National Institute For Health Research Research Articles

Nurses' Perceptions of Organisational Attractiveness and Related Factors in Health Care: A Mixed Methods Systematic Review.

To identify and integrate the best evidence on nurses' perceptions of organisational attractiveness and related factors in health care. A mixed methods systematic review. The review followed the Joanna Briggs Institute Mixed Methods Systematic Review methodology and a convergent segregated approach which involved separate qualitative and quantitative syntheses followed by integration in a narrative form. A systematic search was conducted in August 2023 with no time or geographical limits in CINAHL, PubMed, Finnish database Medic, Scopus, ProQuest, Web of Science, MedNar and EBSCO databases. Studies published in English, Finnish and Swedish were included. Eleven studies (three qualitative, eight quantitative) were identified and studied further. The results indicated that key themes of organisational attractiveness in health care were the dimensions of patient and professional work well-being, opportunities for professional growth and the responsibilities of the organisation. Patient and work well-being for nurses have a considerable effect on organisational attractiveness. Organisations play a notable role in enabling nurses' professional growth. Responsibilities of the organisation extend to higher political decision-making as well as to managers of the healthcare organisations. Organisational attractiveness covers the entire organisation, its patients, professionals and managers. Enhancing multi-professional cooperation, implementing effective management practices and branding of the organisation can contribute to increased organisational attractiveness. Organisations should consider nurses' wishes, develop strategies to improve competencies, leverage social media to develop their brand, extend the orientation to all levels of the organisation and increase interdepartmental and external collaboration. Future research on organisational attractiveness is necessary in health care and the views of healthcare professionals on a wider scale. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used when reporting the results. There was no patient or public contribution. The protocol was registered in the PROSPERO database of the National Institute of Health Research (CRD42023451680).

Trends in Specialty Training and National Institutes of Health Funding Among Surgeon-Scientists

Purpose: To determine if dual-degree training [ie, completion of a National Institutes of Health (NIH)-funded MD/PhD program], among other professional development and demographic variables, predicted academic productivity (eg, K-to-R conversion, number of publications, etc.) among early-career surgeon-scientists. Methods: We analyzed publicly available data from the National MD/PhD Program Outcomes Study and the Association of American Medical Colleges Graduate Medical Education Track database to identify trends in the number and proportion of MD/PhD graduates pursuing surgical specialties. NIH Research Portfolio Online Reporting Tool Expenditures and Results was interrogated to identify a cohort of early-career academic surgeon-scientists receiving K-awards from 2011 to 2021. Results: The total number of MD/PhD program graduates completing Graduate Medical Education training increased each decade after the Medical Scientist Training Program was established by the National Institute of General Medical Sciences, but the proportion completing surgical specialties did not change significantly (P = 0.96) from 1965 to 2014. More recent residency match trends demonstrate an increase in both the proportion and number of MD/PhD graduates entering surgical specialties, with 21.5% entering surgical residency training in 2020. Among 476 early-career academic surgeon-scientists receiving K-awards at 70 institutions, 27% were faculty members at only 4 universities, suggesting that federally funded surgeon-scientists are concentrated at a small number of institutions. Although MD/PhD graduates represented only 2.3% of active surgical residents from 2011 to 2020, they constituted a much higher fraction of K-awardees (29%). Of 296 surgeon-scientists who completed K-awards, 35% successfully obtained an R01-equivalent award. Conclusions: These findings emphasize the need for comprehensive career development and institutional resources to support early-career surgeon-scientists.

Comparative analysis of epistemic stance in abstracts of published biomedical research and associated National Institutes of Health funding applications (1985–2020)

Abstract Research funded by the US National Institutes of Health (NIH) exerts considerable influence over the trajectory of biomedical science and healthcare policy and practice. Here, we extend previous research by assessing the relationship between the expression of epistemic stance (i.e. confidence in propositions) in successful NIH funding applications and the subsequent research publications. Analysis of 140 stance features (modal verbs, hedges, and boosters) in all PubMed abstracts describing NIH-funded research during the period 1985–2020 identified trends that broadly mirrored those previously reported for abstracts of the associated funding applications. We argue that trends, in part, indicate that investigators adopted a stance that became less cautious and less tentative (e.g. consistent declines for appear, seem, and probably), and increasingly confident, assertive, and empirical (e.g. consistent increases for highlight, likely, and typically). Discussing our results in relation to changes in the biomedical research system, including growth in promotional writing strategies, we suggest that increasing salesmanship in the NIH research system is in part a downstream effect of funding mechanisms. We also infer methodological and pedagogic implications for analysis of metadiscourse.

The effectiveness and usability of online, group-based interventions for people with severe obesity: a systematic review and meta-analysis.

Long wait times, limited resources, and a lack of local options mean that many people with severe obesity cannot access treatment. Face-to-face group-based interventions have been found effective and can treat multiple people simultaneously, but are limited by service capacity. Digital group interventions could reduce wait times, but research on their effectiveness is limited. This systematic review aimed to examine the literature about online group-based interventions for adults with severe obesity (BMI ≥ 35 kg/m2). The review followed the PRISMA and PICOS frameworks. MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials were searched. Two authors independently screened articles. Data extraction, analysis, and quality assessment (using RoB2 and MMAT) was shared between two authors. A meta-analysis was conducted on eligible studies; other results were descriptively analysed. 20 papers reporting on 15 studies were included. Most studies reported some evidence of weight loss, but evidence of weight-related behaviour change was mixed. A meta-analysis on four studies indicated that online, group-based interventions had a statistically significant impact on weight loss (p = 0.001; 95% CI -0.69 to -0.17) with a small-to-moderate effect size, compared to waitlist or standard care conditions. Online interventions were considered more convenient but lack of familiarity with the group or counsellor, accessibility issues, and time constraints hindered engagement. Technical support, incentives, and interactive forums to improve group cohesion could mitigate these barriers. The findings suggested that online, group-based interventions are feasible and potentially beneficial, but barriers such as internet accessibility, digital literacy, and unfamiliarity with group members need to be mitigated. Key recommendations to improve experience and impact include providing instructions and run-throughs, building group cohesion, and providing session and additional content throughout the intervention. Future studies should focus on the influence of specific intervention characteristics and investigate the effect of these interventions compared to face-to-face interventions. Registration: National Institute for Health Research, PROSPERO CRD42021227101; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227101 .

Abstract 4136687: VTRNA2-1 Promoter Methylation as a Prognostic Biomarker in Peripheral Artery Disease: Implications for Maternal Nutritional Influence

Background: Peripheral artery disease (PAD) is associated with high morbidity and mortality and is closely related to diabetes mellitus (DM) and atherosclerosis. Recent advances in epigenetics have highlighted the critical relationships of non-coding RNA Vault RNA 2-1 (VTRNA2-1) promoter methylation and periconceptional nutritional status. Furthermore, the abundance of methylation of the VTRNA2-1 promoter is associated with glucose metabolism and cell aging. This study investigates the association between VTRNA2-1 promoter methylation and clinical outcomes in PAD patients requiring revascularization. Hypothesis: VTRNA2-1 promoter methylation status is associated with clinical outcomes in PAD patients requiring revascularization. Methods: A total of 133 PAD patients requiring revascularization were enrolled. Inclusion criteria included adults over 20 years old, consent to participate, and a requirement for angioplasty. Blood samples were processed to isolate leukocytes, and DNA was extracted using the DNeasy blood kit. Bisulfite pyrosequencing was performed to quantify CpG site-specific DNA methylation at the VTRNA2-1 promoter locus. General population samples from the National Health Research Institutes were used as the control group to compare the methylation status. Patients' one-year clinical outcomes were evaluated. Results: The study found significant differences in VTRNA2-1 promoter methylation status between PAD patients and the control group (P < 0.001). Hypomethylation of VTRNA2-1 promoter was associated with a higher amputation rate in PAD patients (HR 2.19, 95% CI 1.09-4.42, p=0.027). Among patients without ESRD (N=79), those with hypomethylation had a significantly increased risk of major adverse limb events (MALE) (HR 2.78, 95% CI 1.11-6.97, p=0.024), amputations (HR 2.58, 95% CI 1.02-6.57, p=0.044), and progression to ESRD (p=0.039). Conclusion: The methylation status of VTRNA2-1 promoter is significantly different between PAD patients and the normal population, with hypomethylation linked to poorer clinical outcomes in PAD patients undergoing revascularization. These findings suggest that VTRNA2-1 promoter methylation status could serve as a valuable biomarker for predicting prognosis and guiding treatment strategies in PAD. Our results open a molecular link between the periconceptional environment and the risks of PAD.

Improving pharmacy professionals’ research capability and confidence: evaluation of a national e-learning course

Abstract Introduction In 2023, the Royal Pharmaceutical Society (RPS) launched nine collaborative e-Learning modules funded by the National Institute for Health Research (NIHR)1. The modules cover qualitative and quantitative research methods, how to critically analyse evidence, research ethics, research funding, and publishing research findings. The content was designed to improve pharmacy professionals’ research capability and confidence. Aim Eighteen months following the final module’s launch, this evaluation aims to analyse module uptake and user feedback to assesses the impact of the modules on pharmacy professionals’ self-reported research confidence and determine what improvement can be made. Methods All module feedback surveys had the same thirteen questions, focussing on learners’ confidence engaging with research and their thoughts on the length and interactive aspects of the modules. Open-text questions gathered qualitative data on how organisations are supporting research activity and their barriers to undertaking research. E-Learning module data, including number of users, module scores, and feedback survey responses, were exported to Microsoft Excel. Quantitative data was analysed using descriptive statistics and open text feedback were themed. Ethical approval was not required as this is a service evaluation. Results As of 06 June 2024, 835 users have enrolled in the RPS’ Research Learning Programme for Pharmacy Professionals course. Module 1 (Introduction to Research) had the highest learner numbers at 567, whereas module 5 (Quantitative methods – data collection and analysis) had the lowest at 49. Average modules scores range from 81.87% for module 3 to 93.73% for module 5. Users’ confidence conducting research noticeably improved after completing the eLearning. The whole course average saw users who rated their confidence engaging with research as “confident” or “strongly confident” raise from 29% to 60% after completing the modules. A mean of 60% of users believed the expected length; however, this value varied, with the lowest value being 48% for module 4 (Research methods – an overview). 96% of all users found activities useful to reinforce learning, and 95% reported that quizzes were "somewhat useful” or “very useful” for testing their understanding. Across all modules, 77% of users shared they would recommend the eLearning to a colleague. This value varied between modules, with the highest being 85% for module 1, and the lowest being 72% for modules 6 and 9. The open-text questions gathered valuable qualitative data. The positive feedback highlighted that users like the interactive format and that the content level was appropriate. However, noted areas for improvement were that the lack of in-module quiz feedback and a measure of success which isn’t self-assessment. Time, staff shortages, and funding were the primary barriers to undertaking research in users’ current roles/organisations. Conclusion The Research Learning Programme for Pharmacy Professionals has been reported by those who completed it to improve their research confidence, and more than three quarters would recommend the e-learning course to others. Further effort is ongoing to further disseminate the eLearning course, and to communicate the importance of understanding all aspects of research to research-active pharmacists, or those that wish to be. Reference 1. Course: The Royal Pharmaceutical Society Research Learning Programme for Pharmacists and Pharmacy Technicians | NIHR Learn. https://learn.nihr.ac.uk/course/view.php?id=1008.

A Systematic Literature Review of Modelling Approaches to Evaluate the Cost Effectiveness of PET/CT for Therapy Response Monitoring in Oncology.

This systematic literature review addresses model-based cost-effectiveness studies for therapy response monitoring with positron emission tomography (PET) generally combined with low-dose computed tomography (CT) for various cancer types. Given the known heterogeneity in therapy response events, studies should consider patient-level modelling rather than cohort-based modelling because of its flexibility in handling these events and the time to events. This review aims to identify the modelling methods used and includes a systematic assessment of the assumptions made in the current literature. This study was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Information sources included electronic bibliographic databases, reference lists of review articles and contact with experts in the fields of nuclear medicine, health technology assessment and health economics. Eligibility criteria included peer-reviewed scientific publications and published grey literature. Literature searches, screening and critical appraisal were conducted by two reviewers independently. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) were used to assess the methodological quality. The Bias in Economic Evaluation (ECOBIAS) checklist was used to determine the risk of bias in the included publications. The search results included 2959 publications. The number of publications included for data extraction and synthesis was ten, representing eight unique studies. These studies addressed patients with lymphoma, advanced head and neck cancers, brain tumours, non-small cell lung cancer and cervical cancer. All studies addressed response to chemotherapy. No study evaluated response to immunotherapy. Most studies positioned PET/CT as an add-on modality and one study positioned PET/CT as a replacement for conventional imaging (X-ray and contrast-enhanced CT). Three studies reported decision-tree structures, four studies reported cohort-level state-transition models and one study reported a partitioned survival model. No patient-level models were reported. The simulation horizons adopted ranged from 1 year to lifetime. Most studies reported a probabilistic analysis, whereas two studies reported a deterministic analysis only. Two studies conducted a value of information analysis. Multiple studies did not adequately discuss model-specific aspects of bias. Most importantly and regularly observed were a high risk of structural assumptions bias, limited simulation horizon bias and wrong model bias. Model-based cost-effectiveness analysis for therapy response monitoring with PET/CT was based on cohorts of patients instead of individual patients in the current literature. Therefore, the heterogeneity in therapy response events was commonly not addressed appropriately. Further research should include more advanced and patient-level modelling approaches to accurately represent the complex context of clinical practice and, therefore, to be meaningful to support decision making. This review is registered in PROSPERO, the international prospective register of systematic reviews funded by the National Institute for Health Research, with CRD42023402581.

A qualitative study evaluating a health evidence intervention with local government for influencing healthier urban development

BackgroundUrban development impacts on population health and wellbeing through multiple mechanisms. Many issues are considered in urban development decision-making, including amount and type of housing, greenspaces, transport, neighbourhood amenity, safety and community infrastructure. Costs and financial viability are important and public health may not be prioritised. This study seeks to understand how sharing locally-relevant health evidence at key decision points can influence creation of healthier environments. MethodsThe local government of a UK city was developing a spatial regeneration framework for a 15 ha area, changing from predominantly industrial to residential use, alongside community and employment spaces and parks. An embedded researcher worked with the framework's practitioner team (October, 2020 to February, 2024) to iteratively provide locally-relevant health evidence in different formats. Sources included routine and local data, and a new health economic model developed by academics to quantify health impacts of possible development scenarios. The embedded researcher conducted semi-structured interviews with a purposive sample of practitioners involved in framework development (N=5, July, 2023 to September, 2023; average 46 min) to explore the evidence's influence on design decisions. Observational fieldnotes and meeting notes were also collected. Data were analysed using a framework approach and inductive thematic analysis. FindingsPractitioners used health evidence in three key ways: highlighting problems, e.g. noise and air pollution risks to future residents from busy roads; supporting good or aspirational designs, e.g. providing additional greenspaces; or considering competing issues, e.g. balancing housing, employment and climate resilience needs. The iterative and locally-relevant nature of the health evidence increased its value for practitioners, although health was not the main decision-making priority. InterpretationTailoring health evidence to fit local contexts, and working collaboratively to meet practitioners’ requirements for information at key decision points, can influence urban development plans to support health. This approach could be transferred to other local authorities. FundingThis work was funded as part of a multi-disciplinary research project called TRUUD (‘Tackling Root causes Upstream for Unhealthy Urban Development’). It was supported by the UK Prevention Research Partnership (award reference: MR/S037586/1), which is funded by the British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division (Welsh Government), Medical Research Council, National Institute for Health Research, Natural Environment Research Council, Public Health Agency (Northern Ireland), The Health Foundation and Wellcome.

Bibliometrics and National Institutes of Health Funding: Associated Factors in Academic Rhinology

AbstractOur study aims to evaluate demographics and research productivity in academic rhinology and to establish the relationship between bibliometrics such as the Hirsch index (h-index) and the more recently developed relative citation ratio (RCR) and National Institutes of Health (NIH) funding. Retrospective cohort study. The demographics of academic rhinologists were collected from institutional faculty profiles (N = 207). Funding data were obtained from the NIH Research Portfolio Online Reporting Tools Expenditures and Reports Database. The h-index was calculated using Scopus. The mean (m-RCR) and weighted RCR (w-RCR) were calculated using the NIH iCite tool. The majority of academic rhinologists were men (72.9%). Only 8.7% of rhinologists (N = 18) received NIH funding. Rhinologists receiving NIH funding had greater h-index (31 vs. 11), m-RCR (2.6 vs. 1.6), and w-RCR (339.9 vs. 44.7) (P < 0.001). Men had greater h-index (14 vs. 10, P < 0.001) and w-RCR (56.8 vs. 36.9, P = 0.025) but not m-RCR (1.7 vs. 1.6, P = 0.799) than women. Stratifying by academic professorship rank and across all career durations, h-index, m-RCR, and w-RCR were not significantly different between men and women. Among academic rhinologists the h-index, m-RCR, and w-RCR were all associated with receiving NIH funding. Similar h-index, m-RCR, and w-RCR between men and women across all academic professorship ranks and career durations suggests production of similar quality and quantity of research. The m-RCR and w-RCR help to address some of the limitations of the h-index and are useful for assessing research productivity.

4.F. Scientific session: Progress in assessing climate change risks to health and implementation in UK and Europe

Abstract Climate change poses one of the greatest threats to health security. Climate change is increasing the frequency and intensity of environmental health threats like flooding and heatwaves and is creating conditions which heighten the risks from infectious diseases. Whilst everyone will be at some risk from adverse health impacts from climate change, the impacts will vary at individual level and the most disadvantaged both here in the UK and around the world will be disproportionately affected. Many of the anticipated adverse health impacts of climate change in the UK are still avoidable through mitigation and adaptation and that there are other benefits to health to be gained, therefore rapid action is critical to avoid the most severe potential scenarios. The Health Protection Research Unit in Environmental Change and Health, funded by the National Institute of Health Research, provides multi-disciplinary research to support decision-making relating to the impacts and responses to environmental changes that affect human health and well-being in the UK and beyond. In this workshop we present the results of recent research on the progress in assessing climate change risk factors on health in the UK and review the evidence on implementation of mitigation and adaptation measures in Europe. The workshop aims to support evidence translation for climate action that prioritises health protection and equity. The workshop will include presentations on reviewing risk assessment methods for quantifying health impacts across Europe as well as analysing the effects of fuel poverty on cold-related mortality. We present results from an analysis of primary care data to identify individual level characteristics associated with increased risk of mortality during heatwaves. Furthermore, we review national food-based dietary guidelines across Europe and South America to determine how environmental sustainability is being integrated to benefit health. The workshop will comprise 4 -5 oral presentations and we will then open the floor to have a wider facilitated discussion about what are the evidence needs for UK and European policy to further address climate risks to health. Key messages • The progress in assessment and understanding of risks from climate change on health is improving. • The health risks we face from climate change will not be distributed equally across the UK and Europe.

Association between Scabies Treatment and Parkinson's Disease: A Nationwide, Population-Based Study.

Scabies is typically treated with scabicides like lindane, which poses a risk for acute neural toxicity. Lindane's prolonged use, particularly in agriculture, is linked to neurodegenerative diseases, including Parkinson's disease (PD), the second most common neurodegenerative disorder. This study aimed to evaluate whether scabies patients, particularly those treated with topical lindane, are at increased risk of developing PD. A nationwide population-based cohort study was conducted using data from Taiwan's National Health Research Institutes claims database from 2000 to 2018. The study included 27,173 patients with scabies, matched to a control group, with both groups followed for up to 18 years. The primary outcome was the incidence of newly diagnosed PD, and the hazard ratio (HR) for PD was calculated, focusing on those treated with topical lindane. Among the 54,346 patients, 1639 (3.0%) were newly diagnosed with PD, with 993 (60.6%) from the scabies group and 646 (39.4%) from the control group. Scabies patients had an adjusted hazard ratio (aHR) of 1.46 (95% CI 1.32-1.63) for developing PD compared to controls. However, patients treated with topical lindane had a significantly lower aHR for PD at 0.15 (95% CI 0.12-0.19; p < 0.001), with a lower cumulative incidence of PD also observed in this group (p < 0.001). Scabies patients are at a 1.46-fold increased risk of developing PD, but those treated with lindane exhibit a significantly lower risk, suggesting potential protective effects of lindane against PD.

Combined interventions for the testing and treatment of HIV and schistosomiasis among fishermen in Malawi: a three-arm, cluster-randomised trial

Undiagnosed HIV and schistosomiasis are highly prevalent among fishermen in the African Great Lakes region. We aimed to evaluate the efficacy of lakeside interventions integrating services for HIV and male genital schistosomiasis on the prevalence of schistosomiasis, uptake of antiretroviral therapy (ART) for HIV, and voluntary male medical circumcision (VMMC) among fishermen in Malawi. We conducted a three-arm, cluster-randomised trial in 45 lakeshore fishing communities (clusters) in Mangochi, Malawi. Clusters were defined geographically by their home community as the place where fishermen leave their boats (ie, a landing site). Eligible participants were male fishermen (aged ≥18 years) who resided in a cluster. Clusters were randomly allocated (1:1:1) through computer-generated random numbers to either enhanced standard of care (SOC), which offered invitation with information leaflets to a beach clinic offering HIV testing and referral, and presumptive treatment for schistosomiasis with praziquantel; peer education (PE), in which a nominated fisherman was responsible for explaining the study leaflet to promote services to his boat crew; or peer distribution education (PDE), in which the peer educator explained the leaflet and distributed HIV self-test kits to his boat crew. The beach clinic team and fishermen were not masked to intervention allocation; however, investigators were masked until the final analysis. Coprimary composite outcomes were the proportion of participants who had at least one Schistosoma haematobium egg observed on light microscopy from 10 mL of urine filtrate and the proportion who had self-reported initiating ART or scheduling VMMC by day 28. Outcomes were analysed by intention to treat; multiple imputation for missing outcomes was done; random-effect binomial models adjusting for baseline imbalance and clustering were used to compute unadjusted and adjusted risk differences, risk ratios (RRs) and 95% CIs, and intracluster correlation coefficients for each outcome. This trial is registered with ISRCTN, ISRCTN14354324. Between March 1, 2022, and Jan 29, 2023, 45 (65·2%) of 69 clusters assessed for eligibility were enrolled in the trial, with 15 clusters per arm. Of the 6036 fishermen screened at baseline, 5207 (86·3%) were eligible for participation: 1745 (87·6%) of 1991 in the enhanced SOC group, 1687 (81·9%) of 2061 in the PE group, and 1775 (89·5%) of 1984 in the PDE group. Compared with the prevalence of active schistosomiasis in the enhanced SOC group (292 [16·7%] of 1745), 241 (13·6%) of 1775 fishermen in the PDE group (adjusted RR 0·80 [95% CI 0·69-0·94]; p=0·0054) and 263 (15·6%) of 1687 fishermen in the PE group (0·92 [0·79-1·07]; p=0·28) had schistosomiasis at day 28. 230 (13·2%) in the enhanced SOC group, 281 (16·7%) in the PE group, and 215 (12·1%) in the PDE group initiated ART or were scheduled for VMMC. ART initiation or VMMC scheduling was not significantly increased with the PDE intervention (0·88 [0·74-1·05); p=0·15) and was marginally increased with the PE intervention (1·16 [0·99-1·37]; p=0·069) when compared with the enhanced SOC group. No serious adverse events were reported in this trial. We found weak evidence for the use of peer education to increase uptake of ART and VMMC, but strong evidence for the added distribution of HIV self-test kits to promote high engagement with services and reduce the prevalence of active schistosomiasis, suggesting a high potential for scale-up in hard-to-reach communities across Malawi. Wellcome Trust and the UK National Institute for Health Research.

The effectiveness of relaxation exercises on fatigue in hemodialysis patients: a meta-analysis study.

This study was conducted to determine the effect of relaxation exercise on fatigue symptoms in hemodialysis patients. This is a meta-analysis study. The literature review was carried out by searching studies published between 2011 and 2020. This meta-analysis was recorded on PROSPERO in the National Health Research Institute (Registration no: CRD42022313646). Seven studies meeting the inclusion criteria were included in the meta-analysis. The effect size of the studies included in the meta-analysis was found to be g=1.232 (p=0.028), which indicated a "huge effect size." The scale used in the subgroup analyses, the application time of the relaxation exercise, and the number of relaxation exercise applications were evaluated, and a significant difference was found at p<0.05. Relaxation exercises can be used as an effective method for reducing fatigue in hemodialysis patients.

The relationship between radiation oncology department NIH funding and institutional community inclusion/investment.

153 Background: Disparities in healthcare access and funding allocation persist among racial minorities and low-income populations. Radiation Oncology departments play a crucial role in cancer treatment, yet the extent to which these departments serve historically underrepresented communities following receipt of National Institutes of Health (NIH) funding remains unclear. This study accessed the relationship between radiation oncology departments that are awarded National Institute of Health (NIH) funding and Lown Institute Hospitals Index rankings for community benefit and inclusivity. Methods: Radiation oncology departments awarded funding from the NIH from 2019-2021 were retrospectively studied. The 2023 Lown Institute Hospital Index rankings for community benefit and inclusivity were examined. The community benefit metric measures financial assistance spending, community investment spending, and Medicaid as a portion of patient revenue. The inclusivity metric measures the similarities of income, race, and education level between the hospital patient population and the surrounding community. Kendall’s correlation coefficient (tau value) and linear regression were used to evaluate the relationship between measures of community benefit and inclusivity and NIH radiation oncology department research funding. Results: Twenty-two radiation oncology departments that received NIH funding (median = $ 419,555.00) were included. A statistically significant positive correlation was observed between the amount of radiation oncology NIH research funding received and institutional rankings for overall community benefit (tau = 0.378; P &lt; 0.034), with a trend towards significance for institutional rankings for community investment spending (tau = 0.497; P &lt; 0.053). No significant correlation was observed between the amount of radiation oncology department funding and institutional rankings for charity care spending (P = 0.430), Medicaid as a portion of patient revenue (P = 0.837), and service of patients from racial and or ethnic minorities (P = 0.505), with low income (P = 0.612), or with lower levels of education (P = 0.700). Conclusions: Our study highlights the relationship between recent NIH funding received by Radiation Oncology departments and their commitment to community health and inclusivity. Our findings indicate a significantly positive correlation between NIH funding received by radiation oncology departments and overall community benefit. This suggests that departments receiving NIH funding may be incentivized to allocate resources towards initiatives to improve community health outcomes beyond direct patient care. This study prompts further exploration into the mechanisms through which NIH-funded radiation oncology departments allocate resources and engage with their surrounding communities.

Relationship Between Radiation Oncology Department National Institutes of Health Funding and Institutional Community Inclusion/Investment

PURPOSE Disparities in health care access and funding allocation persist among racial minorities and low-income populations. Radiation oncology departments play a crucial role in cancer treatment, yet the extent to which these departments serve historically underrepresented communities following receipt of National Institutes of Health (NIH) funding remains unclear. METHODS Radiation oncology departments awarded NIH funding from 2019 to 2021 were studied using the 2023 Lown Institute Hospital Index rankings for community benefit and inclusivity to assess the relationship between measures of community benefit and inclusivity and NIH radiation oncology department research funding. RESULTS Twenty-two radiation oncology departments were analyzed in this study. A significant positive correlation was identified between the NIH research funding these departments received and their institutional rankings for overall community benefit (tau = 0.38; P &lt; .034). Additionally, there was a trend toward significance for the relationship between NIH funding and institutional rankings for community investment spending (tau = 0.497; P &lt; .053). No significant correlation was observed for other variables, including institutional rankings for charity care spending, Medicaid as a portion of patient revenue or services provided to patients from minoritized groups, low-income backgrounds, or those with lower levels of education. CONCLUSION Our findings indicate a significantly positive correlation between NIH funding received by radiation oncology departments and overall community benefit (measured by spending on financial assistance, community investment, and Medicaid). This suggests that departments receiving NIH funding may be incentivized to allocate resources toward initiatives aimed at improving community health outcomes extending beyond direct patient care.

Hyaluronic Acid in Bone Regeneration: Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when hyaluronic acid (HA) was added and mixed with graft materials in bone regeneration. This review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) of the National Institute of Health Research (registration number CRD42024530030). Electronic research was performed, and involved studies published up to 29 February 2024 using a specific word combination. The primary outcome was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when HA was added and mixed with graft materials in bone regeneration. The search resulted in 138 potential studies. Meta-analyses were performed using the fixed and random effects model to identify significant changes in new bone formation and in the remaining graft particles. After screening procedures, only three randomized controlled trials fulfilled the inclusion criteria and were selected for qualitative and quantitative analysis. The effect size of HA in the new bone formation was not statistically significant at 95% CI (Z = 1.734, p-value = 0.083, 95 % CI -,399; 6516). The effect size of HA in the remaining graft particles was not statistically significant at 95% CI (Z = -1.042, p-value = 0.297, CI -,835; 255). Within the limitations of the present systematic review and meta-analysis, the addition of HA to bone graft did not result in significant changes in bone regeneration procedures in terms of new bone formation and residues, even if the included studies showed encouraging and promising results.

Evaluating Research Activity and NIH-Funding Among Academic Ophthalmologists Using Relative Citation Ratio

ABSTRACT Purpose The objective of this study was to evaluate the relationship between research activity and National Institutes of Health (NIH) funding status of the United States (US) academic ophthalmologists. Methods A retrospective cross-sectional analysis of bibliometric data was conducted. The NIH Research Portfolio Online Reporting Tools Expenditures and Reports (rePORTER) website was utilized to identify ophthalmology departments in the US that received NIH funding. Affiliated faculty from these institutions were then identified using NIH rePORTER and institutional websites. H-index was calculated using the Scopus database, and the NIH iCite tool was used to determine the Relative Citation Ratio (RCR). The h-index and w-RCR quantified research productivity, while m-RCR measured research impact. Results Data on 2688 faculty members from 66 departments we re identified, of which 21% were NIH-funded. Faculty members who received NIH-funding had significantly greater research productivity and impact as measured by h-index (32.5 vs 16.6; p < .001), m-RCR (2.2 vs 1.6; p < .001), and w-RCR (147.2 vs 70.1; p < .001) than their non-funded peers. When stratified by academic rank, NIH-funded faculty still had significantly higher h-index (16.1 vs 7.9; p < .001), m-RCR (2.2 vs 1.4; p < .001), and w-RCR (63.2 vs 61.8; p < .001) than non-funded peers. A similar trend was observed among non-tenured faculty members. Conclusion NIH funding is associated with higher research productivity and impact among US academic ophthalmologists as measured by h-index and RCR, which suggests that NIH funding may be a critical factor in enhancing scholarly contributions of ophthalmologists. These findings underscore the importance of continued investment in NIH funding to foster high-impact research within the field of ophthalmology.

Potential impact of replacing the 13-valent pneumococcal conjugate vaccine with 15-valent or 20-valent pneumococcal conjugate vaccine in the 1 + 1 infant schedule in England: a modelling study

Paediatric pneumococcal conjugate vaccine (PCV) programmes in England using seven-valent PCV (PCV7) in 2006 and 13-valent PCV (PCV13) in 2010 have reduced vaccine-type invasive pneumococcal disease, but the overall effect has been reduced by an increase in invasive pneumococcal disease due to non-vaccine serotypes and serotype 3. We developed pneumococcal transmission models to investigate the potential effect on invasive pneumococcal disease of higher valency PCVs covering an additional two (ie, 15-valent PCV [PCV15]) or seven serotypes (ie, 20-valent PCV [PCV20]) in England. We conducted a modelling study using realistic, age-structured, and compartmental deterministic models fitted to carriage data from before the introduction of PCVs and invasive pneumococcal disease data from before and after the introduction of PCV7 and PCV13 in England from the UK Heath Security Agency invasive pneumococcal disease surveillance system. We estimated key parameters, including PCV7 and PCV13 efficacy against vaccine-type carriage and invasiveness of PCV7 serotypes; the additional serotypes in PCV13, PCV15 and PCV20; and non-vaccine serotypes. We simulated the effect of transitioning from PCV13 to PCV15 or PCV20 in infants under the current 1 + 1 vaccination schedule and investigated the effect of reduced carriage protection against PCV13 serotypes due to attenuation of immunogenicity in higher valency vaccines. Our results suggest that PCV15 might increase overall invasive pneumococcal disease as the reduction in vaccine-type invasive pneumococcal disease would be counterbalanced by an increase in non-PCV15 invasive pneumococcal disease. By contrast, PCV20 is projected to have a substantial impact on overall invasive pneumococcal disease due to higher invasiveness of the additional serotypes covered by PCV20 than the replacing non-vaccine serotypes. Reduced carriage protection against PCV13 serotypes with higher valency vaccines would amplify these effects. Replacing PCV13 with PCV20 is likely to have a substantial public health benefit, but PCV15 could potentially increase the overall burden of disease. UK Health Security Agency and National Institute of Health Research.

CHARACTERISTICS OF SCIATICA PATIENTS LISTED FOR A SPINAL EPIDURAL STEROID INJECTION AND CLINICAL OUTCOMES: RESULTS FROM THE POISE COHORT STUDY

BackgroundClinical guidelines recommend epidural steroid injection (ESI) for severe sciatica but there is uncertainty of effectiveness. The POiSE study aims to identify factors, routinely collected in clinical practice that predict outcome in patients who have ESI. This presentation describes characteristics and early clinical outcomes of POiSE participants.MethodsProspective cohort study in 19 NHS spinal services in England, inviting patients with sciatica listed for an ESI. Participant baseline characteristics and 6-week follow-up outcomes are presented. Outcomes include pain intensity (0–10 NRS), disability (Oswestry Disability Index 0–100) and global change in symptoms.ResultsOver 24 months, 693 patients were invited to participate and 353 (51%) completed baseline questionnaires. Mean (SD) age 49.0 years (14.4), 60% female, and 46% (n=101) of those in work had certified time-off for sciatica. Mean pain intensity was 7.2 (2.0) and 6.2 (2.7) for leg and back pain respectively and mean disability (ODI) was 46.5 (18). 60% (n=210) had leg pain for &gt;6 months. Average confidence at baseline (0 to 10) that the ESI would help symptoms was 5.7 (2.4).Of 217 patients reaching 6-week follow-up, mean leg and back pain intensity is 5.0 (2.8) and 4.9 (2.9) respectively and ODI 36.6 (20.4), with 57% reporting improvement (completely recovered/much better/better). Follow-up data collection at 6, 12 and 24-weeks post-ESI is ongoing.ConclusionInterim analysis shows only just over half of patients are reporting improvement at 6 weeks post ESI. The POiSE cohort study will help better identify the patients with sciatica who are most likely to benefit from this treatment.Conflicts of interestNoneSources of fundingThis study is supported by Health Education England and the National Institute for Health and Care Research (HEE/ NIHR ICA Programme Clinical Lectureship, Dr Siobhan Stynes, NIHR300441). The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care

WILLINGNESS TO RANDOMIZE PATIENTS TO LUMBAR SPINE FUSION SURGERY OR CONSERVATIVE CARE IN THE FORENSIC-UK AND FORENSIC-AUSTRALIA TRIALS

Background and PurposeThe UK's NIHR and Australia's NHMRC have funded two randomised controlled trials (RCTs) to determine if lumbar fusion surgery (LFS) is more effective than best conservative care (BCC) for adults with persistent, severe low back pain (LBP) attributable to lumbar spine degeneration. We aimed to describe clinicians’ decision-making regarding suitability of patient cases for LFS or BCC and level of equipoise to randomise participants in the RCTs.MethodsTwo online cross-sectional surveys distributed via UK and Australian professional networks to clinicians involved in LBP care, collected data on clinical discipline, practice setting and preferred care of five patient cases (ranging in age, pain duration, BMI, imaging findings, neurological signs/symptoms). Clinicians were also asked about willingness to randomise each patient case.ResultsOf 174 responses (73 UK, 101 Australia), 70 were orthopaedic surgeons, 34 neurosurgeons, 65 allied health professionals (AHPs), 5 others. Most worked in public health services only (92% UK, 45% Australia), or a mix of public/private (36% Australia). Most respondents chose BCC as their first-choice management option for all five cases (81–93% UK, 83–91% Australia). For LFS, UK surgeons preferred TLIF (36.4%), whereas Australian surgeons preferred ALIF (54%). Willingness to randomise cases ranged from 37–60% (UK mean 50.7%), and 47–55% (Australian mean 51.9%); orthopaedic and neuro-surgeons were more willing than AHPs.ConclusionWhilst BCC was preferred for all five patient cases, just over half of survey respondents in both the UK and Australia were willing to randomise cases to either LFS or BCC, indicating clinical equipoise (collective uncertainty) needed for RCT recruitment.Conflicts of interestNoneSources of fundingNo specific funding obtained for the surveys. DB, SA, AG and NEF have funding from the National Institute for Health Research (NIHR) UK (FORENSIC-UK NIHR134859); NEF, DB and SA have funding from the Australian National Health and Medical Research Council (NHMRC FORENSIC-Australia GA268233). AG has funding from Orthopaedic Research UK (combined with British Association of Spine Surgeons and British Scoliosis Society) and Innovate UK. NEF is funded through an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (ID: 2018182).