Health Policy Research Programme Research Articles

Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial

Control of blood pressure is a key component of cardiovascular disease prevention, but is difficult to achieve and until recently has been the sole preserve of health professionals. This study assessed whether self-management by people with poorly controlled hypertension resulted in better blood pressure control compared with usual care.This randomised controlled trial was undertaken in 24 general practices in the UK. Patients aged 35-85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension. Participants were randomly assigned in a 1:1 ratio to self-management, consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs, combined with telemonitoring of home blood pressure measurements or to usual care. Randomisation was done by use of a central web-based system and was stratified by general practice with minimisation for sex, baseline systolic blood pressure, and presence or absence of diabetes or chronic kidney disease. Neither participants nor investigators were masked to group assignment. The primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point (6 months and 12 months). All randomised patients who attended follow-up visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis, without imputation for missing data. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN17585681.527 participants were randomly assigned to self-management (n=263) or control (n=264), of whom 480 (91%; self-management, n=234; control, n=246) were included in the primary analysis. Mean systolic blood pressure decreased by 12.9 mm Hg (95% CI 10.4-15.5) from baseline to 6 months in the self-management group and by 9.2 mm Hg (6.7-11.8) in the control group (difference between groups 3.7 mm Hg, 0.8-6.6; p=0.013). From baseline to 12 months, systolic blood pressure decreased by 17.6 mm Hg (14.9-20.3) in the self-management group and by 12.2 mm Hg (9.5-14.9) in the control group (difference between groups 5.4 mm Hg, 2.4-8.5; p=0.0004). Frequency of most side-effects did not differ between groups, apart from leg swelling (self-management, 74 patients [32%]; control, 55 patients [22%]; p=0.022).Self-management of hypertension in combination with telemonitoring of blood pressure measurements represents an important new addition to control of hypertension in primary care.Department of Health Policy Research Programme, National Coordinating Centre for Research Capacity Development, and Midlands Research Practices Consortium.

Post-mortem examination of human fetuses: a comparison of whole-body high-field MRI at 9·4 T with conventional MRI and invasive autopsy

Conventional whole-body MRI at 1.5 T does not provide adequate image quality of small fetuses, thus reducing its potential for use as an alternative to invasive autopsy. High-field whole-body MRI at 9.4 T provides good images of small animals. We therefore compared the diagnostic usefulness of high-field MRI with conventional MRI for post-mortem examination of human fetuses. We did whole-body MRI at 9.4 T and 1.5 T on 18 fetuses of less than 22 weeks' gestation, using three-dimensional T(2)-weighted fast-spin echo sequences, before doing invasive autopsy. Images obtained with MRI for each system were compared with the findings of invasive autopsy in a blinded manner. Tissue contrast of 14 different regions was compared on 1.5 T and 9.4 T images that were provided by paediatric radiologists separately and in a random order, and image quality was scored on a four-point scale. The primary endpoint was diagnostic accuracy. Spatial resolution, tissue contrast, and image quality of all organ systems were much better with high-field MRI than with conventional MRI. All structural abnormalities that were detected with invasive autopsy and internal examination of visceral organs were also detected with high-field MRI, whereas conventional MRI was not diagnostically useful in 14 (78%) cases. Whole-body high-field MRI is a feasible option for post-mortem examination of human fetuses, and can provide good tissue characterisation even in small fetuses (5 g). The use of MRI at 9.4 T might be helpful in the development of a minimally invasive perinatal autopsy system. Department of Health Policy Research Programme, British Heart Foundation, National Institute of Health Research, Higher Education Funding Council for England, Biotechnology and Biological Sciences Research Council, Engineering and Physical Sciences Research Council, Great Ormond Street Hospital, University College London (UCL) Institute of Child Health, UCL Hospital, and UCL.

Valuing People and research: outcomes of the Learning Disability Research Initiative

Prior to the launch of Valuing People (DH, 2001), Gordon Grant and Paul Ramcharan were appointed by the Department of Health as co‐ordinators of the Learning Disability Research Initiative (LDRI). The LDRI was a £2m research initiative, funded through the Department of Health's Policy Research Programme, linked to the implementation of Valuing People. The LDRI was brought to a conclusion in November 2007 with a final conference at which an overview report and accessible summary of the findings were launched (Grant & Ramcharan, 2007a, 2007b). In this paper we summarise the main findings of the LDRI with reference to Valuing People's main principles of rights, choice, inclusion and independence. In conclusion we consider how to build on the evidence base.

‘If We Help You What Will Change?’—Participatory Research with Young People

This article explores the ways in which young people were included as research participants in a major study on teenage pregnancy and young parenthood. The study was funded by UK government through the Teenage Pregnancy Unit (TPU) and the Department of Health (DoH) Policy Research Programme and was part of a national programme of nine projects. This project, ‘Living on the edge (LOTE): Sexual behaviour and young parenthood in seaside and rural areas’ (Bell et al., 2004), took place between 2002 and 2004. It involved three seaside towns and their rural hinterlands in the North‐West, North‐East and South of England. The study was qualitative and most of the interviewees were young people in years 8, 10 and, where available, year 12 in selected secondary schools in both urban and rural areas. Additional interviews were undertaken with young people outside mainstream education, with young parents and with a small number of professionals. This article has been co‐written by a researcher on the project and two peer researchers, who are also young mothers, from one of the study sites. Legislative and ethical support for participatory research with young people is outlined, followed by an examination of a number of methodological approaches that are available in this area. The article concludes by discussing whether or not it is possible to involve young people in research in ways that are more than tokenistic. It also considers whether or not the research process, the researchers and research participants benefit from such involvement.

Editorial: The department of health (policy research programme) drug misuse research initiative

(2004). Editorial: The department of health (policy research programme) drug misuse research initiative. Drugs: Education, Prevention and Policy: Vol. 11, No. 4, pp. 277-280.

Department of Health Research Initiative on Nutrition Phase 2: overview of findings and recommendations.

The purpose of this overview is to synthesise and summarise the findings and recommendations of all 14 projects funded between 1997 and 2002 under Phase 2 of the Department of Health's Policy Research Programme Nutrition Initiative. This is aimed at end users, including policy makers, practitioners, researchers and research funding bodies. The main findings and recommendations for policy and practice, as well as for future research, contained in the peer-reviewed final report of each project are summarised under headings identified as being useful for policy groups and practitioners: Maintenance of a healthy weight; Functional outcomes related to different markers of iron status; Nutritional aspects of bone health in humans; and Dietary interventions. The overview draws together the key findings and recommendations for current and future policy and practice from the second phase of the research programme and identifies research gaps. The findings and recommendations of the Department of Health's Nutrition Research Initiative have contributed to the scientific evidence base for policy development, policy evaluation, and will inform practitioners as well as researchers and research funding bodies.