NIHR open research最新文献

{"title":"Consumer knowledge of and engagement with traditional takeaway and dark kitchen food outlets.","authors":"Lucie Nield, Helen Martin, Claire Wall, Jo Pearce, Rachel Rundle, Simon Bowles, David Harness, Jordan D Beaumont","doi":"10.3310/nihropenres.13735.2","DOIUrl":"10.3310/nihropenres.13735.2","url":null,"abstract":"<p><strong>Background: </strong>Dark kitchens - delivery-only food outlets operating through digital technology platforms - are a contemporary addition to the food environment. Some concerns have been raised around the ability for local authorities to identify and regulate these businesses, with growing concern around the nutritional quality of foods, food safety practices and impact on the local food environment. The present work explores consumer understanding of and engagement with dark kitchen and traditional takeaway establishments.</p><p><strong>Methods: </strong>Healthy adults living in the United Kingdom completed an online survey comprising of questions measuring demographics, engagement with takeaways and dark kitchens, purchasing behaviours and decision making, and knowledge and understanding around dark kitchens. Data were analysed using descriptive statistics.</p><p><strong>Results: </strong>In total, 2,023 participants (46.3 ± 16.7 years) completed the survey. Forty percent purchased a takeaway at least weekly, often through aggregator applications (e.g., Just Eat, Deliveroo). Food was mainly purchased as a treat (79.3%), for enjoyment of the food or taste (60.8%) and for convenience (58.2%). When ordering, consumers considered the taste (88.1%), quality (83.5%), value for money (77.8%), and familiarity with (68.1%) and reputation of the business (60.0%). Only 24.7% of participants had heard of dark kitchens and 9.1% had knowingly purchased from one. After reading a working definition, 54.9% said they would purchase from a dark kitchen, but most would want to know explicitly that they were ordering from these businesses. A major concern when purchasing food from a dark kitchen or takeaway outlet was trust in the food safety and hygiene standards.</p><p><strong>Conclusion: </strong>Consumers are unfamiliar with dark kitchens and are not aware of or confident in identifying these businesses. This confusion and concerns around food safety mean dark kitchens are often viewed negatively. Consumers would prefer more transparency in where their foods are being prepared to allow for more informed decision-making.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"64"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving follow-up care for people after minor stroke using early personalised care: A protocol for a randomised, mixed-methods, feasibility study.","authors":"Jennifer Crow, Hilary Watt, Mary Wells, Paresh Malhotra","doi":"10.3310/nihropenres.13649.3","DOIUrl":"https://doi.org/10.3310/nihropenres.13649.3","url":null,"abstract":"<p><strong>Background: </strong>Of the 150 000 people per year in the UK who have strokes, third to half will experience a so-called 'minor stroke'. Although appearing benign these strokes put a person at increased risk of further strokes and survivors are usually considered 'too good' for referral onto community stroke services. When back at home the hidden effects of stroke like fatigue and changes in mood and cognition become apparent and impact return to work, relationships and everyday activities. Alongside this, managing the risk of recurrence, highest early after an initial stroke, is a priority. People with stroke report feeling abandoned after discharge with unmet information and support needs.</p><p><strong>Methods: </strong>To address this issue, we reviewed the literature, met with people with stroke and other stakeholders to develop an early, personalised follow-up programme of care for those who currently only receive routine medical follow-up appointments. The design of this complex intervention is informed by the NIHR/MRC framework for complex intervention development and the framework of action described by O'Cathain and colleagues. The intervention is underpinned by self-determination theory. We will be conducting a randomised, mixed methods, single-centre feasibility study to explore the acceptability and feasibility of the intervention. Sixty participants will be recruited from a Hyperacute Stroke Unit and Rapid Assessment Clinic and randomised to the intervention or control group. The intervention group will receive personalised follow-up appointments at two- and six-weeks post-discharge. All participants will have outcome measures taken at baseline and twelve-weeks post-stroke. Patient reported outcomes will be reviewed to assess their suitability for a later definitive trial. Qualitative interviews will be conducted to gain a deeper understanding of life after stroke from those who did and did not receive the intervention.</p><p><strong>Conclusions: </strong>Study findings will be used to further refine the intervention, methods and outcome measurements used. These refinements will inform a future multicentre randomised controlled trial.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"44"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe, uncontrolled epilepsy in pregnancy: A population-based case-control study.","authors":"Bryn Kemp, Andrew Kelso, David Williams, Marian Knight","doi":"10.3310/nihropenres.13743.2","DOIUrl":"10.3310/nihropenres.13743.2","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy affects one percent of the UK population and is the most common serious neurological condition experienced during pregnancy. We compared the characteristics, clinical management, and pregnancy outcomes in women with severe, uncontrolled epilepsy to those of women with well controlled disease.</p><p><strong>Methods: </strong>We conducted a population-based case-control study in all UK consultant-led maternity units. Cases of severe uncontrolled epilepsy during pregnancy were identified prospectively and reported via the UK Obstetric Surveillance System (UKOSS). Severe epilepsy was defined <i>a-priori</i> as ≥1 of the following: admission to hospital during pregnancy to manage seizures; prescribed ≥3 antiepileptic medications; or died from epilepsy. Controls comprised women with epilepsy not meeting the case definition, identified within the same centres as cases. Pre-pregnancy epilepsy control and pregnancy outcomes were compared between groups using multivariable logistic regression.</p><p><strong>Results: </strong>We identified 94 cases between 1 October 2015 and 31 March 2017 and compared these with 186 controls. Cases were significantly more likely to be admitted to manage seizures in the year preceding pregnancy (42/94 cases vs 10/186 controls, adjusted odds ratio [aOR]=7.38 [95% CI 2.70-20.2]), and to report their most recent seizure within 3 months of pregnancy (51/94 cases vs 18/186 controls, aOR=5.86 [95% CI 2.30-15.0]). Cases were significantly more likely to deliver before 37 weeks (20/94 cases vs 8/186 controls, aOR=7.61 [95% CI 2.87-20.2]).</p><p><strong>Conclusions: </strong>Women admitted for seizure management in the year before pregnancy are at higher risk of severe epilepsy during pregnancy and of preterm birth. These women should be prioritised for discussion about pregnancy and contraception. When pregnant, they should be reviewed as early as possible by specialists in the management of epilepsy during pregnancy. Delivering messages about the importance of pregnancy planning and contraception to all women with epilepsy should be viewed as the responsibility of all clinicians involved their care.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"53"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"improving Pain mAnagement for childreN and young people attendeD by Ambulance (PANDA): protocol for a realist review.","authors":"Georgie Nicholls, Georgette Eaton, Marishona Ortega, Kacper Sumera, Michael Baliousis, Jessica Hodgson, Despina Laparidou, Aloysius Niroshan Siriwardena, Paul Leighton, Sarah Redsell, Bill Lord, Tatiana Bujor, Gregory Adam Whitley","doi":"10.3310/nihropenres.13627.2","DOIUrl":"10.3310/nihropenres.13627.2","url":null,"abstract":"<p><strong>Background: </strong>Each year in England, 450,000 children and young people (CYP) under 18 years of age are transported by ambulance to emergency departments. Approximately 20% of these suffer acute pain caused by illness or injury. Pain is a highly complex sensory and emotional experience. The intersection between acute pain, unwell CYP and the unpredictable pre-hospital environment is convoluted. Studies have shown that prehospital pain management in CYP is poor, with 61% of those suffering acute pain not achieving effective pain relief (abolition or reduction of pain score by 2 or more out of 10) when attended by ambulance. Consequences of poor acute pain management include altered pain perception, post-traumatic stress disorder and the development of chronic pain. This realist review will aim to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP.</p><p><strong>Methods: </strong>A realist review will be conducted in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. A five-stage approach will be adopted; 1) Developing an Initial Programme Theory (IPT): develop an IPT with key stakeholder input and evidence from informal searching; 2) Searching and screening: conduct a thorough search of relevant research databases and other literature sources and perform screening in duplicate; 3) Relevance and rigour assessment: assess documents for relevance and rigour in duplicate; 4) Extracting and organising data: code relevant data into conceptual \"buckets\" using qualitative data analysis software; and 5) Synthesis and Programme Theory (PT) refinement: utilise a realist logic of analysis to generate context-mechanism-outcome configurations (CMOCs) within and across conceptual \"buckets\", test and refine the IPT into a realist PT.</p><p><strong>Conclusion: </strong>The realist PT will enhance our understanding of what works best to improve acute prehospital pain management in CYP, which will then be tested and refined within a realist evaluation.</p><p><strong>Registration: </strong>PROSPERO Registration: CRD42024505978.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for the economic evaluation of integrated community-based care compared with integrated facility-based care for HIV, hypertension and diabetes in Tanzania and Uganda (INTE-COMM trial).","authors":"Gerard Joseph Abou Jaoude, Ivan Namakoola, Faith Aikaeli, Godfather Kimaro, Faith Moyo, Francis Xavier Kasujja, Erik Van Widenfelt, Sokoine Kivuyo, Josephine Birungi, Gerald Mutungi, Omary Said Ubuguyu, Stephen Watiti, Kaushik Ramaiya, Sayoki Mfinanga, Moffat Nyirenda, Anupam Garrib, Shabbar Jaffar, Jolene Skordis, Neha Batura","doi":"10.3310/nihropenres.13794.2","DOIUrl":"10.3310/nihropenres.13794.2","url":null,"abstract":"<p><strong>Background: </strong>The number of people living with multiple chronic conditions in sub-Saharan Africa is increasing, but health facilities are unable to meet demand. To improve health system capacity and access to care, community models of HIV care have been trialled in countries such as Tanzania and Uganda. However, no evidence exists to inform policymakers on the effectiveness and cost-effectiveness of integrated community-based models of care for HIV and chronic non-communicable conditions. This protocol outlines a within-trial economic evaluation to address this gap.</p><p><strong>Methods & analysis: </strong>We will estimate the costs and cost-effectiveness of integrated community-based care for HIV, hypertension and diabetes compared with facility-based care within the INTE-COMM pragmatic cluster-randomised trial in Tanzania and Uganda. Analyses will adopt a 52-week time horizon, the duration of trial follow-up. The full enrolled trial sample will be analysed from a societal perspective, comprising provider and patient perspectives. Economic costs will be estimated, which includes valuing inputs such as donated goods or time foregone by participants because of receiving care. For provider costs, participant case report forms will inform resource use along with data from facilities and community sites. Resources will be valued using project accounts, facility spending, and locally available cost data. Patient costs will be estimated based on a care-seeking and cost questionnaire administered to participants. Estimated costs will be analysed with co-primary trial outcomes on plasma viral load suppression, glycaemia and blood pressure control to calculate incremental cost-effectiveness ratios (ICER). We will also calculate ICERs for secondary trial outcomes related to health-related quality of life and wellbeing. Cost drivers and outcomes will be varied within confidence bounds in a two-way sensitivity analysis. We will investigate equity impact by estimating the mean difference in outcomes between integrated community-based and facility-based care across household socio-economic quintiles and by measuring whether participants incurred catastrophic health expenditures.</p><p><strong>Trial registration number: </strong>The ISRCTN Registry: ISRCTN15319595. Registered on 07 June 2022: https://doi.org/10.1186/ISRCTN15319595.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"80"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping decision-making pathways: Determination of intervention entry points for diagnostic tests in suspected serious infection.","authors":"Raasti Naseem, Nicola Howe, Sara Pretorius, Cameron Williams, Clare Lendrem, Philip Pallmann, Enitan D Carrol","doi":"10.3310/nihropenres.13568.2","DOIUrl":"10.3310/nihropenres.13568.2","url":null,"abstract":"<p><strong>Background: </strong>PROTECT ( Platform Randomised evaluation of clinical Outcomes using novel TEChnologies to optimise antimicrobial Therapy) has brought together a team of researchers to design a platform trial to rapidly evaluate and adopt into care multiple diagnostic technologies, bringing immediate benefit to patients. Rapid diagnostic tests will be used to identify patients at risk of deterioration from severe infection, before they become critically unwell. The platform will assess their comparative clinical effectiveness and cost-effectiveness relative to current standard of care. Preliminary work, conducted under a Health Technology Assessment Application Acceleration Award, provided key evidence to optimise the design of the PROTECT platform.</p><p><strong>Methods: </strong>Qualitative methods which involved consulting key stakeholders in the field of serious infection addressed the key priorities. A high-level care pathway analysis focusing on serious infection in secondary care, captured the points of contact, actions, decisions, and potential outcomes associated with a patient's care.</p><p><strong>Results: </strong>Two use cases of rapid diagnostic tests for serious infection were identified; (1) in acute emergency medicine to decide on antimicrobial initiation and/or escalation of care, and (2) in hospitalised patients to monitor treatment response. The \"ideal\" test should be rapid, point-of-care, cheap to procure, have capacity for high usability, and ability to be performed and interpreted by all staff. Facilitators to the adoption of infection diagnostic tests is their clinical need, and the main potential barrier is poor change management and behavioural change.</p><p><strong>Conclusions: </strong>Any new test should provide robust evidence of its clinical effectiveness and have the potential to accelerate ruling in or out serious infection which benefits the clinical pathway for patients, clinicians, and hospitals as a whole, to be considered for adoption as a new standard of care.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The SIMCA Study Protocol: Factors influencing the implementation of the Midwifery Continuity of Carer (MCoC) model of care in NHS maternity care in England: A mixed methods cross case analysis involving clinicians, women and policy makers.","authors":"Rebecca Milton, Susan Channon, Julia Sanders, Sara Kenyon, Aimee Middlemiss, Heather Strange, Kate Davies, Lena Choudary-Salter, Susan Barry, Tina Prendeville, Aled Jones","doi":"10.3310/nihropenres.13745.1","DOIUrl":"10.3310/nihropenres.13745.1","url":null,"abstract":"<p><strong>Background: </strong>During pregnancy, labour and early motherhood, most women in the UK receive care from different midwives. NHS policy change in England sought to introduce a model of care whereby each woman is cared for by the same midwife throughout antenatal, intrapartum and postnatal periods, supported by a small team of midwives to cover off-duty periods. This model is called the Midwifery Continuity of Carer (MCoC). This study proposes to evaluate the implementation and delivery of MCoC across England, aiming to better understand the factors that result in different rates of progress with MCoC implementation.</p><p><strong>Aim: </strong>To identify the local, regional and national factors which contribute to variable progress with implementation of MCoC in the NHS in England?</p><p><strong>Methods: </strong>A sequential mixed-methods study, informed by implementation science frameworks will be delivered over three work packages. Following a literature review of the challenges and successes of previous attempts to implement MCoC (work package 1), six case studies in NHS Trusts will be undertaken to better understand different rates of progress with MCoC implementation and people's experiences of MCoC implementation through: interview and questionnaire (maternity services staff); interviews (service-users); observation of relevant implementation meetings and organisational documentation collection (work package 2). Interviews will be undertaken with national and regional stakeholders relevant to MCoC implementation (work package 2). Data analysis will be conducted both inductively and deductively, informed by implementation science constructs (work package 3).</p><p><strong>Dissemination: </strong>Study findings will be disseminated through peer-reviewed journals, conferences and events. Results will be of interest to the public, clinical and policy stakeholders in the UK and will be disseminated accordingly.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"5 ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study.","authors":"Nuala Lucas, Alison Gooda, Ruth Tunn, Marian Knight","doi":"10.3310/nihropenres.13797.1","DOIUrl":"10.3310/nihropenres.13797.1","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary aspiration of gastric contents is the most frequent cause of death associated with complications of airway management during general anaesthesia. Pregnancy increases aspiration risk owing to factors including delayed gastric emptying and increased intragastric pressure. We describe the incidence, risk factors, management, and outcomes of maternal pulmonary aspiration in pregnancy in the UK.</p><p><strong>Methods: </strong>We conducted a population-based surveillance and case-control study. Between September 2013 and August 2016, all UK consultant-led obstetric units prospectively identified cases of pulmonary aspiration among parturient women using a pre-defined case definition, and reported them via the UK Obstetric Surveillance System (UKOSS). Controls (n=1982) were obtained from four UKOSS studies conducted between 2005 and 2014. We calculated the incidence of pulmonary aspiration using 2013-2015 maternities as the denominator. We explored potential risk factors for aspiration using univariable logistic regression and described outcomes.</p><p><strong>Results: </strong>We identified 12 cases of pulmonary aspiration, giving an incidence of 5.2 per 1,000,000 maternities (95% CI 2.69-9.09). Cases were significantly less likely than controls to be multiparous (unadjusted odds ratio [uOR] 0.255, 95% CI 0.069-0.946), and significantly more likely to undergo caesarean section (uOR 24.89, 95% CI 3.18-194.85) and to receive general anaesthetic for caesarean section (p<0.001). Gestation was significantly shorter in cases than controls (uOR 0.782, 95% CI 0.702-0.870). Women who aspirated were significantly more likely to be admitted to the intensive therapy unit than controls (p<0.001). Infants of women who aspirated had significantly lower Apgar scores and were more likely to be admitted to the neonatal intensive care unit or to be stillborn compared with infants of women in the control group.</p><p><strong>Conclusions: </strong>Pulmonary aspiration is rare in UK obstetric anaesthetic practice; however, it remains a risk of general anaesthesia. Despite a large study population, our analyses lacked power to evaluate many potential risk factors. Future research should focus on developing methods to accurately identify pregnant women at risk of aspiration.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"5 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacist-led DE-eSCALation of opioids post-surgical dischargE (DESCALE) - A multi-centre, non-randomised, feasibility study protocol.","authors":"Emma L Veale, Johanna Theron, Melanie Rees-Roberts, Julie H Hedayioglu, Ellie Santer, Sabina Hulbert, Vanessa J Short","doi":"10.3310/nihropenres.13716.2","DOIUrl":"10.3310/nihropenres.13716.2","url":null,"abstract":"<p><strong>Background: </strong>Opioids are frequently prescribed for short-term acute pain following surgery. Used appropriately, opioids deliver extremely favourable pain relief. Used longer than 90-days, however, can result in health complications, including unintentional overdose and addiction. Globally, >40 million people are dependent on opioids and annually >100,000 die from opioid misuse. With >4.7 million surgical procedures occurring annually in the United Kingdom it is imperative that opioid-use is managed upon discharge. A declining General Practitioner (GP) workforce and increased patient numbers, however, means gaps in healthcare during transfer of care. Here we report a mixed-methods protocol to understand the feasibility, and acceptability of a clinical pharmacist (CP)-led early opioid deprescribing intervention for discharged surgical patients.</p><p><strong>Methods: </strong>DESCALE is a multicentre, non-randomised, pragmatic feasibility study. Participants aged ≥18 years who have undergone a surgical procedure at a single NHS trust in Southeast England and discharged with opioids and without a history of long-term opioid use, cancer diagnosis or study contraindications will be offered a Medicines Use Review (MUR) within 7-10 days of discharge. The MUR will be delivered by CPs at participating GP practices. Feasibility outcomes will focus on recruitment, fidelity of CPs to deliver the MUR, and barriers within primary care that affect delivery of the intervention, with a maximum sample size of 100. Clinical outcomes will focus on the number of participants that reduce or stop opioid use within 91 days. Prescribing, medical, surgical, and demographic data for individual participants will be collected and analysed to inform future trial design. Qualitative interviews with participants and associated healthcare professionals will explore acceptability and implementation of the intervention.</p><p><strong>Conclusion: </strong>Data collected with respect to opioid use post-surgery, feasibility and acceptability of the intervention, patient experience and outcome data will inform the design of future research and larger clinical trials.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"48"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The UK Breast Cancer in Pregnancy (UKBCiP) Study. Incidence, diagnosis, management and short-term outcomes of breast cancer first diagnosed during pregnancy in the United Kingdom: A population-based descriptive study.","authors":"Claudia Hardy, Andrew Brand, Julie Jones, Marian Knight, Philip Banfield","doi":"10.3310/nihropenres.13652.1","DOIUrl":"10.3310/nihropenres.13652.1","url":null,"abstract":"<p><strong>Background: </strong>The incidence of breast cancer first arising during pregnancy has been estimated in several countries to be 2.4-7.8/100,000 births, but has not been established in the United Kingdom (UK). We aimed to estimate the incidence of breast cancer diagnosed during pregnancy in the UK and to describe its management and short-term outcomes for mothers and babies.</p><p><strong>Methods: </strong>This population-based descriptive study used the UK Obstetric Surveillance System (UKOSS). Cases were prospectively identified through monthly UKOSS mailings to all UK consultant-led maternity units. All cases of breast cancer diagnosed first during pregnancy, between October 1, 2015, and September 30, 2017, were eligible, with 84 confirmed cases analysed. Women with breast cancer diagnosed before pregnancy or with a recurrence were excluded. The primary outcomes were the incidence of breast cancer first diagnosed during pregnancy, maternal mortality, severe maternal morbidity, perinatal mortality, and severe neonatal morbidity.</p><p><strong>Results: </strong>The incidence was 5.4/100,000 maternities (95% CI 4.37, 6.70). Nine women (11%) had undergone <i>in vitro</i> fertilisation (IVF), compared with a contemporaneously estimated 2.6% IVF pregnancies in the UK. During pregnancy, 30 women (36%) underwent surgery and 37 (44%) received chemotherapy. Three women had major maternal morbidity during pregnancy. Two women died and two perinatal deaths occurred.</p><p><strong>Conclusions: </strong>The incidence of breast cancer arising in pregnancy in the UK is similar to that reported elsewhere. The higher proportion of IVF pregnancies among affected women needs further investigation, as it may not be entirely explained by relatively advanced maternal age. With caveats, management followed that outside pregnancy, but there was considerable variation in practice. Although short-term outcomes were generally good for mothers and babies, a larger prospective study is required. Iatrogenic pre-term delivery and its associated risks to the infant can often be avoided; treatment was administered during pregnancy without evidence of harms to the infant.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}