and provide both short- and long-term benefits.

This article reflects on the progress that has been made in Britain since publication of the Black report on workplace health in 2008. It provides an overview of the key recommendations of the report, reflecting on the interventions that have been put in place in response to these recommendations by the end of September 2011. [ABSTRACT FROM AUTHOR]

Summary In 2008, the Food and Agricultural Organization (FAO)/World Health Organization (WHO) reviewed its recommendations on dietary fat and fatty acids in light of the growing evidence base on dietary fatty acids and health outcomes. These new FAO/WHO recommendations are considerably broader than the current UK recommendations, in that the FAO/WHO report makes separate recommendations for adults and children and sets ranges of intake for n-3 and n-6 polyunsaturated fatty acids (PUFAs) based, not only on prevention of deficiency, but also on their role in contributing to optimum and long-term health. The key recommendation of this report is that saturated fatty acids (SFAs) should be limited to 10% of dietary energy intake and, compared with the UK recommendations, there is a stronger emphasis on replacing excess dietary SFAs with PUFAs (both n-3 and n-6) because of convincing evidence that this dietary exchange reduces low density lipoprotein cholesterol and the risk of coronary heart disease. It may therefore be timely to consider the need for a modification of the UK dietary guidelines on dietary fat and fatty acid intake to take account of the growing evidence base for the potential benefit of replacing SFAs with PUFAs. [ABSTRACT FROM AUTHOR]

Task and Finish Group of Diabetes UK was convened over 14 months to undertake a systematic review of the original 1999 British Diabetic Association guidance on care home diabetes, incorporate new research findings and produce a set of recommendations that are evidenced-based, practical and implementable within UK care home settings. The anticipation of Diabetes UK is that these guidelines will represent a national policy of good clinical practice for diabetes care within care homes. This executive summary demonstrates how the full guidelines should provide a framework of assessment of the quality of diabetes care within care homes, for use by regulatory bodies who have responsibility for this provision of diabetes care. This document is primarily base don recommendations for adults living within British care home environments and its focus, by virtue of the nature and characteristics of residents, is on older adults. Improvements in diabetes care within residential and nursing homes are likely to follow a sustained commitment by health and social care professionals to ensure that the well-being of residents with diabetes is paramount, that high-quality policies of diabetes care are implemented and monitored and effective diabetes education is a mandatory and integral part of care home staff training. [ABSTRACT FROM AUTHOR]

The article presents the results of a study on the effectiveness of a guideline-based medication assessment tool (MAT) in measuring and enhancing compliance with the recommendations for preventing coronary heart disease in Great Britain. According to the authors, the reliability testing of MAT showed in the range 0.79 to 0.90 while applicability in the pilot study was 63 percent and compliance was 65 percent. They mention that the mean application time for the experienced user was 1.5 minutes. They indicate the benefit of MAT to clinical pharmacists.

More women are living with and surviving breast cancer, because of improvements in breast cancer care. Trastuzumab (Herceptin) has significantly improved outcomes for women with HER2-positive tumours. Concerns about the cardiac effects of trastuzumab (which fundamentally differ from the permanent myocyte loss associated with anthracyclines) led to the development of cardiac guidelines for adjuvant trials, which are used to monitor patient safety in clinical practice. Clinical experience has shown that the trial protocols are not truly applicable to the breast cancer population as a whole, and exclude some women from receiving trastuzumab, even though they might benefit from treatment without long-term adverse cardiac sequelae. Consequently, five oncologists who recruited patients to trastuzumab trials, some cardiologists with whom they work, and a cardiovascular lead general practitioner reviewed the current cardiac guidelines in the light of recent safety data and their experience with adjuvant trastuzumab. The group devised recommendations that promote proactive pharmacological management of cardiac function in trastuzumab-treated patients, and that apply to all patients who are likely to receive standard cytotoxic chemotherapy. Key recommendations include: a monitoring schedule that assesses baseline and on-treatment cardiac function and potentially reduces the overall number of assessments required; intervention strategies with cardiovascular medication to improve cardiac status before, during, and after treatment; simplified rules for starting, interrupting and discontinuing trastuzumab; and a multidisciplinary approach to breast cancer care. [ABSTRACT FROM AUTHOR]

The article focuses on the three-tier structure of homicide consisting of first degree murder, second degree murder and manslaughter being proposed by Great Britain's Law Commission. It discusses whether the label of second degree murder is the most appropriate outcome of a successful partial defense. It cites the deceptive aspect of the expression partial defense as applied to defenses such as provocation. It explores the effect of some defenses/excuses on overall criminal liability.

The article focuses on the structure of second degree murder and the proper place of partial defenses. It examines some of the broader issues of structure and approach raised by the final report on "Murder, Manslaughter and Infanticide," released by Great Britain's Law Commission. It provides a comparison between the category of murder 2 and the second head of murder 1. It details the three-tier structure for the law of homicide recommended by the Law Commission.

In recent years, there has been a dramatic increase in both professional and public awareness of the incidence of a condition commonly referred to as 'shaken baby syndrome'. One of the most common markers of the syndrome is the detection of a subdural haemorrhage (SDH) in an infant. This paper is based on the results of a 2-year research study on the legal and social consequences which arise when children sustain a subdural haemorrhage. The study, which was funded by the Nuffield Foundation, is based on data collected from medical, police, social services and court records of sixty-eight children under the age of 2 years, who were diagnosed with a SDH between 1992 and 1998 in Wales and South West England. [ABSTRACT FROM AUTHOR]

Background: Rare disease patients and carers report significant impacts on mental health but studies on UK populations have focussed on relatively few, specific conditions. Collectively rare conditions represent a substantial health burden, with an estimated 3.5 million affected individuals in the UK., Method: We explored the impact on mental health of living with a rare condition, and experiences of health service support, through an online survey. The survey assessed the impact of specific experiences commonly reported by those affected by a rare condition through multiple choice questions and Likert scale items, and open text question boxes. Through a multi-stakeholder workshop that involved facilitated discussion of our findings with patients/carers, clinicians and a government advisor, we developed recommendations for policy and practice toward a more person-centred and integrated approach., Results: Eligible responses came from 1231 patients and 564 carers. Due to their rare condition, the majority of respondents (> 90%) had felt worried/anxious; stressed; and /or low/depressed. Thirty-six percent of patients and 19% of carers had had suicidal thoughts. Challenges that are particular to rare conditions and which negatively affect mental health included limited knowledge of the condition amongst healthcare professionals (88%), and not being believed or taken seriously by them. Only 23% of respondents felt healthcare professionals considered mental and physical health as equally important. Almost half reported never having been asked about mental health by healthcare professionals. Our findings indicate that access to, and appropriateness of, professional psychological support needs to be improved. Peer group support is important but signposting is inadequate. Our recommendations are for healthcare professionals to be supported to effectively and sensitively recognise and address patients' and carers' mental health needs; and for service level coordination of care to integrate professional psychological support with rare disease services., Conclusion: Living with a rare disease substantially impacts mental health. Many of the drivers of poor mental health reflect issues specific to managing rare conditions. To meet UK government commitments, there should be a focus on empowering healthcare professionals who treat rare disease patients and on integration of mental health support with rare disease services., (© 2022. The Author(s).)

Regulatory frameworks associated to building design are usually complex, representing extensive sets of requirements. For healthcare projects in the UK, this includes statutory and guidance documents. Existing research indicates that they contain subjective requirements, which challenge the practical adoption of automated compliance checking, leading to limited outcomes. This paper aims to propose recommendations for the adoption of automated compliance checking in the design of healthcare buildings. Design Science Research was used to gain a detailed understanding of how information from existing regulatory requirements affects automation, through an empirical study in the design of a primary healthcare facility. In this study, a previously proposed taxonomy was implemented and refined, resulting in the identification of different types of subjective requirements. Based on empirical data emerging from the research, a set of recommendations was proposed focusing on the revision of regulatory documents, as well as to aid designers implementing automated compliance in practice. • Automated compliance checking has been approached mostly replacing human operations. • Automation can be easily achieved for quantitative and objective requirements. • Subjectivity is still a fundamental constraint in the automated compliance process. • Requirements subjectivity has been identified as natural or artificial. • Need of multiple automated compliance approaches due to diversity of requirements. [ABSTRACT FROM AUTHOR]

This review aims at giving a picture of the progress of the UK wave energy and suggesting key steps needing to be taken for its contribution to the Net Zero greenhouse gas emissions target by 2050. It follows consultation through scoping wave energy workshops held by the Engineering and Physical Sciences Research Council (EPSRC) in August 2019 and by Supergen Offshore Renewable Energy (ORE) Hub in January 2020 and a series of structured interviews with academics, policy-makers, funding bodies and industry professionals. It is believed that the UK has excellent wave resources and advanced techniques that need to be rapidly developed to achieve the target of 22 GW of installed capacity by 2050 Greaves et al. (2020). The wave energy resources in the UK are reviewed, summarising wave energy hotspots for development and identifying openly accessible wave data. The progress and achievements of wave energy development in the UK are reviewed and described to underline the important roles that UK government and industry support have to play in securing a leading position in wave energy. The potential benefits of wave energy for the decarbonisation of UK industry (including utility scale and niche markets) to achieve Net Zero target by 2050 are presented, as well as the steps that need to be taken in the next 30 years to achieve its potential. • Review the progress and achievements of wave energy sector in the UK 1970–2020. • Summarise the UK's hotspot sites for wave energy development. • Discuss the UK Government and industry's important roles in promoting wave energy. • Summarise wave energy utility and niche markets' benefits to decarbonise industry. • Propose key steps to be taken in the next 30 years to promote wave energy in the UK. [ABSTRACT FROM AUTHOR]

Despite widespread use, community-based physical activity prescription is controversial. Data limitations have resulted in a lack of clarity about what works, under what circumstances, and for whom, reflected in conservative policy recommendations. In this commentary we challenge a predominantly negative discourse, using contemporary research to highlight promising findings and "lessons learnt" for design, delivery, and evaluation. In doing so, we argue for the importance of a more nuanced approach to future commissioning and evaluation. Novelty: Amalgamating learning from multiple research teams to create recommendations for advancing physical activity prescription.

Systematic literature reviews are frequently used in biodiversity conservation to identify knowledge gaps and strategies for improvement. Despite their important role, systematic reviews are not standardized and often use different methods, standards for success, and data sources. We compared two systematic reviews on terrestrial arthropod conservation translocations, unknowingly conducted by two research groups at the same time. Both studies found geographic and taxonomic biases, with most projects focusing on certain countries (e.g., United States, United Kingdom) and taxa (e.g., butterflies, grasshoppers), and found similar success rates (range: 52–58%). However, the studies had different conclusions about which factors significantly influenced translocation success, driven by the data sources used (published literature vs. data from corresponding authors). Release numbers reported by corresponding authors were approximately double those in the published literature, causing the two studies' data sets to differ dramatically. The results show that improved communication among researchers and practitioners is needed to ensure access to current data and prevent duplication of efforts. We recommend that: i) planned, ongoing, and unpublished work be integrated as best possible in reviews; ii) expert perspectives be included alongside quantitative measures; iii) online tools be used more to promote communication; iv) an online catalogue of translocation projects be established to facilitate awareness and contact among researchers; and v) standardization of translocation reporting be increased. We provide practical pathways and actions to help achieve these recommendations. These improved review practices can benefit both systematic reviewers and conservation practitioners by increasing the quality and accuracy of systematic reviews. • Key conclusions differed between two replicated systematic reviews despite similar methods. • Different data sources and definitions of success drove differences in study conclusions. • Communication gaps and outdated data decrease efficiency and effectiveness of reviews. • 'Living' forms of communication among researchers and practitioners are crucially needed. • Geographic and taxonomic biases need to be addressed for terrestrial arthropods. [ABSTRACT FROM AUTHOR]

Women's health often declines in middle and old age for reasons that are avoidable. Simple measures including lifestyle change could make a significant difference. Education of women is all important. The BMS feels that the provision of a simple health check of all women at the age of 50 years would provide an excellent opportunity that would serve as a screening as well as an educational visit at which balanced information about appropriate treatments and lifestyle changes in natural and premature menopause should be given to empower women to make an informed choice. [ABSTRACT FROM AUTHOR]

The 2008 report of the Chief Medical Officer of the United Kingdom includes a focus on chronic pain. A description of the report and the impact of pain on persons in the UK are described. Specific recommendations include training of health care staff, including pain in UK primary care's performance management system, pain assessment as a routine vital sign in hospital, developing models for delivery of pain services, and audit and data collection. [ABSTRACT FROM AUTHOR]

Objective: To assess the quality of recommendations from 161 clinical practice guidelines (CPGs) using AGREE-REX-D (Appraisal of Guidelines REsearch and Evaluation-Recommendations Excellence Draft).Design: Cross-sectional study SETTING: International CPG community.Participants: Three hundred twenty-two international CPG developers, users, and researchers.Intervention: Participants were assigned to appraise one of 161 CPGs selected for the study using the AGREE-REX-D tool MAIN OUTCOME MEASURES: AGREE-REX-D scores of 161 CPGs (7-point scale, maximum 7).Results: Recommendations from 161 CPGs were appraised by 322 participants using the AGREE-REX-D. CPGs were developed by 67 different organizations. The total overall average score of the CPG recommendations was 4.23 (standard deviation (SD) = 1.14). AGREE-REX-D items that scored the highest were (mean; SD): evidence (5.51; 1.14), clinical relevance (5.95; SD 0.8), and patients/population relevance (4.87; SD 1.33), while the lowest scores were observed for the policy values (3.44; SD 1.53), local applicability (3,56; SD 1.47), and resources, tools, and capacity (3.49; SD 1.44) items. CPGs developed by government-supported organizations and developed in the UK and Canada had significantly higher recommendation quality scores with the AGREE-REX-D tool (p < 0.05) than their comparators.Conclusions: We found that there is significant room for improvement of some CPGs such as the considerations of patient/population values, policy values, local applicability and resources, tools, and capacity. These findings may be considered a baseline upon which to measure future improvements in the quality of CPGs. [ABSTRACT FROM AUTHOR]

Introduction: Adaptive designs offer a flexible approach, allowing changes to a trial based on examinations of the data as it progresses. Adaptive clinical trials are becoming a popular choice, as the prudent use of finite research budgets and accurate decision-making are priorities for healthcare providers around the world. The methods of health economics, which aim to maximise the health gained for money spent, could be incorporated into the design and analysis of adaptive clinical trials to make them more efficient. We aimed to understand the perspectives of stakeholders in health technology assessments to inform recommendations for the use of health economics in adaptive clinical trials., Methods: A qualitative study explored the attitudes of key stakeholders-including researchers, decision-makers and members of the public-towards the use of health economics in the design and analysis of adaptive clinical trials. Data were collected using interviews and focus groups (29 participants). A framework analysis was used to identify themes in the transcripts., Results: It was considered that answering the clinical research question should be the priority in a clinical trial, notwithstanding the importance of cost-effectiveness for decision-making. Concerns raised by participants included handling the volatile nature of cost data at interim analyses; implementing this approach in global trials; resourcing adaptive trials which are designed and adapted based on health economic outcomes; and training stakeholders in these methods so that they can be implemented and appropriately interpreted., Conclusion: The use of health economics in the design and analysis of adaptive clinical trials has the potential to increase the efficiency of health technology assessments worldwide. Recommendations are made concerning the development of methods allowing the use of health economics in adaptive clinical trials, and suggestions are given to facilitate their implementation in practice.

A review of the risks and benefits of intravenous iron medicines undertaken by the European Medicines Agency Committee for Medicinal Products for Human Use will have a significant impact on home haemodialysis and non-dialysis patients across the UK. Karen Jenkins outlines the main recommendations and implications for renal practice. [ABSTRACT FROM AUTHOR]

The results of a number of prospective randomized controlled clinical trials have led to changes in established strategies for the treatment of antineutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAV) in recent years. Since 2014, a total of 4 scientific societies and study groups have systematically reviewed the new data and have formulated evidence-based recommendations for the management of AAV based on the analysis. These recommendations contain information on diagnosis, treatment (induction and maintenance), supportive care and monitoring of disease activity and resulting damage. This review compares the recently published recommendations of the German Society of Rheumatology (Deutschen Gesellschaft für Rheumatologie, DGRh), the European League Against Rheumatism (EULAR)/European Renal Association (ERA), the British Society of Rheumatology (BSR) and the Canadian Vasculitis Research Network (CanVasc). The comparative analysis reveals a high level of agreement on numerous topics but also shows some minor and even a few major differences in the respective recommended approach to diagnosis and treatment of AAV. Divergent recommendations predominantly exist in areas with little scientific evidence from clinical studies. Furthermore, some differences result from different interpretation of existing data or are influenced by characteristic features of the respective national healthcare system.

Abstract: The structure and role of the NCEPOD The UK National Confidential Enquiry into Perioperative Deaths (NCEPOD), a registered charity established in the late 1980s, reviews clinical practice and identifies areas where changes in surgical and anaesthetic practices may improve patient outcome. NCEPOD is a largely government-funded, yet independent, body with a chief executive, a steering group, clinical coordinators (representing specialties such as anaesthesia, surgery, pathology, oncology) and administrative staff. NCEPOD relies on a network of reporters located at every NHS and private hospital in England, Wales, Northern Ireland, Guernsey, Jersey, Isle of Man and the Defence Secondary Care Agency. Reporters notify NCEPOD of all deaths occurring in hospital after surgery. While participation in NCEPOD is voluntary in the private sector, it is compulsory for NHS Trusts. A similar function is performed by the Scottish Audit of Surgical Mortality. [Copyright &y& Elsevier]

The five parts of the ISO EN 13606 standard define a means by which health-care records can be exchanged between computer systems. Starting within the European standardisation process, it has now become internationally ratified in ISO. However, ISO standards do not require that a reference implementation be provided, and in order for ISO EN 13606 to deliver the expected benefits, it must be provided not as a document, but as an operational system that is not vendor specific. This article describes the evolution of an Extensible Markup Language (XML) Schema through three iterations, each of which emphasised one particular approach to delivering an executable equivalent to the printed standard. Developing these operational versions and incorporating feedback from users of these demonstrated where implementation compromises were needed and exposed defects in the standard. These are discussed herein. They may require a future technical revision to ISO EN 13606 to resolve the issues identified.