NIHR Clinical Research Network

BackgroundMood monitoring is widely used by people with depression and bipolar disorder (BD) to prevent relapse and improve insight into their condition, but it is unclear if these interventions have an impact on symptoms and for whom. As the capacity for passive mood monitoring increases, it is vital to improve our understanding of frequent mood assessment.ObjectiveThis systematic review and meta-analysis assessed the effect of mood monitoring interventions in people with depression and BD to decrease relapse risk and symptoms of depression and mania.MethodsWe conducted a systematic review and meta-analysis (PROSPERO, International Prospective Register of Systematic Reviews: CRD42023396473) and reported results according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Randomized controlled trials with clinically important follow-up periods were identified via multiple database searches and rated for risk of bias using the Cochrane Risk of Bias tool. The primary outcomes were symptoms of depression and mania. Available data were pooled to calculate standardized mean differences (SMDs) for the primary outcomes: severity of depression, bipolar depression, and mania/hypomania.ResultsWe included 8 trials of 1230 participants and 6 different mood monitoring protocols. In BD, meta-analysis found a small but not statistically significant effect of mood monitoring interventions on decreasing mania symptoms (6 comparisons, n=873; SMD 0.16, 95% CI−0.34 to 0.01; P=.06) and no effect on bipolar depression (6 comparisons, n=873; SMD −0.08, 95% CI −0.31 to 0.15; P=.02). In depression, we found a small effect in decreasing symptoms of depression of borderline statistical significance at 12 months (2 comparisons, n=262; SMD −0.25, 95% CI −0.49 to 0.00; P=.05) but not at 6 months (2 comparisons, n=268; SMD −0.21, 95% CI −0.54 to 0.12; P=.21). There was an absence of evidence on the effect of mood monitoring on decreased relapse rates or readmission rates. Studies had a low risk of bias. There was no evidence on mood monitoring through ecological momentary assessment.ConclusionsOverall mood monitoring interventions do not increase or decrease mood symptoms in people with BD, nor is there robust evidence of such effects in people with unipolar depression. Further research is merited on different forms of mood monitoring and to determine under what circumstances mood monitoring might have beneficial or adverse effects. These results initially suggest that ambulatory assessment does not induce large placebo effects or significantly negatively or positively affect mood, and thus that mood monitoring may be an appropriate outcome measure for research or for clinical practice.

Available data on the demand for orthotic services is limited, especially in low- and middle-income countries, yet the development and delivery of services relies on this information. In this study, routinely collected digital patient records are used to provide insights into orthotic service users from three Cambodian physical rehabilitation centres. Analysis of the digital patient records from 1998–2019 investigated trends by sex, clinic, reason for orthosis use, orthotic type, and age. The analysis showed that the characteristics of service users and the provision of orthotics have changed over time. The predominant reason for orthosis use prior to 2006 was polio, whereas in 2019 it was cerebral palsy. Ankle Foot Orthoses (AFOs) are the most common type of orthosis provided; however, key differences have been found between type of orthosis and age which suggests older individuals have different experiences of physical rehabilitation compared to younger age groups. Longitudinal trends indicate a substantial reduction in orthotics appointments which may be associated with change in service delivery and changing service user characteristics. The study has illustrated the insights which can be derived from digital patient records into the demand for orthotics services over two decades and demonstrates the need for targeted resources and planning for the provision of services.

Objectives:This study aimed to examine symptom patterns between healthcare workers (HCWs) with and without long COVID, identify the most common long COVID symptom groups and investigate how these symptom profiles vary across different ethnic groups, demographic characteristics, clinical factors and occupational roles in UK HCWS.Design:We conducted a cross-sectional study using data from the United Kingdom Research study into Ethnicity and COVID-19 outcomes in Healthcare workers (UK-REACH) cohort study. Data were collected electronically between October 2021 and October 2022.Setting:United Kingdom.Participants:Individuals aged 16 years or older, residing in the UK, working as HCWs or ancillary workers in a healthcare setting and/or registered with one of seven major UK healthcare professional regulators.Main outcome measures:Long COVID was defined as symptoms persisting for ⩾12 weeks following SARS-CoV-2 infection. Our primary outcome was the presence or absence of particular groups of long COVID symptoms. We collapsed 28 symptoms into seven groups: cardiopulmonary, gastrointestinal, musculoskeletal, neurocognitive/neurologic, upper respiratory tract, psychological/social and systemic.Results:Among 4033 HCWs with a history of COVID-19, those with long COVID (26.5%; 1067/4033) reported a higher prevalence of systemic, neurological and psychological symptoms compared with those without long COVID. Among those with long COVID, the most commonly reported symptom groups were neurocognitive/neurologic (63.4%), cardiopulmonary (40.0%) – highest among Asian HCWs at 45.6% – and systemic (54.6%), which particularly affected Black and Mixed ethnicities at 64.0% and 63.9%, respectively. In multivariable analyses, Asian HCWs had higher odds of experiencing cardiopulmonary symptoms (adjusted odds ratio (aOR): 1.62, 95% CI 1.04–2.51, p = 0.032), while female HCWs were more likely to experience gastrointestinal (aOR: 3.78, 95% CI 1.14–12.45, p = 0.029) and neurocognitive symptoms (aOR: 1.58, 95% CI 1.10–2.28, p = 0.014). Compared with those in medical roles, musculoskeletal symptoms were more commonly reported by those in nursing (aOR: 2.50, 95% CI 1.32-4.72, p = 0.005), allied health professional (aOR: 1.82, 95% CI 1.01–3.30, p = 0.048) and dental roles (aOR: 3.07, 95% CI 1.31–7.17, p = 0.010). Vaccination with two or three doses was protective against several symptom groups, including cardiopulmonary, musculoskeletal and neurocognitive symptoms.Conclusions:Our findings are the first to reveal distinct patterns in long COVID symptoms among HCWs with significant variations by ethnicity, sex and occupational role. These findings emphasise the need for targeted support strategies and workplace adjustments that consider both occupation-specific risks and individual sociodemographic factors.

As the 8 patient partners serving on the PCORnet® Steering Committee, we stand at the forefront of a transformative movement in clinical research. PCORnet® Network Partners have been pioneers in integrating patient voices into every aspect of the research process, and we applaud the progress in operationalizing the Patient-Centered Outcomes Research Institute’s (PCORI) Framework for Patient Engagement and for leading the way as funders to change how to effectively involve patients and other interested parties in research. However, we believe that now is the time to amplify our efforts and call for a fundamental shift in how health research is conducted across the board. This commentary serves as both a reflection on our journey and a rallying cry for deeper, more authentic patient engagement and partnership in clinical research. The landscape of clinical research has undergone significant changes over the past decade, with patient engagement emerging as a cornerstone of patient-centered outcomes research. This shift is evidenced by major funding agencies now requiring patient engagement and a growing body of literature demonstrating improved study quality, recruitment, and relevance when patients are engaged as partners. As patient partners participating in PCORnet®, we have been at the forefront of this evolution, witnessing firsthand the progress made and the challenges and learnings that remain. Drawing on our experiences and evidence from the literature, we propose strategies to enhance patient involvement across all stages of research. We introduce and explore the concept that clinical research should be “careful, kind, and connected.” Our reflections underscore that meaningful patient involvement is essential for advancing health outcomes and achieving a truly patient-partnered research ecosystem.

The purpose of this article is to share insights from the National Institute for Health and Care Research Clinical Research Network (NIHR CRN) in delivering research for Multiple Long Term Conditions (MLTC) and to highlight lessons of wider relevance across the research ecosystem. Designing health and care systems to be more responsive to the needs of people living with MLTC requires a considerable evidence base. When compared with research focused on a single disease area, research relating to MLTC raises unique considerations at the stages of planning, placing, and delivering research studies. Our article describes challenges associated with MLTC research outcomes and outlines different types of interventions to target MLTC, along with related research delivery considerations. Our article also raises important considerations for placing research in the most appropriate setting and highlights the vital role of robust feasibility studies, informed by the lived experience of patients and carers with MLTC, for ensuring that studies are conducted, recruited to, and completed in a timely and appropriate way. Increasing the evidence base for the prevention and management of MLTC is a necessity for our health and care system. This presents novel challenges that require collaboration between multiple stakeholders. The UK benefits from a unique research infrastructure, including support for the stages of planning and delivery of health and care research. As the health and care system moves towards bringing care closer to patients and service users, the appropriate selection of the health and care settings and research sites in which to deliver MLTC research, in addition to understanding and removing barriers to recruitment and participation for people with MLTCs, are important considerations to enable us to collectively respond to this challenge.

Most staff working in the UK National Health Service (NHS) earn less in real terms than in 2010 and NHS pay lags behind the rest of the public sector.1 In 2024 only one-third of healthcare staff were satisfied with their pay.2 Following strikes in July 2025, resident doctors remain in dispute with the government, and other healthcare unions have also announced they are in pay disputes with the government.3,4

Abstract Recent evidence has shown a substantial RSV burden in healthy term-born children, but there is less data quantifying the relative burden compared to those with co-morbidity or prematurity. There is also limited primary care and emergency department (ED) data due to the lack of routine pathogen detection. These data are important for the development of RSV immunisation strategies. A prospective surveillance study of children < 3 years old, presenting with lower respiratory infection and a sub-study in primary care of upper respiratory infection was conducted. The primary endpoint was RSV prevalence by healthcare setting. Secondary endpoints included proportion of hospitalisations, level of ventilatory support and admission to higher levels of care. An economic analysis assessing the costs associated with healthcare utilisation was also conducted. The primary analysis revealed RSV prevalence was 50.4% in children admitted to hospital, 36.3% in ED discharges, 36.5% in primary care and 12.8% in primary care children with upper respiratory infection. Healthy term-born children accounted for 73.3% of medically-attended RSV cases and 70.1% of hospitalisations. Risk factors for severe disease included any level of prematurity, age < 3 months and congenital cardiac disease. RSV positive cases incurred a higher mean cost than RSV negative cases (mean = £1,706; incremental = £683) per illness. The findings revealed a substantial burden associated with RSV. Even moderate prematurity was a risk factor for severe disease, and these children may not benefit from the full maternal immune response to vaccination and would not be eligible for Nirsevimab under UK guidance, we therefore recommend broadening eligibility to include these children. What is already known on this topic Recent cohort studies have revealed a substantial healthcare and economic RSV burden from previously healthy term-born children which has supported the implementation of a maternal RSV vaccination programme in the UK, providing protection for infants from birth up to 6 months old. What this study adds We have shown that children born prematurely, including moderately preterm children, are at increased risk of severe RSV disease. These children may not benefit from full protection by maternal RSV vaccination, and may not be eligible for Nirsevimab, the long-acting monoclonal antibody, which is currently reserved for only the most high-risk children in the UK. How this study might affect research, practice or policy This data supports broadening eligibility for Nirsevimab, to include preterm children, who were born before full maternal protection from RSV vaccination may have developed, and to infants born to mothers not receiving maternal vaccination.