NIHRDataInsights/HRCSData huggingface dataset:
Title: 2nd maternity Supplement
Funder: Wellcome Trust

Abstract: The overall theme of our proposal is personalised healthcare. Much of the 20th century was devoted to developing therapies that are broadly effective in a large proportion of the population. However, from the management of long-term conditions such as diabetes or high blood pressure to drug-based cancer therapies, it has become clear that conditions are best managed by taking into account how the individual is responding to the therapy. The common factor in our proposal is therefore the development of techniques and strategies in which the individual?s response is measured precisely and used to adjust the management or therapy. As a result of doing this, we believe that our Centre of Excellence will have a real impact on the major diseases of the 21st century: long-term conditions, cancer, cardiovascular disease leading to stroke or brain aneurysms and degenerative diseases such as osteoarthritis. The improved diagnosis and personalisation of therapy and management will lead to lower mortality rates for cancer and stroke and to an increased quality of life for an ageing population, many of whom will be living with a long-term condition.


Research activity codes: 5.1 PHARMACEUTICALS;7.3 MANAGEMENT AND DECISION MAKING;5.2 CELLULAR AND GENE THERAPIES;5.3 MEDICAL DEVICES
Health categories: STROKE;GENERIC HEALTH RELEVANCE;CANCER AND NEOPLASMS;CARDIOVASCULAR
Title: COVID-19 and Stroke Grant Award
Funder: Stroke Association

Abstract: Aim In a cohort of ~65 million people across the UK, we will reliably estimate the excess risks of different types of stroke after infection with SARS-CoV-2, the virus leading to the illness COVID-19. Background Case series suggest increased stroke risk in patients with COVID-19. However, these studies were uncontrolled and too small to reliably determine risk of different stroke subtypes or the influence of different patient characteristics. Very large-scale population-wide data with prospective follow-up for stroke and other vascular events of COVID-19 cases from community and hospital settings are urgently needed. Methods We will leverage a newly established network of national secure research environments holding linked healthcare data from the entire British population facilitated by the BHF Data Science Centre. We will determine stroke risk in patients with SARS-CoV-2 infections from 1/2020. The excess risk of stroke after SARS-CoV-2 will be compared with: (i) excess risk of stroke after other viral infections in previous years, (ii) other vascular conditions post-SARS-CoV-2. Expected outcomes If the risk of stroke after SARS-CoV-2 is substantial, developing better stroke prevention in those at highest risk will be a priority. If it is small, or undetectable, this will be reassuring to people recovering from COVID-19.

Lay abstract: Aim In a cohort of ~65 million people across the UK, we will reliably estimate the excess risks of different types of stroke after infection with SARS-CoV-2, the virus leading to the illness COVID-19. Background Case series suggest increased stroke risk in patients with COVID-19. However, these studies were uncontrolled and too small to reliably determine risk of different stroke subtypes or the influence of different patient characteristics. Very large-scale population-wide data with prospective follow-up for stroke and other vascular events of COVID-19 cases from community and hospital settings are urgently needed. Methods We will leverage a newly established network of national secure research environments holding linked healthcare data from the entire British population facilitated by the BHF Data Science Centre. We will determine stroke risk in patients with SARS-CoV-2 infections from 1/2020. The excess risk of stroke after SARS-CoV-2 will be compared with: (i) excess risk of stroke after other viral infections in previous years, (ii) other vascular conditions post-SARS-CoV-2. Expected outcomes If the risk of stroke after SARS-CoV-2 is substantial, developing better stroke prevention in those at highest risk will be a priority. If it is small, or undetectable, this will be reassuring to people recovering from COVID-19.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: STROKE;INFECTION
Title: Research Evaluation of The Impact Of COVID-19 On Stroke (RETICOS)
Funder: Stroke Association

Abstract: The SARS-CoV-2 virus is now known to mediate some of its pathological effects through induction of a coagulopathy. Early evidence suggests that one manifestation of the infection may be COVID-19-related ischaemic stroke. This condition may require its own specific management strategy, particularly with regard to choice of antithrombotic agent. In addition COVID-19 may have an important impact on primary intracerebral haemorrhage. High quality case-control studies, comparing stroke patients with and without COVID-19, are an essential step in understanding COVID-19-associated stroke. Registry data without contemporaneous controls are of little value, as the characteristics of the COVID-19-negative controls changed substantially during the COVID-19 pandemic, invalidating comparisons between stroke patients with COVID-19 and historical controls. Our objective is to build on the success of SETICOS, the only current UK multicentre case-control study of stroke patients with and without COVID-19 at onset, to expand the existing collection of 1890 patients (86 with COVID-19-associated stroke) to a target of 4000 patients (150 with COVID-19-assocated stroke). Collection will be more systematic than was possible during the pandemic, including curation of imaging data and collection of 12 month follow-up data. We will report case-control comparisons which will enable us understand the impact that COVID-19 has on stroke.

Lay abstract: The SARS-CoV-2 virus is now known to mediate some of its pathological effects through induction of a coagulopathy. Early evidence suggests that one manifestation of the infection may be COVID-19-related ischaemic stroke. This condition may require its own specific management strategy, particularly with regard to choice of antithrombotic agent. In addition COVID-19 may have an important impact on primary intracerebral haemorrhage. High quality case-control studies, comparing stroke patients with and without COVID-19, are an essential step in understanding COVID-19-associated stroke. Registry data without contemporaneous controls are of little value, as the characteristics of the COVID-19-negative controls changed substantially during the COVID-19 pandemic, invalidating comparisons between stroke patients with COVID-19 and historical controls. Our objective is to build on the success of SETICOS, the only current UK multicentre case-control study of stroke patients with and without COVID-19 at onset, to expand the existing collection of 1890 patients (86 with COVID-19-associated stroke) to a target of 4000 patients (150 with COVID-19-assocated stroke). Collection will be more systematic than was possible during the pandemic, including curation of imaging data and collection of 12 month follow-up data. We will report case-control comparisons which will enable us understand the impact that COVID-19 has on stroke.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: STROKE;INFECTION
Title: Sabrina Eltringham - How does variation in assessment and clinical management of dysphagia in acute stroke affect development of stroke-associated pneumonia (SAP)?
Funder: Stroke Association

Abstract: Stroke-associated pneumonia (SAP) is common in acute stroke. A significant risk factor is dysphagia. To identify dysphagia, patients are screened using a bedside tool and those suspected of dysphagia then have a specialist Speech and Language Therapy (SLT) assessment. Currently there is a wide range of screening protocols used. The aim of this research is to investigate the variation in dysphagia assessment and management to identify what factors affect the risk of SAP. The type of screen and other variations in management and practice (such as time from hospital admission to when the screen is done) will be investigated to identify any associations with higher risk of SAP. A mixed methods study will include a systematic review of the literature, interviews with patients, carers and staff and a review of medical records to investigate the patient journey during the first 72 hours from admission. Findings will be triangulated to inform a national survey of dysphagia screening and management in hospitals registered with the Sentinel Stroke National Audit Programme (SSNAP). Data from the survey will be cross-referenced with the SSNAP register and analysed to identify relationships. Results will inform development of an intervention to reduce SAP for subsequent feasibility testing.

Lay abstract: Stroke-associated pneumonia (SAP) is common in acute stroke. A significant risk factor is dysphagia. To identify dysphagia, patients are screened using a bedside tool and those suspected of dysphagia then have a specialist Speech and Language Therapy (SLT) assessment. Currently there is a wide range of screening protocols used. The aim of this research is to investigate the variation in dysphagia assessment and management to identify what factors affect the risk of SAP. The type of screen and other variations in management and practice (such as time from hospital admission to when the screen is done) will be investigated to identify any associations with higher risk of SAP. A mixed methods study will include a systematic review of the literature, interviews with patients, carers and staff and a review of medical records to investigate the patient journey during the first 72 hours from admission. Findings will be triangulated to inform a national survey of dysphagia screening and management in hospitals registered with the Sentinel Stroke National Audit Programme (SSNAP). Data from the survey will be cross-referenced with the SSNAP register and analysed to identify relationships. Results will inform development of an intervention to reduce SAP for subsequent feasibility testing.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: STROKE;INFECTION
Title: Cluster randomised trials using a primary care database: utilising electronic patient records for intervention research.
Funder: Wellcome Trust

Abstract: Cluster randomised trials (CRTs) are trials in which the groups of healthy subjects or patients are randomly allocated to different health interventions. In primary care, cluster trials are commonly implemented with general practices as the unit of allocation. A common problem in the conduct and design of conventional CRTs is that too few practices are included. We suggest that this difficulty may be overcome by implementing cluster randomised trials within a primary care database that includes electronic patient records from large numbers of general practices. We propose to implement two cluster randomised trials within the General Practice Research Database (GPRD). The GPRD collects electronic data prospectively for medical diagnoses and drug prescribing for patients registered with about 5% of UK general practices. General practices will be sampled and randomised from the GPRD and patient case-mix and outcome measures will be evaluated from data that is routinely collected into pati ents electronic records. The first trial will aim to reduce unnecessary antibiotic prescribing for respiratory illness in adults aged 18 to 59 years. The second will aim to enhance stroke secondary prevention by implementing the recommendations of the Intercollegiate Stroke Working Group.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: STROKE;INFECTION
Title: Evaluating public health interventions using non-randomised study designs: thrombectomy service and police carriage of naloxone
Funder: Chief Scientist Office, Scotland

Abstract: In this research, we will evaluate two important public health interventions, recently undertaken in Scotland, using non-randomised study designs. The first intervention is a national thrombectomy service for stroke patients. We will evaluate whether thrombectomy is effective in increasing the length of time spent in own home after a stroke. This will be for all stroke patients and for those who are under-represented in randomised studies (the gold standard) such as older patients and those with frailty. The second intervention is a pilot project of police carrying and administering naloxone at drug overdose events. We will evaluate whether this intervention reduces drug-related deaths in the pilot areas. Effective interventions are desperately needed as Scotland has a higher drug-related death rate than any country in the European Union. As mentioned above, although randomised studies are the gold standard for evaluating public health interventions, they are not always possible, or desirable, to conduct. In such circumstances, non-randomised studies (such as those in this research) are an alternative approach which, although more prone to bias, have the advantage of taking place in ‘real-life’ settings and including participants who are less likely to be part of randomised studies. To learn more about how best to analyse non-randomised studies, we will also carry out a simulation study to compare the performance of different statistical methods and models when measuring effectiveness of interventions using non-randomised study designs. This is important as these study designs are increasingly being used to evaluate whether public health interventions are effective


Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: STROKE;MENTAL HEALTH
Title: Long term psychological consequences of stroke: prevalence, mechanisms, trajectories and impact
Funder: Stroke Association

Abstract: The aim of this project is to determine the prevalence, nature, trajectories and wider impact of cognitive impairment in long term stroke survivors, in relation with mood and fatigue. A 3 year longitudinal observational study with yearly detailed neuropsychological profiling will be conducted in a well-defined cohort (N=200) of long term (> 1 year) survivors. Importantly, detailed baseline and 6month stroke and cognitive information is available on this cohort. These repeated in depth neuropsychological profiles allow us to distinguish between domain-general (e.g. sustaining attention) and domain-specific cognitive problems (e.g. aphasia), which contribute differentially to recovery and decline. In addition, we will examine the cognitive underpinnings of post stroke fatigue, and map long term changes in mood and behaviour. We will investigate the impact of these complex psychological consequences on survivors’ and their carers, in terms of symptoms, quality of life and achievement of personal goals. This research will significantly enhance our understanding of post-stroke cognition and its inter-relations with mood and fatigue in long term stroke survivors, impacting the policies on planning of services for longer term follow up after stroke. Additionally, specific cognitive intervention developments (e.g. neglect, apraxia) can build on this increased understanding, of trajectories.

Lay abstract: The aim of this project is to determine the prevalence, nature, trajectories and wider impact of cognitive impairment in long term stroke survivors, in relation with mood and fatigue. A 3 year longitudinal observational study with yearly detailed neuropsychological profiling will be conducted in a well-defined cohort (N=200) of long term (> 1 year) survivors. Importantly, detailed baseline and 6month stroke and cognitive information is available on this cohort. These repeated in depth neuropsychological profiles allow us to distinguish between domain-general (e.g. sustaining attention) and domain-specific cognitive problems (e.g. aphasia), which contribute differentially to recovery and decline. In addition, we will examine the cognitive underpinnings of post stroke fatigue, and map long term changes in mood and behaviour. We will investigate the impact of these complex psychological consequences on survivors’ and their carers, in terms of symptoms, quality of life and achievement of personal goals. This research will significantly enhance our understanding of post-stroke cognition and its inter-relations with mood and fatigue in long term stroke survivors, impacting the policies on planning of services for longer term follow up after stroke. Additionally, specific cognitive intervention developments (e.g. neglect, apraxia) can build on this increased understanding, of trajectories.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: STROKE;MENTAL HEALTH
Title: Music for the brain: Music and mindfulness intervention for the improvement of cognition and mood after stroke.
Funder: The Dunhill Medical Trust

Abstract: Around 150,000 people have a stroke in the UK annually1 with the majority occurring in people over 602. Cognitive and psychological problems are common post-stroke3,4 leading to poorer recovery5,6 and lower quality of life7. Both music listening8 and mindfulness9 have shown promise in improving cognition and mood and may share a common mechanism mediating wellbeing10 but the feasibility of combining these two approaches needs investigating. Aim To investigate the feasibility and acceptability of music listening combined with brief mindfulness training (M&M), within a randomised controlled trial (RCT) context. Methods Single-blind pilot RCT. An estimated 100 acute stroke patients will be randomised to music listening, M&M or control intervention during the first month post-stroke. Cognition and mood will be assessed at baseline, three and six months post-stroke with qualitative interviews performed post-intervention. Data from these measures will be used to power a future full scale efficacy trial.


Research activity codes: 5.8 COMPLEMENTARY;6.8 COMPLEMENTARY
Health categories: STROKE;MENTAL HEALTH
Title: 2012 Bamford Call: Parental Alcohol Use and Resilience in Young People in Northern Ireland: A study of Family, Peer & School Processes
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: Alcohol misuse is a significant social and public health issue in Northern Ireland and continues to be a key priority (DHSSPSNI, 2011). Parental alcohol misuse, in particular, can have considerable negative effects on the lives of young people and the family environment (Harwin et al., 2010; NSPCC, 2010). However, not all families affected by alcohol misuse will experience difficulties. Evidence suggests that many children who live with parents who are drinking harmfully, are not adversely affected by exposure to such environments, either as children or as adults (Velleman & Orford, 1999; Tunnard, 2002a). The proposed study aims to investigate family, peer and schools processes in the development of resilience among young people in Northern Ireland within the context of parental alcohol use. The planned programme of work, involving secondary analyses of datasets, will make maximum use of the ‘Belfast Youth Development Study,’ a longitudinal study of young people’s development in Northern Ireland which collected data from the cohort over 10 years (11-21 years of age) complemented by data collected from their parents and siblings as part of the ‘Family Study.’ These datasets of community samples will provide the unique opportunity to investigate the development of resilience and indeed the internal (e.g. mental health) and external factors (e.g. positive peer relationships) that may mediate or moderate resilience among young people, within the context of their parent or caregivers use of alcohol. These datasets also provide the opportunity to investigate the health, social and educational outcomes for young people during adolescence and emerging adulthood. The study will make a valuable contribution in advancing current knowledge on family, peer and school processes that promote resilience among young people with a view to informing interventions specifically designed to promote resilience among youth exposed to parental alcohol use in Northern Ireland and further afield.


Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: STROKE;MENTAL HEALTH;CANCER AND NEOPLASMS;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL
Title: Self Affirmation-Based Enhancement of Risks/Harms-Feedback (SABER-F)
Funder: Alcohol Research UK

Abstract: Brief internet-based interventions involving personalised-feedback may reduce harmful drinking through large-scale programmes, potentially reaching many at-risk drinkers. However, the effects of these interventions are small. Psychological theory and experimental studies suggest that these modest effects can be amplified by introducing a minor additional procedure: ‘self-affirmation.’ This involves orienting individuals towards positive aspects of ‘the self’ by reminding them about cherished values and personal attributes. This brief activity makes people more receptive to unwelcome news (e.g. that their continued heavy drinking may have serious long-term health consequences). In a randomised online experiment with two groups university students who are heavy drinkers, we will compare the effects of personalised-feedback relating to alcohol health-risks, to the same feedback plus self-affirmation. A demonstration of enhanced web-based personalised-feedback effectiveness through self-affirmation would be the first demonstration of such an effect and would provide a basis for incorporating this procedure into new and existing feedback interventions.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: STROKE;MENTAL HEALTH;CANCER AND NEOPLASMS;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL
Title: m-WELLCARE@ an integrated mHealth system for the prevention and care of chronic diseases.
Funder: Wellcome Trust

Abstract: Heart attacks and strokes (cardiovascular diseases, CVD) account for a third of all deaths in India and are becoming more common. Smoking, high blood pressure, and diabetes are common causes of CVD which can be detected early and controlled by inexpensive, effective and widely available treatments. These risk factors are often not detected or well controlled and patient outcomes are poor. Common mental disorders such as anxiety and depression frequently co-exist with CVD risk factors and often contribute to failure to follow treatment plans. Community health centres provide primary care which is the best place to prevent and manage these chronic conditions. We will develop and evaluate a mobile phone software application mWELLCARE. This will assess a person's health profile, help health workers make the best treatment plan and follow up the patients and involve them in self-management. The research will follow the recommended steps for evaluation of complex interventions. Software will be tested with users and problems in using mWELLCARE will be sorted out. mWELLCARE will be evaluated in two states, Harayana and Tamil Nadu, by examining its use, impact on patterns health care received and changes in risk factors. In parallel a business plan will be developed to scale up to more CHCs and make mWELLCARE financially sustainable.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: STROKE;MENTAL HEALTH;CARDIOVASCULAR