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The objective of this study is to examine the contribution of pain catastrophising to Axial Spondyloarthritis (axSpA) patient's physical function and to test the mediating role of fear of movement, and uniquely, the contribution of competence frustration to the fear-avoidance model. Participants (N = 98, 70% female, M age = 45.62, SD 12.16) completed an online survey (December 2020–May 2021) distributed in the United Kingdom via the National Axial Spondyloarthritis Society (n ≈ 3500; NASS, 2019). The PROCESS SPSS macro was used to test three mediation models using percentile bootstrap 95% confidence intervals (PBCI). A significant indirect effect on the relationship between pain and physical function via fear of movement (β = 0.10, 95% PBCI = 0.030–0.183) was observed (Model 1). Model 2 showed the relationship between pain catastrophising and physical function to be significantly mediated by fear of movement (β = 0.16, 95% PBCI = 0.005–0.322). Finally, Model 3 showed a significant indirect effect on the relationship between pain catastrophising and physical function via competence frustration (β = 0.15, 95% PBCI = 0.014–0.309) but not through fear of movement (β = 0.062, 95% PBCI = − 0.134 to 0.248). To our knowledge, this is the first study to examine and demonstrate the unique contribution of competence need frustration to the Fear-avoidance model in people that live with axSpA. Identifying modifiable factors that contribute to disease outcomes such as physical function can improve the care and quality of life for people living with a disease currently without a cure. [ABSTRACT FROM AUTHOR]

The General Medical Council (GMC) issues annual surveys to all doctors within the United Kingdom (UK) in a formal postgraduate training scheme. This facilitates the monitoring of experiences for quality assurance purposes. Low job satisfaction has been associated with heightened levels of burnout and staff turnover, alongside deteriorating clinical care and productivity levels. We gathered and extracted data from the publicly available online GMC reporting tool. Data ranged from 2013 to 2023 and spanned 12 postgraduate surgical training programmes across all 18 indicators available. In total, 198 individual metrics were recorded, in addition to burnout. We conducted trend analysis and yearly average mean scores for individual metrics, burnout and geographical differences for 141 individual training programmes within the 16 training regions. Of the 198 metrics analysed, 83 (42 ​%) were found to have statistically significant negative trends (P ​< ​0.05), in comparison to 24 (12 ​%) with positive trends. 5 specialities had over 50 ​% of metrics showing a significant negative trend. Overall satisfaction was negative in all 12 programmes, with eight reaching significance (P ​< ​0.05). Of 141 individual training programmes, 29 ​% showed a significantly negative trend in overall satisfaction, with 1 ​% demonstrating a significant positive trend (P ​< ​0.05). Our study is the first to explore long-term trends in trainee reported surgical training experiences within the UK. Our data have revealed widespread worsening trainee reported experiences and dissatisfaction across multiple specialities and geographical regions, especially in key areas of overall satisfaction, self-development, and clinical supervision. • UK surgical trainees have reported worsening experiences over the last decade. • 75 ​% of surgical specialities had significant negative overall satisfaction trends. • 42 ​% of all metrics analysed showed significant negative trends. • Burnout is increasing within UK surgical trainees. • 85 ​% of all individual training programmes showed negative trends with 29 ​% being significant. [ABSTRACT FROM AUTHOR]

Objectives: Choices about which dental treatments to provide in a publicly funded system should be guided by the value that the general population place on those treatments. The aim of this study was to estimate United Kingdom (UK) general population willingness to pay (WTP) for dental check‐ups, and to investigate what factors influence WTP. Methods: WTP was elicited using a hypothetical question in an online survey. The sample consisted of 594 participants, nationally representative of the UK general population in terms of age and gender. Regression analysis was used to examine what factors are associated with WTP. Analyses were conducted including and excluding protest answers. Results: The mean WTP for a dental check‐up is £31.32 for the full sample and £33.17 excluding protest answers. Respondents on higher incomes and those with higher university education had higher WTP. Respondents in Scotland were WTP less than respondents living in the rest of the UK which may be the result of NHS dental check‐ups being free to patients in Scotland. Conclusion: The general UK population value dental check‐ups. This study provides estimates of WTP for dental check‐ups which can be used in Cost–Benefit Analyses. [ABSTRACT FROM AUTHOR]

Background: In the UK approximately half of women requiring perinatal mental health (PNMH) care do not receive treatment despite having routine contact with midwives (MWs) and health visitors (HVs). Limited research has been undertaken regarding MWs'/HVs' decision-making around referring women for secondary PNMH care. In particular, the impact that the level of local secondary PNMH services may have on MWs'/HVs' referral decisions is unexplored. Aim: To understand MWs'/HVs' decision-making in relation to referring women with identified PNMH problems, to identify barriers and facilitators to effective and timely referrals including any impact of the local secondary PNMH service provision. Methods: Participants were recruited from four National Health Service (NHS) Trusts in England, located across two geographical areas, that provided different types of PNMH services. One area had PNMH services that met National Institute for Health and Care Excellence (NICE) guidelines; the other area had no secondary PNMH services. A sequential mixed methods design was used: In-depth semistructured interviews with practising MWs/HVs (n = 24) to explore their approach to PNMH referral decision-making, analysed using thematic analysis; Questionnaire offered to all practising MWs/HVs in the two geographical areas to measure factors that may impact on PNMH referral decision-making allowing for statistical comparisons to be made between the professional groups/geographical areas. Findings: Three themes were identified from the interviews that impacted on MWs'/HVs' PNMH referral decision-making: identifying need; education, skills and experience; and referral pathways. Questionnaire response rate 13.1% (n = 99). The most reported facilitators to referral decision-making were a trusted relationship between MWs/HVs and women and routine enquiry about women's mental health; the most reported barriers were stigma associated with mental ill-health and women's perceived fear of child removal. Conclusion: Fundamental to MWs'/HVs' decision-making was their perceived relationship between themselves and women. Although PNMH service provision is important for women to ensure they receive appropriate PNMH care, service provision appeared less important to MWs'/HVs' referral decision-making than how maternity/health visiting services were delivered. Further important factors to MWs/HVs were to the ability to provide continuity of carer with women allowing MWs/HVs to identify women who would benefit from referral for secondary PNMH care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Myalgic encephalomyelitis (ME) is a complex, multi-system neurological condition. The defining feature of ME is post-exertional malaise (PEM) with over 30 symptoms triggered by physical, cognitive, emotional and social activity. The cause of PEM is unclear but one area of research using cardio-pulmonary exercise tests show a reduced ventilatory anaerobic threshold (VAT) with repeated tests leading to PEM. Pacing with heart rate monitoring (HRM) provides feedback to maintain activity intensity below the VAT. There is only one piece of research investigating the use of HRM although a number of guidelines recommend it. OBJECTIVE: To identify the experiences and attitudes of people with ME towards HRM. METHODS: A 40 question online survey was devised and released on ME websites, Twitter and Facebook pages. People with ME read the information sheet and followed an online link to the survey. The survey was open for three weeks and all answers were anonymous. RESULTS: 488 people with ME completed the survey. Most participants were female, 35-50 years and with a reported illness of greater than 5 years. Over 100 types of HR monitor used. Over 30 benefits and over 30 negatives identified. HRM reduced severity of ME and severity and duration of PEM. CONCLUSION: Although there are limitations, HRM has many benefits including helping PwME to understand and manage their PEM and support them to increase their activities, including work. There is a need for more research and education of healthcare professionals in the safe use of HRM. [ABSTRACT FROM AUTHOR]

Background: Palliative medicine physicians may be at higher risk of burnout due to increased stressors and compromised resilience during the COVID-19 pandemic. Burnout prevalence and factors influencing this among UK and Irish palliative medicine physicians is unknown. Aim: To determine the prevalence of burnout and the degree of resilience among UK and Irish palliative medicine physicians during the COVID-19 pandemic, and associated factors. Design: Online survey using validated assessment scales assessed burnout and resilience: The Maslach Burnout Inventory Human Services Survey for Medical Personnel [MBI-HSS (MP)] and the Connor-Davidson Resilience Scale (CD-RISC). Additional tools assessed depressive symptoms, alcohol use, and quality of life. Setting/participants: Association of Palliative Medicine of UK and Ireland members actively practising in hospital, hospice or community settings. Results: There were 544 respondents from the 815 eligible participants (66.8%), 462 provided complete MBI-HSS (MP) data and were analysed. Of those 181/462 (39.2%) met burnout criteria, based on high emotional exhaustion or depersonalisation subscales of the MBI-HSS (MP). A reduced odds of burnout was observed among physicians who worked ⩽20 h/week (vs 31–40 h/week, adjusted odds ratio (aOR) 0.03, 95% confidence interval (CI) 0.002–0.56) and who had a greater perceived level of clinical support (aOR 0.70, 95% CI 0.62–0.80). Physicians with higher levels of depressive symptoms had higher odds of burnout (aOR 18.32, 95% CI 6.75–49.73). Resilience, mean (SD) CD-RISC score, was lower in physicians who met burnout criteria compared to those who did not (62.6 (11.1) vs 70.0 (11.3); p < 0.001). Conclusions: Over one-third of palliative medicine physicians meet burnout criteria. The provision of enhanced organisational and colleague support is paramount in both the current and future pandemics. [ABSTRACT FROM AUTHOR]

BACKGROUND: Malnutrition adversely affects clinical outcomes, necessitating a prompt and accurate assessment of nutritional status on admission. A variety of tools exist to aid nutritional assessment, of which the malnutrition universal screening tool (MUST) is recommended, but remains difficult to implement in practice. OBJECTIVE: The aim of this audit was to improve the utilisation of the malnutrition universal screening tool (MUST) in the Acute Medical Unit (AMU) at Queen Elizabeth Hospital, King's Lynn. Specifically, patients should have a completed and accurate MUST score within 6 hours of arrival to AMU and high-risk patients (MUST score ≥2) should be referred to dieticians within 48 hours of admission. The first cycle was conducted by March 2019 and the second cycle was completed 1 year later to allow assessment of interventions actioned after the first cycle. METHODS: We conducted a two-cycle audit evaluating the MUST completion and dietician referral rate of high-risk patients (defined as MUST ≥2) on the Acute Medical Unit in a district general hospital, with the standards of 80% and 100% respectively. A questionnaire was distributed after the first cycle exploring nurses' current experience and competence in using MUST. RESULTS: In the first cycle, MUST scores were calculated correctly in 111/150 patients (74%) and 1/9 (11%) high-risk patients were referred to dieticians. After interventions, MUST scores were calculated correctly in 77/101 patients (76%) and 2/4 high-risk patients (50%) were referred to dieticians. The nurses (n = 19) who took part in the questionnaire felt confident in MUST completion, but the average score in an objective assessment was 67%. CONCLUSIONS: As per the literature, the first cycle demonstrated the under-utilisation of MUST in clinical practice. In response, we proposed additional face-to-face training for existing staff, the inclusion of an e-learning module within the staff's induction, and provision of ward MUST 'troubleshooting' booklets. MUST utilisation rates improved upon re-auditing, but not to target standards. We will need to consider potential barriers to sustainable change and implement interventions such as identification of nursing champions to overcome them. [ABSTRACT FROM AUTHOR]

Background: The first wave of lockdown measures to control the COVID-19 pandemic in the UK resulted in suspension of 'non-essential' services, including contraceptive care. Aim: To examine women's perceptions and experiences of contraceptive care in the UK during the first lockdown. Design & setting: A cross-sectional survey during the lockdown period from March-June 2020. Method: An online questionnaire was designed asking women aged 16-54 years their experiences of contraceptive care during lockdown. Questions were based on Maxwell's evaluation framework on access, acceptability, relevance or appropriateness, and equity. It was promoted on social media from 27 May-9 June 2020. A descriptive analysis was conducted of quantitative data and thematic analysis of free-text data. Results: In total, 214 responses were analysed. General practice was the source of contraception for 43.4% (n = 49) and 52.3% (n = 34) of responders before and during the lockdown, respectively. The study found 55.1% (n = 118) of responders, including regular and new users, were uncertain where or how to get contraception during the pandemic. Responders reported reduced access to contraception during lockdown, and some thought sexual health clinics and general practices were closed. Remote consultations and electronic prescriptions facilitated contraceptive access for some responders. Long-acting reversible contraception (LARC) was unavailable in some areas owing to restrictions, and alternatives were not acceptable to those who used methods for non-contraceptive benefits to treat medical conditions; for example, menorrhagia. Conclusion: The study highlighted the need for better information and signposting for contraception during lockdown. Contraception, including LARC, should be reframed as an essential service with robust signposting for pandemic planning and beyond. [ABSTRACT FROM AUTHOR]

Objectives: To identify suitable patients for glaucoma home monitoring and explore clinicians' perceptions of the possible benefits and risks of home monitoring within the National Health Service., Design: An online survey composed of open-ended and closed-ended questions., Setting: Secondary care., Participants: Glaucoma specialists registered with the UK and Eire Glaucoma Society., Outcome Measures: Agreement with clinical scenarios., Results: The estimated response rate was 68% (n=49). Of 49 participants, 92% (n=45) were consultant ophthalmologists and 71% (n=35) had over 10-year experience. There was a poor agreement regarding an ideal glaucoma patient for home monitoring, with only one scenario achieving over 60% agreement. Most participants believed that home monitoring would be most suitable for low-risk scenarios, rather than high-risk, due to fear of missing progression. In relation to acceptability, key facilitators included the potential to increase healthcare capacity and promote patient safety. However, low clinician trust in equipment reliability and fear of patient harm were reported as concerns., Conclusions: There was no clear consensus on which patients would benefit most from glaucoma home monitoring. While many clinicians believe home monitoring may enhance healthcare, there were also many concerns about the technologies themselves. Further work to address clinician concerns is warranted., Research Registry Registration Number: 6213., Competing Interests: Competing interests: AJK has received funding from the pharmaceutical industry for contributions to Advisory Boards and conference organisers for attendance/speaking at conferences. AJK is also chairman/trustee of Glaucoma UK. AT has received funding from the pharmaceutical industry for contributions to consulting, lectures and/or presentations, and advisory board participation. AT is also a member of the European Glaucoma Society executive committee., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Incurable cancer is a major contributor to societal suffering and disability, and palliative rehabilitation is recommended to be integrated within and between cancer services at all healthcare levels. However, little knowledge exists on how integration of palliative rehabilitation in cancer is understood and achieved in clinical practice. INSPIRE (Integrated short-term palliative rehabilitation to improve quality of life and equitable care access in incurable cancer) is a large European-funded project that aims to promote quality of life through a novel rehabilitation model for people disabled by advanced cancer., Aim: To compare the existing integration of palliative rehabilitation in cancer within official documents and in clinical practice across five European countries including United Kingdom, France, Denmark, Norway, and Italy., Methods: Mixed methods study with a concurrent research design, comprising a document analysis (N = 23), stakeholder interviews (N = 22), and an online survey (N = 225). Data from each sub-study were analysed separately before results were merged., Results: There was limited integration of palliative rehabilitation in cancer in official documents and in clinical practice, though some indicators of integration, including participation in multidisciplinary teams and adherence to standardised pathways, were identified in the survey. Notably, integration of palliative rehabilitation in cancer in clinical practice was observed within limited organisations in secondary healthcare systems, without widespread adoption. Although palliative rehabilitation in cancer as a concept was sparingly used by stakeholders, they recognised the need for a comprehensive approach including multidisciplinary teams that aligns with the individual patient's needs and goals. Moreover, the ambiguous distinction between the terms 'palliative rehabilitation' and 'palliative care', insufficient funding, lack of well-defined care pathways and competence gaps among healthcare professionals represented barriers to integration of palliative rehabilitation in cancer into clinical practice., Conclusion: Integration of palliative rehabilitation in cancer was limited in the five EU partnership countries investigated. Clarifying the concept of palliative rehabilitation, including adoption of the concept into official documents and delineating it from palliative care, is essential for more successful integration. This can possibly be achieved by addressing the barriers identified and fostering close collaboration across disciplines., Competing Interests: Declarations Ethics approval and consent to participate All data handling adhered to EU’s General Data Protection Regulation (GDPR) 2018 and the University of Bergen regulations for GDPR and safe data handling. According to the national regulations for medical and health research (the Health Research Act of 2008-06-20 no. 44; •• 4a and 4d), ethical approval was deemed unnecessary by the Regional Ethics Committee (REC West). However, approval from the Norwegian Agency for Shared Services in Education and Research was required, as the interviews were recorded (reference number 414708). The study was registered in University of Bergen’s System for Risk and Compliance (ID F2402). Written and/or oral informed consent was provided by all participants in the interviews and cross-sectional survey. Consent for publication All authors have provided their consent for publication. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: To assess the prevalence and severity of paruresis ('shy bladder syndrome') in a population of university staff and students and to determine if there was any relationship between demographics, self-esteem, presence of social anxiety disorders and negative toilet experiences and paruresis., Design: We undertook an anonymised cross-sectional online survey using Microsoft Forms. We invited participants aged 18 and over to complete the survey which included demographic information; any pre-existing medically or self-diagnosed anxiety-related conditions; Shy Bladder Scale (SBS); Rosenberg Self-Esteem Scale (RSES) and questions about using school toilets in their younger life. We defined 'mild' and 'severe' paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40. We calculated prevalence of paruresis, and explored differences in self-esteem, school toilet experience and social anxiety disorders between individuals with and without paruresis. Multivariable logistic regression was used to determine which variables had any influence on having a 'mild' and 'severe' paruresis diagnosis., Setting: We distributed the survey to all staff and students via their university email address as well as promoting the survey on university social media sites., Results: We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18-30 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders. The prevalence of 'mild' paruresis was 25.8% and of 'severe' paruresis 14.9% in this sample. 73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder. There was a statistically significant difference in the total SBS score between individuals with and without an existing anxiety disorder (8 vs 19, <0.001). The adjusted odds of 'mild' paruresis were higher for men than women (OR 3.39; 95% CI 1.90 to 6.06), lower for those with a lower RSES score (OR 0.90; 95% CI 0.85 to 0.96), lower for those for a lower school toilet experience score (OR 0.88; 95% CI 0.78 to 0.99) and higher for those with at least one anxiety disorder (OR 3.164; 95% CI 1.52 to 6.59). The adjusted odds of 'severe' paruresis were higher for men than women (OR 2.60; 95% CI 1.32 to 5.12), lower for those with a lower RSES score (OR 0.90; CI 0.84 to 0.97) and higher for those with at least one anxiety disorder (OR 2.99 (1.18-7.56))., Conclusion: Large organisations should consider measures to help manage anxiety and improve toilet experiences. These could include resources and signposting to manage anxiety disorders and single-occupancy toilets and toilets in quiet areas to limit anxiety associated with shy bladder syndrome., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Healthcare systems data (HCSD) could improve the efficiency of clinical trials, but their accuracy and validity are uncertain. Our objective was to assess the accuracy of HCSD as the sole method of outcome detection in the REstart or STop Antithrombotics Randomised Trial (RESTART; ISRCTN71907627) compared with adjudicated questionnaire follow-up and compare estimates of treatment effect., Methods: RESTART was a prospective, open, assessor-blind, parallel-group randomised controlled trial (RCT) of antiplatelet therapy after intracerebral haemorrhage (ICH) in the UK. We included 496 (92%) of 537 RESTART participants, who were resident in England or Scotland at randomisation. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. RESTART used annual questionnaires to detect its primary outcome (recurrent ICH) and secondary outcome (a composite of haemorrhagic or ischemic major adverse cardiovascular events [MACE]) over a median of 2.0 years; an independent adjudication committee verified outcomes using medical records and brain imaging. We obtained ICD10-coded HCSD on hospital admissions and deaths in England and Scotland to identify primary and secondary outcomes. We compared HCSD with a reference standard of adjudicated outcomes. We estimated the effects of antiplatelet therapy using HCSD alone in a Cox proportional hazards model adjusted for minimisation variables., Results: In the original RESTART trial, 31 people experienced a primary outcome event. HCSD had sensitivity of 84% (95% CI 66 to 95%) and positive predictive value of 68% (51 to 82%) for recurrent ICH. HCSD estimated an effect of antiplatelet therapy (adjusted hazard ratio [aHR] 0.51, 95% CI 0.27 to 0.98; p = 0.044) that was almost identical to adjudicated outcomes (aHR 0.51, 95% CI 0.25 to 1.03; p = 0.060). HCSD had sensitivity of 84% (76 to 91%) and positive predictive value of 78% (69 to 85%) for MACE, on which HCSD estimated an effect of antiplatelet therapy (aHR 0.81, 95% CI 0.56 to 1.16; p = 0.247) that was similar to adjudicated outcomes (aHR 0.65, 95% CI 0.44 to 0.95; p = 0.025)., Conclusions: In a RCT of antiplatelet therapy for people with ICH, HCSD was reasonably accurate and provided similar estimates of treatment effect compared with adjudicated outcomes., Trial Registration: ISRCTN71907627 . Registered on 25 April 2013., Competing Interests: Declarations Ethics approval and consent to participate The Scotland A research ethics committee approved RESTART before recruitment began (reference 12/SS/0138). The funding application and trial protocol pre-specified that HCSD would be collected alongside other methods to identify outcome events, for which participants gave consent. Consent for publication Not applicable—no identifying images or other personal or clinical details of participants are presented. Competing interests The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: The CapaCiTY programme includes three, multi-centre, randomised controlled trials aiming to develop an evidence based adult chronic constipation treatment pathway. The trials were conducted in the United Kingdom, National Health Service, aiming to recruit 808 participants from 26 March 2015 to 31 January 2019. Sites were selected based on their responses to site feasibility questionnaires (2014-2015), a common tool employed by sponsors to assess a site's recruitment potential and ability to undertake the trial protocol. Failure to recruit the planned sample jeopardises reliability of results and wastes significant time and resources. The purpose of this study was to investigate barriers to recruitment in 2017., Methods: We conducted site feasibility assessments with thirty-nine sites prior to trial commencement. Twenty-seven were selected to participate in the CapaCiTY programme, twelve were deemed unsuitable. We compared site contracted recruitment rates with actual recruitment rates and conducted a telephone survey and analysis from 5 July to 7 December 2017 (n = 24) to understand barriers to recruitment. Three sites declined to participate in the survey., Results: At the time of survey, 15% of sites in the CapaCiTY programme were meeting recruitment targets, 85% were recruiting half or less of their target. Of these, 28% recruited no participants. The main barriers to recruitment were lack of resources, high workloads, lack of suitable participants and study design not being compatible with routine care. Despite multiple strategies employed to overcome these barriers, the trials were eventually stopped due to futility, recruiting only 34% of the programme sample size., Conclusions: Improving the reliability of site feasibility assessments could potentially save a substantial amount in failed research investments and speed up the time to delivery of new treatments. We recommend 1) investment in training researchers in conducting and completing site feasibility; 2) funders to require pilot and feasibility data in grant applications, with an emphasis on patient and public involvement in trial design; 3) conducting site feasibility assessment at the pre-award stage; 4) development of a national database of sites' previous trial recruitment performance; 5) data-driven site level assessment of recruitment potential., Trial Registration: ISRCTN11791740; 16/07/2015, ISRCTN11093872; 11/11/2015, ISRCTN11747152; 30/09/2015., Competing Interests: Declarations Ethics approval and consent to participate This study within a trial (SWAT) was approved by the Queen Mary University of London Ethics Committee, QMREC2023a. The overarching clinical trials were approved by London City and East Human Research Ethics Committee; CapaCiTY01 REC 14/LO/1786 ISRCTN11791740, CapaCiTY02: REC 15/LO/0732, ISRCTN11093872, CapaCiTY03: REC 15/LO/0732, ISRCTN11747152. Informed consent was provided by all participants in accordance with the ethics approvals. All methods were carried out according to the clinical trial regulations, local governance requirements and quality assurance procedures including; The Medicines for Human Use (Clinical Trials) Regulations 2004, Good Clinical Practice, Data Protection Act, NHS Caldicott Principles, The UK Research Governance Framework for Health and Social Care, Pragmatic Clinical Trials Unit Standard Operating Procedures. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Health care staff should be given the opportunity to participate in research, but recruiting clinicians via their employing organisation is not always straightforward or quick in the UK. Unlike many countries outside the UK, very low-risk survey, interview or focus group studies can be subject to some of the same governance approval procedures as interventional studies. An exemplar study carried out by the NIHR funded Palliative Care Research Partnership North West Coast is used to highlight the challenges still faced by researchers and health care organisations when setting up a low-risk staff study across multiple NHS and non-NHS sites., Methods: A study database was created and information was collected on the first point of contact with the clinical site, Health Research Authority (HRA) and local organisational approval times, time from trust or hospice agreement to the first survey participant recruited and overall site survey recruitment numbers. Descriptive statistics (median, range) were used to analyse these data., Results: Across participating NHS trusts, it took a median of 147.5 days (range 99-195) from initial contact with the local collaborator to recruitment of the first survey participant and hospice sites mirrored these lengthy timescales (median 142 days, range 110-202). The lengthiest delays in the HRA approval process were the period between asking NHS trusts to assess whether they had capacity and capability to support the research and them granting local agreement. Local approval times varied between trusts and settings which may indicate organisations are applying national complex guidance differently., Conclusions: There is the potential for HRA processes to use more NHS resources than the research study itself when recruiting to a low-risk staff study across multiple organisations. There is a need to reduce unnecessary administrative burden and bureaucracy to give clinicians and research staff more opportunities to participate in research, and to free up NHS R&D departments, research nurses and clinicians to focus on more demanding and patient focused research studies. Hospices need standardised guidance on how to assess the risk of being involved in low-risk research without adopting the unnecessarily complex systems that are currently used within the NHS., Competing Interests: Declarations Ethics approval and consent to participate For the exemplar study, approval was granted by the East of England - Cambridge South Research Ethics Committee (Ref: 22/EE/0049) on the 24/02/2022. Survey instructions clarified that consent to participate was implied when the participant clicked through to the first page of the survey. Electronic consent was obtained prior to the working groups. Informed consent was obtained from all subjects. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Competing interests All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: all authors had financial support from NIHR Public Health Research strand NIHR135334 for the submitted work; AN has received a Churchill Fellowship to fund research related travel, BS is a member of the Advanced Disease & End of Life Care Workstream of the NCRI Living With and Beyond Cancer Clinical Studies Group and has received research grants from Marie Curie, North West Cancer Research and the NIHR, SM is chair of the Palliative Care Research Society, SP has received research grants from European Commission Horizon Europe, European Commission Horizon 2020 and NIHR Research for Patient Benefit NIHR204041, AD has received payments from Oxford University Press for royalties, Becton Dickinson for consulting fees, Napp Pharmaceuticals Ltd, Sandoz, Kyowa Kirin for educational purposes and is a committee member of the Association of Palliative and Supportive Care Pharmacy, no other relationships or activities that could appear to have influenced the submitted work. Data availability: Data are stored in Lancaster University’s PURE repository. The authors may be contacted to obtain further clarifications on aspects of the study not provided in this paper or supplementary material wherever ethically or legally appropriate., (© 2024. The Author(s).)

Background: Physicians play an important role in management and governance of healthcare systems, yet many lack formal leadership training and skills. Despite leadership training through placements in wards at a graduate level, this should take place early on (undergraduate level), to lay the foundations for future physicians to consider a career choice in leadership positions long before entering practice. The fundamentals of leadership and management should be incorporated in the medical curriculum, with input from experts in the area such that relevant concepts are appropriately adapted with a healthcare context., Methods: We developed a pilot leadership and management module for undergraduate medical students, drawing from sources such as the UK National Health System and General Medical Council, primary literature, and undergraduate business school curricula. Students in their clinical years (4-6) of an undergraduate, six-year medical degree, were invited to participate in five 2-hour online sessions. Participants completed a questionnaire before and after module completion to assess whether individual perspectives on 22 skills relevant to leadership knowledge, and their self-rated competence in each one, changed following module attendance., Results: Sixteen medical students participated in the study. Module attendance resulted in mean self-reported competence increase in 18 of the 22 skills, with "inspire others", "public speaking", "coding and billing", "risk management" and "conflict resolution" displaying the largest positive change. Free-text comments provided encouraging feedback regarding the module and its contents, and the teaching method of such skills (case-studies or more applied scenarios, as opposed to taught lectures)., Conclusions: The positive changes in student perceptions and self-reported competence in leadership skills that are not traditionally included in the undergraduate medical curriculum, but are part of the business curriculum, further support the importance of inter-professional learning. Our findings are expected to inform the development of a module that could be incorporated in undergraduate medical curricula as part of future research with larger sample size and objective measures of skill competence., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Cyprus National Bioethics Committee (protocol number: ΕΕΒΚ/ΕΠ/2022.01.39). Participation was voluntary and written consent was obtained. This study does not have a Clinical Trial Number (CTN) as it does not meet the criteria for a clinical trial. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Almost 40% of the Nobel-Prize-winning discoveries in medicine are made by physician-scientists, who are a driving force in the evolving medical, academic and research landscape. However, their training has few defined milestones. To be effective clinicians, educators and researchers, they need to maintain and hone skills, often via continuous professional development (CPD) activities covering different domains. They have recurrently been described as an endangered species. Yet, warnings and recommendations across several decades did not stop the declining number of physician-scientists, which is now a chronic issue. This is further exacerbated by a lack of resources and support, especially after the COVID-19 pandemic., Methods: We administered a questionnaire called Positive and Negative Affect Schedule (PANAS-GEN) to get an initial emotional snapshot before performing individual semi-structured interviews with five physician-scientists in neurology working in the United Kingdom. We explored the key factors they balance before selecting CPD activities, along with their views on compulsory CPD events and assessments. We investigated their general feelings towards compulsory and non-compulsory CPD, how they felt the night before and the morning of the events, and the perceived consequences attending these have on their learning., Results: In our study, physician-scientists tend to choose training in their area of expertise but would enjoy exploring more if they had more time. The CPD choice was chiefly driven by speakers and topics, followed by learning needs. They disputed the utility of the current assessments, which are often seen as box-ticking exercises. While frustration, hostility and negative feelings were voiced for the compulsory ones, other CPD activities were welcomed with excitement, curiosity and a sense of adventure. Enthusiasm and excitement were felt the night before and the morning of the non-compulsory ones. CPD events were perceived to positively affect further learning, with the most immediate consequences being reading an article, networking or interacting with the speakers., Discussion: This is the first study exploring the key factors driving a group of physician-scientists while selecting CPD activities and investigating their feelings and emotions related to CPD attendance. More engaging and less box-ticking CPD should be on the cards, along with an adequate evaluation of these activities. It is essential to increase enthusiasm, which can facilitate engagement, and decrease frustration surrounding compulsory CPD activities. We still know too little about the role of emotions in learning, especially about CPD. Future studies should investigate the emotional side of learning across different career stages to restore the leaky pipeline and create a tailored environment with benefits for each of the three sides of the physician-scientist's identity: the clinical, the research, and the academic., Competing Interests: Declarations Ethics approval and consent to participate All methods were carried out in accordance with relevant guidelines and regulations. This work received ethical approval from the relevant Education Ethics Review Process at Imperial College London. Informed consent to participate was obtained from all the study participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Haemophilia is a rare bleeding disorder caused by a deficient or absent clotting factor, leading to frequent bleeding. Multiple intravenous (IV) infusions have been the standard prophylactic treatment; however, newer treatment options involve less frequent subcutaneous (SC) injections. To inform future health economic evaluations, this study applied the time trade-off (TTO) method for estimation of utilities associated with haemophilia treatment for both people with the disease and potential caregivers., Methods: Using the TTO method, utilities were estimated through two online surveys distributed in the UK, Canada and the US. In survey 1 (S1), adults from the general population aged 18 years and above evaluated health states as if they were living with haemophilia themselves and were receiving treatment for the condition. In survey 2 (S2), adults from the general population with a child under the age of 15 years evaluated health states as if they were treating their child for haemophilia. The surveys assessed the following treatment aspects: frequency of treatment, treatment device and injection site reactions., Results: In total, 812, 739 and 703 respondents completed S1 and 712, 594 and 527 completed S2 in the UK, Canada and the US, respectively. In both surveys, the treatment device was associated with the largest impact on utilities for both people with haemophilia and caregivers. Monthly SC injections with a prefilled pen-device were associated with a significant utility gain compared with SC injections with a syringe and IV infusions. In S1, a lower treatment frequency was preferred in all three countries, while in S2, a lower treatment frequency was preferred only in the UK. Avoiding injection site reactions was associated with a significant utility gain in both surveys, but only in the UK and Canada., Conclusions: The study suggests that the administration of haemophilia treatment in particular has an impact on utilities for both people and caregivers living with the disease. Thus, less complex and time-consuming treatment devices are expected to improve health-related quality of life. This can be further modified additively by less frequent administration. These results can inform future health economic analyses of haemophilia and haemophilia treatment., Competing Interests: Declarations Ethics approval and consent to participate This study was not a clinical trial, did not include patients and did not gather biological or human samples or identifiable personal information, and ethical review board approval was therefore not required. All respondents gave consent to participate before answering the surveys. Consent for publication Not applicable. Competing interests Medical writing support was provided by AO and CY from EY Godkendt Revisionspartnerselskab, Denmark, and funded by Novo Nordisk. Publication review support was provided by AXON Communications, London, UK, and funded by Novo Nordisk. MLW and MNW are employees of Novo Nordisk, and MLW owns stocks in Novo Nordisk. AO and CY received funding for performing the study and medical writing support but were not paid for their role as author., (© 2024. The Author(s).)

Background: Knowledge sharing is a crucial part of any knowledge management implementation. It refers to sharing skills and experience among team members in an organization. In a health care setting, sharing knowledge, whether tacit or explicit, is important and can lead to better health care services. In medical imaging departments, knowledge sharing can be of particular importance. There are several factors that affect knowledge-sharing practices in medical imaging departments: individual, departmental, and technological. Evaluating the importance of these factors and understanding their use can help with improving knowledge-sharing practices in medical imaging departments., Objective: We aimed to assess the level of motivation, identify current knowledge-sharing tools, and evaluate factors affecting knowledge sharing in the medical imaging departments of 2 cancer centers, The Christie, United Kingdom, and the Kuwait Cancer Control Center (KCCC)., Methods: A concurrent mixed methods study was conducted through nonprobability sampling techniques between February 1, 2023, and July 30, 2023. Semistructured interviews were used to validate the results of the quantitative analysis. Data were collected using an electronic questionnaire that was distributed among health care professionals in both cancer centers using Qualtrics. Semistructured interviews were conducted online using Microsoft Teams. The quantitative data were analyzed using the Qualtrics MX software to report the results for each question, whereas the qualitative data were analyzed using a thematic approach with codes classified through NVivo., Results: In total, 56 respondents from the KCCC and 29 from The Christie participated, with a 100% response rate (56/56, 100% and 29/29, 100%, respectively) based on the Qualtrics survey tool. A total of 59% (17/29) of health care professionals from The Christie shared their knowledge using emails and face-to-face communication as their main tools on a daily basis, and 57% (32/56) of health care professionals from the KCCC used face-to-face communication for knowledge sharing. The mean Likert-scale score of all the components that assessed the factors that affected knowledge-sharing behaviors fell between "somewhat agree" and "strongly agree" in both centers, excepting extrinsic motivation, which was rated as "neither agree nor disagree." This was similar to the results related to incentives. It was shown that 52% (15/29) of health care professionals at The Christie had no incentives to encourage knowledge-sharing practices. Therefore, establishing clear policies to manage incentives is important to increase knowledge-sharing practices., Conclusions: This study offered an evaluation of factors that affect knowledge sharing in 2 cancer centers. Most health care professionals were aware of the importance of knowledge-sharing practices in enhancing health care services. Several challenges were identified, such as time constraints, a lack of staff, and the language barrier, which limit knowledge-sharing practices. Therefore, establishing a clear policy for knowledge sharing is vital to practicing knowledge-sharing behaviors and facing any challenges that limit this practice., (©Maryam Almashmoum, James Cunningham, John Ainsworth. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 13.11.2024.)

Introduction: Depression disorders are one of the most widespread mental disorders among college students. In university students, depression has been associated with lower academic performance, worse work performance, and increased dropout risk. his study aims to assess the prevalence of depression and highlight risk factors among Saudi international university students (IUS) in the United States (US), the United Kingdom (UK), and Australia., Subject and Methods: This cross-sectional study was conducted among Saudi students who chose to study abroad. A self-administered online questionnaire was sent to the students using an online survey. The questionnaire includes socio-demographic data (e.g., age, gender, specialty, etc.), medical characteristics, social status, and the Patient Health Questionnaire (PHQ-8) to assess the student's depression., Results: Of the 401 students, 52.4% were younger (age 18 - 25 years), and more than half were males (53.9%). Most of the participants were studying in the US (46.6%), followed by the UK (40.6%) and Australia (12.7%). The rate of major depression among Saudi students studying abroad was 40.4%. In univariate analysis, major depression was influenced by age, marital status, specialty, personal and family history of mental illness, contact with family and friends, and feeling like a stranger. However, after conducting multivariate regression analysis, previous diagnoses of mental illness and feeling a stranger were identified as the significant independent risk factors for major depression., Conclusion: This study provides insights into the prevalence and risk factors associated with depression among Saudi IUS. The prevalence of major depression among Saudi IUS was 40.4%. Previous history of mental illness and feeling like strangers were identified as the most prominent risk factors in this study. Identifying the prevalence and contributing factors of depression can guide academic institutions and governments in the development of effective interventions and support for IUS's mental well-being. Future research could diversify the sample and employ longitudinal designs., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval was obtained from the Research Ethics Committee at King Faisal University in Al-Ahsa, Saudi Arabia (KFU-REC-2023-FEB-ETHICS525). All methods were carried out under relevant guidelines and regulations. There was no experimentation on humans, human tissue, or other species. Participants responded anonymously to the online survey, which began with an informed consent form in the first section. In this consent form, participants were informed about the confidentiality of the information. They were provided with information concerning the research purpose and that they had the right to revoke their participation without prior justification. Consent for publication Not Applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The Covid-19 pandemic led to a rapid increase in the use of virtual consultations across healthcare. Post-pandemic, this use is expected to continue alongside the resumption of traditional face-to-face clinics. At present, research exploring when to use different consultation formats for palliative care patients is limited., Aim: To understand the benefits and limitations of a blended approach to outpatient palliative care services, to provide recommendations for future care., Methods: A mixed-methods study. Component 1: an online survey of UK palliative care physicians. Component 2: a qualitative interview study exploring patients' and caregivers' experiences of different consultation formats. Findings from both components were integrated, and recommendations for clinical practice identified., Results: We received 48 survey responses and conducted 8 qualitative interviews. Survey respondents reported that face-to-face consultations were appropriate/necessary for physical examinations (n = 48) and first consultations (n = 39). Video consultations were considered appropriate for monitoring stable symptoms (n = 37), and at the patient's request (n = 42). Patients and caregivers felt face-to-face consultations aided communication. A blended approach increased flexibility and reduced travel burden., Conclusions: A blended outpatient palliative care service was viewed positively by physicians, patients and caregivers. We identified 13 clinical practice recommendations for the use of different consultation formats., Competing Interests: Declarations Ethics approval and consent to participate This study has been performed in accordance with the Declaration of Helsinki and was approved by the UK Research Ethics Committee (project ID 308342). I, the submitting author, declare that all methods in this work were carried out in accordance with relevant guidelines and regulations. Consent for publication N/A. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: It is illegal in the UK to sell tobacco or nicotine e-cigarettes to people under the age of 18 years, as is displaying tobacco cigarettes at the point of sale. This paper examined changes in exposure to display of these products in shops and sources of these products among children and adolescent users over time METHODS: Data from representative repeated online cross-sectional surveys of youth in Great Britain (11-18 years) were used (2018-2022; n=12 445). Outcome measures included noticing product displays and sources of e-cigarettes and tobacco cigarettes. Logistic regressions examined the associations of these outcome variables over time and with sociodemographic variables., Results: Of 12 040 participants with complete data, 10.1% used some form of nicotine product (4.2% cigarettes, 2.9% e-cigarettes, 3.0% both) at least occasionally. The likelihood of noticing tobacco cigarettes on display fell over time for both supermarkets (2018: 67.1% to 2022: 58.5%) and small shops (2018: 81.3% to 2022: 66.3%), but the likelihood of noticing e-cigarettes in supermarkets rose (2018: 57.4% to 2022: 66.5%). Sources of tobacco cigarettes did not differ over time, but e-cigarette users were more likely to get their e-cigarettes from small shops in 2022 (51.2%) vs 2019 (34.2%) (OR 2.02, 95% CI 1.24, 3.29)., Conclusion: This study provides evidence that current policies to limit awareness of and access to both tobacco and e-cigarettes among adolescents in the UK may not be effective. UK policies on the advertising, promotion and sale of both tobacco and e-cigarettes need to be reinforced to deter use among children and adolescents., Competing Interests: Competing interests: NSH is chair of Action on Smoking and Health and medical director of Asthma and Lung UK. AAL is a trustee of Action on Smoking and Health. HC and LB are employees of Action on Smoking and Health., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objectives: During 2015-2018, a randomised controlled trial (RCT) evaluated eRAPID, an eHealth intervention designed to capture patient-reported symptoms online during cancer treatment. eRAPID provides patients with advice on when to self-manage or seek medical support. Clinicians accessed symptom reports within electronic patient records. 508 participants starting systemic cancer treatment were recruited and followed for 18 weeks. The intervention group (n=256) was asked to access eRAPID and complete weekly online symptom reports. Clinicians received training on accessing and interpreting symptom reports. Overall, eRAPID had a positive impact on patients' symptoms, quality of life and self-efficacy, particularly early in treatment and for patients with early-stage disease. Using mixed methods, we aimed to gather insight from patients and clinicians on how eRAPID worked to facilitate the interpretation of RCT findings., Methods: Following a concurrent triangulation design, patient experiences of eRAPID were gathered via end-of-study interviews (n=45) and questionnaires (n=186). Clinician experiences were obtained by end-of-study interviews (n=18) and completion, throughout the trial, of feedback questionnaires (n=787 from n=55 clinicians). Framework analysis was applied to examine qualitative data and close-ended questions were descriptively summarised. Findings were mapped against results from the RCT., Setting: Medical oncology services, UK cancer centre., Results: Patient feedback indicated eRAPID was easy to use. Adherence to weekly reporting was influenced by health status, reminders, perceived value and clinical use. Patient-reported benefits of eRAPID included an enhanced connection with the hospital, provision of practical advice and personal monitoring, which provided reassurance and empowerment. Clinicians were positive about the potential for online symptom monitoring but had mixed levels of direct experience with using eRAPID during the trial. Patients echoed this and recommended more explicit clinician use of symptom data., Conclusions: The mixed-method approach to capturing patient and clinician opinions provided valuable insight into the eRAPID intervention and complementary information on how the intervention was received and functioned., Competing Interests: Competing interests: GV has received honoraria from Eisai, Pfizer, Novartis and has provided consulting/advisory roles for Roche UK, Eisai, Novartis, Sanofi, Pfizer, AstraZeneca, Seagen. JB has received institutional funding from National Institute for Health and Care Research, Roche, European Union, Janssen, AbbVie, Pierre Fabre. We declare no other competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Higher consumption of sugary beverages (SB) has been associated with type 2 diabetes (T2D), but whether these associations are modified by physical activity remains unclear. This study aimed to examine the associations of SB intake, including sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and natural juices (NJ) with the risk of incident T2D, and the potential role of physical activity., Methods: We included 153,862 diabetes-free participants in the UK Biobank who completed both the International Physical Activity Questionnaire at recruitment (2006-2010) and at least one 24-h dietary recall questionnaire in 2009-2012. We assessed the associations of each SB with the risk of incident T2D using Cox proportional hazard models, and explored the interactions between each SB and physical activity., Results: During a median follow-up of 11.8 years, 6631 participants developed incident T2D. Participants consuming more SSB and ASB (comparing > 2 to 0 unit/d) had a higher hazard of T2D (hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 1.05-1.31 for SSB; 1.54, 1.37-1.74 for ASB), while medium intake of NJ showed an inverse association (HR > 0-1 vs. 0 unit/d : 0.87, 95% CI: 0.82-0.92; HR > 1-2 vs. 0 unit/d : 0.88, 95% CI: 0.81-0.97) with incident T2D. No significant interactions between physical activity and SSB/ASB were found (P-interaction=0.204 for SSB, 0.926 for ASB), but the protective association of medium NJ intake with T2D was stronger among participants with higher level of physical activity (P-interaction = 0.043)., Conclusions: Higher intake of SSB and ASB was related to higher risks of T2D. Medium NJ intake was associated with a lower risk of T2D, particularly among individuals with higher physical activity level. These findings emphasized the importance of healthy beverage intake and adequate physical activity in diabetes prevention., (© 2024. The Author(s).)

Aim: Identify the skills and knowledge future nurse and midwife leaders might require in the next 6 years. Design/methodology/approach: An online questionnaire elicited health professionals' perspectives on the future requirements for nurse and midwife leaders. Qualitative data were generated in response on health care and the likely leadership skills for the future. Data were extracted and analysed using qualitative content analysis., Findings: Four generic categories were abstracted from the core category 'Nursing and Midwifery Leadership'. These were values/traits; creating positive healthcare cultures; digital capability/competence; and systems thinking. Limitations/implications. This first stage evaluation has gained a wide variety of perspectives regarding the perceived skills and knowledge future nurse and midwife leaders might need. This is important to enable those who deliver leadership development programmes to plan appropriately, ensuring their programmes are designed and adjusted in response to the needs of a shifting health and care landscape. However, over 50% of respondents were White, so the data may not be representative of the diversity of registered nurses and midwives. The findings may not have direct relevance to the global context due to geographical limitations.

The coronavirus disease 2019 (COVID-19) pandemic was a challenging experience for children and young people's services, and the workforce. The Valuing All Staff Together programme was a one-year project hosted by the North West Paediatric Critical Care, Surgery in Children, Long Term Ventilation Operational Delivery Network to support teams caring for children and young people to reflect on their experiences of the COVID-19 pandemic. Using an online survey, focus groups and interviews, it gave staff the opportunity to explore and understand the effects of the pandemic and the subsequent surge in demand, including how these affected services and the emotional health and well-being of staff. This would enable better preparation for future surges in respiratory illness in terms of learning, training and development. This article describes the programme's aim, method and findings, and the main recommendations for practice., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

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 (CBDI w ), 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 CBDI w values were determined from the average dosimetry data for each type of linear accelerator, and median CBDI w and scan length were calculated for each treatment site at each centre. Median CBDI w 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 CBDI w 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., (© 2024 Institute of Physics and Engineering in Medicine. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

This paper explores public perceptions of the Hippocratic Oath (Physician's Oath) in the U.K. Results of a questionnaire administered online to 106 adults indicated that the majority were of the opinion that their primary and secondary health care doctors had taken the Oath (88% and 86% respectively). A majority thought that nurses, paramedics, psychotherapists and graduate scientists and researchers should also take some form of professional oath. Elements of the Oath which were deemed most important included that it is a sworn oath, that doctors should not harm patients, act in the best interests of patients, abide by the principles of autonomy and informed consent and maintain patient confidentiality. A significant proportion - about 20% - of the UK public felt that doctors had forgotten their Hippocratic Oath during COVID-19 lockdowns and associated vaccination programme, suggesting that recent history may have damaged the public faith in the medical profession., (© 2024. The Author(s).)

There is a growing number of non-medical prescribers in the UK. Practitioners working in advanced and specialist roles access university-based non-medical prescribing programmes to enhance their clinical practice. Despite this clinical and cultural shift, there is a paucity of literature and evidence on this issue. Using a mixed-methods approach of a focus group and the Likert survey, this study explored the experiences of specialist practice district nursing students undertaking non-medical prescribing. The findings of the study suggested that while the students felt supported by their teams, university and peers, there were limitations to the supervisors available and supervised prescribing opportunities, with a variance in the experiences of prescribing supervision. Further exploration into the experiences of prescribing supervision is warranted, as is the experience of prescribing students across multiple care settings.

Background: Syrian hamsters are a relatively common pet species in the UK. However, we know very little about how they are kept. The aim of this study was to identify areas of good and poor practices among Syrian hamster owners using owner surveys., Method: A survey of pet hamster owners was conducted with questions on husbandry, behaviour and health., Results: There were 548 survey responses. Over 95% of the owners provided a wheel, hideaway or chew toy, and over 90% housed their hamster alone. However, 18.4% of the owners used hamster balls, hamsters may have been fed a diet that was not entirely appropriate, and over 45% of respondents reported that their hamsters were housed in close proximity to predator species. Most (65.9%) hamsters had never been taken to a veterinarian. Hamster ball use, shallower substrate depth and more frequent handling were significantly associated with greater owner observations of bar biting., Limitations: A key limitation is that the respondents may not be representative of the average pet hamster owner, so this research does not provide a complete picture of the current state of hamster welfare., Conclusion: There are some welfare concerns regarding the way Syrian hamsters are currently kept in the UK. Therefore, attempts to better distribute information about hamster care to owners should be made., (© 2024 The Author(s). Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Aims To assess and compare how UK general dental practitioners (GDPs) restore endodontically treated molars and what tooth-related factors they consider relevant to their management.Method An online cross-sectional vignette survey was sent out to UK dentists via email and the use of social media platforms. Three clinical cases were designed.Results In total, 394 participants completed the survey. GDPs showed a preference towards restoring the endodontically treated molars with indirect restorations, such as crowns and onlays. Material selection varied, with a notable inclination towards gold and lithium disilicate. This was influenced by factors such as the number of remaining tooth walls, thickness of walls and the presence of parafunction.Conclusion Clinicians generally agreed on whether to place a direct or indirect restoration but there was greater disagreement when deciding on the type of restoration and material. Further evidence and education are required to help UK dentists decide more objectively whether to place an onlay or a crown, what material to select and what prognostic factors are most pertinent to the case., (© 2024. The Author(s).)

Aims This study aimed to: i) identify current teaching practice and approaches to embedding environmental sustainability (ES) in the undergraduate dental curriculum in the UK and Republic of Ireland (ROI); and ii) uncover existing barriers and drivers to incorporating ES in dental education.Methods A questionnaire was developed and distributed to all dental schools in the UK and ROI in the form of an online survey. The intended respondents were deans, heads of schools, directors of education, or senior academics of all dental schools in the UK and ROI that deliver undergraduate dentistry/dental surgery programmes.Results In total, 18 dental schools responded to the survey, representing a response rate of 100% from the intended respondents. Note 56% of dental schools do not currently teach ES. Time constraints and a lack of knowledge and learning resources were the most reported barriers.Conclusion Currently, ES is not taught in most dental schools in the UK and ROI. Many schools face challenges in finalising the delivery modalities of ES teaching, particularly in clinical environments. Numerous barriers have been identified that complicate embedding this topic in the curriculum. Positively, universities, staff, students and the recently published learning outcomes are driving impactful change across the sector., (© 2024. The Author(s).)

Aim: Health technology assessment (HTA) and payer organizations are often faced with early decision-making in oncology. To design and conduct robust indirect treatment comparisons (ITCs), it is important to better understand HTA and payer decision-maker perceptions of ITCs. Here we aim to describe what individuals with HTA and payer experience see as the acceptability of ITCs for HTA and payer organization coverage and reimbursement decision-making. Materials & methods: This survey included 30 current and former HTA and payer decision-makers from five countries: Australia, France, Germany, the UK (n = 5 each) and the US (n = 10). Main outcomes included the ratings of acceptance of ITCs and the presence of well-defined methodological guidance for ITCs. Results: ITCs are generally accepted by participants in Australia and the UK but are more likely evaluated on a case-by-case basis in France, Germany and the US. Four of five participants in Germany and the UK, two of five in Australia and one of five in France reported that well-defined and prescribed criteria regarding the use of ITCs were in place. Conclusion: There is a need for harmonization of methods used to assess ITCs by HTA and payers, especially in the rapidly evolving treatment landscape in oncology.

The effects of air pollution on health outcomes are well-established. However, little is known about perceptions of air pollution and how it may influence exercise behaviours. The aim of this study was to understand the perceived importance of air pollution during planned exercise, and where relevant, explore how those perceptions may differ between those living in different locations. A questionnaire was disseminated to several running and cycling clubs in the United Kingdom, covering population characteristics to determine urban, rural or coastal residents and exercisers, self-reported asthma, perceptions of air quality during active travel, planned exercise and attitudes towards learning more about the topic. Anonymised responses were gained from 381 adult participants (≥18 years and 60% female), 119 of whom answered questions related to active travel. More than half (54%) of all respondents think about the air quality they are exposed to during exercise and how it may affect their health. More urban than rural respondents (59% vs. 47% and p = 0.03) think about air quality and the impact it may have on their health when exercising. There were insufficient coastal respondents for direct comparison. Most survey respondents (57%) state that they would take the most severe course of action regarding exercise behaviour by avoiding it altogether during periods of heavy road traffic. Individuals with self-reported asthma (n = 60), irrespective of place of residence, are the most likely to be conscious of the potential effects of air pollution on their health and exercise performance compared to counterparts without self-reported asthma., (© 2024 The Author(s). European Journal of Sport Science published by Wiley‐VCH GmbH on behalf of European College of Sport Science.)

Introduction: The ketogenic diet is a valuable nonpharmacologic therapy for the treatment of refractory epilepsy in children and adults. It can be time-intensive for ketogenic teams, typically comprised of a physician and dietitian at a minimum. Challenges and barriers to providing ketogenic diet services to patients by members of these teams has not been studied extensively., Methods: A survey was created and distributed to attendees at a ketogenic diet training conference (KetoCollegeAdvance™) held 21-23 May 2024 in United Kingdom. Questions included Likert scales and fill-in responses. Surveys were provided by 63 attendees (mostly dietitians) from 17 countries., Results: Respondents were mostly dietitians (45/63, 71 %) and from the United Kingdom. In regards to perceived interest levels in KD in general in their countries, dietitians were perceived as 80 % very or extremely interested, parents (66 %), and neurologists (45 %). The majority of teams included a dietitian (79 %) and physician (78 %). The majority, 43 (68 %) of respondents, assumed care of all aspects of epilepsy care once the KD was started. Common barriers to starting KD services included a long waiting list, lack of adult KD services, funding dietitians, and low referrals. Barriers to continuing KD services included poor patient compliance, a lack of financial resources for some families to afford foods, and a need for more pre-made ketogenic foods including bread, pizza, pasta, potato fries, and chocolates., Conclusions: These results from a conference of international ketogenic dietitians and physicians highlights common difficulties in providing the ketogenic diet successfully. Addressing these barriers may help expand the usage of this therapy for more patients with epilepsy., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: EK – Consultant to Simply Good Foods, Nutricia, Bloom Science, Cerecin, LivaNova. Data Safety Monitoring Board to NeuroPace, Royalties from Springer, Johns Hopkins University Press, UpToDate, Oxford University Press, and Elsevier. ZS – Honorarium from Nutricia and Vitaflo. Matthews Friends Medical Board Member and British Dietetic Association Professional Committee Member. JF – Director, KetoCollege., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Proportion Of suboptimal Disease Control And Strategy of Treatment in IBD (PODCAST-IBD) was an international real-world study which aimed to quantify disease control in IBD using STRIDE-II recommendations., Design/method: Cross-sectional assessment of IBD patients attending routine clinic appointments in four UK centers October 2022 to January 2023. Clinician-reported outcomes, patient-reported outcomes and retrospective data from medical chart review were used to assess IBD control against red flags aligned to STRIDE-II., Results: Data were available from 198 UK patients. IBD was suboptimally controlled in 52.4% (54/103) of patients with Crohn's disease (CD) and 45.3% (43/95) with ulcerative colitis (UC). Impaired quality of life (QOL), defined as Short inflammatory bowel disease questionnaire (SIBDQ) score <50, was the main contributor to suboptimal disease control. Suboptimal disease control has a detrimental impact on fatigue and disability with significantly lower mean Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) score in suboptimally controlled disease (CD: 81.5 vs 125, UC: 87.4 vs 122.8) and IBD Disk. Suboptimal disease control results in higher health care resource use (HCRU) (CD: £4,746 vs £1,924; UC: £2,428 vs £1,121) and higher rates of work productivity loss (CD: 41.7% vs 11.9%, UC: 38.0% vs 22.6%)., Conclusion: IBD was suboptimally controlled in around one-half of patients. Impaired QOL was the most common contributor (64%, 62/97) to suboptimal control. Suboptimal control had a considerable economic impact; HCRU more than doubled and productivity fell. Physicians could consider regular QOL assessments to prompt timely disease monitoring to enable identification of early active disease and appropriate treatment.

Objectives: The gold standard approach to diagnose periodontitis is based on clinical examination and radiographic investigations. This, however, is expensive, tedious, and not feasible in population-level assessments. The self-reported periodontitis questionnaire offers great benefit to facilitate larger epidemiological surveys. There is limited evidence on cognitive validation of self-reported periodontitis questionnaire. This study employed a think aloud approach to investigate if participants interpreted, comprehended, and understood the items in a self-reported periodontitis questionnaire, in the same way as researchers' intended., Methods: 20 adults, resident of the UK and fluent in English participated in online recorded think aloud interviews. The self-reported periodontitis questionnaire consists of 15 questions and 2 open ended questions. The interviews were then transcribed and coded by two independent researchers according to predefined categories representing comprehension and conventional content analysis was used to analyse open-ended data., Results: The think aloud approach revealed that most of the questions in the self-reported periodontitis questionnaire were well understood by the participants. Two items, however, were identified as problematic: one was misinterpreted, and another question was not understood by most of the participants. Qualitative conventional content analysis of open-ended questions reiterated and complemented the findings of the think aloud study. Further questions coded as problematic for 3 or more participants were then considered for rephrasing., Conclusions: This study revealed the interpretation and understanding of self-reported periodontitis questions by English speaking UK residents and highlighted the probable reason for lower sensitivity values of the self-reported periodontitis questionnaire., Clinical Significance: This study employed think-aloud approach to capture the thought process of the participants as they answered questions on self-reported periodontitis questionnaire. Overall, the questionnaire was well received by the participants, however, some questions were misunderstood/misinterpreted. This study highlights the potential information bias if participants do not understand the questions in epidemiological surveys., Competing Interests: Declaration of competing interest We the authors declare that we have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. We have nothing to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: To ascertain current nutritional knowledge and training needs of community-based nurses caring for older adults in the United Kingdom., Method: 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., Results: 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)., Conclusion: 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, 50 (11), 13-19.].

Introduction: Silicone breast implants are widely prevalent. An increasing group of patients detail self-reported somatic and psychological symptoms that have been ascribed as breast implant illness (BII) and seek capsulectomy and implant removal. To guide consultations and shared decision making, more outcome data relating to this intervention are required., Aim: To present a multicentre study of patient-centred (n = 100) outcome data, following total capsulectomy with implant removal for BII., Method: A questionnaire survey was cross-referenced with medical records. Collected data included demographics, operation details, pre- and postoperative symptom scores, overall self-perceived percentage improvement in BII symptoms and breast shape satisfaction ratings after explantation., Results: The 10 most frequently self-reported symptoms were fatigue (81%), pains/aches (72%), brain/memory fog (56%), mood disturbances (36%), neuropathic pain (28%), hair loss (28%), headaches (25%), gastric symptoms/intolerances (24%), eczema/rash (18%) and vision disturbance (17%). A high proportion of patients (98%) experienced a 62 ± 4% average symptom improvement; most self-reported symptoms (21/28) improved significantly after explantation with total capsulectomy (p < 0.05). Furthermore, patients had high overall self-perceived BII percentage improvement (76 ± 3%) and satisfaction with breast shape numerical rating score (8 ± 0.30) postoperatively., Conclusion: Despite BII not being a defined disease entity, symptom association with silicone breast implants continues for a growing number of patients. It is important to recognise that in this patient group, capsulectomy and implant removal may not be curative, however we have demonstrated that symptom improvement can occur. It is very difficult to prove a causal link between breast implants and BII; to do so will require extensive prospective data collection., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Functional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs., Aim: To explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken., Methods & Procedures: An online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks., Outcomes & Results: There were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues., Conclusions & Implications: Therapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence-based interventions to provide adequate care., What This Paper Adds: What is already known on the subject FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management. What this study adds to the existing knowledge This is the first UK-wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence-based interventions. What are the practical and clinical implications of this work? This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence-based practice., (© 2024 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: Human milk feeding rates in the United Kingdom are a public health concern. Changes to United Kingdom policy and practice are needed to improve lactation support. These should be informed by those with lived experience of human milk feeding and those who provide support., Research Aim: The aim of this study was to identify research, policy, and practice priorities for increasing human milk feeding rates using insights from a wide range of stakeholders. A secondary aim was to evaluate the influence of a World Café on individual attendees and their interactions within the organizations and communities of which they are a part., Methods: The research employed a participatory qualitative design, incorporating a cross-sectional survey and World Café discussions. World Café is a novel approach to engaging stakeholders in discussion, resulting in consensus-building and participatory-driven recommendations. A pre-event survey was completed by a self-selected sample of 67 participants; 37 of these (55%) took part in World Café discussions or an online focus group. World Café discussions and the online focus groups were recorded and transcribed verbatim. Following the World Café, 12 participants (32%) completed a post-event survey, and eight (22%) completed an additional follow-up survey at 2 months., Results: Priority policy and practice changes were identified, including enhancing education, the need for dedicated funding for human milk feeding support, the need to include family within support provision, and the need to change policy regarding media representations of infant feeding. In addition, World Café methodology proved valuable for facilitating networking and instigating changes in relation to support., Conclusion: World Café generated stakeholder agreed-on priorities for research and policy. Many of the recommendations from historical policy and guidance continue to be areas for further development., Competing Interests: Disclosures and Conflicts of InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Since the completion of this project AB has commenced training to become a peer supporter with The Breastfeeding Network. The authors declare no other conflicts of interest.

Purpose: To investigate the contribution of demographic trends in countries' age and gender composition to value set validity and obsolescence., Methods: Time-trade off (TTO) valuation data from 3 EQ-5D-3L value sets of 20 years or older from the United Kingdom, Japan, and the United States were re-analyzed using Bayesian heteroskedastic Tobit models with sex and age group-specific scale parameters. Original value sets were obtained by weighting the original preference structures with the countries' original demographic composition at the time of the data collection. Updated value sets were created using the original preference structure weighted using the countries' most recent demographic composition. The differences between the original and updated value sets were monitored and compared based on 95% credible intervals., Results: The gender and age composition of the investigated countries changed in all 3 countries over time. The modelled health state preferences also depended on the respondents' gender and age. However, the overall impact of this demographic change on the investigated value sets was negligeable in all 3 countries and this finding was robust to accounting for the impact of ethnicity trends in the United States., Conclusion: Value sets may become redundant and obsolete for various reasons, but demographic change was not identified as a contributing factor., (© 2024. The Author(s).)

Background: During the COVID-19 pandemic, online sexual health service delivery increased across Britain. We investigated inequalities in STI testing access and methods of access during the first year of the pandemic., Methods: Natsal-COVID, an online-survey of people 18-59 years in Britain, explored sexual health experiences in the first year of the pandemic. We describe the socio-demographics of participants who used STI testing services and compare those who reported being "online service users", defined as using services with no direct clinician interactions (regardless of whether they also used other methods), with those who were exclusively "other service users", defined as face-to-face, telephone, or video calls., Results: 246/6,064 participants (4.2%) reported STI testing between 03/2020-03/2021. Of those, 35.8% (95%CI 29.2-42.8) used online services. Online service users (compared to other service users) were more often white (74.9% (62.2-84.4) versus 68.5% (59.4-76.3)), less often had anxiety (39.0% (28.4-50.9) versus 57.2% (48.4-65.6)) and less often had disabilities (25.8% (16.8-37.4) versus 48.1% (39.4-56.9)). Among women (only), online users were more often in good health (91.4% (81.3-96.2) versus 69.3% (57.4-79.2))., Conclusions: More than one third of STI testers used online services during this period. Differences exist in the characteristics of people accessing online versus other testing services. These data suggest that online services were more likely to be accessed by groups with typically lower risk of poor sexual health (white and in good health). Further investigation is needed, especially if online services are the only option offered, as differences in ability to access services could widen inequalities., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aims: There are longstanding concerns relating to clinical academic training pipelines, with evidence for multiple barriers and enablers to clinical academic career progression. We sought to assess the extent to which these and other factors apply to academic training in clinical oncology in the United Kingdom., Materials and Methods: A cross-sectional survey was undertaken using a bespoke, pre-piloted online electronic questionnaire that was distributed to clinical oncology specialty trainees and consultants who had at any point between January 2013-January 2024 commenced an academic post whilst in training. Collated information included demographic data, location and stage of training, research experience and ambitions, research skill confidence and academic career progression., Results: Seventy eligible responses were included, representing 84% (n = 16/19) of UK training deaneries. Thirty-seven (53%) of the respondents had obtained their certificate of completion of training (CCT) whilst 11% (n = 8/70) and 40% (n = 28/70) were at specialty trainee level and respectively pre- or within-/post-doctoral studies. Of 34 post-CCT respondents, 58% (n = 20) had ongoing research commitments but this reached 30% of their overall activity for just 30% (n = 10). Barriers to academic progression included clinical training requirements, post availability and limited mentorship. Most (60%; n = 35/58) undertook doctoral studies in their final two training years. A majority of respondents lacked confidence in radiation oncology (RO) skills relevant to their career ambitions, with 60%, 40% and 30%, respectively, confident in RO clinical research outcome evaluation, in vitro radiation analyses and using RO animal models., Conclusion: These data provide a granular, long-term analysis of academic clinical oncology training at a national level; identifying poor progression to research independence underlined by limited confidence in RO research skills and multiple barriers to academic career progression. These data provide areas in which policy makers, research funders and training programmes can focus to improve academic training in clinical oncology., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The clinical landscape for endometrial cancer in the UK is evolving to include new management guidelines and targeted treatment options. An understanding of current treatment and management practices in the UK will help services plan and adapt to upcoming changes., Aim: The purpose of this survey was to understand current and anticipated real-world practices for endometrial cancer care in the UK and potential areas for optimisation., Materials and Methods: Telephone interviews were conducted in November/December 2021 with UK-based healthcare professionals involved in endometrial cancer management. Questions were aligned with the British Gynaecological Cancer Society/European Society for Medical Oncology recommendations, covering the pathway from diagnosis and treatment to follow-up., Results: A total of 63 healthcare professionals (HCPs) involved in the management of patients with endometrial cancer participated in telephone interviews. The results highlighted variations in management and treatment practices for endometrial cancer and suggest that current UK practice appears to diverge from national and international guidance in some instances. While somatic mismatch repair deficiency testing was used by 89.7% of respondents as mainstream testing, the survey highlighted a lack of access to other key molecular biomarker tests, such as polymerase epsilon (POLE) sequencing (used by only 9.8% of HCPs at the time of the survey)., Conclusion: The results highlighted several perceived practical barriers to the swift adoption of new therapeutic options, including funding access, limited staff, treatment-related resources, staff education, and support. Our findings support the need for better access to biomarkers that could enable more effective and targeted treatments., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

To date, most efforts to decolonise curricula have focussed on the arts and humanities, with many believing that science subjects are objective, unbiased, and unaffected by colonial legacies. However, science is shaped by both contemporary and historical culture. Science has been used to support imperialism, to extract and exploit knowledge and natural resources, and to justify racist and ableist ideologies. Colonial legacies continue to affect scientific knowledge generation and shape contemporary research priorities. In the biomedical sciences, research biases can feed into wider health inequalities. Reflection of these biases in our taught curricula risks perpetuating long-standing inequities to future generations of scientists. We examined attitudes and understanding towards decolonising and diversifying the curriculum among students and teaching staff in the biomedical sciences at the University of Bristol, UK, to discover whether our current teaching practice is perceived as inclusive. We used a mixed methods study including surveys of staff (N = 71) and students (N = 121) and focus groups. Quantitative data showed that staff and students think decolonising the curriculum is important, but this is more important to female respondents (P < 0.001). Students are less aware than staff of current efforts to decolonise the curriculum, while students from minority ethnic groups feel less represented by the curriculum than white students. Thematic analysis of qualitative data revealed three themes that are important for a decolonised curriculum in our context: rediscovery, representation and readiness. We propose that this '3Rs framework' could guide future efforts to decolonise and diversify the curriculum in the biomedical sciences and beyond., (© 2024 The Author(s). FEBS Open Bio published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.)

Aim: The Royal College of Radiologists (RCR) recognizes the importance of addressing differential attainment, bridging existing disparities, and fostering diversity and equity., Materials and Methods: A joint-faculty reverse mentoring (RM) pilot launched from July 2023 to January 2024. Participation was voluntary, mentors (trainees) from ethnic minority backgrounds and mentees (RCR officers) were recruited across the UK. Mentoring pairs engaged in regular meetings focused on sharing lived experiences and informal discussions. Data were collected through prepilot and postpilot surveys, virtual question polls at induction meeting, and written reports. Data were analyzed using descriptive statistics and thematic analysis for quantitative and qualitative data, respectively., Results: Eight matched pairs met predominantly online, on average 4 times over 6 months. Discussions covered a wide range of topics exploring systemic biases and professional development. Expectations expressed were to learn from others' experiences and achieve personal and professional growth. The prepilot survey revealed that 50% of respondents had experienced or witnessed racial discrimination, with only 28.5% feeling capable of supporting colleagues facing challenges. By mid-pilot, meaningful connections were established, allowing mentors to share experiences, and foster safe spaces. The postpilot survey results indicated that 90% of respondents felt better equipped to support colleagues facing challenges related to protected characteristics. Key lessons included understanding cultural differences, resilience, and empowering participants to drive change., Conclusions: The exchange of perspectives and experiences between individuals from diverse backgrounds and levels of expertise enhanced mutual understanding and inclusivity. This dynamic process has the potential to catalyze positive change across diverse domains, underlining its significance in shaping a more equitable postgraduate training landscape., (Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Background: Talking therapy for people with intellectual disabilities is often specifically adapted. One adaptation is the involvement of significant others in therapy, however, there is no systematic description of the use of this adaptation in routine clinical practice., Method: An online survey of UK psychologists regarding the inclusion of significant others in individual therapy with people with intellectual disabilities. Data were analysed using qualitative content analysis., Results: Ninety-five psychologists who work with people with intellectual disabilities provided responses to questions regarding the decision to include significant others in therapy, factors that make including significant others more or less likely and how the role of significant others is explained to them., Conclusions: Psychologists consider a range of factors in deciding the involvement of significant others. We discuss implications for training of therapists working with people with intellectual disabilities, issues of consent and how the roles of significant others are understood., (© 2024 The Author(s). Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Prcis: This survey highlights a deficiency in gonioscopy practices across the UK, particularly in the utilization of indentation gonioscopy and training of junior ophthalmologists. Recommendations include standardizing practice and enhancing training opportunities to improve patient care., Objective: Gonioscopy is an important general skill learned and practiced by all grades of ophthalmologists. The aim of this study is to discover the general attitude, perception, and practice of gonioscopy among ophthalmologists in the UK., Materials and Methods: A National gonioscopy survey was carried out by utilizing an anonymous electronic questionnaire of 18 questions. The questionnaire was electronically distributed online, using the survey tool, Microsoft 2016 "MS Forms" to all grades of ophthalmologists in the UK., Results: A total of 146 responses were analyzed. Overall, 89% of the participants felt "comfortable in performing slit lamp gonioscopy," but only 38% of junior trainees (ophthalmic specialist trainees years 1-3) felt comfortable in gonioscopy. Only 13% of the junior trainees felt they had adequate training in performing gonioscopy compared with 68% of the total respondents. Surprisingly, the majority of consultants (58%) did not "strongly agree" to be confident in assessing the angle and its configuration on gonioscopy. The most commonly used gonioscopic lens in this survey was the Zeiss four-mirror gonio lens, but only 38% of participants performed indentation gonioscopy routinely. The majority of the participants utilized the modified Shaffer's classification for gonioscopy. Fewer than expected numbers performed gonioscopy routinely for new patients with glaucoma., Conclusion: This survey suggests that gonioscopy is not being performed according to the UK national recommendations, and few ophthalmologists perform indentation gonioscopy. Additional gonioscopy training in the curriculum may be helpful., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The Individualized Neuromuscular Quality of Life Questionnaire (INQoL) is used to measure quality of life in neuromuscular disorders such as non-dystrophic myotonia (NDM). Here we report methods to estimate utilities, with a focus on NDM, from this questionnaire based on two preference elicitation exercises., Methods: Eight items from the INQoL were selected with input from three neuromuscular disorder clinical experts with expertise in treating NDM. A discrete choice experiment (DCE) survey of UK general public respondents (n = 508) described outcomes defined by the INQoL items. The same 8 items were also valued using time trade-off (TTO) face-to-face interviews (n = 200). A hybrid regression modelling approach combined both datasets to inform the utility weights., Results: Hybrid modelling of DCE and TTO data in conjunction improved out-of-sample predictive accuracy. The selected INQoL utility model indicates substantial disutility associated with all eight dimensions of health, with the greatest losses associated with subjective items such as pain and depression., Discussion: The hybrid modelling approach allows us to combine data from the two methodologies and maximize the information from each to inform the utility weights for the INQoL. The TTO is the more conventional valuation method, but combined with the larger DCE study produced better descriptive coverage. This is a relatively novel method for estimating weights which we think is particularly well suited to economic evaluations of orphan drugs., (© 2024. The Author(s).)

Paranoid thoughts have been reported in 20-30% of adolescents, and preliminary research has shown that paranoia and psychotic-like experiences have increased during the COVID-19 pandemic. However, previous research has typically used general measures to assess paranoia, rather than those specific to COVID-19, which may overlook particular facets of paranoia related to the pandemic and result in an under-reporting of paranoia prevalence rates during this time. Therefore, this study aimed to examine the psychometric properties of the Pandemic Paranoia Scale for Adolescents (PPS-A), which was adapted from the original scale to be appropriate for younger respondents, and to assess the prevalence of pandemic paranoia among adolescents. Adolescents (N = 462) recruited on Qualtrics from the United States (US) and United Kingdom (UK) completed an online survey consisting of the PPS-A and measures of general paranoia and negative affect. A subset of adolescent's parents (N = 146) also completed an online survey providing dyadic data. Findings showed that the PPS-A shared the same three factor structure as the adult PPS (i.e., persecutory threat, paranoid conspiracy, and interpersonal mistrust) and across participant nationality, race, gender, and mental health diagnosis. It also demonstrated strong psychometric properties. The overall prevalence rate of pandemic-related paranoia among adolescents was 21% and prevalence rates were higher among US participants than UK participants. This study provides the most comprehensive psychometric evaluation of a pandemic paranoia scale designed for adolescents and highlights the continued prevalence of pandemic paranoia in this age-group nearly two years after COVID-19 began., Competing Interests: Declarations Disclosure The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the United States Government or Department of Veterans Affairs. Conflict of Interest None to report., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)