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MRC annual report and accounts 2019 to 2020

Activities and achievements of the Medical Research Council (MRC) from April 2019 to March 2020.

MRC annual report and accounts 2019 to 2020 (web-optimised PDF)

Ref: ISBN 978-1-5286-2296-7, CCS1120629358, HC 1023

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This annual review sets out the activities and achievements of the Medical Research Council ( MRC ) from April 2019 to March 2020. It includes:

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Medical Research Council framework for development and evaluation of complex interventions: A comprehensive guidance

Hooman shahsavari.

Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

Pegah Matourypour

Shahrzad ghiyasvandian, mohammad reza golestan nejad.

1 Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran

Introduction

Complex intervention framework is extensively used in health service delivery, community, health and social policy, such as education, with important health outcomes. Such interventions are sensitive and flexible to the regional context and culture. Complex interventions introduce the use of two or more information sources or two or more research methods to answer a research question.[ 1 , 2 ]

Using more than two research methods with triangulation techniques increases the validity of the research findings. Such studies are considered as mixed methods.[ 2 ] Complex intervention framework includes the steps which are not necessarily linear and there is also no clear boundary between simple and complex interventions. Such steps include plan development, feasibility and pilot, evaluation, and implementation. These steps have no linear or cyclic order.[ 3 ]

This framework emphasizes that any intervention should be presented to the patients tailored to the context and culture of that society (political, social, and geographical). Even if the intervention can be presented equally in different societies, the context of that society cannot be ignored in the face of the intervention because one intervention may have different effects on two different societies. In fact, this framework introduces the mechanisms which are sufficiently relevant to that society in order to achieve some changes. In addition, the context of the society after the intervention should be considered in interpreting the findings.[ 4 ] Meanwhile, Lakshman et al . considered the use of this framework to infants' nutritional behaviors in lactation with the analysis of cost-effectiveness of a complex intervention in his study as a challenging, long and costly intervention. He even suggested conducting interventional research with or without a framework to evaluate their effectiveness alongside costs.[ 5 ]

Initial Version

In 2000, the Medical Research Council introduced a framework which could facilitate the use of appropriate methods for researchers and research support organizations. This framework was a guide for developing and evaluating complex interventions [ Figure 1 ]. Complex interventions were introduced as the interventions with more than one component. In addition, these interventions have some other features as follows:

The steps of complex intervention framework 2000 Version

• The number of groups and levels of the organization which are the target group for interventions
• The number and severity of behaviors shown by intervention providers or recipients
• The number and variety of the variables are considered as estimate in the intervention
• The degree of flexibility in the permitted interventions.[ 1 ]

Complex Intervention Framework; 2006 Version

In 2006, 2000 version was revised due to some limitations, some were: (1) the linear form of the steps and its similarity to those which traditionally evaluate the effect of drugs, (2) there was no evidence for many of the recommendations, (3) there was little guidance on how to develop and implement a plan and (4) lack of paying attention to the geographical, political, and social context, in which interventions take place.[ 1 ] In this version, the complex intervention framework includes the steps which are not necessarily linear and there is no clear boundary between simple and complex interventions. These steps include plan development, feasibility and pilot, evaluation, and implementation. Such steps have no linear or cyclic order [ Figure 2 ].[ 3 ]

Complex intervention framework 2006 Version

The best method for developing a plan is using the current evidence and appropriate theory and then a specific approach to evaluate the plan as a pilot (aimed at clarifying the ambiguities) and then evaluate the plan. The results are extensively published to help further studies with the implementation of their interventions. It is essential for decision makers and policymakers of organizations to explain the advantages and disadvantages of the plan and then intervene in the implementation and progress of the plan. This framework emphasizes that any intervention appropriate to the context and culture of that society (political, social, and geographical) should be presented to patients. Even if the intervention itself can be presented equally in different societies, the context of those societies cannot be ignored while implementing the intervention because a constant intervention may have different effects on two different societies. In fact, this framework introduces the mechanisms which are sufficiently relevant to that society in order to achieve some changes. For interpreting the findings, the context of the society should be taken into account after using the intervention.[ 4 ] Lakshman et al . considered the use of this framework to infants' nutritional behaviors in lactation with the analysis of cost-effectiveness of a complex intervention in his study as a challenging, long, and costly intervention. He even suggested conducting interventional research with or without complex framework to evaluate their effectiveness alongside costs.[ 5 ]

Sometimes, evaluation can be performed before using the interventions. Some evidence, though valid, because of political unacceptability, is better to completely deleted.[ 1 ]

This framework has been used so far for designing and evaluating different care interventions such as infants' nutritional habits, the prevention of childhood obesity,[ 5 ] high blood pressure control,[ 6 ] diabetes prevention,[ 7 ] secondary prevention of stroke, followed by transient ischemic attack[ 2 ] and reintegration to normal life in patients with upper extremity amputation.[ 8 ]

Step 1: Developing Complex Interventions

Introducing the current evidence.

The evidence related to the subject is searched ideally as a systematic review. Even if a new quality review has been recently conducted optimistically, the researcher should carry out his/her study.[ 1 ]

Introducing/developing an appropriate theory

Sometimes, a practical and useful theory can make a better intervention. The current evidence can be used or a new study can be conducted for this purpose.[ 1 ] Therefore, it should be decided whether you intend to develop and evaluate the intervention yourself or evaluate an already-existing intervention.[ 4 ]

Modeling the process and estimates

Before implementing and evaluating the intervention, it is better to model it and specify some information about the design. For example, an economic estimate can be used before the intervention begins. This should be performed at an early stage.[ 1 ]

Step 2: Feasibility and Pilot

This step includes testing the procedure in terms of acceptance by the participants, the extent of samples' participation, and attrition rate in research and calculating the sample size. At this step, qualitative and quantitative research may be required to examine the barriers to intervention from the perspective of participants and determine the response rate.[ 1 ]

Step 3: Evaluating Complex Interventions

Clinical trials can be used for evaluating effectiveness of the intervention. Randomization ensures the prevention of bias in selection, otherwise it cannot be ensured that the recipients of the intervention are systematically equal to those who did not receive the intervention. Clinical trials can take place at the individual or cluster levels.[ 4 ] In measuring the estimates, researchers should decide what estimates are more important to them and what estimates are at the second degree of importance.[ 1 ] Useful approaches in the evaluation phase are listed in Table 1 .

Useful approaches in the evaluation phase[ 1 ]

SD=Standard deviation

Understanding the intervention process

Evaluating the intervention process is highly valuable because it can understand the cause of the unexpected results of the intervention or its failure. Such an evaluation can be implicitly performed during the intervention so that the quality of the intervention can be assessed. In addition, the cultural factors which can be related to changes associated with research variables can be also introduced.[ 1 ]

Investigating the effectiveness cost

Cost effectiveness is ideally performed during the evaluation phase. Cost effectiveness makes it possible compare cost of intervention versus its advantages.[ 3 , 4 ]

Step 4: Implementation

Disseminating the intervention and the results of the study is essential. Interventions and their results should be accessible and understandable to decision makers and policymakers to be used in routine clinical care. It has become clear over time that vague strategies (actors and roles are not exactly clear) will become ineffective and inefficient in clinical care. Information should be available and informed actively.[ 1 ]

Survival, monitoring and long-term outcomes

Clinical trials typically have a low degree of generalizability. Therefore, in interpreting the results of the trials, the characteristics of samples and the time scope should be considered in interpreting the results of the trials. Sometimes, following up the effects of interventions is made over a long period of time. Although this case is not usually conducted, sometimes, it is performed to evaluate the long-term effectiveness of interventions. Sometimes, unexpected results show up over time. In addition, it is studied whether the advantages are endangered by the real results of the study or not.[ 3 ]

Due to the valuable advantages of following up the patients in the long term, it is important to think about how to follow-up them or a communication can be conducted again with them or for example follow their registered information which is accessible.[ 4 ] Patients maybe, have chronic disease like stroke and hypertension or acute like sudden upper limb amputation.[ 8 ]

The final goal is not to present a prescriptive guide to other researchers, decision makers and research supportive organizations, but to help them make methodological and practical choices in the clinical area. Furthermore, the editor-in-chief of magazines should emphasize the presentation of studies with a detailed reporting system.[ 1 ]

This study attempted to use the relevant sources in complex intervention framework and its stages to help researchers, especially nurse researchers, to design more effective care plans by considering important factors like culture of the society; accompanying stakeholders collaboration for better implementation of care plan; implementing the pilot and feasibility phase to identify problems and present solutions by a panel of experts before evaluation plan in the form of randomized controlled trial; and emphasizing on the dissemination of results. Weakness points of complex framework are time consuming and cost of implementation. Calculating the cost-effectiveness and time of plan in the pilot phase can show the value of implementation of plan.

Financial support and sponsorship

Tehran University of Medical Science

Conflicts of interest

There are no conflicts of interest.

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NIHR publishes new framework on complex interventions to improve health

Published: 01 October 2021

The NIHR and The Medical Research Council (MRC) has launched a new complex intervention research framework.

The new framework provides an updated definition of complex interventions, highlighting the dynamic relationship between the intervention and its context.

Complex interventions are widely used in the health service, in public health practice, and in areas of social policy that have important health consequences, such as education, transport, and housing. 

Interest in complex interventions has increased rapidly in recent years. Given the pace and extent of methodological development, there was a need to update the core guidance and address some of the remaining weaknesses and gaps. 

Using the framework’s core elements

There are four main phases of research: intervention development or identification, e.g. from policy or practice, feasibility, evaluation, and implementation.

At each phase, the guidance suggests that six core elements should be considered: 

• how does the intervention interact with its context?
• what is the underpinning programme theory?
• how can diverse stakeholder perspectives be included in the research? 
• what are the key uncertainties?
• how can the intervention be refined?
• do the effects of the intervention justify its cost?  

These core elements can be used to decide whether the research should proceed to the next phase, return to a previous phase, repeat a phase, or stop.

The journey of a research project through the phases of complex intervention research is illustrated in the below NIHR-funded study: Football Fans In Training (FFIT) . 

A randomised controlled trial set in professional football clubs established the effectiveness and cost-effectiveness of the Football Fans in Training (FFIT) programme. FFIT aimed to help men lose at least 5-10% of their weight and keep it off over the long term. The programme was developed to appeal to Scottish football fans and to help them improve their eating and activity habits.

Researchers found that participation in FFIT leads to significant sustained weight loss and improvements in diet and physical activity. As well as losing weight, participants benefited from reduced waist size, less body fat and lower blood pressure, which can all be associated with a lower risk of heart disease, diabetes and stroke. The study team considered all of the 6 core elements of complex intervention research, during each of the four phases of the research. 

Implementation was considered from the outset, the study team engaged with key stakeholders in the development phase to explore how the intervention could be implemented in practice, if proven to be effective. 

A cost effectiveness analysis demonstrated that FFIT was inexpensive to deliver, making it appeal to decision makers for local and national health provision.  The positive and sustainable results have made the programme appealing for nations with similar public health priorities such as the reduction of obesity, heart disease and improvement of mental health.

Professor Hywel Williams, NIHR Scientific and Coordinating Centre Programmes Contracts Advisor, said: “This updated framework is a landmark piece of guidance for researchers working on such interventions. The updated guidance will help researchers to develop testable and reproducible interventions that will ultimately benefit NHS patients. The guidance also represents a terrific collaborative effort between the NIHR and MRC that I would like to see more of.”

Professor Nick Wareham, Professor Nick Wareham, Chair of MRC’s Population Health Sciences Group, said: “Previous versions of the guidance on the development and evaluation of complex interventions have been extremely influential and are widely used in the field. We are delighted that the successful partnership between MRC and NIHR has enabled the guidance to be updated and extended. It is particularly important to see how the new framework brings in thinking about the interplay between an intervention and the context in which it is applied.”

Dr Kathryn Skivington, Research Fellow, MRC/CSO Social and Public Health Sciences Unit and lead author of the framework, said: “The new and exciting developments for complex intervention research are of practical relevance and I feel sure they will stimulate constructive debate, leading to further progress in this area.”

Read the full paper, published in the British Medical Journal

Find out more in the NIHR Journals Library

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• Copy URL https://www.pbs.org/newshour/world/8-doctors-among-62-killed-in-brazils-horrifying-plane-crash

8 doctors among 62 killed in Brazil’s horrifying plane crash

RIO DE JANEIRO (AP) — Arianne Risso worked every day to help her patients battle cancer. That made it all the more heart wrenching when her life — along with that of seven other doctors — ended abruptly after a plane tumbled from the sky in Brazil.

She boarded the ill-fated flight Friday in the city of Cascavel, in Parana state, bound for Sao Paulo’s Guarulhos international airport. It crashed in the city of Vinhedo, and footage of the ATR 72 twin-engine turboprop plunging while in a flat spin horrified people across Brazil.

It smashed into the backyard of a home inside a gated community and transformed into a fiery wreck. All 62 people aboard were killed, among them the eight doctors, according to a statement from Parana’s Medical Council. Risso and at least one colleague were headed for an oncology conference to sharpen their knowledge about a disease that kills tens of thousands of Brazilians every year.

“They were people used to saving lives, and now they lost theirs in such tragic circumstances,” Parana Gov. Ratinho Júnior told journalists in Vinhedo on Friday, adding that he had friends on the doomed plane. “It is a sad day.”

Risso’s cousin, Stephany Albuquerque, recalled in a phone interview that the two often played together when she was young. Even then, Risso wanted to become a doctor and, as she grew older, applied herself so intensively to her studies that she rarely went out on the town. Medicine was her calling.

“Arianne treated people who were terminally ill at a time in their lives when they were struggling. But Arianne was always available and did everything with a lot of love,” Albuquerque told The Associated Press by phone from Florida, where she now lives. “She wasn’t the kind of doctor who would the tell the patient, ‘This is your illness, take this.’ No, Arianne took care of people. … She would give out her personal phone number to patients.”

Risso, 34, was flying with her colleague Mariana Belim, 31. The two had been in residencies at Cascavel’s cancer hospital, and a statement from the institution praised them for the conscientiousness, care and respect with which they treated their patients.

“It’s no wonder that praise for them both would often reach us. Their love of the profession was very clear,” the hospital said.

READ MORE: Rescuers retrieve remains of all passengers in Brazil plane crash as families gather in Sao Paulo

Willian Rodrigo Feistler, a general practitioner who grew up in Cascavel, knew six people who died in the crash and was particularly close to Belim, with whom he studied and had maintained a 15-year friendship.

“Mariana was serene with a melancholic temperament, but very intelligent, empathetic and devoted to her profession,” Feistler said by phone from Cascavel. “She dedicated much of her life to studies and medical training. She had already specialized in clinical medicine and was completing her specialization in clinical oncology.”

José Roberto Leonel Ferreira, a recently retired doctor who also died in the fiery wreck, was one of Feistler’s teachers during his undergraduate studies. He had a radiology clinic in Cascavel.

“I went over cases with him on several occasions. He was a receptive person who helped other doctors in the discussion of cases to reach diagnoses,” Feistler said.

Brazil’s Federal Council of Medicine said the loss of the doctors left Brazil’s medical world in mourning, and expressed its solidarity for the victims’ friends and relatives. They were venturing forth from Cascavel in search of knowledge as a means to better treat their patients, its statement said.

For now, there are more questions about the crash than answers. Metsul, one of Brazil’s most respected meteorological companies, said Friday that there were reports of severe icing in Sao Paulo state around the time of the crash. Local media cited experts pointing to that as a potential cause, although others cautioned against jumping to a conclusion.

Both the plane’s “black boxes” — one with flight data and the other with cockpit audio — were recovered. The air force’s center for the investigation and prevention of air accidents began analyzing them at its laboratory in the nation’s capital, Brasilia. Airports Minister Silvio Costa Filho said the center was also opening a criminal probe. The airline Voepass and the French-Italian ATR manufacturer are assisting investigations, they said in statements.

All of Brazil — but in particular victims’ loved ones — are eager to learn why these people were ripped from this world.

“It wasn’t God who took my daughter; it wasn’t God, because he chose her to save lives,” Risso’s mother, Fatima Albuquerque, told reporters Sunday. She said she blamed the crash on profit-hungry capitalists and authorities’ neglect.

Stephany Albuquerque echoed her indignation.

“I only hope that the prosecutors will investigate,” she said. “I hope justice is done, because that’s the least my cousin and the other 61 people deserve.”

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74th session of the WHO Regional Committee for Europe

WHO launches Collaborating Centre on Cardiovascular Diseases, eHealth and Value-based Care in St Petersburg

The Institute of Heart and Vessels of the Almazov National Medical Research Centre, based in St Petersburg, Russian Federation, has now joined the international community of more than 800 WHO collaborating centres. The Almazov Centre, of the Ministry of Health, is a leading national institution, which combines basic and applied research in a variety of medical fields, from cardiovascular diseases to neurosurgery. The Centre provides multidisciplinary specialized care, which includes high-tech surgery, and continuous medical education for researchers and practicing doctors.

As a WHO collaborating centre, the Institute of Heart and Vessels is now part of a multilateral international network of research, clinical and academic institutions. This community supports WHO through concrete collaboration and contributions to the implementation of its plans, projects and objectives. Specifically, the Institute will use its expertise in the areas of cardiovascular diseases, eHealth and value-based care.

A special event was held in St Petersburg on 18 October 2019 to launch the collaborating centre. Opened by Professor Evgeny Shlyakhto, Director of the Almazov Centre, alongside country and regional representatives of WHO and representatives of the Ministry of Health, the programme highlighted achievements and future plans for collaboration between WHO and the Centre to an audience representing major national and international institutions. Recent collaborative work between WHO and the Institute was shared, which included reviewing services for acute care and rehabilitation of heart attack and stroke patients in Belarus, Kyrgyzstan and Turkmenistan, as part of WHO country support.

“The potential of the Almazov Centre is extremely high,” stated Professor Shlyakhto. “With its core specializations in cardiology and angiology, it is at the forefront not only in clinical practice but also in creating the framework for the innovative development of medical science and health care towards personalized medicine. The Centre is committed to scientific and technological advancement, personnel training and rapid integration of research findings into health-care practice.” Professor Shlyakhto noted that “The Almazov Center is working on 3 megatrends: digitalization, super-specialization and personalized medicine, and can contribute its expertise to the entire Region”.

Dr Bente Mikkelsen, Director of the Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO/Europe, added: “The Almazov Centre’s potential for impact at country level lies in its impressive broadness of activities: health policies, health education, health literacy, research and innovation, capacity-building, and digital health; an example that builds trust between institutions and people. It can help focus our efforts in the Region to reach SDG target 3.4: reducing premature mortality from noncommunicable disease”.

Brief State Non-Medical Exemptions from School Immunization Requirements

All 50 states and Washington D.C. have laws requiring certain vaccines for students to attend school. Many states align their vaccine requirements with recommendations from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices . All states allow exemptions from school immunization requirements for children who are unable to receive vaccines for medical reasons. State laws vary regarding non-medical exemptions, for religious or personal reasons. Personal exemptions are also referred to as "philosophical exemptions" by some states.

Thirty states and Washington D.C. allow exemptions for people who have religious objections to immunizations. Thirteen 13 states allow exemptions for either religious or personal reasons. Two states, Louisiana and Minnesota, do not specify whether the non-medical exemption must be for religious or personal reasons. Five states do not allow any type of non-medical exemption.

The map below indicates each state's non-medical exemption policy. The map also links to the statutes for each state regarding school vaccine requirements and exemptions. Below the map is a table which provides more information about state exemption laws including exemption exceptions, requirements to obtain a non-medical exemption and information on states that have removed certain exemption policies.

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Map Source: Adapted from the LexisNexis StateNet Database and the Immunization Action Coalition.

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