UK Survey Research Articles

Understanding the benefits of renin-angiotensin-aldosterone system inhibitors and influence of hyperkalaemia on their prescription: a UK survey of healthcare professionals' views and practice

Abstract Background Renin–angiotensin–aldosterone system inhibitors (RAASi) improve outcomes in heart failure with reduced ejection fraction (HFrEF) and they should be increased to the maximally tolerated dose. However, their use is often hindered by hyperkalaemia leading to discontinuation or down titration. Purpose Assess perceptions of primary and secondary healthcare professionals regarding benefits of RAASi according to indication and, in the context of developing hyperkalaemia, to identify barriers to optimal utilisation, and to explore options for improving management protocols, specifically in HFrEF. Methods An electronic survey was distributed in primary and secondary care setting in Hampshire, UK, to evaluate knowledge about benefits of RAASi, clinical response to varying level of potassium (K+), and decision-making using several clinical scenarios. Hyperkalaemia was graded into mild (serum K+ 5.5 – 5.9 mmol/L), moderate (serum K+ 6.0 – 6.4 mmol/L) or severe (serum K+ ≥ 6.5 mmol/L). Results Between November 2021 and January 2023, 300 questionnaires were completed by 274 (91%) physicians (varying grades of seniority), 22 (7%) non-medical prescribers, and 4 (1%) pharmacists. 80% were working in secondary care across different specialities (31 working in cardiology and 15 in nephrology). The majority were aware of prognostic benefit of angiotensin converting enzyme inhibitors (ACEi) in patients with HFrEF although this was lower for mineralocorticoid receptor antagonists (MRA) (Fig 1). Fewer than 2/3 of respondents were aware of impact of ACEi on symptoms. In the presence of mild hyperkalaemia, 75% and 88% of healthcare professionals would stop or reduce ACEi and MRA, respectively. In moderate or severe hyperkalaemia, this increased to 96% and 97%, respectively (Fig 2A-B). When considering the scenario of a patient with HFrEF who had ACEi stopped due to K+ 5.9 mmol/L, the potassium at which the responder would consider re-starting the ACEi ranged from 77% when potassium level < 5.5 mmol/L to 1% in moderate or severe hyperkalaemia (Fig 2C). 74% of healthcare professionals were familiar with local hyperkalaemia management protocol and 93% supported dedicated training on RAASi dose adjustment and hyperkalaemia management. Conclusion This survey, across a broad range of healthcare professionals, shows uncertainties around knowledge of benefits of RAASi in patients with HFrEF and there is sizeable variation in the prescribing response to degrees of hyperkalaemia. Given the voluntary nature of the survey, it is plausible that these data are biased towards individuals with greater understanding. Regardless, there is a need for continued education with a goal of improving patient-centred care.

A UK survey of young people's views on condom removal during sex.

Non-consensual condom removal (NCCR) refers to the act of removing a condom during sex without the other person's permission. It poses physical and psychological risks to women's health. Views and attitudes regarding this sexual practice are not well understood in the UK. This study aimed to explore young people's views on the morality and criminality of NCCR and how their views are affected by negative health outcomes, relationship status, and socio-demographic characteristics. A quantitative online survey of people aged 18-25 living in the UK was conducted. The survey consisted of two NCCR scenarios, varied by health outcome and relationship status, followed by questions about the morality and criminality of NCCR and respondents' socio-demographic characteristics. Statistical analysis included Chi-square testing and logistic regression modelling. Most of the 1729 respondents considered NCCR to be a violation of consent to sex (97.4%-98.1%), to be wrong (99.3%-99.5%), and to be sexual assault (86.3%-89.2%). Respondents were more likely to support prison time for NCCR if the victim got pregnant (52.1%) (rather than depressed (41.6%)) or was part of a casual hook-up (53.9%) (as opposed to a long-term dating relationship (47.2%). Respondents who were female or non-heterosexual were more likely to view NCCR as sexual assault and support prison as a penalty for NCCR. The majority of young UK adults in this survey considered condom removal during sex without the other person's permission to be a violation of consent, morally wrong, and a form of sexual assault. Support for prison as a penalty was lower. These findings can inform future campaigns on consent in sexual relationships and legislation to provide support for women affected by NCCR.

IPEM topical report: the first UK survey of cone beam CT dose indices in radiotherapy verification imaging for adult patients.

Cone beam CT is integral to most modern radiotherapy treatments. The application of daily and repeat CBCT imaging can lead to high imaging doses over a large volume of tissue that extends beyond the treatment site. Hence, it is important to ensure exposures are optimised to keep doses as low as reasonably achievable, whilst ensuring images are suitable for the clinical task. 
This IPEM topical report presents the results of the first UK survey of dose indices in radiotherapy CBCT. Dose measurements, as defined by the Cone Beam Dose Index (CBDIw), were collected along with protocol information for seven treatment sites. Where a range of optimised protocols were available in a centre, a sample of patient data demonstrating the variation in protocol use were requested. Protocol CBDIw values were determined from the average dosimetry data for each type of linear accelerator, and median CBDIw and scan length were calculated for each treatment site at each centre. Median CBDIw values were compared and summary statistics derived that enable the setting of national dose reference levels (DRLs). 
A total of 63 UK radiotherapy centres contributed data. The proposed CBDIw DRLs are; prostate 20.6 mGy, gynaecological 20.8 mGy, breast 5.0 mGy, 3D-lung 6.0 mGy, 4D-lung 11.8 mGy, brain 3.5 mGy and head/neck 4.2 mGy. However, large differences between models of imaging system were noted. Where centres had pro-active optimisation strategies in place, such as sized based protocols with selection criteria, dose reductions on the 'average' patient were possible compared with vendor defaults. Optimisation of scan length was noted in some clinical sites, with Elekta users tending to fit different collimators for prostate imaging (relatively short) compared with gynaecological treatments (longest). This contrasts with most Varian users who apply the default scan length in most cases.

An International Survey of the Diagnosis and Management of Ménière's Disease Amongst Otolaryngology Consultants.

Ménière's Disease (MD) is a disease that may be difficult to diagnose and manage. Our UK survey showed variability in the practice of UK Otolaryngology consultants. We hence surveyed Otolaryngology consultants internationally, to assess their confidence levels in diagnosing MD, their use of the AAO-HNS guidelines and current diagnostic and treatment modalities. An online questionnaire was distributed internationally over four weeks. The questionnaire asked respondents to anonymously rank their confidence in diagnosing MD, identify the minimum investigations required to make a diagnosis, describe their use of the AAO-HNS criteria, share their preferred treatment modalities for acute attacks, and state their 1st and 2nd-line preventative treatment options. A total of 173 responses were collected with 77% of respondents reporting high levels of confidence in diagnosing MD. Most respondents stated the minimum tests required were "History, Otoscopy, Clinical Vestibular testing, and Pure Tone Audiometry" although some chose as few as 1 test. Regarding the use of the AAO-HNS criteria, responses ranged from "always" (20.2%) to "never" (22.5%). Cinnarizine was the first-line treatment for acute attacks followed by betahistine. Betahistine (30.1%) and dietary restrictions (28.3%) were recommended almost equally as first-line preventative measures. The most popular second-line measure was intratympanic steroids injection (30.1%). Our survey revealed disparities in the diagnosis of MD and its management, like the results of our previously conducted UK survey. This suggests the need for an international consensus regarding the diagnosis and subsequent management strategies for this disease.

Describing Community-Based Nurses' Knowledge, Attitudes, and Practices in the Nutritional Care of Older Adults: Results of a UK Survey.

To ascertain current nutritional knowledge and training needs of community-based nurses caring for older adults in the United Kingdom. A descriptive cross-sectional, anonymized, online survey of nurses' knowledge, attitudes, and practices related to older adults' nutrition was developed. Community-based nurses working with older adults in the United Kingdom were recruited via social media and convenience sampling. Responses were received from 194 community-based nurses. Nutritional care was seen as a multidisciplinary responsibility by 62% of participants. Most undertook nutrition screening (93%), were confident in providing nutritional advice (83%), and ease of identifying those in need (88%) was high. However, some aspects of nutritional knowledge were less complete, including recommended daily intakes of protein (60% unsure) and fiber (52% unsure). High confidence in delivering nutritional advice contrasted with uncertainty around some aspects of nutritional knowledge, suggesting opportunities to improve training on the nutritional needs of older adults. [Journal of Gerontological Nursing, xx(xx), xx-xx.].

Undergraduate rheumatology teaching in the UK: a survey of current practice by teachers and students.

The last major UK survey of medical undergraduate rheumatology teaching was 25 years ago. This study aimed to describe current teaching practice, the perceptions of teachers and students and their engagement with Versus Arthritis teaching resources and future challenges and opportunities. Electronic surveys were distributed by e-mail and/or social media to relevant teachers and students identified within all 37 UK medical schools. A total of 34/37 (91%) teacher and 30/37 (81%) student surveys were returned. Compared with the last survey, the proportion of schools delivering rheumatology-identifiable teaching has fallen from 100% to 86% and the mean number of teaching days from 30 to 10. Rheumatology teaching is now more dispersed throughout the curriculum. Students preferred active learning methods such as simulation and expert patient teaching, while teachers preferred small-group teaching, online learning and lectures. The Versus Arthritis resources appeared underutilized by students but were considered useful. Most students thought rheumatology careers were not promoted within their medical school. A decrease in dedicated rheumatology teaching time was noted since the last survey 25 years ago. Greater promotion of rheumatology as a speciality and future career is required to maintain its professional identity and prevent marginalization.

973: Black, Asian, and ethnically diverse student experiences in radiotherapy education - A UK survey

973: Black, Asian, and ethnically diverse student experiences in radiotherapy education - A UK survey

UK survey of patient and caregiver perspectives on the impact of chronic kidney disease-associated anaemia

ObjectiveChronic kidney disease (CKD)-associated anaemia has substantial biopsychosocial impacts. This study explores the impact of CKD-associated anaemia and treatment preferences from the patient perspective.DesignCross-sectional survey.SettingAnonymised online survey implemented by Ipsos...

End-of-life care in multiple system atrophy: UK survey of patients and families

ObjectivesPeople with multiple system atrophy (MSA) and their carers may have many concerns about their disease and the future. This survey of people with MSA and their carers aimed to...

2247 Clinical pharmacists working in primary care supporting people living with dementia: a UK survey

Abstract Background Clinical pharmacists are increasingly working as part of primary care teams in UK. Many people living with dementia live at home with the support of primary care. Given the complexity of their health problems and their use of several medications, clinical pharmacists may potentially play a crucial role in their support. Aims To explore clinical pharmacists’ experiences of working in primary care with people living with dementia and identify any specific training needs to provide effective support for this patient group. Methods An online survey sent via email in 2023 through professional organisations, social media, and utilising research team contacts. The survey covered topics including clinical pharmacists’ background, experience of working with people with dementia, and training needs. Results 57 clinical pharmacists responded to the survey; the mean time working as a clinical pharmacist was 9.6 years (standard deviation 8.6) and within a primary care setting was 6.1 years (standard deviation 6.1). Just over three-quarters of respondents (n = 31, 77%) work with people living with dementia. While almost two thirds (n = 35, 61%) had undertaken training for dementia care, such training often lasted a few hours (less than a day) (n = 17, 49%). Most respondents (n = 39, 89%) wanted further information or training; including non-pharmacological interventions to improve quality of life in dementia and how to support carers and relatives. Practice challenges reported included a lack of face-to-face consultations and getting assurance that the patient could safely take medications. Conclusions These findings indicate an interest in dementia care, a willingness to undertake further training but practice uncertainties that suggest a system approach might be beneficial.

Changing labour migration flows after Brexit: An analysis of UK survey and administrative data

Changing labour migration flows after Brexit: An analysis of UK survey and administrative data

The Role of Fear, Sadness, and Anger in Shaping Support for Climate Policies: Evidence from a UK Survey Experiment

The Role of Fear, Sadness, and Anger in Shaping Support for Climate Policies: Evidence from a UK Survey Experiment

Engagement in sustainable horticulture is associated with greater perceived health benefits amongst gardeners

Gardens are unique ecosystems with the potential to deliver an array of important environmental and health benefits, particularly for urban populations. A large body of research has established that contact with nature and activities within green spaces (including gardening) are beneficial for our physical, mental and social health. An adjacent body of research has explored whether and how pro-environmental behaviours are also linked to positive outcomes for human health and wellbeing. But published research has not yet established whether pro-environmental behaviour in the context of gardening (“sustainable horticulture”) further increases the health and wellbeing benefits that gardeners derive. This paper uses evidence from a nationally representative UK survey (n=2086) conducted in August 2021 to explore this question. We used multiple regression analysis to quantitatively demonstrate that a positive association between gardening more sustainably and perceived health benefits from gardening exists at the population level amongst UK adults. This finding implies the possibility that promoting environmentally-minded gardening techniques may lead to an increase in the health and wellbeing benefits that gardeners can derive from their actions. The paper puts forth a range of potential mechanisms that could explain the identified positive association between sustainable gardening and perceived health benefits and identifies related policy implications.

Who has an R&D investment opportunity? Who goes ahead? How much do they invest?

We know a lot about how much firms invest in R&D, but less about the critical first step which is a potential R&D opportunity. We use a large UK survey and detailed case study evidence to establish the chain of events from opportunity to the investment choice. Our results show that 34% of firms had identified an R&D investment opportunity. Realised R&D investment projects were typically between £100,000 and £1/2 m over a 5‐year window. The dominant factors were firm size, industry, equity investment, knowledge and absorptive capacity. The process of R&D management also had an outward, market facing aspect, and an inward, engineering and financial aspect that were often conducted in parallel.

The challenges of managing direct oral anticoagulants and acute hip fracture surgery: a UK survey

The challenges of managing direct oral anticoagulants and acute hip fracture surgery: a UK survey

The adverse effects of vaping in young people

Vapes or e-cigarettes are battery operated devices that heat a liquid until it becomes a vapour, which is inhaled. Typically, e-liquids contain nicotine, different flavourings, and propylene glycol. Vaping devices are either disposable vapes or rechargeable. Vapes were initially developed as stop smoking aid but they have now become a recreational product popular among teenagers.Vaping has increased at an alarming rate among teenagers and young adults in Ireland. The European Schools Project for Alcohol and Other Drugs (ESPAD) survey 2019 showed that almost 4 in 10 Irish 16-year-olds had tried vaping and 15 % currently use them. More worrying is the dramatic rise in the use of disposable vapes in recent years. An Action on Smoking and Health (ASH) UK survey data revealed a 9-fold increase from 2021 to 2023 in their use (7.7 % to 69 %) among 11–17-year-old vapers.A combination of clever marketing by vaping companies, a strong social media presence, attractive flavours and easy accessibility has contributed to the increasing use of vapes by young people.Exposure of children and adolescents to nicotine in vaping solutions can lead to long-term negative impacts on brain development, as well as addiction. Many teenagers who vape experience poor concentration, anxiety, mood disorders and sleep disturbance. A paper from NEJM in 2022 reported a case series where chronic vaping resulted in small airway fibrosis of the airways. A systematic review conducted in 2021 concluded that teenager vapers were three to five times more likely to take up tobacco smoking when compared with non-vapers.Strong legislation is required to ban the sale of disposable vapes to teenagers along with controls on marketing online. Healthcare Professionals should ask and counsel their patients about vaping. Increased public awareness and education for Health care professionals on teenage vaping needs to be addressed.Vaping has become a global public health issue that must be addressed urgently.

Healthcare professionals’ knowledge, understanding and confidence to manage chronic pain after cancer treatment: A UK survey

IntroductionHealthcare professionals are vital in preparing people living with and beyond cancer about the risks of chronic pain after cancer treatment. To do so, healthcare professionals need to be knowledgeable and confident about chronic pain after cancer treatment, yet little is known about their understanding or confidence of this common long-term and late side effect of cancer treatment. AimTo identify healthcare professionals’ knowledge and understanding of chronic pain after cancer treatment and consider how confident they are to inform, listen and signpost people living with and beyond cancer to appropriate information and support. MethodA cross sectional online survey was distributed to healthcare professionals in the UK via cancer and primary care networks, cancer alliances and social media. The survey consisted of four domains: 1) knowledge and understanding, 2) information and support, 3) confidence and 4) barriers. Quantitative data were analysed with descriptive statistics and free text comments were analysed using qualitative content analysis. ResultsHealthcare professionals reported limited knowledge and understanding of chronic pain after cancer treatment. Healthcare professionals lacked confidence to talk to people about chronic pain after cancer treatment and viewed their lack of knowledge as a barrier. Additional barriers included ‘Limited service provision’, ‘Conflict between services’, ‘Not my role’ and ‘Challenges in diagnosing chronic pain in cancer survivors’. ConclusionChronic pain after cancer can be a significant issue for those living with and beyond cancer, yet healthcare professionals report limited knowledge of it or understanding of the impact. More education is needed to increase healthcare professionals’ knowledge and confidence in chronic pain after cancer treatment.

#1204 Measuring needling experience: development and validation of the Needling Patient Reported Experience Measure (NPREM)

Abstract Background and Aims Most people on haemodialysis rely on having reliable access to their vascular system, often via surgically created arteriovenous fistula or graft. At the beginning of each dialysis session, needles must be inserted. While ‘needling’ is a key step, an annual UK survey shows that needling is one of the lowest scoring areas of reported experience for individuals receiving haemodialysis in a kidney centre or satellite unit. Qualitative research indicates that needling can be painful and cause anxiety. Although an emerging area of research, no validated measures exist which assess patient reported experience of needling. We aimed to develop a questionnaire which reliably measures needling experience. The Needling Patient Reported Experience Measure (NPREM) was developed over multiple phases consisting of qualitative interviews with patients, item generation involving a multidisciplinary expert group including experts by experience, cognitive interviewing and pilot testing. Here we report the results of the final validation phase. Methods Seven NHS kidney centres participated in the validation phase (aiming for 500 participants). Between February-April 2023, participants completed either online or paper versions of the questionnaire. A subset of participants (aiming for 80-120) completed a follow-up questionnaire pack (NPREM, Change of Circumstances) 2-4 weeks after the first to assess the reliability of the scale over time. Analyses included a full evaluation of the scale psychometric properties and factor analyses to assess dimensional structure. Correlations with other validated measures (Vascular Access Quality of Life [VASQoL], EuroQol 5 Dimension [EQ5D-5L], and Patient Activation Measure [PAM]) were used to assess the convergent and divergent validity of the NPREM. Results 468 people participated (sample characteristics: male 66%, mean age 66 years (SD 14), White 75%, access via fistula 95%, first access 76%), of which 99 completed the follow-up. Overall, the NPREM showed good internal consistency (Cronbach's alpha = 0.94) and moderate to strong inter-item correlations. Factor analyses indicated that needling experience was a unidimensional construct, with one strong, main factor. Follow-up scores were strongly correlated (r = 0.89) with participants’ initial NPREM responses, demonstrating high reliability. Evidence of convergent validity was seen in the strong correlations between the NPREM and 1) the VASQoL (r = 0.60) and 2) the Overall Needling Experience question (r = 0.79). NPREM did not correlate with the EQ-5D (r = −0.31), the EQ-5D overall health (r = 0.24) or PAM (0.17), demonstrating divergent validity. The research team reviewed all items and themes reaching a consensus on items included, resulting in the validated 28-item NPREM (v 1.0), across five themes of care (Communicating with the Team, My Fistula/Graft and Needling, Steps in Needling, Working Together, My Personal Experience) plus Overall Needling Experience. Conclusion These results indicate that the NPREM offers a robust needling-specific tool to measure patient experience in those receiving haemodialysis. It addresses a gap by offering a way for kidney care providers to assess needling experience, both as a whole and across themes of care, which may facilitate meaningful service improvements. When published, the NPREM will be publicly available and free to use.

Propensity to spend and borrow at a time of high pressure: the role of the meaning of Christmas and other psychological factors

In countries where Christmas is celebrated, people are under pressure in the pre-Christmas period to spend on gift giving and socializing. In two surveys we investigated the role of the meaning of Christmas and other psychological factors in predicting propensity to spend and to borrow at Christmas (UK, N = 190; Norway, N = 234). Factor analysis identified three components of the meaning of Christmas: financial concerns, indulgence, and social aspects. In both surveys: (1) experienced financial hardship predicted lower propensity to spend and greater propensity to borrow; (2) more proactive money management practices predicted lower propensity to borrow; (3) material values predicted both propensity to spend and propensity to borrow; and (4) seeing Christmas as a time for indulgence, experiencing more negative affect, or less positive affect, predicted greater propensity to spend. Additionally: (1) in the UK survey, participants who said that lately they had been feeling more negative (more angry, sad etc.) had a greater propensity to borrow; and (2) in the Norway survey, an obligation gift motivation predicted propensity to spend. The findings show that in addition to experienced financial hardship and proactive money management practices, the psychological factors of material values, affect, and gift motivation play significant roles in propensity to spend and/or borrow at this time of high pressure. We discuss implications for theory and financial interventions.

Uncovering associations between interest in One Health and pre-existing conditions and behaviours: Evidence from a UK survey

This paper endeavours to unveil individual characteristics associated with an interest in One Health. Through the distribution of an online survey randomly distributed among the United Kingdom population, we discovered significant correlations between pre-existing attitudes towards and relationships with nature and animals and interest in One Health, which is quantified by the number of additional pages of One Health information participants agreed to view at the survey's conclusion. Additionally, individuals with poorer mental health demonstrated a higher level of interest in One Health. The findings suggest that interest in One Health and people's connections with nature and animals are driven by the same personal preferences. These insights point towards the potential for more targeted communication strategies to specific groups, facilitating more effective promotion of the One Health concept.