Despite the availability of training and funding opportunities with the UK's National Institute for Health and Care Research (NIHR), early career researchers (ECRs) invariably experience concern in sustaining an academic career in health research given the uncertainties of success following rejection from peer-reviewed funding bodies. The objective of this study was to consider what motivates ECRs when applying for funding to NIHR programmes and how they overcome funding setbacks. Eleven ECRs took part in a one-to-one virtual in-depth interview; the sample included more women (n = 8) than men (n = 3) and participants included pre-doctoral researchers (n = 5), and both doctoral (n = 2) and post-doctoral (n = 4) ECRs. The interviews were analysed using the logic of a systems theory framework identifying factors impacting on ECRs occurring within an individual, within their social system and within their broader environment. The central themes that emerged from the data focussed on: (1) facilitators for ECRs to apply for NIHR funding; (2) exploring ECRs' setbacks and disappointments; (3) improving chances of funding; and (4) deciding to apply with a view to re-applying in future. The participants' responses provided an honest and frank reflection of the uncertainties and challenges as ECRs in the current climate. Further strategies to support ECRs could be facilitated through local NIHR infrastructure, mentorship, better access to local support networks and hard-wiring research into an organisation's strategic priorities.
Dear Editor Evidence indicates that despite prophylaxis, boys with severe and moderate haemophilia still bleed one to two times per year.1 It is well established that muscle weakness is associated with haemophilic arthropathy in adults2 and it is now becoming apparent that muscle strength may be reduced in children, prior to the onset of clinical arthropathy.3, 4 Therapeutic exercise is an important component of the management of other forms of arthropathy (eg osteoarthritis and rheumatoid arthritis),5 and it would appear logical that exercise would be effective for people with haemophilia. It is a commonly held view of some clinicians that increases in muscular strength might improve motor performance and cardiovascular fitness and limit exaggerated end-range joint movement.6 It may also promote optimal transfer of weight-bearing forces through joints, thereby minimizing muscle imbalance, synovial impingement and associated haemarthroses or synovitis.6 However, there is a lack of evidence to support these assumptions. A recent Cochrane Review evaluating the safety and effectiveness of exercise for people with haemophilia reported four randomized controlled studies of an exercise intervention in children with the condition and concluded the studies were of low or very low quality, due to small sample sizes and potential bias.7 Furthermore, no paediatric study compared a muscle strengthening intervention to a control group or intervention without muscle strengthening exercises. Additionally, pre-adolescent and adolescent boys were included in the same study, and it is not known whether the groups were matched for pubertal status. In pre-adolescent children, there is a linear relationship between strength, age and body size, but in young adolescent children, increases in strength are related to puberty rather than age which is likely to influence comparisons of strength and functional outcomes between children.8 Despite the apparent benefit, there is a lack of robust evidence to determine whether muscle strengthening exercise can improve or negatively affect outcomes for young children with haemophilia. The purpose of this two-centre feasibility randomized controlled trial (RCT) was to test the feasibility of an age-appropriate physiotherapy intervention co-designed by healthcare professionals and patients9 to improve muscle strength and physical function in pre-adolescent boys with haemophilia. Favourable ethical approval was obtained from the Health Research Authority and London—Fulham Research Ethics Committee and (17/LO/2043). The full protocol published elsewhere9 utilized a single-blinded randomized approach. Following screening and informed consent, participants were randomly allocated into one of two groups (Treatment Group 1 received a 12-week exercise intervention; Treatment Group 2 received usual physiotherapy care for 12 weeks) on a ratio of 1:1. The intervention developed by expert clinicians and patients utilizing a modified Nominal Group Technique is a 24-session, 12-week programme designed as 2-week progressive levels (intensity and or load) with no more than 10 exercises in each session. The intervention aims to master movement control and emphasizes body-weight strength development. Pictures of the exercises and instructions for each phase were provided in 2-week exercise diaries. Participants completed the same exercises and were asked to complete the exercises twice per week: once with the physiotherapist who visited the participant at home and once supervised by their parents/ guardian. Completion of exercises, along with treatment regimen, any adverse events and comments in relation to the exercise programme were recorded in the exercise diary. Primary outcome was safety and adherence. Secondary outcomes were recruitment rate: lower limb maximum muscle strength; six-minute timed walk (6MTW); timed up- and downstairs (TUDS)10; EQ-5D-Y; and costs relevant to the study. Safety, adherence, recruitment and follow-up are described as percentages. Demographic and disease variable distributions were analysed for descriptive purposes and covariant analysis. Estimates of differences between treatment arms in the changes from baseline (adjusted for baseline) and 75% CI were calculated to estimate the potential effect of the intervention and provide estimates of variability to inform the sample size required for a full RCT, as well as to refine the outcome measures by evaluating their responsiveness to change. Unit costs were combined with the duration, number of sessions recorded and number of clinicians involved in the sessions to provide a pragmatic intervention cost for the usual care and intervention groups. Individual-level resource use was combined with unit costs to calculate the total health services cost for each participant. Hospital outpatient and A&E visits were combined with the national average (unit cost) from national databases such as the Unit Costs of Health and Social Care 201811 and the United Kingdom Department of Health and Social Care National Schedule of Reference Costs (2017-2018). Nine children participated in the feasibility study: seven were diagnosed with severe haemophilia A and two with severe haemophilia B. Five were randomly allocated to the exercise intervention and four to usual care. Mean age of the children was 9.77 years (SD 2.18); mean height, 1.40 m (0.17); and mean BMI, 18.65 kg/m2 (3.11). We recruited 75% (target > 50%) of participants who met the inclusion criteria from two study sites; all were willing to be randomized, and the follow-up retention rate was 100%. Participants reported feeling 'satisfied with the group they were allocated and understood the logic of randomisation and needing a control arm of the trial'. They did not feel any detrimental impact for not receiving the exercise programme by being offered the exercise programme at the end of the study, which they were informed about during the consent process. We conducted a single-blinded approach with outcome data collected by a physiotherapist blinded to the participant allocation. Outcome data were collected by the same physiotherapist at both sites. Blinding was maintained throughout the study with participants and physiotherapists delivering the intervention encouraged to withhold the group allocation from the assessor during data collection. Eighty-three (83) per cent (24/29) of exercises were completed by all participants at least twice per week during the 12-week intervention (target = 75%). Adherence to the intervention was 100% (exercises performed at least twice per week) in the first ten weeks of the intervention and 62.5% during the final 2 weeks. The mean time taken to complete each exercise session was 56.00 ± 5.48 minutes. Two adverse events were reported during the study: one lower limb muscle bleed following a game of football at school for one of the participants, and a knee joint bleed following a fall at the park for a second participant. Both events were reviewed by the Research Monitoring Group and considered not directly attributable to the intervention. There were no serious adverse events or adverse reactions reported during the study. Although the efficacy was not the aim of this study, muscle strength of ankle plantarflexors and knee extensors, distance walked in six-minutes and time taken to ascend and descend 12 steps improved in children receiving the intervention compared with those who did not (Table 1 and Figure 1). However, we acknowledge these findings in such a small sample are underpowered. The total actual intervention cost was £802.12 (SD £66.62) per participant, ranging between £714.10 and £860.80. In partnership with children with haemophilia, their families and healthcare professionals we have co-produced a low-cost intervention and study design that is safe and suitable to test efficacy on muscle strength, function and participation in physical activities in children with the condition. Our study strategies ensured high recruitment and retention. Random allocation was acceptable to those who participated, and we were able to successfully maintain a single-blinded approach. We developed an intervention that had no adverse events and was acceptable to patients and physiotherapists that we plan to evaluate in a fully powered single-blinded two-arm pragmatic randomized controlled trial. We gratefully acknowledge the National Institute for Health Research—Research for Patient Benefit Programme for providing funds to support this project (grant number PB-PG-0215-36091). This paper reports independent research funded by the National Institute for Health Research (Research for Patient Benefit Programme, PB-PG-0215-36091). The views expressed in the publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The authors stated that they had no interests which might be perceived as posing a conflict or bias.
Abstract Background The growth of the UK’s population together with an aging society with increasingly complex health and social care needs has placed a greater demand on statutory care services. In view of this emerging landscape, the UK Government has sought to increase its medically trained workforce in order to better respond to the demands placed on the health service. Five universities were announced as homes to new medical schools offering undergraduate places to boost the numbers of doctors training in England. The aim of this narrative review was to explore how new medical schools could improve the health outcomes of the local population and evaluate the potential contribution it may make to the local economy, workforce and to research and education. Methods A narrative review was undertaken using a systematic approach for the search literature strategy. The articles were evaluated by undertaking a critical assessment evaluating the fitness of a paper for review according results, methods used to test the hypothesis, conclusions and impact and limitations. Thematic analysis was employed to organise and summarise the findings across a heterogeneous body of literature included in the review. The analysis was developed in an inductive manner and there were not any predefined themes to guide data extraction and analysis. Results: Thirty-six articles were selected for inclusion for this narrative review. The review identified eight key themes: rural / primary care career choices, rural undergraduate medical education and rural exposure, recruitment and retention in primary care / rural settings, workforce, health outcomes of local populations, social accountability, economic contribution of medical schools to communities and impact on rural research. Conclusions: The studies included found a wealth of information on a wide-range of topics on the expansion of undergraduate education and its implications on the future medical workforce. It was shown that medical schools can have a positive effect on the health, social, economic and research activity of a region, but this literature tended to be heterogeneous in focus without consideration of the inter-connections between the wider societal and economic impacts arising from long-term sustainable change being brought to a region.
Introduction: There is a growing recognition of the impact of work on health both positive and negative. It is important that all health care professionals are equipped to understand the effects of work and worklessness on health and help patients remain in work or manage a healthy return to work where appropriate. Despite explicit reference to health and work in the General Medical Council's Outcomes for Graduates, currently, this is not a theme that is integrated across the undergraduate medical curricula.Aim: This study evaluates medical tutors' and undergraduates' perspectives of a selection of health and work topics in a teaching pilot to consider the suitability and appropriateness for delivery, integration into the curriculum, tailoring of the resources, and appropriateness and expected attainment of learning objectives.Methods: Qualitative, semi-structured interviews and focus groups were carried out with five medical tutors and 36 undergraduates. Interviews and focus groups were recorded, transcribed and thematically analysed.Results: Medical tutors and undergraduates identified suitability of appropriate subject specialities and years of teaching, whether learning objectives were important and if these had been achieved, and recommendations for future delivery.Discussion: Medical tutors were committed to delivering the health and work topics with the flexibility of tailoring the resources to existing subject specialities and with respect to the year of study. Learning objectives were perceived appropriate by tutors, despite ambivalence about their importance from some undergraduates. Resources were identified as having relevance to public health undergraduate teaching and during general practice placements.
Despite the often cited idea that racial identities are socially constructed, and potentially fluid, much public policy is still based on surveys that elicit only one measure of racial identity. A number of U.S. studies have employed “best single race” questions on racial identification, in which multiracial respondents are asked to choose only one race to describe themselves. We extend some American studies by examining responses to a “best single race” survey question posed to a small sample of multiracial young people in Britain. In-depth interviews with British multiracial respondents are employed to investigate the extent to which a “best single race” (BSR) question captures someone's sense of attachment and belonging to a particular ethnic or racial group. In particular, we focus on how we should interpret East Asian/white respondents' choice of “white” as their BSR.
On 14 May 2021, the Health Service Executive (HSE) of Ireland suffered a major ransomware cyberattack which resulted in all of its national and local IT systems being shut down.The cyberattack had a brutal impact on healthcare services already exhausted from dealing with the COVID-19 pandemic for over a year.The attack was unprecedented in the history of the Irish state affecting 41 hospitals nationwide.Core services around the country were affected, including radiology and diagnostic systems, maternity and infant care, patient administration systems, chemotherapy, radiation oncology, referral systems, remote consultations, and email.Outpatient appointments and elective admissions were cancelled to ensure patient safety.The COVID-19 vaccination program was not affected and continued as planned.The haemophilia services in Ireland had no access to PC's, printers, e-mail and reduced access to diagnostic results.Health care professionals had to rely on contingency measures such as manual paper-based systems and telephone communication.The haemophilia services in Ireland utilise an externally supported cloud based patient electronic record and were therefore, able to access this system on a laptop during the cyberattack.A Russian-based organised cybercrime group was identified as responsible for the HSE cyberattack.In line with state policy, no ransom was paid by the Irish Government or the HSE.Despite a High Court injunction obtained by the HSE to prohibit the sharing of its data, 520 patient's data, corporate documents, and minutes of meetings were released online.A national helpline was set up to assist individuals who have had health information published due to the hack.On the 20th of May, the cybercrime group gave the HSE a decryption key at no cost.This enabled the HSE to recover files that the group had locked and encrypted.It has taken months to repair and recover the HSE systems, with 95% of servers and devices restored by September 2021.This was achieved with the help of HSE IT officers, The Defence Forces, the National Cyber Security Centre (NCSC), and its private cyber contractors.Individual hospital IT teams continue to work tirelessly to achieve complete system restoration.The estimated cost of the HSE cyberattack on its IT systems is more than €100 million.
The historic partition of Bengal in 1947 caused a shift in the composition of the Muslim and Hindu political elite who were now geographically bounded into two separate newly formed provincial states of East Pakistan and West Bengal. The aim of this article is to explore the transformation in elite conceptions of identity in East Pakistan from the post-1947 era until the creation of Bangladesh in 1971. The prevalence of two new competing elites created a great dichotomy in the way identity was conceived. The change of these elite groups fundamentally altered the view of identity that was articulated during this period.
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