Health Services Research Toolkit

The National Institute for Health Research has launched a new Health Services Research Toolkit.  The toolkit brings together ideas, guidance and support to help researchers deliver the high quality health services research that the NHS and health and social care settings needs.

The following areas are covered:

Fried food consumption and risk of coronary artery disease

Full reference: Honerlaw, J. P. et al. |2019|Fried Food Consumption and Risk of Coronary Artery Disease: The Million Veteran Program| Clinical Nutrition| https://doi.org/10.1016/j.clnu.2019.05.008

A sample of more than 150,000 US veterans was used in a study that measured ifconsuming fried foods on a regular basis is linked to a higher risk of coronary artery diesease (CAD). The authors  report that fried food consumption has a positive, dose-dependent association with CAD.

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Abstract 

Introduction: Previous studies of the relationship between fried food consumption and coronary artery disease (CAD) have yielded conflicting results. We tested the hypothesis that frequent fried food consumption is associated with a higher risk of incident CAD events in Million Veteran Program (MVP) participants.
Methods: Veterans Health Administration electronic health record data were linked to questionnaires completed at MVP enrollment. Self-reported fried food consumption at baseline was categorized: (less than 1, 1 e3, 4e6 times per week or daily). The outcome of interest was non-fatal myocardial infarction (MI) or CAD events. We fitted a Cox regression model adjusting for age, sex, race, education, exercise, smoking and alcohol consumption.
Results: Of 154,663 MVP enrollees with survey data, mean age was 64 years and 90% were men. During a mean follow-up of approximately 3 years, there were 6725 CAD events. There was a positive linear relationship between frequency of fried food consumption and risk of CAD (p for trend 0.0015).
Conclusions: In a large national cohort of U.S. Veterans, fried food consumption has a positive, dosedependent association with CAD.

The full text of the article is available from the journal Clinical Nutrition

In the news:

MailOnline Fried food DOES increase your risk of coronary artery disease: Scientists discover fries block the blood vessels that supply the heart after years of ‘conflicting’ results

Yoga improves health in later life, reports systematic review

University of Edinburgh | June 2019 | Yoga improves health in later life, study says

Edinburgh researchers synthesised existing evidence on the effects of yoga on physical function and health related quality of life (HRQoL) in older adults not characterised by any specific clinical condition. 

The team of researchers have reviewed 22 randomised controlled trials that had investigated the effects of yoga on physical and mental wellbeing in older adults (those aged over 60). The yoga programmes in the studies varied in length  and duration of sessions ranged from 30 to 90 minutes.

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This review is the first to compare the impact of yoga with active and inactive controls in older adults not characterised by a specific clinical condition. The group that practised yoga were found to have improved balance, flexibility, leg strength, depression, sleep quality, vitality and perceived mental and physical health – than the controls.

The study’s findings provide robust evidence for promoting yoga in physical activity guidelines for older adults as a multimodal activity that improves aspects of fitness like strength, balance and flexibility, as well as mental wellbeing (Source: University of Edinburgh).

Read the Edinburgh news release in full here 

Abstract

Background

Yoga has been recommended as a muscle strengthening and balance activity in national and global physical activity guidelines. However, the evidence base establishing the effectiveness of yoga in improving physical function and health related quality of life (HRQoL) in an older adult population not recruited on the basis of any specific disease or condition, has not been systematically reviewed. The objective of this study was to synthesise existing evidence on the effects of yoga on physical function and HRQoL in older adults not characterised by any specific clinical condition.

Methods

The following databases were systematically searched in September 2017: MEDLINE, PsycInfo, CINAHL Plus, Scopus, Web of Science, Cochrane Library, EMBASE, SPORTDiscus, AMED and ProQuest Dissertations & Theses Global. Study inclusion criteria: Older adult participants with mean age of 60 years and above, not recruited on the basis of any specific disease or condition; yoga intervention compared with inactive controls (example: wait-list control, education booklets) or active controls (example: walking, chair aerobics); physical function and HRQoL outcomes; and randomised/cluster randomised controlled trials published in English. A vote counting analysis and meta-analysis with standardised effect sizes (Hedges’ g) computed using random effects models were conducted.

Results

A total of 27 records from 22 RCTs were included (17 RCTs assessed physical function and 20 assessed HRQoL). The meta-analysis revealed significant effects (5% level of significance) favouring the yoga group for the following physical function outcomes compared with inactive controls: balance (effect size (ES) = 0.7), lower body flexibility (ES = 0.5), lower limb strength (ES = 0.45); compared with active controls: lower limb strength (ES = 0.49), lower body flexibility (ES = 0.28). For HRQoL, significant effects favouring yoga were found compared to inactive controls for: depression (ES = 0.64), perceived mental health (ES = 0.6), perceived physical health (ES = 0.61), sleep quality (ES = 0.65), and vitality (ES = 0.31); compared to active controls: depression (ES = 0.54).

Conclusion

This review is the first to compare the effects of yoga with active and inactive controls in older adults not characterised by a specific clinical condition. Results indicate that yoga interventions improve multiple physical function and HRQoL outcomes in this population compared to both control conditions. This study provides robust evidence for promoting yoga in physical activity guidelines for older adults as a multimodal activity that improves aspects of fitness like strength, balance and flexibility, as well as mental wellbeing.

The full article is available from the International Journal of Behavioral Nutrition and Physical Activity

A miniature robot that could check colons for early signs of disease

University of Leeds | July 2019| A miniature robot that could check colons for early signs of disease

An  academic at the University of Leeds is a senior author of a piece of research that demonstrates it is technically possible to guide a tiny robotic capsule inside the colon to take micro-ultrasound images. The capsule, known as Sonopill, has taken an international consortium of scientists and engineers a decade to develop. 

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It is hoped that the technology will one day mean patients will not need to undergo an endoscopic examination- as the Sonopill is capable of intelligent magnetic manipulation. Based on the principle that magnets can attract and repel one another, a series of magnets on a robotic arm that passes over the patient interacts with a magnet inside the capsule, gently manoeuvring it through the colon (Source: University of Leeds).

The full news story is available from the University of Leeds

Full reference:

Norton, J.C. et al. | 2019| Intelligent magnetic manipulation for gastrointestinal ultrasound | Science Robotics | Vol. 4|31| eaav7725
DOI: 10.1126/scirobotics.aav7725

Abstract

Diagnostic endoscopy in the gastrointestinal tract has remained largely unchanged for decades and is limited to the visualization of the tissue surface, the collection of biopsy samples for diagnoses, and minor interventions such as clipping or tissue removal. In this work, we present the autonomous servoing of a magnetic capsule robot for in situ, subsurface diagnostics of microanatomy. We investigated and showed the feasibility of closed-loop magnetic control using digitized microultrasound (μUS) feedback; this is crucial for obtaining robust imaging in an unknown and unconstrained environment. We demonstrated the functionality of an autonomous servoing algorithm that uses μUS feedback, both on benchtop trials and in vivo in a porcine model. We have validated this magnetic μUS servoing in instances of autonomous linear probe motion and were able to locate markers in an agar phantom with 1.0 ± 0.9 mm position accuracy using a fusion of robot localization and μUS image information. This work demonstrates the feasibility of closed-loop robotic μUS imaging in the bowel without the need for either a rigid physical link between the transducer and extracorporeal tools or complex manual manipulation.

Diagnostic endoscopy in the gastrointestinal tract has remained largely unchanged for decades and is limited to the visualization of the tissue surface, the collection of biopsy samples for diagnoses, and minor interventions such as clipping or tissue removal. In this work, we present the autonomous servoing of a magnetic capsule robot for in situ, subsurface diagnostics of microanatomy. We investigated and showed the feasibility of closed-loop magnetic control using digitized microultrasound (μUS) feedback; this is crucial for obtaining robust imaging in an unknown and unconstrained environment. We demonstrated the functionality of an autonomous servoing algorithm that uses μUS feedback, both on benchtop trials and in vivo in a porcine model. We have validated this magnetic μUS servoing in instances of autonomous linear probe motion and were able to locate markers in an agar phantom with 1.0 ± 0.9 mm position accuracy using a fusion of robot localization and μUS image information. This work demonstrates the feasibility of closed-loop robotic μUS imaging in the bowel without the need for either a rigid physical link between the transducer and extracorporeal tools or complex manual manipulation.

Rotherham NHS staff can request a copy of this article here 

 

 

Young women who smoke face highest risk of major heart attack, research shows

University of Sheffield | June 2019 | Young women who smoke face highest risk of major heart attack, research shows

Research produced as part of a collaboration between the University of Leeds and  Sheffield Teaching Hospitals NHS Foundation Trust is the first to shed light on the risk impact of smoking on heart attack. It finds female smokers have a higher risk of heart attack than males, earlier research has not quantified and compared the incidence of acute ST Segment Elevation Myocardial Infarctio (STEMI) associated with smoking between genders and within different age groups.

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Heart disease is the major cause of death for women and men worldwide, and STEMI is among the most life-threatening forms of heart disease. The study employed a retrospective ecological cohort study to compile data for all patients in the South Yorkshire region of the UK who presented with acute STEMI between January 2009 and July 2014.

The largest relative risk difference between men and women smokers was in the 50-64 years old group, but the highest risk increase in both genders was in the 18-49 years group—the youngest group.

Female smokers in this age group had a greater than 13 times higher risk of STEMI compared to their non-smoking female contemporaries. Young male smokers had an 8.6 times increased risk (Source: University of Sheffield)

Unabridged press release Young women who smoke face highest risk of major heart attack, research shows

Abstract

Background Smoking is a well-documented risk for acute ST-segment elevation myocardial infarction (STEMI). The differential effect between sexes has yet to be quantified.

Objectives The purpose of this study was to differentiate the effect of smoking on increased risk of STEMI between sexes.

Methods For this retrospective ecological cohort study, all patients at a U.K. tertiary cardiothoracic center who presented between 2009 and 2014 with acute STEMI were combined with population data to generate incidence rates of STEMI. Age-standardized incidence rate ratios (IRRs) using the Poisson distribution were calculated comparing STEMI rates between smokers and nonsmokers stratified by sex and 3 age groups (18 to 49, 50 to 64, and more than 65 years).

Results A total of 3,343 patients presented over 5,639,328 person-years. Peak STEMI rate for current smokers was in the 70 to 79 years age range for women (235 per 100,000 patient-years) and 50 to 59 years (425 per 100,000 patient-years) in men. Smoking was associated with a significantly greater increase in STEMI rate for women than men (IRR: 6.62; 95% confidence interval [CI]: 5.98 to 7.31, vs. 4.40; 95% CI: 4.15 to 4.67). The greatest increased risk was in women age 18 to 49 (IRR: 13.22; 95% CI: 10.33 to 16.66, vs. 8.60; 95% CI: 7.70 to 9.59 in men). The greatest risk difference was in the age 50 to 64 years group, with IRR of 9.66 (95% CI: 8.30 to 11.18) in women and 4.47 (95% CI: 4.10 to 4.86) in men.

Conclusions This study quantifies the differential effect of smoking between sexes, with women having a significantly increased risk of STEMI than men. This information encourages continued efforts to prevent smoking uptake and promote cessation.

The Library can provide access to this article, Rotherham NHS staff  request  here 

University of Sheffield Young women who smoke face highest risk of major heart attack, research shows

 

NIHR makes it easier than ever to be part of research

National Institute of Health Research | June 2019 | NIHR makes it easier than ever to be part of research

NIHR have launched our Be Part of Research study search site. Designed for the public, it makes information about research available to anyone who wants it.

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Image source: bepartofresearch.nihr.ac.uk/

The website also acts as a simple tool that busy clinicians and healthcare professionals can use to support patients who ask about research. In this way, it enables them to fulfil the pledge in the NHS constitution to inform patients about research opportunities, which give people the opportunity to access the best care and latest treatments (Source: NIHR).

Full details from NIHR

See also:

NIHR [press release] NIHR makes it easier than ever to be part of research

Preparing Primary and Community Care in the NHS for Genomic Research: a joint report by the NIHR CRN and RCGP

National Institute of Health Research, Royal College of General Practioners & King’s College London | June 2019 | Preparing Primary and Community Care in the NHS for Genomic Research: a joint report by the NIHR CRN and RCGP

The new genomic revolution is predicted to impact on mainstream medicine and the heart of the NHS in the near future. The NIHR Clinical Research Network (CRN) has worked through stratified medicine initiative to prepare the NHS for personalised medicine studies. It has become apparent that primary and community care may not be as prepared for the advent of genomic medicine studies as other parts of the NHS – in areas such as family history reporting, recording of genomic abnormalities through clinical data systems, or through the recording of detailed phenotypic traits.

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Now a new report from NIHR- Preparing Primary and Community Care in the NHS for Genomic Research: a joint report by the NIHR CRN and RCGPoutlines the outcome of  a collaborative project and contains recommendations from both organisations to promote genomic research in primary and community care. Three key workstreams were identified: Informatics relating to genomic research in primary care;  Operationalising Genomics Research; and developing the Genomics workforce. Workstream teleconferences were held with stakeholders (Source: NIHR).

Further details from NIHR

See also:

Press release NIHR Preparing primary and community care in the NHS for genomic research: A joint report by the NIHR CRN and RCGP