Priority Setting Research Articles

The relative importance of severity and rarity criteria in health resource allocation: an umbrella review.

The primary objectives of this umbrella review were to (a) quantify the relative importance, of "severity" and "rarity" criteria in health resource allocation; and (b) analyze the contextual factors influencing the relative importance. The secondary objective was to examine how "severity" and "rarity" criteria are defined. Searches were carried out in PubMed and Embase to identify eligible systematic reviews. Quality appraisal of systematic reviews was undertaken. From identified systematic reviews, primary studies were extracted and further screened for eligibility. The inclusion of severity and rarity criteria and their respective weights in primary studies were examined. Descriptive and regression analyses were performed. Twenty-nine systematic reviews were screened, of which nine met the inclusion criteria. Primary studies included in these systematic reviews were retrieved and screened, resulting in forty articles included in the final analysis. Disease severity was more frequently considered (n=29/40) than disease rarity (n=23/40) as an evaluation criterion. Out of all cases where both were included as evaluation criteria, disease severity was assigned higher weights 84 percent of the time (n=21/25). Our review found consistent evidence that disease severity is more relevant and preferred to rarity as a priority-setting criterion albeit constraints in statistical analysis imposed by limited sample size and data availability. Where funding for rare diseases is concerned, we advocate that decision-makers be explicit in clarifying the significance of disease severity and/or rarity as a value driver behind decisions. Our findings also reinforce the relevance of disease severity as a criterion in priority setting.

QOL-09. “I’VE DEFINITELY CHANGED WHO I AM”: A THEMATIC ANALYSIS OF CHALLENGES FACED BY PATIENTS WITH IDH-MUTANT GLIOMAS

Abstract BACKGROUND Despite their more favorable prognosis, patients with isocitrate dehydrogenase (IDH)-mutant gliomas experience significant psychological distress across their disease trajectory. The specific drivers of distress in this population are poorly understood, and interventions to support these patients are lacking. We sought to better characterize drivers of distress and ways to enhance support for patients with IDH-mutant gliomas as they confront potentially prolonged but ultimately unpredictable survival with an incurable, progressive brain tumor. METHODS Eligible individuals were English-speaking adults ages 65 and younger diagnosed with an IDH-mutant glioma at a single academic medical center. We conducted semi-structured interviews (N=20) to better understand the distress patients experience as they progress along their illness trajectories. We audio-recorded and transcribed interviews and analyzed interview content using reflexive thematic analysis. RESULTS Distress among participating patients (female = 7/20; age <40 years = 10/20) was linked to their struggles to maintain a coherent sense of identity while adapting to 1) neurocognitive changes and 2) altered life plans amidst prognostic uncertainty. Patients described feeling self-conscious and distrustful of their cognitive capacities, frequently comparing their current performance to their premorbid functioning (e.g. by checking their symptoms and indexing perceived deficits against scan results). Patients felt overwhelmed by the need to make decisions and set priorities (e.g., regarding family planning, retirement) due to the uncertain timing of their tumor’s progression and its unclear impact on their future functioning. Patients identified the transition from treatment to surveillance as a time of heightened worry, as they shifted their focus from the logistics of cancer care to the task of planning – financially, occupationally, socially – for an uncertain future. CONCLUSION These findings highlight the need for tailored supportive care to help patients with IDH-mutant gliomas cope with the distress caused by significant changes to identity and ongoing uncertainties regarding their future.

Contexts and complexities: a realist evaluation of integrated care system leadership.

This paper presents a realist evaluation of leadership within an integrated care system (ICS) in England. This paper aims to examine which aspects of leadership are effective, for whom, how and under what circumstances. Realist evaluation methodology was used, adopting prior realist review findings as the theoretical framework to refine explanations of how and why leadership within an ICS is effective. Between January and November 2023, 23 interviews with ICS leaders took place, alongside 7 meeting observations and documentary analysis. The Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) guidance informed the study design, conduct and reporting. The findings highlight two overarching infrastructural contexts influencing leadership in ICSs: the impact of the post-COVID-19 pandemic legacy and the differences between health and social care regulatory and financial environments. Findings demonstrate that ICS leaders identified a strong sense of purpose as crucial for guiding decisions and creating a psychologically safe environment for open, honest discussions, fostering calculated risk-taking. Whilst a shared vision directed priority setting, financial pressures led to siloed thinking. Leadership visibility was linked to workforce morale, with supportive leadership boosting morale amidst evolving ICS landscapes and confidence in data-driven decisions supported prevention activities. However, financial constraints hindered responsiveness and innovation in addressing health inequalities. By examining ICS leadership post-COVID-19 pandemic and amidst varying regulatory and financial environments, this study contributes to the emerging literature on systems leadership and offers practical guidance for leaders navigating the complexities of integrated care.

Decompensated Liver Cirrhosis Research Network (UK-CLIF): Building consensus for hepatology trials in the UK

Liver disease is a major, and increasing, cause of death in the UK. The UK Chronic Liver Failure network (UK-CLIF) was developed as a multi-stakeholder network with the aim to advance cirrhosis research, with emphasis on geographical areas of high disease prevalence or limited research activity. The process involved network development through dissemination and snowball sampling techniques, with monitoring of network development and connections between participants, developed over two online meetings. Network membership included representatives from patients, carers, clinicians, researchers, R&D professionals, industry representatives, and the third sector. Subsequently, two facilitated in-person workshops were conducted with network participants. World Café methodology and participant dot voting was used to develop areas of priority and consensus in: (i) research infrastructure for cirrhosis clinical trials, (ii) clinical factors affecting research delivery, and (iii) research priorities for future trials. Thematic analysis demonstrated that the need for patient-centric trial materials, a lack of resource for clinicians to participate in research, and variability in the standard of inpatient care for cirrhosis, were barriers for cirrhosis clinical trials. Future activities for UK-CLIF include participation in a process of quality standard setting for inpatient care for cirrhosis, and coordination of a James Lind Alliance Priority Setting Partnership to develop research questions for liver cirrhosis.

Economic effects of priority setting in healthcare: a scoping review of current evidence

ObjectivesStudy objective was to map the current literature on the economic effects of priority setting at the system level in healthcare.DesignThe study was conducted as a scoping review.Data sourcesScopus electronic database was searched in June 2023.Eligibility criteriaWe included peer-reviewed articles published 1 January 2020–1 January 2023. All study designs that contained empirical evidence on the financial effects or opportunity costs of healthcare priority setting were included excluding disease, condition, treatment, or patient group-specific studies.Data extraction and synthesisTwo independent researchers screened the articles, and two additional researchers reviewed the full texts and extracted data. We used Joanna Briggs Institute checklists to assess the quality of qualitative, quasi-experimental and economic evaluations and the mixed methods appraisal tool for the mixed method studies. Synthesis was done qualitatively and through descriptive statistics.Results8869 articles were screened and 15 fulfilled the inclusion criteria. The most common study focus was health technology assessment (7/15). Other contexts were opportunity costs, effects of programme budgeting and marginal analysis, and disinvestment initiatives. Priority setting activities analysed in the studies did not achieve cost savings or cost containment (4/15) or have mixed findings at best (8/15). Only five studies found some indication of cost savings, cost containment or increased efficiency. Also, many of the studies consider costs only indirectly or qualitatively.ConclusionsAll in all, there is very little research addressing the pressing question of whether explicit priority setting and priority-setting methods can support cost containment on a health service system level (regional or national). There is limited evidence of the economic effects of priority setting.

Patient and public involvement in HIV research: a mapping review and development of an online evidence map.

Increasing evidence indicates the benefits of patient and public involvement (PPI) in medical research, and PPI is increasingly expected by funders and publishers. We conducted a mapping review of studies reporting examples of PPI implementation in HIV research, and developed an online evidence map to guide HIV researchers. We systematically searched Medline and Embase up until 18 August 2024, including search terms with variations for PPI and HIV. We extracted information from identified studies in duplicate and analysed the data descriptively and qualitatively to describe types of PPI models and reported benefits, challenges, and mitigation strategies. This study was co-initiated and co-led by people living with HIV. We identified 17 studies reporting PPI in HIV research between 1992 and August 2024. Most PPI examples informed prospective clinical studies, but also qualitative research, questionnaire development, research priority setting and surveys. Ten studies described the number and characteristics of PPI members involved. We observed four PPI models, from a model that solely engaged PPI members for a specific task to a model whereby PPI representatives were integrated into the study team with decision-making authority. Benefits reported included wider dissemination of research results, better understanding of research material and results, and higher levels of trust and learning between researcher and communities. The most commonly reported challenges were the lack of specific resources for PPI, differing levels of knowledge and expertise, concern about HIV status disclosure, and lack of diversity of the PPI team. Uneven power dynamics, tensions, and differing expectations between stake-holder groups were also frequently noted. This mapping review summarizes published examples of PPI in HIV research for various phases of research. There is a clear need to strengthen the reporting on PPI processes in HIV research, for example by following the Guidance for Reporting Involvement of Patients and the Public (GRIPP) 2 guidelines, and developing guidance on its hands-on implementation. We embedded PPI from study inception onwards, which potentially pre-empted some of the challenges reported in the reviewed examples. The resulting online evidence map is a starting point to guide researchers on integrating PPI into their own research.

Coupling and coordination of food security and agricultural carbon emission efficiency: Changing trends, influencing factors, and different government priority scenarios

Seeking a balance between food security and carbon mitigation is key to achieving sustainable agricultural development. This study evaluates the coupling coordination degree (CCD) between the food security index (FSI) and agricultural carbon emission efficiency (ACEE) in China from 2010 to 2021 using the coupled coordination model. By adjusting the model coefficients, different government priority scenarios are simulated to explore their impact on CCD. The Geodetector method is employed to identify the influencing factors of CCD, investigate their interactions, and assess the differences in these factors across various government priority settings. The average CCD between FSI and ACEE exhibits a notable upward trend, rising from 0.4583 in 2010 to 0.6595 in 2021. Furthermore, regional disparities are widening, particularly in the major production areas. Catch-up effects exist within regions. Policy simulations showed staged interactions between food security and agricultural carbon efficiency, shifting from food security to balanced production and ecology, then to prioritizing low-carbon production for food security. Adjusting policy priorities can effectively improve coupling coordination in the short term, with increasing impact as priority shifts. CCD is influenced by policy, technology, economy, and society, varying with policy priorities. In the baseline scenario, key factors for CCD include the urban-rural income gap, technological advancement, urbanization, and farmers' education level. When the government prioritizes food security, the impact of narrowing income gaps and agricultural industry agglomeration becomes more pronounced. Conversely, emphasizing carbon emission efficiency enhances the influence of technological advancements and urbanization on CCD. Tailoring agricultural production strategies to local conditions and emphasizing interactive effects among factors is crucial for achieving environmentally friendly and high-quality agricultural development goals.

Using Importance-Performance Analysis for Measuring University Reputation and Setting Priorities

This study aimed to measure the university reputation using the importance-performance analysis (IPA) to determine the strengths and weaknesses in the aspects of the university reputation from the students' point of view and to identify the priorities for improvement based on the priority index. Data were drawn from a sample of 354 students through a questionnaire. The results indicated that many of the areas that require more focus and resource allocation, which are the quality of education, the efficiency of the faculty, community service projects, and the provision of educational resources and equipment, The results of the Priority Index presented the most pressing areas that the university leaders should deal with immediately to improve their university reputation. This study contributes to the theory of marketing for higher education by introducing IPA as a useful quantitative tool used in higher education research to measure the reputation of universities and set priorities. Keywords: Organizational Reputation, University Reputation, Importance-performance Analysis (IPA), Measuring University Reputation, Improve Reputation

Embedding voices of under-served communities in Health Research Priority Setting in Thailand

Health research is needed to develop new treatments, diagnostic methods and prevention strategies for many diseases, but resources are limited particularly in low-and middle-income countries (LMICs). Our proposed project involves in-depth engagement with community advisory boards and existing community groups in healthcare research priority setting in Thailand. We will use Wellcome’s “Responsive Dialogues” engagement approach, focusing on “underserved” groups, as their voices are seldom heard in healthcare research priority setting. We estimate that we will engage with 6–8 community groups involving 48–80 participants. Our objectives are firstly, to contribute to the health research agenda setting in Thailand for government, non-governmental actors, academia, and others who conduct health research in the next 5 to 10 years. Secondly, we aim to identify ethical and practical issues related to healthcare research priority setting, specifically in relation to involving under-served communities.

Excess mortality associated with chikungunya epidemic in Southeast Brazil, 2023

The chikungunya virus (CHIKV) was first detected in Brazil in 2014 and has since caused major epidemics. In 2023, a major chikungunya epidemic occurred in Minas Gerais, one of the most populous states in the country. We analyzed the North and Northeast Health Macroregions of Minas Gerais, with 2.5 million inhabitants. The study used epidemiological data from the Ministry of Health’s laboratory surveillance, disease notification and mortality systems. A robust Poisson regression model was constructed to estimate expected monthly mortality. Excess deaths were calculated by comparing observed deaths with model estimates during the epidemic period. During the epidemic, there were 890 excess deaths attributed to chikungunya, translating into a mortality rate of 35.1/100,000 inhabitants. The excess mortality rate was significantly 60 times higher than the deaths reported by surveillance, with only 15 confirmed deaths. The correlation between excess deaths and laboratory-confirmed chikungunya cases was strong, while the correlation with dengue and COVID-19 was not statistically significant. The results highlighted the serious underestimation of chikungunya mortality by epidemiological surveillance. During the same year, only 420 chikungunya deaths were reported by all PAHO member countries. Routine epidemiological surveillance systems cannot capture the full impact of this disease. Excess mortality is a key measure for understanding the impact of epidemics, as demonstrated by COVID-19 and influenza pandemics. The study highlights the need for complementary tools to traditional surveillance to better assess impacts on morbidity and mortality and support priority setting in public health interventions.

A systematic review of the financial issues of higher education institutions (HEIs) and possible strategies to cope with them

The field of higher education has not only been for elites since the last three decades. It has also included the general masses in it. That’s why the transformation of the socio-economic status and general awareness in the present age owes to higher education. On the other hand, challenges have also emerged and set conditions on the path to sustainability. Thus, higher education has faced problems, especially financial problems. These issues further give birth to some other issues. This study is an attempt to understand the issues caused by financial issues. The study also aimed to propose strategies to deal with these issues. Based on the systematic literature review, the problems have been categorized as lack of internet, digitalization, and online teaching; underdeveloped infrastructure for STEAM; lack of priorities; and quality issues. These findings create hurdles in achieving the quality of HEIs. To cope with these issues, clear policy and setting priorities were proposed as the top most important strategies to bring about quality and achieve HEIs’ organizational objectives. It can be concluded that HEIs need appropriate strategic and financial managers and administrators who can align their strategy with the vision and mission of the institutions.

Assessing progress towards viral hepatitis B and C elimination in prisons in the European region

Abstract Background In 2016 the WHO launched the global health sector strategy for the elimination of viral hepatitis, alongside a dedicated monitoring&evaluation (M&E) framework to assess progress at national, regional and global levels. Despite being a priority setting for viral hepatitis elimination in Europe, prisons are rarely integrated into national monitoring efforts. Besides, prisons are particular contexts with a high viral hepatitis prevalence, where it is possible to utilize adequate micro-elimination strategies. Objectives We aimed to assess available metrics of viral hepatitis burden and coverage of prevention and control interventions in prison settings in Europe using routine sources of data. Methods We adapted the WHO M&E framework for viral hepatitis elimination to the prison context. The resulting M&E framework has 49 indicators of which 10 are defined as core. Data were sourced from available European prison surveillance systems at European level, namely: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and WHO Health in Prisons European Database (HIPED). Results In total 38 countries in the European region provided data to either data sources for 2020. For WHO-HIPED, among core indicators, 3 out of 10 could be calculated for HCV, and covered prevalence, HCV treatment availability and treatment outcome. Concerning HBV, 3 core indicators out of 10 could be calculated and covered prevalence, screening availability and treatment coverage in prison. With EMCDDA surveillance system we could calculate 4 HCV core indicators and 6 HBV core indicators. Lessons Availability of health data from prison settings is scarce, hampering the current capacity to monitor the progress in the viral hepatitis elimination within prisons contexts strategies and its relative contribution to global health goals achievement. A coordinated and standardised M&E framework tailored to this specific setting is needed to foster data collection and systematic monitoring. Key messages • Micro-elimination strategies in prison context contribute to the global health goals achievement. • A coordinated and standardized M&V framework, adapted to the prison context, is needed to foster data collection and monitoring of the viral hepatitis elimination strategy.

Severity and Temporality in Healthcare Priority Setting - A Case for A Condition-specific Affectable Time-neutral Approach.

Priority setting of scarce resources in healthcare is high on the agenda of most healthcare systems implying a need to develop robust foundations for making fair allocation decisions. One central factor for such decisions in needs-based systems, following both empirical studies and theoretical analyses, is severity. However, it has been noted that severity is an under-theorized concept. One such aspect is how severity should relate to temporality. There is a rich discussion on temporality and distributive justice, however, this discussion needs to be adapted to the practical and ethical requirements of healthcare priority setting principles at mid-level. In this article, we analyze how temporal aspects should be taken into account when assessing severity as a modifier for cost-effectiveness. We argue that when assessing the severity of a condition, we have reason to look at complete conditions from a time-neutral perspective, meaning that we take the full affectable stretch of the condition into account without modifying severity as patients move through the temporal stretch and without discounting the future. We do not find support for taking the 'shape' of a condition into account per se, e.g. whether the severity has a declining or inclining curve, or that severity is intermittent rather than continuous. In order to take severity seriously, we argue that we have reason to apply a quantified approach where every difference in severity should impact on priority setting. In conclusion, we find that this approach is practically useful in actual priority setting.

Introduction: Mobilizing during COVID-19: social movements in times of crisis

ABSTRACT Early 2020 saw the beginning of a pandemic that triggered an unprecedented global health crisis and economic turmoil. The COVID-19 pandemic also crucially affected the dynamics of political mobilization in social movements. This introduction seeks to reflect on such effects. In particular, we ask: How did the pandemic change or hinder existing struggles? To what extent did new activist networks, issues, and forms of action emerge? Drawing on the special issue’s contributions, we highlight how the pandemic gave way to new incentives and forms of mobilization, in particular the anti-lockdown protests with covid-specific claims, and actor constellations that often brought together people with diverse ideological orientations. These mobilizations were crucially facilitated by social media, bringing together previously disconnected people and harnessing heightened emotions of fear, anger, distrust, uncertainty, and anxiety. At the same time, existing movements continued their work on longer standing issues and often effectively adapted their organizational infrastructures, repertoires of action, or goals to a new set of priorities and circumstances. As in other crises, the pandemic spurred mutual aid and solidarity activism for those most affected by the pandemic.

Adult day programs and their effects on individuals with dementia and their caregivers (ADAPT-DemCare): a realist synthesis to develop program theories on the how and why

BackgroundAdult day programs aim to facilitate aging in place by supporting the health and well-being of persons with dementia and providing respite to their caregivers. However, studies on the effects of day programs are inconclusive, and we especially lack insights into the context conditions and mechanisms of day programs that may produce different outcomes for different groups of persons with dementia and their caregivers. Our objective was to conduct a realist review, synthesizing research on day programs to develop program theories explaining how and why day programs do or do not produce positive or negative outcomes for different groups of persons with dementia, and caregivers.MethodsWe identified 14 literature reviews (including 329 references published between 1975 and 2021) on adult day programs. From this initial pool of studies, we will include those that focused on day program attendees with dementia or meaningful cognitive impairment, and/or their caregivers, and that report how day program contexts (C) and mechanisms (M) bring about outcomes (O) for attendees and caregivers. We will extract CMO statements (i.e., narratives that explain how and why day programs do or do not bring about certain outcomes for whom and under what circumstances). Using additional focused searches, citation mapping, citation tracking, and discussions with our researcher and expert team members, we will identify additional references. CMO statements will be synthesized, transformed into hypotheses, and linked and visualized to form program theories. Using focus groups and the James Lind Alliance Priority Setting Partnership method, we will discuss and prioritize our CMO statements and refine our program theories with 32 experts (older adults, caregivers, Alzheimer societies, caregiver organizations, day program staff and managers, and health system and policy decision makers). DiscussionBy identifying essential elements and processes of day programs and related knowledge gaps, this study will generate much-needed knowledge to leverage the full potential of day programs so they can provide appropriate care, preventing premature institutionalization, and unnecessary acute and primary care use. This will ultimately improve the quality of life of persons with dementia and their caregivers, alleviate caregiver burden, and reduce social costs. Systematic review registrationPROSPERO CRD42024504030

Online availability of antibiotics from within the UK: shifting patterns from 2016 to 2023

Abstract Background We previously reported a cross-sectional analysis of online pharmacy practices and processes. Since then, the demand for and context of online healthcare has changed. However, the current state of access to and usage of antibiotics obtained online remains poorly understood. Objectives This study aimed to: (i) determine the legality of online pharmacies selling antibiotics in the UK; (ii) describe processes for obtaining antibiotics online; (iii) identify antimicrobial stewardship (AMS) and patient safety issues; and (iv) compare data with those obtained in 2016 to understand changes in context, and set priorities for targeted research in antibiotic access and usage. Methods Searches for ‘buy antibiotics online’ were conducted using ‘Google’ and ‘Yahoo’. The first 10 websites with unique URL addresses for each were reviewed. Analyses were conducted on evidence of pharmacy registration, prescription requirement, whether choice was ‘prescriber-driven’ or ‘consumer-driven’, and whether information was required (allergies, comorbidities, pregnancy) or given (adverse effects) prior to purchase. Results Twenty unique URL addresses were analysed. Those evidencing UK location (n = 20; 100%) required a prescription and were appropriately registered. For 11 (55%) online pharmacies, decisions were initially consumer-driven for antibiotic choice, but not for dose or duration; contrasting with 2016 when for most (n = 16; 80%), decisions were consumer-driven for antibiotic choice, dose and quantity. Conclusions Variation continues to exist in relation to antibiotic practices online. We make several key recommendations for lawmakers and stakeholders. Targeted research, improved public engagement, professional education and new best practice guidelines are urgently needed for online UK antibiotic suppliers.

Gambling-related attitudes and dimensional structure of the GABS-15 in outpatient addiction care patients: associations with gambling disorder.

Individuals with gambling disorder (GD) harbor cognitive distortions and dysfunctional beliefs about gambling that may foster problematic gambling behaviour. Evidence on particularly detrimental attitudes and beliefs is however lacking. To close this knowledge gap, we analysed associations between gambling attitudes and beliefs (Gambling Attitudes and Beliefs Survey (GABS-15)) and severity of gambling disorder (DSM-5 criteria met) in a German cohort of 123 individuals receiving outpatient gambling treatment. Data from the "Katamnese-Study" covering a 36-months timeframe with 5 assessment points was pooled. The multidimensional structure of the GABS-15 was examined using explorative and confirmatory factor analyses, followed by mixed-effect regression models using different operationalizations of the GABS-15. A three-factorial structure comprising "attitudes while gambling", "sensation-seeking / excitement", and "gambling fallacies" demonstrated better fit indices than the GABS-15 sum score. Only the "gambling fallacies " factor (1.00, p<0.05; 15.36, p < 0.01) was significantly associated with increased severity of GD. As a one-dimensional conceptualization of gambling-related attitudes and beliefs might not sufficiently guide staff of outpatient treatment facilities regarding priority setting in gambling care, evidence on attitudes with particularly detrimental associations is highly warranted. Here, focussing on mitigating "gambling' fallacies" by tailored treatment strategies appears promising.

Institutional Mechanisms for Enhancing Production of Doctoral Research Outputs at Makerere University

In the contemporary knowledge society, research production is being re-purposed in terms of not just its academic value, but also its wider societal value. As such, doctoral research ought to be produced in the context of application. Therefore, universities have a responsibility to enhance the uptake and use of doctoral research outputs. This necessitates institutional mechanisms for enhancing the production of doctoral research outputs for uptake and use beyond the academia. We examined the institutional mechanisms for enhancing production of doctoral research outputs at Makerere University using the research knowledge infrastructure (RKI) framework as the analytical lens. This was in light of the dismal uptake and use of research produced at Makerere University by students and staff. We used qualitative single case study research design. We collected data through interviewing and review of documents. We interviewed 10 doctoral program coordinators, three managers of research and graduate training and 13 PhD students we selected purposively. We reviewed seven institutional documents pertaining graduate training at Makerere University: two plans, three policies, one framework and one guideline. We used thematic data analysis to make sense of the data. The findings revealed that due to policy-practice gaps and funding constraints, mechanisms to enhance doctoral research production to facilitate uptake and use of doctoral research outputs beyond the academia were not adequately integrated into doctoral research training. This was shown by the lack of mechanisms to enhance doctoral research commissioning and execution, and gaps in priority setting. Opportunities for productive interactions between doctoral researchers and potential users were missed. As such, doctoral research outputs largely remained within the scholarly community. We recommend that the university should establish interface structures and co-creation spaces to leverage doctoral research commissioning, execution and priority setting to facilitate the uptake and use of doctoral research outputs beyond the scientific community

Building locally anchored implementation science capacity: the case of the adolescent HIV implementation science alliance-supported local iS alliances.

The Fogarty International Center-led Adolescent HIV Implementation Science Alliance (AHISA) supports region-/country-specific implementation science (IS) alliances that build collaborations between research, policy, and program partners that respond to local implementation challenges. AHISA supported the development of seven locally-led IS alliances: five country-specific (i.e., Kenya, South Africa, Tanzania, Uganda, and Zambia), one in Central and West Africa, and one with youth researchers. This article outlines the aims, activities, and outcomes of local alliances, demonstrating how they enhance sustainable IS activities to address local challenges. We conducted a desk review of each alliance's funding applications, reports, and data from the initial findings of a larger AHISA evaluation. The review analyzes common approaches, highlights their local relevance, and summarizes initial outcomes. The local alliances have a common goal: to expand implementation of successful interventions to improve adolescent HIV. We identified four overarching themes across the local alliances' activities: capacity building, priority setting, stakeholder engagement, and knowledge dissemination. Research capacity building activities include long-term mentorship between junior and senior researchers and short-term training for non-research partners. Setting priorities with members identifies local research needs and streamlines activities. Alliances incorporate substantial engagement between partners, particularly youth, who may serve as leaders and co-create activities. Dissemination shares activities and results broadly. Local IS alliances play a key role in building sustainable IS learning and collaboration platforms, enabling improved uptake of evidence into policy and programs, increased IS research capacity, and shared approaches to addressing implementation challenges.

The Eczema Bathing Study: Weekly versus daily bathing for people with eczema? Protocol of an online, randomised controlled trial

Background A priority setting partnership for eczema (syn atopic eczema, atopic dermatitis) has identified that bathing frequency is a key area of patient interest. However, there are nolarge, high-quality randomised controlled trials (RCTs) investigating this. The Rapid Eczema Trials project is a novel programme of research that aims to deliver multiple online RCTs, using a citizen science approach. This project involves working with members of the public to co-design and conduct studies that answer questions of importance to them. The first trial to be conducted through this project is assessing the impact of bathing frequency on eczema. Methods This is an online, two-arm, parallel-group superiority RCT with internal pilot phase. People aged ≥1 year with eczemaliving in the United Kingdom are eligible. Exclusion criteria are: people with other types of eczema such as venous eczema, hand eczema and contact eczema; recently started a new eczema treatment; taking part in another eczema trial; Patient Oriented Eczema Measure (POEM) ≤2; planning to swim more than twice a week; unable/unwilling to change bathing practices. Participants are allocated 1:1 to either the weekly bathing group (bathe 1 or 2 times a week) or the daily bathing group (bathe 6 or more times a week) for 4 weeks. The primary outcome is POEM, assessed weekly over 4 weeks. Secondary outcomes include skin specific quality of life, eczema control, itch severity, use of usual eczema treatments, proportion who achieve an improvement in POEM of ≥3 points, global change in eczema and safety outcomes. A sample of participants will also be invited to a semi-structured interview to discuss their experience. The primary comparative analysis will be according to randomised allocation regardless of actual frequency of bathing. The trial will be reported in accordance with CONSORT guidelines. The study has received ethical approval by the London - Surrey Research Ethics Committee (2 Redman Place, London, E20 1JQ, United Kingdom) on 11/10/2023 ( approval number: 23/PR/0899). Trial registration ISRCTN12016473, 22/11/2023, https://doi.org/10.1186/ISRCTN12016473