NIHR Race Equality Framework: development of a tool for addressing racial equality in public involvement

BACKGROUND

While there has been a long recognition of the importance of race equality in health and care research, there is a lack of sustained action among research funding and research performing organisations to address racial equality in public involvement. This paper describes how the UK's National Institute for Health and Care Research (NIHR) convened a Race Equality Public Action Group (REPAG), which co-developed with public contributors and stakeholders a Race Equality Framework - a tool for addressing racial equality in public involvement.

METHODS

The REPAG, through meetings and discussions, defined the focus of the Framework, and developed an initial draft of the Framework. Public contributors identified the need for broader consultation with other public members. Three community consultation events with a total of 59 members of Black African-, Asian- and Caribbean-heritage communities were held to seek their views on health and care research generally and on the draft Framework specifically. The draft Framework was modified and piloted among 16 organisations delivering health and care research. Following feedback from the pilot, the Framework was modified and prepared for publication.

RESULTS

The Framework is designed as a self-assessment tool comprised of 50 questions pertaining to five domains of organisational activity: 1) individual responsibility, 2) leadership, 3) public partnerships, 4) recruitment, and 5) systems and processes. The questions were co-designed with REPAG public members and provide key concepts and elements of good practice that organisations should consider and address on their path to achieving racial competence. The accompanying materials provide implementation guidance with 20 detailed steps, case studies of actions taken in seven pilot organisations, and links to additional resources. The pilot demonstrated the feasibility of conducting a meaningful self-assessment over a period of three months and the usefulness of the results for developing longer-term action plans.

CONCLUSION

The Framework represents the first self-assessment tool for addressing racial equality in public involvement. Co-design with REPAG public members enhanced its authenticity and practicality. Organisations in the field of health and care research and any other organisations that use partnerships with the public are encouraged to adopt the Framework.

The effectiveness of knowledge-sharing techniques and approaches in research funded by the National Institute for Health and Care Research (NIHR): a systematic review

BACKGROUND

The National Institute of Health and Care Research (NIHR), funds, enables and delivers world-leading health and social care research to improve people's health and wellbeing. To achieve this aim, effective knowledge sharing (two-way knowledge sharing between researchers and stakeholders to create new knowledge and enable change in policy and practice) is needed. To date, it is not known which knowledge sharing techniques and approaches are used or how effective these are in creating new knowledge that can lead to changes in policy and practice in NIHR funded studies.

METHODS

In this restricted systematic review, electronic databases [MEDLINE, The Health Management Information Consortium (including the Department of Health's Library and Information Services and King's Fund Information and Library Services)] were searched for published NIHR funded studies that described knowledge sharing between researchers and other stakeholders. One researcher performed title and abstract, full paper screening and quality assessment (Critical Appraisal Skills Programme qualitative checklist) with a 20% sample independently screened by a second reviewer. A narrative synthesis was adopted.

RESULTS

In total 9897 records were identified. After screening, 17 studies were included. Five explicit forms of knowledge sharing studies were identified: embedded models, knowledge brokering, stakeholder engagement and involvement of non-researchers in the research or service design process and organisational collaborative partnerships between universities and healthcare organisations. Collectively, the techniques and approaches included five types of stakeholders and worked with them at all stages of the research cycle, except the stage of formation of the research design and preparation of funding application. Seven studies (using four of the approaches) gave examples of new knowledge creation, but only one study (using an embedded model approach) gave an example of a resulting change in practice. The use of a theory, model or framework to explain the knowledge sharing process was identified in six studies.

CONCLUSIONS

Five knowledge sharing techniques and approaches were reported in the included NIHR funded studies, and seven studies identified the creation of new knowledge. However, there was little investigation of the effectiveness of these approaches in influencing change in practice or policy.

United Kingdom oral and maxillofacial surgeons support changes to current specialty recruitment process, which could include 'Walport' style local selection and national benchmarking

Recruitment to oral and maxillofacial Surgical (OMFS) specialty training was centralised in 2010. The 'flexibility' for OMFS to respond to specialty specific recruitment issues is reducing and many Specialty Trainees' (ST) posts are left unfilled. The National Institute for Health and Care Research (NIHR) appointment process designed to address the problem of recruiting and appointing academic surgeons with local selection with national benchmarking has worked. Using a database of all UK OMFS consultants/trainees, an electronic questionnaire was shared by e-mail, WhatsApp, and other social media. Of 306 replies, 125 (41%) were Consultants/post-certificate of completion training (CCT) individuals, 66 (22%) ST, 61 (20%) second degree students, 27 (9%) pre-second degree, 26 (9%) dual degree pre-ST trainees, and one did not indicate their status. A total of 249 (76%) studied dentistry first and 230 (75%) were male. Of those replying, 147 (48%) had no direct experience of national selection. 120 (39%) had experience as a candidate, 20 (7%) as a selector only, 17 (6%) as a candidate and selector, and two did not record their experience. Of 250 expressing an opinion, 156 (62%) supported local selection with 140 (56%) supporting local selection and national benchmarking, which is a process used for research training posts by the NIHR. Geographical continuity was most important for 78% of pre-second-degree trainees, 45% of STs, and 54% of second-degree students. A total of 57 respondents completed free text comments. There is support for changes in OMFS ST selection including creating OMFS posts which include Foundation and second-degree training in NIHR style locally recruited nationally benchmarked posts.

Developing an application for the UK Pre-Doctoral Clinical and Practitioner Academic Fellowship (PCAF): the collective experience of a community of physiotherapists

For physiotherapists and other healthcare professionals, developing capability and expertise in research can be challenging. However, involvement in research is beneficial at organisational and individual levels, both for clinicians and patients. One way to embark on research is to apply for a personal fellowship such as the National Institute for Health and Care Research (NIHR) Pre-Doctoral Clinical Academic Fellowship (PCAF). While the NIHR has guidance on how to complete the application form, it can be difficult to implement this guidance and understand what a competitive application looks like. As a group of physiotherapists and academic supervisors, who have applied for NIHR PCAFs, what follows is a supportive resource, to inform others who might be thinking of applying. CONTRIBUTION OF PAPER.

Where are all the surgeons in clinical academia?

INTRODUCTION

High-quality research into surgical disease will benefit surgical patients. Whereas nearly one-fifth of National Health Service (NHS) England consultants are surgeons, less than 5% of the government's health research funding supports surgical research.

METHODS

Using an observational study, we identified surgeons in active research fellowships and on selection panels for the three largest pan-specialty medical funding bodies in the UK. We quantified the proportion of editorial board members that are surgeons, and the proportion of surgical research published over a 1-year period in the New England Journal of Medicine, The Lancet and the British Medical Journal.

RESULTS

Some 185/1,579 (12%) of research fellowships held by clinicians were awarded to surgeons, with relatively fewer surgeons holding senior fellowships compared with predoctoral fellowships. Across the three research funding bodies, 9/165 (5%) of the clinical panel members were surgeons, whereas for the three pan-specialty journals, 5/84 (6%) of the clinical editorial board members were surgeons. Of the 541 original articles published by the same three journals, only 45 (8%) were classified as surgical.

CONCLUSIONS

We show that surgeons were underrepresented across differing domains of clinical academia. The causes of this are likely multifactorial; there are fewer senior surgeons occupying decision-making positions, fewer role models in senior fellowship positions and surgical training may leave less time to engage in research. We propose further qualitative research within the surgical community, funding bodies and journals to understand the origins of the problem and begin to form evidence-based solutions.

Multicentre clinical evaluation of the safety and performance of a simple transperineal access system for prostate biopsies for suspected prostate cancer: The CAMbridge PROstate Biopsy DevicE (CamPROBE) study

Objectives:

To report the prospective multicentre clinical evaluation of a first-in-man disposable device, Cambridge Prostate Biopsy Device, to undertake local anaesthetic outpatient transperineal prostate biopsies.

Material and methods:

Disposable single-use Cambridge Prostate Biopsy devices were manufactured based on a previous prototype. The lead site developed a user training course and disseminated the method to other sites. The Cambridge Prostate Biopsy Device (CamPROBE) was offered as an alternative to transrectal ultrasound guided biopsy to men due for a biopsy as part of their clinical management. Data on safety (infections and device performance), clinical utility, patient reported experience, biopsy quality and cancer detection were collected. Procedure time and local anaesthetic use was recorded in the lead site. The study was funded by a United Kingdom National Institute for Health Research (NIHR) i4i product development award.

Results:

A total of 40 patients were recruited (median age 69 y) across six sites; five sites were new to the procedure. Overall, 19/40 were first prostate biopsies and 21/40 repeat procedures. Both image-targeted and systematic biopsy cores taken. There were no infections, device deficiencies or safety issues reported. The procedure was well tolerated with excellent patient-reported perception and low pain scores (median of 3, scale 0–10). Histopathology quality was good and the overall cancer diagnosis rate (first diagnostic procedures) was 68% (13/19) and for significant cancers (⩾ histological Grade Group 2), 47% (9/19). In the lead centre (most experienced), median procedure time was 25 minutes, and median local anaesthetic use 11 ml (n=17).

Conclusions:

Data from this device evaluation study demonstrate that the United Kingdom-developed Cambridge Prostate Biopsy Device/method for transperineal biopsies is safe, transferable and maintains high diagnostic yields. The procedure is well tolerated by patients, suited to the local anaesthetic outpatient setting and could directly replace transrectal ultrasound guided biopsy.

Level of evidence:

Level III

Understanding Plain English summaries. A comparison of two approaches to improve the quality of Plain English summaries in research reports

PLAIN ENGLISH SUMMARY

There is a need for the authors of research reports to be able to communicate their work clearly and effectively to readers who are not familiar with the research area. The National Institute for Health Research (NIHR), along with a number of other funding bodies and journals, require researchers to write short lay summaries, often termed plain English summaries (PESs), to make research accessible to the general public. Because many researchers write using technical, specialised language, particularly in scientific reports, writing PESs can be challenging. In this study we looked at how to improve the quality of PESs. We took PESs which had been submitted to the NIHR Journals Library and asked authors to rewrite them using new guidance. We also asked an independent medical writer to edit the summaries. We measured the quality of these three versions (original summary, rewritten summary and edited summary) in two ways. First, we asked a group of people who were not specialists in the subject area to read and rate how easy the summaries were to understand. Secondly, we used a well-known measure called the Flesch reading ease score to assess how easy the PESs were to read. We found that there was no difference in how easy people found the summaries to understand across the three versions. However, the PESs that were rewritten by the authors and that were edited by the independent medical writer were both easier to read than the originals. This shows that PESs can be improved and for organisations who feel that employing an independent writer to edit summaries, providing clear, practical guidance to authors may be a cost-effective alternative.

BACKGROUND

Plain English summaries (PES) or lay summaries are often included as part of research reports and journal articles. These summaries are vital to ensure that research findings are accessible and available to non-specialist audiences, for example patients and members of the public. Writing a PES requires the adoption of a different style than is generally used in a traditional scientific report, and researchers can find this challenging. This study explored two possible ways to improve the quality of PESs in the NIHR Journals Library: 1) Providing enhanced guidance to authors and asking them to rewrite the PES and 2) Employing an independent medical writer to edit the PES.

METHODS

We compared the three versions of the PES (original, author rewritten and independent writer edited) to assess 1) how easy they were to understand and 2) how easy they were to read. In order to establish how easy PESs were to understand, a group of 60 public reviewers read a set of summaries and rated them on a four point scale from "Did not understand" to "Understood all". The Flesch reading ease score was used to measure how easy the summaries were to read.

RESULTS

Results indicated no significant difference across the three versions of the PES in terms of ease of understanding. However, both the author rewritten and independent writer edited versions were significantly easier to read than the original. There was no significant difference in ease of reading between these two versions.

CONCLUSION

These findings suggest that employing independent medical writers to edit PESs and providing clear, practical guidance to authors are two ways in which the readability of PESs could be improved. Results have implications for journal editors and publishers seeking to enhance accessibility and availability of research findings.

Increasing support for the next generation of clinical trials leaders

The National Institute for Health Research (NIHR) has identified a gap in the number of people it funds who are on a pathway to become future leaders of clinical trials, compared to how much the NIHR invests in clinical trials. In order to support the clinical trials of tomorrow, it is vital that the right people are supported now to lead these trials. To address this issue, NIHR organised a workshop with key stakeholders to understand the barriers to embarking on a clinical trials career and explore initiatives to increase capacity and capability in clinical trials. The output from the workshop was a set of recommendations which NIHR is now considering to shape future support.

Paclitaxel-coated balloon fistuloplasty versus plain balloon fistuloplasty only to preserve the patency of arteriovenous fistulae used for haemodialysis (PAVE): study protocol for a randomised controlled trial

Background

The initial therapy for a stenosis in an arteriovenous fistula used for haemodialysis is radiological balloon dilatation or angioplasty. The benefit of angioplasty is often short-lived, intervention-free survival is reported to be 40–50 % at 1 year. Previous small studies and observational data suggest that paclitaxel-coated balloons may be of benefit in improving outcomes after fistuloplasty of stenotic arteriovenous fistulae.

Methods/design

We have designed a multicentre, double-blind randomised controlled trial to test the superiority of paclitaxel-coated balloons for preventing restenosis after fistuloplasty in patients with a native arteriovenous fistula. Two hundred and eleven patients will be followed up for a minimum of 1 year. Inclusion criteria include a clinical indication for a fistuloplasty, an access circuit that is free of synthetic graft material or stents, and a residual stenosis of 30 % or less after plain balloon fistuloplasty. Exclusion criteria include a synchronous venous lesion in the same access circuit, location of the stenosis central to the thoracic inlet or a thrombosed access circuit at the time of treatment. The primary endpoint is time to end of target lesion primary patency. This is defined as a clinically-driven radiological or surgical re-intervention at the treatment segment, thrombosis that includes the treatment segment, or abandonment of the access circuit due to an inability to re-treat the treatment segment. Secondary endpoints include angiographic late lumen loss, time to end of access circuit cumulative patency, the total number of interventions, and quality of life. The trial is funded by the National Institute for Health Research.

Discussion

We anticipate that this trial will provide rigorous data that will determine the efficacy of additional paclitaxel-coated balloon fistuloplasty versus plain balloon fistuloplasty only to preserve the patency of arteriovenous fistulae used for haemodialysis.

Trial registration

ISRCTN14284759. Registered on 28 October 2015.

Developing a clinical research network: the Northern Region Endoscopy Group experience

Research is central to the National Health Service. Clinical trial recruitment has been aided by the National Institute for Health Research's Comprehensive Research Network but these networks do not support development of research. The Northern Region Endoscopy Group (NREG) was founded in 2007, encompasses 17 endoscopy units and has become a highly successful collaborative research network. The network is now a major contributor to UK trials, has published over 20 papers (>60 abstracts) and holds grants totalling more than £1.5 million. The NREG provides an exemplar model of how collaborative working can contribute significantly to biomedical research.