Clinical Research Fellow Research Articles

Maternal and infant outcomes for women experiencing homelessness, prior to and during pregnancy, in England: a retrospective cohort study

BackgroundSafe, secure, healthy housing is a crucial determinant of health. The aim of this study was to determine whether women that experienced homelessness (WEH) in England prior to or during pregnancy, are at greater risk of adverse pregnancy outcomes than women that are housed. MethodsA retrospective nationwide population study was conducted using English national Hospital Episode Statistics Admitted Patient Care database. The population included one randomly selected singleton birth with a gestational age >24 weeks’ per women, in hospital, between the 1st January 2013 and 31st March 2023. WEH were identified as having at least one homeless code (“no fixed abode”, “registered with a homeless-exclusive GP practice”, “clinical diagnosis of homelessness”) at the time of birth. Logistic regression was used to estimate the odds ratios of severe maternal morbidity (SMM), preterm birth (<37 weeks’) and low birthweight (<2500 g) for WEH compared to housed women overall and those in the most deprived areas. Results were adjusted for age, ethnicity, parity, year of birth and pre-existing medical conditions. FindingsThe study population comprised 3 349 601 births from 2013–23. 3301 (0·1%) births were from WEH. Homelessness increased the risk of SMM, preterm birth and low birthweight, with fully adjusted odds ratios (aOR) of 1·28 (95% CI 1·02–1·60), 2·02 (95% CI 1·81–2·25) and 2·16 (95% CI 1·94–2·40) respectively compared to housed women. This remained significant when compared to women living in the most deprived areas: aOR 1·24 (95% CI 0·99–1·55), 1·94 (95% CI 1·62–2·34), 1·87 (95% CI 1·69–2·08) respectively. InterpretationThese results highlight the need for prioritisation in policy to improve housing prior to and during pregnancy. Quality research that investigates not just dichotomous homelessness, but the impact of frequent moves during pregnancy, housing quality and overcrowding is required, which necessitates the collection of detailed housing information through pregnancy and the postnatal period. FundingNV is funded by a clinical research fellowship from Nuffield Department of Population Health and Academy of Medical Sciences Starter Grant for Clinical Lecturers.

Early employment after childbirth: A cross-sectional analysis using data from the National Maternity Survey in England

BackgroundEarly participation in paid work after childbirth may have long-lasting health and socioeconomic impacts for women and their families, yet there has been little research on women's early postpartum employment behaviours in England since the 2000s. We investigated women's employment patterns within six months of childbirth and the factors that influence them. MethodsUsing data from a population-based national maternity survey in England in 2018, employment status at six months postpartum was assessed. Descriptive analysis was used to explore employment characteristics of women in paid work. Logistic regression was used to explore sociodemographic, pregnancy- and birth-related factors associated with postpartum employment status. FindingsOf the 4313 participants included, 7·7% were in paid work within six months of childbirth. The most frequently reported motivation for being in paid work was needing the money (76%), followed by wanting to work (41%). The median time for (re)entering paid work was 17 weeks (IQR 13–26 weeks) and the median weekly hours worked was 24 (IQR 12–36 hours). The childcare option most frequently reported was the baby's grandparent(s) (47·8%), followed by spouses/partners (44·5%). Maternal age ≥35 years (compared to 30–34 years) was positively associated with being in paid work within six months of childbirth (aOR: 1·37, 95% CI 1·02–1·84), while not living with a partner (aOR 0·50, 95% CI 0·28–0·90), and having a pre-term birth (aOR 0·38, 95% CI 0·20–0·69) were negatively associated with being in paid work within six months. InterpretationThe low prevalence of women in paid employment within six months of childbirth aligns with recent downward trends. Factors associated with early postpartum employment show mixed patterns, however, which may reflect variation in financial pressures and opportunities. Our findings may assist policymakers when evaluating current and future family-based policies such as amendments to state-funded childcare and paid parental leave allowance. FundingThis research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. GF is funded by a Clinical Research Fellowship awarded by the Nuffield Department of Population Health, University of Oxford.

Lessons from the pandemic: An innovative scheme to support research in the North West Coast

In 2021, a Clinical Research Fellow (CRF) scheme was created to serve the North West Coast (NWC) region in line with the key health priorities set out by the Clinical Research Network. Five doctors in pre-specialist training were placed in NHS trust research departments across the NWC. The scheme aimed to provide early career research experience while also enhancing the provision of research across the region. The CRFs were involved in writing clinical trial grant applications and study protocols, with the scheme providing additional experience in leadership roles and time management. In addition, the CRF scheme has had a positive impact in adopted NHS trusts, which have seen their overall research capacity and capability improve, through increased flexibility and medical oversight. Research departments have benefited from increased financial income and improved national reputations. Overall, this real-world experience provided a vital ‘foot in the door’, which is essential for research-interested medics to advance in a future academic career. In the wider NWC region, the CRF scheme successfully delivered achievable and financially sustainable research. Innovative programmes such as this one should be seen as a viable option for research provision through the NHS, in the UK.

A Longitudinal Evaluation of Collaboration in Plastic Surgery Clinical Research.

Few dedicated, funded clinical research fellowship positions exist in plastic surgery. This study provides insights from an established clinical research fellowship, highlighting its educational impact and confirming the impact of positive institutional support and a collaborative-first approach. All research fellows within the program from 2008 to 2020 were examined during their year of employment and subsequent 2 years. Internal and external collaboration trends were assessed using PubMed affiliations. Correlation between external collaborations and research impact were examined. Research impact was characterized by publication count, journal impact factor, and journal diversity. Thirty-one research fellows were identified, with a 100% match rate. Four phases of development were identified, and a three-period cycle of productivity was noted to occur every 3 years. A shift toward more external collaborations occurred after 2016 (P = 0.008). A positive correlation was observed between external collaborations and academic output (r = 0.72, P = 0.004), journal diversity (r = 0.74, P = 0.004), and journal impact (r = 0.63, P < 0.05). Significant growth was observed in the collaborative networks (P = 0.002), publications (P = 0.003), journal diversity (P < 0.001), and research personnel (P = 0.002). As a result of our strategic decision to engage collaborators across multiple disciplines, there is discernible improvement in measurable impact, contributing to the growth of our program. Dedicating resources to foster deeper collaborations can enrich the field of plastic surgery research, recognizing that this investment fuels the cycle of productivity, offering promising returns to the future.

D65. Clinical Research Fellowship Facilitates Mentorship, Teamwork, And Productivity: Our 11-year Experience with a Cleft and Craniofacial Research Fellowship

D65. Clinical Research Fellowship Facilitates Mentorship, Teamwork, And Productivity: Our 11-year Experience with a Cleft and Craniofacial Research Fellowship

D67. Growing Pains to Collaborative Gains: A Longitudinal Evaluation of a Multi-decade Clinical Research Fellowship Program

D67. Growing Pains to Collaborative Gains: A Longitudinal Evaluation of a Multi-decade Clinical Research Fellowship Program

P080 Supporting shared decision-making about osteoporosis medicines: Combining multiple methods to develop the prototype iFraP intervention

Abstract Background/Aims Shared decision-making (SDM) is a joint process in which a person and healthcare professional work together to reach decisions about care. The iFraP (Improving uptake of Fracture Prevention drug treatments) intervention comprises computerised decision aid (DA), Fracture Liaison Service (FLS) clinician training package, and information resources to support SDM about osteoporosis medicines. This abstract details our multi-method approach to develop this intervention. Methods Intervention development was underpinned by the Medical Research Council guidelines for development of complex interventions. Four studies guided intervention prototype development, including (1) an evidence synthesis of existing osteoporosis DAs to examine quality and effectiveness; (2) a review of patient information about osteoporosis to evaluate quality and optimal language for talking about osteoporosis; (3) a Delphi consensus survey with patients, carers, and health professionals to gain consensus on intervention content, informed by an evidence review of relevant clinical guidelines and behavioural theories; (4) and focus groups and interviews with patients recently attending FLS, FLS clinicians and general practitioners (GPs) to explore current FLS practice, and barriers and facilitators to change. Expert stakeholders and public contributors informed each sub-study. Results Studies one and two informed design of the iFraP computerised DA. Evidence reviews of existing osteoporosis DAs and patient information found that they did not meet patient needs and identified poor readability, variable quality, and unbalanced and confusing content. Public contributors preferred DAs which were individualised, and together with expert stakeholders, supported the development of understandable explanations of osteoporosis and osteoporosis medicines to include in iFraP resources. Study three identified essential components of the FLS consultation which directly informed DA content. Study four identified the need for complementary iFraP information resources, training, and potential barriers to iFraP DA use. Patients expressed that they did not feel adequately prepared for their FLS consultation, leading to the development of an enhanced leaflet to accompany their FLS appointment letter. Patients, FLS clinicians, and GPs all expressed the need for a patient-friendly individualised summary of the FLS consultation, to facilitate consistent information across services and reinforce FLS messaging. This finding informed development of the iFraP Bone Health Record, an individualised, easy-read PDF print-out of the iFraP DA. FLS clinicians identified training needs relating to communicating risk, involving patients in decisions and clinical decision-making. Barriers to use included concerns that the DA would increase consultation duration, and that SDM may undermine their goal to facilitate medicine adherence. Identified barriers to use and training needs informed the content and delivery of the interactive eLearning and role play session, with consideration of theoretically-informed behaviour change techniques. Conclusion The iFraP complex intervention development work demonstrates the use of multiple methods to develop an evidence-based and theoretically-driven intervention in-preparation for testing. Disclosure L. Bullock: None. J. Fleming: None. E.M. Clark: None. S. Leyland: None. S. Thomas: Grants/research support; ST owns Prescribing Decision Support Ltd that developed the iFraP decision aid. C. Gidlow: None. T.W. O'Neill: Grants/research support; TON is supported by the NIHR Manchester Biomedical Research Centre. C.P. Iglesias-Urrutia: None. A. Hawarden: Grants/research support; AH is funded by a Versus Arthritis Clinical Research Fellowship (reference 22726). F. Manning: None. J. Protheroe: None. J. Lefroy: None. S. Ryan: None. R. Horne: None. C.D. Mallen: Grants/research support; CM is funded by the NIHR Applied Research Collaboration West Midlands and the NIHR School for Primary Care Research. C. Jinks: Grants/research support; CJ is part funded by NIHR Applied Research Collaboration (ARC) West Midlands. Z. Paskins: Consultancies; ZP has received consultancy fees from UCB Pharma. Grants/research support; ZP is funded by the National Institute for Health Research (NIHR) [Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy].

Clinical Research Fellowship Fosters Mentorship, Teamwork, and Productivity: Our 11-Year Experience With a Craniofacial Research Fellowship.

This study describes the development and explores the academic impact of a cleft and craniofacial research fellowship. Research and career outcomes from 3 cleft and craniofacial surgeons, 14 clinical fellows, and 25 research fellows between 2010 and 2023 were examined. Academic productivity was measured by the number of peer-reviewed publications indexed in PubMed and podium presentations at national/international meetings. Residency match statistics were recorded for eligible research fellows. Over this 14-year period (11 with research fellows), the team produced 500 publications in 96 peer-reviewed journals, with 153 (31%) in Plastic and Reconstructive Surgery, 117 (23%) in the Journal of Craniofacial Surgery, and 32 (6%) in The Cleft Palate-Craniofacial Journal. Yearly publications increased from 15.3±7.6 per year (before fellowship) to 23.0±5.3 (with 1 fellow) to 38.3±12.9 (2 fellows) to 81.0±5.7 (3 fellows; P<0.001). There was a strong annual linear growth in publications since the beginning the research fellowship position (r=0.88, P<0.001). All (100%) clinical research fellows developed strong relationships with senior surgeons, and all who applied to plastic surgery residency matched a significantly higher success rate than the national average (P<0.05). Implementing a structured cleft and craniofacial clinical research fellowship was associated with a broad impact across all cleft and craniofacial team members, as reflected by increased academic output and high match rates among fellows. The fellowship also strengthens the talent pipeline into plastic surgery by fostering meaningful mentor/mentee relationships and provides a model that can be adopted in both surgical and nonsurgical fields.

The impact of Saudi Arabia – United States clinical pharmacy post-graduate training programs agreements on clinical pharmacy faculty in Saudi universities: A retrospective descriptive study focused on history and future recommendations

BackgroundThere has been a growing demand for clinical pharmacy services in the Kingdom of Saudi Arabia (KSA) in the past 3 decades. The Ministry of Education has established agreements with several institutions in the United States to secure clinical pharmacy residency and research fellowship programs opportunities for Saudi scholars. The aims of this study were to describe the Saudi scholars’ clinical pharmacy training pathways and their contribution to the pharmacy profession in KSA. MethodsThis is a retrospective, descriptive study conducted on clinical pharmacy faculty in governmental Saudi universities who graduated from the US until 2023. The study outcomes included the post-graduate year-1 (PGY-1) residency match rate, post-graduate year-2 (PGY-2) acceptance rate, the PGY-2 specialties of Saudi scholars, and the number of clinical pharmacy programs established in KSA. ResultsIn total, 115 Saudi scholars have pursued clinical pharmacy pathway in the US. The PGY-1 residency match rate was 80 % (92/115). In contrast, the PGY-2 acceptance rate was 60.9 % (70/115). The most common PGY-2 specialty was in infectious diseases (N = 17; 24 %). Two pharmacy colleges had established residency programs and 1 pharmacy college had established a research fellowship. ConclusionThe Ministry of Education's efforts for clinical pharmacy program agreements were fundamental for advancing clinical pharmacy in Saudi universities. A significant number of Saudi scholars returned to KSA with clinical pharmacy degrees. There are more opportunities for further development, including expanding the clinical pharmacy program collaboration in the US and increasing the number of residency and research fellowship positions in KSA.

Impact of pay-for-performance for stroke unit access on mortality in Queensland, Australia: an interrupted time series analysis

Stroke unit care provides substantial benefits for all subgroups of patient with stroke, but consistent access has been difficult to achieve in many healthcare systems. Pay-for-performance incentives have been introduced widely in attempt to improve quality and efficiency in healthcare, but there is limited evidence of positive impact when they are targeted at hospitals. In 2012, a pay-for-performance program targeting stroke unit access was co-designed and implemented within a clinical quality improvement network across public hospitals in Queensland, Australia. We assessed the impact on access to specialist care and mortality following stroke. We used interrupted time series analysis on linked hospital and death registry data to compare changes in level (absolute proportions) and trends in outcomes (stroke/coronary care unit admission, 6-month mortality) for stroke, and a control condition of myocardial infarction (MI) without pay-for-performance incentive, from 2009 before, to 2017 after introduction of the pay-for-performance scheme in2012. We included 23,572 patients with stroke and 39,511 with MI. Following pay-for-performance introduction, stroke unit access increased by an absolute 35% (95% CI 29, 41) more than historical trend prediction, with greater impact for regional/rural residents (41% vs major city 24%) where baseline access was lowest (18% vs major city residents 53%). Historical upward 6-month mortality trends following stroke (+0.11%/month) reversed to a downward slope (-0.05%/month) with pay-for-performance; difference-0.16%/month (95% CI-0.29,-0.03). In contrast, access to coronary care and mortality trends for MI controls were unchanged, difference-in-difference for mortality-0.18%, (95% CI-0.34,-0.02). This clinician led pay-for-performance incentive stimulated significant improvements in stroke unit access, reduced regional disparities; and resulted in a sustained decline in 6-month mortality. As our findings contrast with lack of effect in most hospital directed pay-for-performance programs, differences in design and context provide insights for optimal program design. Queensland Advancing Clinical Research Fellowship, National Health and Medical Research Council Senior Research Fellowship.

Online Patient Education Resources for Anterior Cruciate Ligament Reconstruction: An Assessment of the Accuracy and Reliability of Information on the Internet Over the Past Decade.

The purpose of this study is to evaluate the quality of patient education materials accessible through popular online search engines regarding anteriorcruciateligament (ACL) injuries and anteriorcruciateligament reconstruction (ACLR). Methods: Two search terms ("ACL surgery" and "ACL reconstruction") were entered into three search engines (Google, Yahoo, and Bing). The quality of information was scored using a novel scoring system developed and overseen by sports medicine orthopedic clinical research fellows and fellowship-trained orthopedic surgeons. Website quality, credibility, and readability were further assessed by the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria, and Flesch-Kincaid Reading Grade Level (FKRGL), respectively. The Health On the Net Code of Conduct (HONcode) certification was also utilized to assess the transparency of health information for each website. We evaluated 39 websites. The average score for all websites was 11.2±5.6 out of 28 total points. Six out of the 39 websites (41%) were HONcodecertified. The websites that contained HONcode certification had a higher average JAMA benchmark score (3.5±0.7) and DISCERN score (44.6±14.7) when compared to the websites without the certification, 2.2±1.2and 37.6 ± 15.9for JAMA and DISCERN, respectively. The mean JAMA benchmark score was 2.7±1.2 (67.5%) for all websites out of a possible four points. The average FKRGL for all 39 websites was 10.0±2.0 (range: 5.4-13). The quality of patient education materials accessible on the internet regarding ACL injuries and ACLR can be misleading and directly impact the patient's decision-making process essential to the patient-physician relationship over the past decade. The internet can be a helpful online resource, however, surgeon clarification and consultation with qualified healthcare professionals are strongly recommended prior to clinical decision-making regarding potential treatment options.

Improving cognitive function after cardiac surgery: home-based computerised cognitive training (FACCT study)

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Barts Charity Nurse / Allied Healthcare Professional Clinical Research Fellowship (MRC0229, Improving cognitive health after cardiac surgery) Background Postoperative cognitive dysfunction (POCD) occurs in up to 50% of patients after cardiac surgery. Despite extensive research, the underlying causes and pathophysiology are poorly understood. Further, definitive treatments for POCD are lacking. The focus of this doctoral work was to identify predictors of POCD, examine the effectiveness of existing cognitive interventions on improving cognitive function, and use the findings of both of these systematic reviews to design and develop a cognitive training programme in postoperative cardiac surgery patients. Objectives The aim of this study was to evaluate the feasibility and acceptability of a home-based computerised cognitive training programme in postoperative cardiac surgery patients. Methods This is a single-arm, non-blinded, feasibility and acceptability study involving adult (&amp;gt;18 years of age) patients admitted for first time elective cardiac surgery. Participants were required to complete an 8-week cognitive training programme (40 sessions [20 minutes/day, 5 days/week]), commencing one week postoperatively, and administered using their own computers or tablets. The Montreal Cognitive Assessment (MoCA), a brief test of global cognition, was administered preoperatively and after the training programme. Feasibility outcomes included recruitment and retention rates and adherence to the programme. Acceptability was assessed by the Theoretical Framework of Acceptability Questionnaire (TFA-Q) which was administered post-programme. Results In total, 95 patients were screened, 51 (53.7%) were eligible and approached, and 31 (60.8%) consented to participate. Of these, 29 participants enrolled in the cognitive training programme, 7 (24.1%) were female, 20 (69.0%) were white British, and the mean baseline MoCA was 26.9 (out of 30). Data collection is complete, final analysis will be complete for presentation prior to ACNAP 2023. Interim results suggest that home-based computerised cognitive training (CCT) is feasible in terms of recruitment rate (60.8%, exceeding the target of 50%) and acceptable (with 94.1% of those who completed the TFA-Q identifying CCT as acceptable). Other feasibility indicators measured include retention (58.6%) and adherence (31.0%). Conclusions A trial examining home-based computerised cognitive training appears feasible and acceptable to patients, although strategies to improve retention and adherence will need to be strengthened. If found to be beneficial, such a programme could offer an inexpensive and safe method of improving postoperative cognitive function.

Contribution of the World Health Organization/ the special program for research and training in tropical disease (WHO/TDR’s) in institution building: lessons from Ethiopia

BackgroundWorld Health Organization/Tropical Disease Research (WHO/TDR) has enduring investment in transfers of skills critical to sustaining resilient health research systems through postgraduate training, clinical research and development fellowship (CRDF), bioethics, and grants to neglected tropical disease research. TDR has a long history of partnership with Armauer Hansen Research Institute (AHRI) in Ethiopia. The collaboration started with individuals and lead to institution survival and success. Therefore, the purpose of this study was to explore the impact and lessons learned of TDR initiatives in Ethiopia.MethodThis study was guided by the ‘TDR Impact Pathways’. A total of thirteen in-depth, and five key informant interviews were conducted with individuals who are currently working in Addis Ababa, Gondar, Jimma Universities and AHRI. In addition to the interviews, reports, written communications and publications were reviewed. Interviews were audio recorded, transcribed verbatim, inductively coded, and analyzed thematically. The results were presented following the themes with supportive verbatim quotes.ConclusionTDR’s seed grants, training opportunities and technical support catalyzed individual, institutional and national research capacity in Ethiopia. This is a useful indication of how long-term collaboration between individuals could have broader institutional implication as evidenced from the TDR-AHRI complementary partnership.

Revolutionizing RCC Immunotherapy to Unlock Predictive Biomarkers

Revolutionizing RCC Immunotherapy to Unlock Predictive Biomarkers

Advanced 3D analysis of fibrotic ring-like pattern in non-ischemic cardiomyopathy predicts major arrhythmic events

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ Trust and King’s College, the Centre of Excellence in Medical Engineering funded by the Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC; WT088641/Z/09/Z). M.J.B. is supported by a Medical Research Council New Investigator Grant (MR/N011007/1) and British Heart Foundation (Project grant PG/18/74/34077). This work was supported by EPSRC 2018/19 DTP - EP/R513064/1 grant. This work was supported by a National Heart and Lung Institute Foundation grant awarded to Professor Sanjay Prasad and Dr Richard Jones. This work was supported by a National Heart and Lung Institute Foundation grant awarded to SKP, DJH, REJ, UT and BPH. Additionally, the study was supported by an Intermediate Clinical Research Fellowship awarded to BPH (FS/ICRF/21/26019). Background The presence of ring-like patterns of mid-wall fibrosis identified on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is associated with an increased risk of major arrhythmic events (MAE) in non-ischemic cardiomyopathy (NICM). Analysis of tissue bordering core fibrosis and healthy myocardium (Gray Zone [GZ]) has been suggested as an important pro-arrhythmic substrate in this population. Purpose To investigate refined anatomical definitions of the fibrotic ring pattern, including the importance of GZ inclusion in the association with MAE in NICM. Methods LGE CMR data from 292 NICM patients were analysed to delineate both core and GZ fibrosis. Fibrosis quantification masks for each 2D image slice were used, along with AHA 17-segment maps, to identify fibrotic ring patterns: defined by fibrosis extending by 3 or more continuous AHA-segments for any individually-contiguous fibrotic component within each slice (Fig 1A). Ring patterns were assessed separately for core fibrosis and core + GZ, as well as individually in basal, mid-basal and mid-apical regions. In separate analysis, LGE contours were aligned, interpolated, and used to generate 3D computational volumetric models (Fig 1B). Individually-connected scar components were extracted and the 3D circumferential angular variation (3DCAV) of each separate fibrotic structure quantified as a continuous variable (Fig 1C). Association of the presence of ring patterns and 3DCAV with a composite MAE were investigated. Results Of 292 patients, 67(23%) had core fibrotic ring patterns (54 basal, 28 mid-cavity level, 6 apical). Over a median(IQR) of 6(4) years, 16(24%) patients experienced MAE. On univariate Cox analysis, ring pattern core fibrosis was a strong predictor of MAE (Hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.13-4.31, p=0.021). Apical-basal region analysis showed that basal ring pattern was associated with MAE (HR 2.25, 95%CI, 1.13-4.51, p=0.022). Multivariate Cox analysis including raised NYHA Class and severely reduced LVEF, overall ring (HR 2.14, 95%CI, 1.05-4.33, p=0.035) and basal ring pattern (HR 2.9, 95%CI 1.39-6.02, P=0.004) continued to show independent association with the MAE. Analysis of the full 3D geometry of the individual scar components also showed that our novel 3DCAV metric was associated with the MAE on both univariate (HR 1.31, 95%CI 1.08-1.59, P=0.007) and multivariate (HR 1.3, 95%CI, 1.06-1.60, P=0.013). Analysis of core ring patterns outperformed analysis of core+GZ patterns in all cases. Conclusions Our study confirms that ring-like patterns of fibrosis in NICM are strongly associated with MAE in NICM, with patterns predominantly at the basal regions conferring enhanced risk relative to mid-basal and mid-apical regions. Inclusion of GZ quantification in ring-pattern analysis did not enhance risk prediction. Our novel 3D analysis of circumferential fibrosis patterns may provide a more robust quantitative metric for stratification.

E034 Rheumatology trainees’ experience of osteoporosis and metabolic bone disease: a UK-wide survey

Abstract Background/Aims The 2022 rheumatology curriculum requires trainees to achieve competence in the management of osteoporosis and a number of metabolic bone diseases by the end of their training. In addition, the recent 2022 NOGG guidance states that very high-risk osteoporosis patients should be considered for referral to specialist care. Hence there is a need to ensure high quality training in this area. We aimed to assess rheumatology trainees’ experience of osteoporosis and metabolic bone disease. Methods A Google form was designed, comprising questions relating to experience of and confidence in managing osteoporosis and other metabolic bone disease. A completion link was circulated to rheumatology trainees via regional trainee representatives. Reminders were sent at intervals during the survey period. Trainees completed the survey anonymously. Results 41 trainees responded. Training grade ranged from ST4-ST7, with 1 specialty doctor and 1 individual who had completed training. Six regions in England, plus Wales and Northern Ireland were represented. 23 trainees (56.1%) reported having observed at least one osteoporosis clinic, and 18 (43.9%) reported having participated in an osteoporosis clinic on a weekly basis for at least 12 weeks. Fewer trainees (11, 26.8%) had observed a specialist metabolic bone disease clinic, and 9 (22%) had participated in one. In terms of exposure to individual conditions, 31 trainees (75.6%) reported clinical experience of managing postmenopausal osteoporosis and 29 (70.7%) reported experience of managing Paget’s disease. Exposure to rarer metabolic bone diseases was much lower, with over half reporting no clinical experience of: osteomalacia; osteonecrosis; bone marrow oedema syndromes; hypophosphatasia; osteogenesis imperfecta; fibrous dysplasia; or FGF-23 mediated osteomalacia. 12 trainees (29.3%) had experience reporting DXA scans. Table 1 summarises trainees’ confidence levels across a number of areas. Overall, 9 (22%) rated their confidence in assessing and managing patients with osteoporosis and metabolic bone disease as equal to or higher than for patients with inflammatory arthritis. 22% said they were likely or very likely to consider sub-specialising in osteoporosis/metabolic bone disease. Conclusion Our survey has identified significant variations in training, particularly for rarer metabolic bone diseases. However, despite this, the sub-specialty appears to remain an attractive career option. Disclosure S.A. Hardcastle: None. M. Rutter: Other; M.R. is a Versus Arthritis Clinical Research Fellow and Chair of the BSR trainee committee. Z. Paskins: Consultancies; Unpaid consultancy for non promotional activity with UCB.

Roy H Hamilton: Diversity, Equity, and Inclusion Editor

Roy H Hamilton, MD, MS, FAAN, who is one of two Associate Editors for Diversity, Equity, and Inclusion (DEI) for the Neurology® journals, published by the American Academy of Neurology.1 He is also professor of Neurology, Psychiatry, and Physical Medicine & Rehabilitation at Penn and Vice Chair of Diversity and Inclusion for the Department of Neurology. In this interview with Science Editor, Dr Hamilton discusses his role with the Neurology® journals as a DEI Editor focusing on broadening the definition of expert peer review and helping ensure that the journals use best publishing practices related to unbiased research and reporting. Science Editor: Tell us about your job and organization. How did you get involved in an editorial role? Dr Roy Hamilton: I’ve been involved in the American Academy of Neurology (AAN) for many years since I was a medical student, and I have benefited greatly from AAN programs. I received scholarships to meetings, participated in AAN’s Diversity Leadership Program, and advanced in my career as a recipient of a clinical training research fellowship. I’ve held a number of administrative roles at Penn related to diversity, equity, and inclusion, where I also run a research lab focused on the use of non-invasive brain stimulation (transcranial magnetic stimulation [TMS]) and transcranial electrical stimulation (tES) in neurology. As a researcher, I understand the peer-review process and was already engaged in editorial leadership activities for other journals and had knowledge of the scientific literature, so it seemed a logical step to move into the […]

Emily Steinhagen, MD, FACS, FASCRS.

Dr. Emily Steinhagen was born in New York, NY, and grew up in New Jersey prior to attending the Williams College, where she earned her BA in Political Science cum laude and played hockey. She then attended the Mount Sinai School of Medicine in New York, NY, receiving her MD in 2008. Dr. Steinhagen completed her residency in Surgery at the Mount Sinai Medical Center in 2015, spending 2 years at Memorial Sloan Kettering Cancer Center as a Clinical Research fellow from 2010 to 2012.

Experience of Clinical Research Fellowship at University of California, Los Angeles

Experience of Clinical Research Fellowship at University of California, Los Angeles

New trio for interventional cardiology submissions.

All correspondence relating to this article should be sent to cardiopulse@unicatt.it. From September 2022, a new team of three will be bringing their expertise in interventional cardiology to the process of sifting submissions and shepherding manuscripts for publication in the European Heart Journal (EHJ). Incoming deputy editor Emanuele Barbato, associate editors Tommaso Gori and Margaret McEntegart will take up a two-year tenure from outgoing deputy editor Javier Escaned MD, PhD, from Spain, and associate editors Julinda Mehilli MD, from Germany and Farouc Jaffer, MD, PhD, of the United States (Figure 1). Prof. Barbato graduated in medicine in 1997 and later obtained board certification in Cardiology at the University of Naples Federico II, in Italy. Whilst he was still a medical student, he completed a short-stay research fellowship at Duke University in North Carolina, US. He completed his PhD in Cardiovascular Pathophysiology at the University Tor Vergata in Rome, Italy in 2006. In the early years of the Millennium, he was a clinical research fellow at the Cardiovascular Research Center of Aalst, Belgium, where he eventually became Co-Director of the Cardiovascular Centre. In 2018, he became full Professor of Cardiology at the Department of Advanced Biomedical Sciences of the University of Naples Federico II. In 2022, he was appointed Full Professor of Cardiology at the Department of Clinical and Molecular Medicine of the Sapienza University of Rome.