UK Health Research Articles

Clinical Exercise Physiologists in the United Kingdom: Multi-stakeholder Perspectives

ABSTRACT Background In the UK Academy of Healthcare Science, registered clinical exercise physiologists (CEPs) receive specialist, master’s-level education and training in the knowledge and skills required to work with chronic and complex medical conditions based on a curriculum that was benchmarked against Australian standards. The aim of this study was to explore the perspectives of multiple stakeholders to identify the key knowledge and skills required for a registered CEP to work effectively in the United Kingdom and inform future iterations of the accredited curriculum. Methods Semistructured interviews of academics (n = 5), CEPs (n = 5) and service users (n = 5) explored perspectives of the key knowledge and skills required of a CEP in UK health care. Reflexive thematic analysis was performed to identify the key knowledge and skills of a UK-registered CEP that all the stakeholders deemed important. Results Six themes were identified from the interviews. The CEP-specific themes were identified as pathophysiology, physiological assessments, exercise prescription, exercise delivery, and behavior change and education. Clinical practice was recognized as the overarching concept that linked all the CEP-specific themes together. Conclusion This study provides the first understanding of the knowledge and skills required for a CEP to work effectively in the UK health care system, in addition to providing research evidence and insight to the next iterations of the Clinical Exercise Physiology UK (CEP-UK) curriculum framework. Future research should focus on establishing a more comprehensive, definitive list of the knowledge and skills of a UK CEP that will contribute to subsequent versions of the CEP-UK curriculum framework.

Assessments and developments in constructing a National Health Index for policy-making, in the UK

Abstract Composite indicators are useful for summarizing and comparing changes among different communities. The UK Office for National Statistics has created an annual England Health Index (2015–2018) comprised of three main health domains—lives, places, and people—to monitor health over time and across different geographical areas and evaluate the nation’s health. We reviewed the conceptual coherence and statistical requirements, focusing on three main steps: correlation analysis at different levels, comparison of the implemented weights, and a sensitivity and uncertainty analysis. Based on the results, we have highlighted features that have improved the statistical requirements of the forthcoming UK Health Index.

‘At least you got to see people when you went out for a walk’: older adults’ lived, embodied experiences during COVID-19 times in the United Kingdom

ABSTRACT The COVID-19 pandemic presented myriad global challenges, placing unprecedented pressure on health services. Currently, there is limited qualitative research exploring the ‘felt’ impact of the pandemic on older adults’ health experiences and wider social life. Here, we report on the embodied experiences of older adults (65 and above), before, during and after the COVID-19 pandemic lockdowns in the UK, to chart the physical, social, and mental-health challenges. A figurational sociological lens was adopted to examine data from semi-structured interviews with 18 older adults, face-to-face or via telephone/video call. Notes from follow-up conversations were also recorded. Combined data were analysed thematically. Salient themes cohered around: physical activity engagement; health experiences; the role of family, friends, and community; and the role of modern technology. Our results highlight how older adults reported the felt benefits of increased PA during lockdowns, but also the negative impacts of treatment delays on experiences of hospital services. Participants also recounted how new social community connections were forged during lockdowns. Saliently, we identified a need to support older adults with modern technology so as to capture its potential to modernise, expand, and personalise healthcare within UK health services.

Responsibility for the Environmental Impact of Data-Intensive Research: An Exploration of UK Health Researchers

Concerns about research’s environmental impacts have been articulated in the research arena, but questions remain about what types of role responsibilities are appropriate to place on researchers, if any. The research question of this paper is: what are the views of UK health researchers who use data-intensive methods on their responsibilities to consider the environmental impacts of their research? Twenty-six interviews were conducted with UK health researchers using data-intensive methods. Participants expressed a desire to take responsibility for the environmental impacts of their research, however, they were unable to consolidate this because there were often obstacles that prevented them from taking such role responsibilities. They suggested strategies to address this, predominantly related to the need for regulation to monitor their own behaviour. This paper discusses the implications of adopting such a regulatory approach as a mechanism to promote researchers’ role responsibilities using a neo-liberal critique.

Non-osteoporotic fractures are associated with increased risk of subsequent major osteoporotic fractures

SummaryWe studied the association between non-osteoporotic fractures and future major osteoporotic fractures, using UK health records. Non-osteoporotic fractures were found to increase the risk of major osteoporotic fractures, although to a lesser extent than osteoporotic fractures. This highlights the importance of considering all previous fractures in assessing future fracture risk.PurposePrevious studies demonstrated that osteoporotic fractures—minor and major—increase the risk for future major osteoporotic fractures; we test whether non-osteoporotic fractures are also associated with such increased risk.MethodsThe study is a retrospective cohort study using UK primary care electronic health records. Exposure groups were defined according to fracture location prior to the year 2011 (index date): major, minor, and non-osteoporotic. The outcome of incident major osteoporotic fractures following the index date was compared between the exposure groups and the general population.ResultsThe general study population included 1,951,388 patients. The exposure groups included 39,931 patients with a prior major osteoporotic fracture, 19,397 with a prior minor osteoporotic fracture, and 50,115 patients with a prior non-osteoporotic fracture. The standardized Incidence Rate Ratio for future major osteoporotic fractures was 2.73 (95% confidence interval: 2.64–2.82), 2.43 (2.32–2.54), and 1.83 (1.74–1.92), respectively.ConclusionNon-osteoporotic fractures are significantly associated with increased risk for future major osteoporotic fractures relative to the general population, yet to a lesser extent compared to major and minor osteoporotic fractures.

Who should value children's health and how? An international Delphi study

Valuing child health necessitates normative methodological decisions on whose preferences should be elicited and who should be imagined as experiencing impaired health. Formal guidance is limited and expert consensus unclear. This study sought to establish the degree of consensus among expert stakeholders on normative issues of who to ask and who should be imagined when valuing child health (7–17 years) to inform UK health technology assessment. Sixty-two experts (n = 47 in Round 2) from 18 countries participated in a modified, two-round online Delphi survey (Round 1: May-June 2023; Round 2: September-October 2023). Participants were expert stakeholders in child health valuation, including academics (n = 38); industry/consultancy representatives (including the charity/not-for-profit sector; n = 13); and UK policy/government representatives (n = 11). The Delphi survey was modified between rounds and consisted of 9-point Likert, categorical, multiple-choice, and free-text questions on normative issues in valuing child health. Responses were analysed descriptively and thematically. An a priori criterion of ≥75% agreement was established for formal consensus, while areas approaching consensus (≥70% agreement) and without consensus were identified as a future research primer. Consensus was observed that older adolescents (aged 16–17 years) and adults (18+ years) should be asked to value child health states. There was consensus that the former should think about themselves when valuing the health states and the latter should imagine a child of some form (e.g., imagining themselves as a child or another hypothetical child). However, no consensus was evident on what form this should take. Several other methodological issues also reached consensus. These findings are largely consistent with recent views elicited qualitatively from members of the public and other stakeholders on normative issues in valuing child health. The results mean that, contrary to what has been done in previous child health valuation studies, efforts should be made to involve both older adolescents (16+ years) and adults in child health valuation.

Epidemiological trends in viral meningitis in England: Prospective national surveillance, 2013–2023

BackgroundIn the conjugate vaccine era, viruses are the most common cause of meningitis. Here, we evaluated epidemiological trends in laboratory-confirmed viral meningitis across all age-groups over an 11-year period in England. MethodsIn England, hospital laboratories routinely report laboratory-confirmed infections electronically to the UK Health Security Agency. Records of positive viral detections in cerebrospinal fluid during 2013-2023 were extracted. Incidence rates with confidence intervals were calculated using mid-year resident population estimates. ResultsThere were 22,114 laboratory-confirmed viral meningitis cases, including 15,299 cases during 2013-19 (pre COVID-19), with a gradual increase in incidence from 3.5/100,00 (95%CI, 3.3-3.6) to 3.9/100,000 (95%CI, 3.6-4.1). During 2020-21 when pandemic restrictions were in place, there were 2,061 cases (1.8/100,000; 1.7 - 1.9), which increased to 4,754 (4.2/100,000; 4.0-4.3) during 2022-23 (post pandemic restrictions).Infants aged <3 months accounted for 39.4% (8,702/22,048) of all cases, with a stable incidence 2013-19 (504/100,000, 95%CI: 491-517), followed by a significant decline during 2020-21 (204/100,000; 188-221) and then an increase during 2022-23 (780/100,000; 749-812), with enteroviruses being the commonest cause (84.9%, 7387/8,702; 424.74/100,000; 95%CI, 415.12-434.51), followed by parechoviruses (9.1%, 792/8702; 45.54/100,000; 95%CI, 42.42-48.82) and herpes simplex virus (4.4%, 380/8702; 21.85/100,000; 95%CI, 19.71-24.16). Pandemic restrictions were associated with significant declines in the incidence of enterovirus (77.7%) and parechoviruses (64% lower), with rebounds after societal restrictions lifted. ConclusionsRates of viral meningitis have returned to pre-pandemic levels since societal restrictions were lifted. The highest incidence of viral meningitis remains in infants aged <3 months and most commonly due to enteroviral infection.

Prescribing hepatitis A vaccines in the UK

Hepatitis A is a liver infection caused by a virus that is spread by eating or drinking contaminated food and water or from direct contact (including some types of sexual contact) with an infected person. Hepatitis A virus infection causes liver inflammation that usually results in a mild illness. More rarely, severe symptoms with the potential to develop into liver failure can occur. UK health professionals involved in prescribing hepatitis A vaccines should make sure they are familiar with appropriate vaccine guidance and use current UK hepatitis A vaccine recommendations for international travel as part of their risk assessment. Although most people respond well to the hepatitis A vaccine, the importance of food and water hygiene should still be emphasised to all UK travellers visiting hepatitis A endemic areas.

HAP-FAST: a feasibility study incorporating qualitative, mechanistic and costing sub-studies alongside a randomised pilot trial comparing chest x-ray to low-dose CT scan and empirical antibiotics to antibiotics guided by the BIOFIRE® FILM ARRAY® pneumonia plus panel in adults with suspected non-ventilator-associated hospital-acquired pneumonia

IntroductionNon-ventilator-associated hospital-acquired pneumonia (nv-HAP) is the most common healthcare-associated infection (HCAI), is associated with high mortality and morbidity and places a major burden on healthcare systems. Diagnosis currently relies on...

A large-scale and PCR-referenced vocal audio dataset for COVID-19

The UK COVID-19 Vocal Audio Dataset is designed for the training and evaluation of machine learning models that classify SARS-CoV-2 infection status or associated respiratory symptoms using vocal audio. The UK Health Security Agency recruited voluntary participants through the national Test and Trace programme and the REACT-1 survey in England from March 2021 to March 2022, during dominant transmission of the Alpha and Delta SARS-CoV-2 variants and some Omicron variant sublineages. Audio recordings of volitional coughs, exhalations, and speech were collected in the ‘Speak up and help beat coronavirus’ digital survey alongside demographic, symptom and self-reported respiratory condition data. Digital survey submissions were linked to SARS-CoV-2 test results. The UK COVID-19 Vocal Audio Dataset represents the largest collection of SARS-CoV-2 PCR-referenced audio recordings to date. PCR results were linked to 70,565 of 72,999 participants and 24,105 of 25,706 positive cases. Respiratory symptoms were reported by 45.6% of participants. This dataset has additional potential uses for bioacoustics research, with 11.3% participants self-reporting asthma, and 27.2% with linked influenza PCR test results.

Estimation of the direct health and indirect societal costs of diabetes in the UK using a cost of illness model.

The direct cost of diabetes to the UK health system was estimated at around £10 billion in 2012. This analysis updates that estimate using more recent and accurate data sources. A pragmatic review of relevant data sources for UK nations was conducted, including population-level data sets and published literature, to generate estimates of costs separately for Type 1, Type 2 and gestational diabetes. A comprehensive cost framework, developed in collaboration with experts, was used to create a population-based cost of illness model. The key driver of the analysis was prevalence of diabetes and its complications. Estimates were made of the excess costs of diagnosis, treatment and diabetes-related complications compared with the general UK population. Estimates of the indirect costs of diabetes focused on productivity losses due to absenteeism and premature mortality. The direct costs of diabetes in 2021/22 for the UK were estimated at £10.7 billion, of which just over 40% related to diagnosis and treatment, with the rest relating to the excess costs of complications. Indirect costs were estimated at £3.3 billion. Diabetes remains a considerable cost burden in the UK, and the majority of those costs are still spent on potentially preventable complications. Although rates of some complications are reducing, prevalence continues to increase and effective approaches to primary and secondary prevention continue to be needed. Improvements in data capture, data quality and reporting, and further research on the human and financial implications of increasing incidence of Type 2 diabetes in younger people are recommended.

Real-world service costs for neovascular-AMD clinics in the United Kingdom: structured literature review and scenario analysis

Objective Current cost-effectiveness analyses (CEA) emphasize drug costs as the differentiator between NICE recommended anti-VEGF treatments but may neglect real-world non-drug costs of running nAMD services in the UK. To address this, this study identified real-world non-drug service cost items relevant to UK NHS nAMD clinics, including costs arising from operational strain (demand exceeding capacity). Methods Cost items were identified by a structured literature review of peer-reviewed and grey literature, and an expert panel of 10 UK-based ophthalmologists with relevance to real-world practice. These items underwent meta-synthesis and were then determined in a consensus exercise. Results Of 237 cost items identified, 217 (91.6%) met the consensus threshold of >0.51 and were included in the nAMD Service Non-Drug Cost Instrument (nAS). Sensitivity of cost items taken from UK Health Technology Assessment (HTA) using the nAS as the reference standard was low (HTAmin: 1.84%, 95% CI 0.50–4.65%; HTAmax: 70.51%, 95% CI 63.96–76.49%). False negative rates showed variable likelihood of misclassifying a service by cost burden depending on prevalence. Scenario analysis using cost magnitudes estimated annual per-patient clinic cost at £845 (within capacity) to £13,960 (under strain) compared to an HTAmin estimate of £210. Accounting for cost of strain under an assumed 50% increase in health resource utilization influenced cost-effectiveness in a hypothetical genericisation scenario. Conclusion Findings suggested that HTA underestimates UK NHS nAMD clinic cost burden with cost of strain contributing substantial additional unmeasured expense with impact on CEA. Given potential undertreatment due to strain, durability is suggested as one of the relevant factors in CEA of nAMD anti-VEGF treatments due to robustness under limited capacity conditions affecting UK ophthalmology services.

Transdisciplinary Skills for AI Ecosystems: Using Future Visioning to Collaboratively Unpack Skills in UK Health and Emergency Response Scenarios

Transdisciplinary practices in artificial intelligence (AI) requires good methodological techniques to bring researchers together from diverse disciplines. Different fields and traditions each may have an impact on the greater AI ecosystem, however, to properly gauge this impact, and include diverse voices, research methodologies must evolve to adopt new methods and techniques. To understand the shifting demands for new skills, we conducted a transdisciplinary workshop, bringing together stakeholders from industry, government and academia, by engaging with scenarios in healthcare and emergency response, using future visioning to imagine new skill requirements across job roles. We found that future visioning was a useful methodology to help frame discussions in a manner conducive to eliciting qualitative evidence of different policy approaches. Beyond individual skills, we propose the Human-AI Synergy Matrix as a collaborative competency framework, which integrates technical, professional, and strategic skills with levels of engagement such as awareness, communication, synergy, governance, and transformation. The matrix aims to facilitate evaluation and understanding of skills and critical issues in human-AI collaboration within AI ecosystems, emphasizing the need to address broader challenges in an interconnected manner.

Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study.

Asynchronous outpatient patient-to-provider communication is expanding in UK health care, requiring evaluation. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation service from dermatology (deployed in May 2020) to gastroenterology and pain management clinics. We conducted a mixed methods study using staff, patient, and public perspectives and National Health Service (NHS) numerical data to obtain a rounded picture of innovation as it happened. Focus groups (3 web-based and 1 face-to-face; n=22) assessed public readiness for this service, and 14 interviews with staff focused on service design and delivery. The service's effects were examined using NHS Grampian service use data, a patient satisfaction survey (n=66), and 6 follow-up patient interviews. Survey responses were descriptively analyzed. Demographics, acceptability, nonattendance rates, and appointment outcomes of users were compared across levels of area deprivation in which they live and medical specialties. Interviews and focus groups underwent theory-informed thematic analysis. Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favorable setting and organizational assistance, it was complicated. Key implementation difficulties included pandemic-induced technical integration delays, misalignment with existing administrative processes, and discontinuity in project management. The pain management clinic began asynchronous consultations (digital appointments) in December 2021, followed by the gastroenterology clinic in February 2022. Staff quickly learned how to explain and use this service. It was thought to function better for pain management as it fitted preexisting practices. From May to September 2022, the dermatology (adult and pediatric), gastroenterology, and pain management clinics offered 1709 appointments to a range of patients (n=1417). Digital appointments reduced travel by an estimated 44,712 miles (~71,956.81 km) compared to the face-to-face mode. The deprivation profile of people who chose to use this service closely mirrored that of NHS Grampian's population overall. There was no evidence that deprivation impacted whether digital appointment users subsequently received treatment. Only 18% (12/66) of survey respondents were unhappy or very unhappy with being offered a digital appointment. The benefits mentioned included better access, convenience, decreased travel and waiting time, information sharing, and clinical flexibility. Overall, patients, the public, and staff recognized its potential as an NHS service but highlighted informed choice and flexibility. Better communication-including the use of the term assessment instead of appointment-may increase patient acceptance. Asynchronous pain management and gastroenterology consultations are viable and acceptable. Implementing this service is easiest when existing administrative processes face minimal disruption, although continuous support is needed. This study can inform practical strategies for supporting staff in adopting asynchronous consultations (eg, preparing for nonlinearity and addressing task issues). Patients need clear explanations and access to technical support, along with varied consultation options, to ensure digital inclusion.

Effect of synthetic CT on dose-derived toxicity predictors for MR-only prostate radiotherapy.

Toxicity-driven adaptive radiotherapy (RT) is enhanced by the superior soft tissue contrast of magnetic resonance (MR) imaging compared with conventional computed tomography (CT). However, in an MR-only RT pathway synthetic CTs (sCT) are required for dose calculation. This study evaluates 3 sCT approaches for accurate rectal toxicity prediction in prostate RT. Thirty-six patients had MR (T2-weighted acquisition optimized for anatomical delineation, and T1-Dixon) with same day standard-of-care planning CT for prostate RT. Multiple sCT were created per patient using bulk density (BD), tissue stratification (TS, from T1-Dixon) and deep-learning (DL) artificial intelligence (AI) (from T2-weighted) approaches for dose distribution calculation and creation of rectal dose volume histograms (DVH) and dose surface maps (DSM) to assess grade-2 (G2) rectal bleeding risk. Maximum absolute errors using sCT for DVH-based G2 rectal bleeding risk (risk range 1.6% to 6.1%) were 0.6% (BD), 0.3% (TS) and 0.1% (DL). DSM-derived risk prediction errors followed a similar pattern. DL sCT has voxel-wise density generated from T2-weighted MR and improved accuracy for both risk-prediction methods. DL improves dosimetric and predicted risk calculation accuracy. Both TS and DL methods are clinically suitable for sCT generation in toxicity-guided RT, however, DL offers increased accuracy and offers efficiencies by removing the need for T1-Dixon MR. This study demonstrates novel insights regarding the effect of sCT on predictive toxicity metrics, demonstrating clear accuracy improvement with increased sCT resolution. Accuracy of toxicity calculation in MR-only RT should be assessed for all treatment sites where dose to critical structures will guide adaptive-RT strategies. Patient data were taken from an ethically approved (UK Health Research Authority) clinical trial run at Guy's and St Thomas' NHS Foundation Trust. Study Name: MR-simulation in Radiotherapy for Prostate Cancer. ClinicalTrials.gov Identifier: NCT03238170.

An evaluation of the national testing response during the COVID-19 pandemic in England: a multistage mixed-methods study protocol

IntroductionIn 2020, the UK government established a large-scale testing programme to rapidly identify individuals in England who were infected with SARS-CoV-2 and had COVID-19. This comprised part of the UK...

EE309 Cost-Effectiveness Analysis of Velmanase Alfa in Patients with Alpha Mannosidosis from a UK Health Service Perspective

EE309 Cost-Effectiveness Analysis of Velmanase Alfa in Patients with Alpha Mannosidosis from a UK Health Service Perspective

The NHS at 75: The state of UK health policy. By M.Exworthy, R.Mannion, and M.Powell, Bristol: Policy Press. 2023. pp. 294. £27.99. ISBN: 978‐1447368601

The NHS at 75: The state of UK health policy. By M.Exworthy, R.Mannion, and M.Powell, Bristol: Policy Press. 2023. pp. 294. £27.99. ISBN: 978‐1447368601

Diagnostic overshadowing of mental health conditions in UK health care

Purpose Diagnostic overshadowing (DO) may be contributing to the worsening physical health outcomes for people diagnosed with mental health (MH) conditions. DO is a phenomenon researched worldwide, but there has been no systematic review of the evidence for its prevalence in UK health care. This paper aims to add to this body of knowledge, expanding the understanding of what factors are contributing to the poor physical well-being of people with diagnosed MH conditions. Design/methodology/approach A systematic search of three databases was conducted and after evaluation, three studies were selected for the review. Findings DO was found to have a high prevalence with structural, staffing and patient issues identified through a thematic analysis. Contemporary evidence shows themes identified are still impacting UK health care. Collaborative working across mental and physical health teams, thorough and lengthy assessments, and improved education for physical health care staff have been cited as mitigating factors to this practice. Originality/value To the best of the author’s knowledge, this paper is the first review of the evidence for diagnostic overshadowing taking place in UK health care.

A Profile of Influenza Vaccine Coverage for 2019-2020: Database Study of the English Primary Care Sentinel Cohort.

Innovation in seasonal influenza vaccine development has resulted in a wider range of formulations becoming available. Understanding vaccine coverage across populations including the timing of administration is important when evaluating vaccine benefits and risks. This study aims to report the representativeness, uptake of influenza vaccines, different formulations of influenza vaccines, and timing of administration within the English Primary Care Sentinel Cohort (PCSC). We used the PCSC of the Oxford-Royal College of General Practitioners Research and Surveillance Centre. We included patients of all ages registered with PCSC member general practices, reporting influenza vaccine coverage between September 1, 2019, and January 29, 2020. We identified influenza vaccination recipients and characterized them by age, clinical risk groups, and vaccine type. We reported the date of influenza vaccination within the PCSC by International Standard Organization (ISO) week. The representativeness of the PCSC population was compared with population data provided by the Office for National Statistics. PCSC influenza vaccine coverage was compared with published UK Health Security Agency's national data. We used paired t tests to compare populations, reported with 95% CI. The PCSC comprised 7,010,627 people from 693 general practices. The study population included a greater proportion of people aged 18-49 years (2,982,390/7,010,627, 42.5%; 95% CI 42.5%-42.6%) compared with the Office for National Statistics 2019 midyear population estimates (23,219,730/56,286,961, 41.3%; 95% CI 4.12%-41.3%; P<.001). People who are more deprived were underrepresented and those in the least deprived quintile were overrepresented. Within the study population, 24.7% (1,731,062/7,010,627; 95% CI 24.7%-24.7%) of people of all ages received an influenza vaccine compared with 24.2% (14,468,665/59,764,928; 95% CI 24.2%-24.2%; P<.001) in national data. The highest coverage was in people aged ≥65 years (913,695/1,264,700, 72.3%; 95% CI 72.2%-72.3%). The proportion of people in risk groups who received an influenza vaccine was also higher; for example, 69.8% (284,280/407,228; 95% CI 69.7%-70%) of people with diabetes in the PCSC received an influenza vaccine compared with 61.2% (983,727/1,607,996; 95% CI 61.1%-61.3%; P<.001) in national data. In the PCSC, vaccine type and brand information were available for 71.8% (358,365/498,923; 95% CI 71.7%-72%) of people aged 16-64 years and 81.9% (748,312/913,695; 95% CI 81.8%-82%) of people aged ≥65 years, compared with 23.6% (696,880/2,900,000) and 17.8% (1,385,888/7,700,000), respectively, of the same age groups in national data. Vaccination commenced during ISO week 35, continued until ISO week 3, and peaked during ISO week 41. The in-week peak in vaccination administration was on Saturdays. The PCSC's sociodemographic profile was similar to the national population and captured more data about risk groups, vaccine brands, and batches. This may reflect higher data quality. Its capabilities included reporting precise dates of administration. The PCSC is suitable for undertaking studies of influenza vaccine coverage.