Mealtime difficulties in adults with mental health conditions: an integrative review.

BACKGROUND: Dysphagia and choking are highly prevalent in adults with mental health conditions. However, there is scant research considering the personal experience of dysphagia for this population. AIMS: To understand the evidence-base for strategies to involve the patient in recognition, assessment and treatment of mealtime difficulties. METHODS: This integrative review synthesised the literature on the experience of dysphagia in patients with mental health conditions. Patient consultation led to co-designed search terms and eligibility criteria for a systematic search of five scientific databases following Prisma guidance. Quality assessment of the eligible studies and reflexive thematic analysis were completed. RESULTS: 31 studies were included for review. These included case reports, literature reviews and cross-sectional studies. Quality of evidence was weak and no intervention studies were identified. There was scant detail regarding the personal experience of dysphagia or choking. Themes identified related to biomedical perspectives, influencing factors presented without context, and decision-making led by clinicians. CONCLUSIONS: Guidance on mental healthcare calls attention to under-diagnosis of physical co-morbidities and advocates patient inclusion. However, the patient voice in this population is rarely described regarding dysphagia. Further inclusive research is indicated to explore the impact of dysphagia and choking, and implications for interventions and outcome measures.

A rapid evidence assessment exploring whether antimicrobial resistance complicates non-infectious health conditions and healthcare services, 2010-20.

Antimicrobial resistance (AMR) is one of the greatest public health threats at this time. While there is a good understanding of the impacts of AMR on infectious diseases, an area of less focus is the effects AMR may be having on non-communicable health conditions (such as cancer) and healthcare services (such as surgery). Therefore, this study aimed to explore what impact AMR is currently having on non-communicable health conditions, or areas of health services, where AMR could be a complicating factor impacting on the ability to treat the condition and/or health outcomes. To do this, a rapid evidence assessment of the literature was conducted, involving a systematic approach to searching and reviewing the evidence. In total, 101 studies were reviewed covering surgery, organ transplants, cancer, ICUs, diabetes, paediatric patients, immunodeficiency conditions, liver and kidney disease, and physical trauma. The results showed limited research in this area and studies often use a selective population, making the results difficult to generalize. However, the evidence showed that for all health conditions and healthcare service areas reviewed, at least one study demonstrated a higher risk of death for patients with resistant infections, compared with no or drug-susceptible infections. Poor health outcomes were also associated with resistant infections in some instances, such as severe sepsis and failure of treatments, as well as a greater need for invasive medical support. While there are gaps in the evidence base requiring further research, efforts are also needed within policy and practice to better understand and overcome these challenges.

Mechanisms and pathways to impact in public health research: a preliminary analysis of research funded by the National Institute for Health Research (NIHR).

BACKGROUND: The mechanisms and pathways to impacts from public health research in the UK have not been widely studied. Through the lens of one funder (NIHR), our aims are to map the diversity of public health research, in terms of funding mechanisms, disciplinary contributions, and public health impacts, identify examples of impacts, and pathways to impact that existing reporting mechanisms may not otherwise have captured, and provide illustrations of how public health researchers perceive the generation of non-academic impact from their work. METHODS: A total of 1386 projects were identified as 'public health research' by the NIHR and listed in the NIHR Public Health Overview database (2000-2016). From these, a subset of 857 projects were matched as potentially having begun reporting impacts via an external data-gathering platform (Researchfish). Data on the 857 projects were analyzed quantitatively, and nine projects were selected to investigate further through semi-structured interviews with principal investigators. Two workshops took place to validate emerging and final findings and facilitate analysis. RESULTS: In addition to the NIHR School for Public Health Research and the NIHR Public Health Research Programme, 89% of projects contained in the NIHR Public Health Overview portfolio as 'public health research' are funded via other NIHR research programmes, suggesting significant diversity in disciplines contributing to public health research and outcomes. The pathways to impact observed in our in-depth case studies include contributing to debates on what constitutes appropriate evidence for national policy change, acknowledging local 'unintended' impacts, building trusted relationships with stakeholders across health and non-health sectors and actors, collaborating with local authorities, and using non-academic dissemination channels. CONCLUSIONS: Public health as a discipline contributes substantially to impact beyond academia. To support the diversity of these impacts, we need to recognise localized smaller-scale impacts, and the difference in types of evidence required for community and local authority-based impacts. This will also require building capacity and resources to enable impact to take place from public health research. Finally, support is required for engagement with local authorities and working with non-health sectors that contribute to health outcomes.

Understanding the contribution of UK public health research to clinical guidelines: a bibliometric analysis.

Background: There is an increasing need to understand the wider impacts of research on society and the economy. For health research, a key focus is understanding the impact of research on practice and ultimately on patient outcomes. This can be challenging to measure, but one useful proxy for changes in practice is impact on guidelines. Methods: The aim of this study is to map the contribution of UK research and UK research funders to the National Institute for Health and Clinical Excellence (NICE) public health guidelines, understanding areas of strengths and weakness and the level of collaboration and coordination across countries and between funders. The work consisted of two main elements: analysis of the references cited on NICE guidelines and interviews with experts in public health. Results: Across the papers cited on 62 NICE public health guidelines, we find that 28% of the papers matched include at least one UK affiliation, which is relatively high when compared to other health fields. In total, 165 unique funders were identified with more than three acknowledgements, based in 20 countries. 68% of papers which acknowledge funding cite at least one UK funder, and NIHR is the most highly cited funder in the sample.   Conclusions: The UK makes an important contribution to public health research cited on NICE PH guidelines, although the research does not appear to be bibliometrically distinct from other research sectors, other than having a relatively low level of international collaboration. However, the extent to which NICE public health guidelines reflect practice at the local authority level is less clear. More research is needed to understand the sources of evidence to support public health decision making at the local level and how NICE guidance can be made more applicable, timely and accessible in this new context.

Understanding mental health in the research environment: A Rapid Evidence Assessment.

This study aimed to establish what is known about the mental health of researchers based on the existing literature. There is limited published evidence on the prevalence of specific mental health conditions among researchers. The majority of the identified literature on prevalence relates to work-related stress among academic staff and postgraduate students in university settings. Survey data indicate that the majority of university staff find their job stressful. Levels of burnout appear higher among university staff than in general working populations and are comparable to "high-risk" groups such as healthcare workers. The proportions of both university staff and postgraduate students with a risk of having or developing a mental health problem, based on self-reported evidence, were generally higher than for other working populations. Large proportions (>40 per cent) of postgraduate students report symptoms of depression, emotion or stress-related problems, or high levels of stress. Factors including increased job autonomy, involvement in decision making and supportive management were linked to greater job satisfaction among academics, as was the amount of time spent on research. Opportunities for professional development were also associated with reduced stress. UK higher education (HE) and research staff report worse wellbeing, as compared to staff in other sectors, in most aspects of work that can affect workers' stress levels. The evidence around the effectiveness of interventions to support the mental health of researchers specifically is thin. Few interventions are described in the literature and even fewer of those have been evaluated.

Estimating the returns to United Kingdom publicly funded musculoskeletal disease research in terms of net value of improved health outcomes.

BACKGROUND: Building on an approach applied to cardiovascular and cancer research, we estimated the economic returns from United Kingdom public- and charitable-funded musculoskeletal disease (MSD) research that arise from the net value of the improved health outcomes in the United Kingdom. METHODS: To calculate the economic returns from MSD-related research in the United Kingdom, we estimated (1) the public and charitable expenditure on MSD-related research in the United Kingdom between 1970 and 2013; (2) the net monetary benefit (NMB), derived from the health benefit in quality adjusted life years (QALYs) valued in monetary terms (using a base-case value of a QALY of £25,000) minus the cost of delivering that benefit, for a prioritised list of interventions from 1994 to 2013; (3) the proportion of NMB attributable to United Kingdom research; and (4) the elapsed time between research funding and health gain. The data collected from these four key elements were used to estimate the internal rate of return (IRR) from MSD-related research investments on health benefits. We analysed the uncertainties in the IRR estimate using a one-way sensitivity analysis. RESULTS: Expressed in 2013 prices, total expenditure on MSD-related research from 1970 to 2013 was £3.5 billion, and for the period used to estimate the rate of return, 1978-1997, was £1.4 billion. Over the period 1994-2013 the key interventions analysed produced 871,000 QALYs with a NMB of £16 billion, allowing for the net NHS costs resulting from them and valuing a QALY at £25,000. The proportion of benefit attributable to United Kingdom research was 30% and the elapsed time between funding and impact of MSD treatments was 16 years. Our best estimate of the IRR from MSD-related research was 7%, which is similar to the 9% for CVD and 10% for cancer research. CONCLUSIONS: Our estimate of the IRR from the net health gain to public and charitable funding of MSD-related research in the United Kingdom is substantial, and justifies the research investments made between 1978 and 1997. We also demonstrated the applicability of the approach previously used in assessing the returns from cardiovascular and cancer research. Inevitably, with a study of this kind, there are a number of important assumptions and caveats that we highlight, and these can inform future research.

100 Metrics to Assess and Communicate the Value of Biomedical Research: An Ideas Book.

Biomedical research affects society in many ways. It has been shown to improve health, create jobs, add to our knowledge, and foster new collaborations. Despite the complexity of modern research, many of the metrics used to evaluate the impacts of research still focus on the traditional, often academic, part of the research pathway, covering areas such as the amount of grant funding received and the number of peer-reviewed publications. In response to increasing expectations of accountability and transparency, the Association of American Medical Colleges (AAMC), in collaboration with RAND Europe, undertook a project to help communicate the wider value of biomedical research. The initiative developed resources to support academic medical centers in evaluating the outcomes and impacts of their research using approaches relevant to various stakeholders, including patients, providers, administrators, and legislators. This study presents 100 ideas for metrics that can be used to assess and communicate the value of biomedical research. The list is not comprehensive, and the metrics are not fully developed, but they should serve to stimulate and broaden thinking about how academic medical centers can communicate the value of their research to a broad range of stakeholders.

How do NIHR peer review panels use bibliometric information to support their decisions?

Bibliometrics is widely used as an evaluation tool to assist prospective R&D decision-making. In the UK, for example, the National Institute for Health Research (NIHR) has employed bibliometric analysis alongside wider information in several awarding panels for major funding schemes. In this paper, we examine various aspects of the use of bibliometric information by members of these award selection panels, based on interviews with ten panel members from three NIHR panels, alongside analysis of the information provided to those panels. The aim of the work is to determine what influence bibliometrics has on their decision-making, to see which types of bibliometric measures they find more and less useful, and to identify the challenges they have when using these data. We find that panel members broadly support the use of bibliometrics in panel decision-making, and that the data are primarily used in the initial individual assessment of candidates, playing a smaller role in the selection panel meeting. Panel members felt that the most useful measures of performance are normalised citation scores and the number or proportion of papers in the most highly cited X% (e.g. 5, 10%) for the field. Panel members expressed concerns around the comparability of bibliometrics between fields, but the discussion suggested this largely represents a lack of understanding of bibliometric techniques, confirming that effective background information is important. Based on the evidence around panel behaviour and concerns, we set out guidance around providing bibliometrics to research funding panels.

Assessing and Communicating the Value of Biomedical Research: Results From a Pilot Study.

PURPOSE: Assessing the impact of research requires an approach that is sensitive both to the context of the research and the perspective of the stakeholders trying to understand its benefits. Here, the authors report on a pilot that applied such an approach to research conducted at the Collaborative Center for Health Equity (CCHE) of the University of Wisconsin School of Medicine and Public Health. METHOD: The pilot assessed the academic impact of CCHE's work; the networks between CCHE and community partners; and the reach of CCHE's programs, including an attempt to estimate return on investment (ROI). Data included bibliometrics, findings from a stakeholder survey and in-depth interviews, and financial figures. RESULTS: The pilot illustrated how CCHE programs increase the capacity of community partners to advocate for their communities and engage with researchers to ensure that research benefits the community. The results illustrate the reach of CCHE's programs into the community. The authors produced an estimate of the ROI for one CCHE program targeting childhood obesity, and values ranged from negative to positive. CONCLUSIONS: The authors experienced challenges using novel assessment techniques at a small scale including the lack of comparator groups and the scarcity of cost data for estimating ROI. This pilot demonstrated the value of research from a variety of perspectives-from academic to community. It illustrates how metrics beyond grant income and publications can capture the outputs of an academic health center in a way that may better align with the aims of the center and stakeholders.

Consensus-building on developing dysphagia competence: a North West of England perspective.

BACKGROUND: Dysphagia has been an increasing area of practice for speech and language therapists (SLTs) for over 20 years, and throughout that period there has been debate about how practical skills in dysphagia can best be developed. The implementation of the new Royal College of Speech and Language Therapists (RCSLT) framework was considered from a regional perspective seeking to establish consensus across different speech and language therapy settings. AIM: To explore practical solutions to the development of dysphagia competency in new graduates whilst acknowledging the wide variation in staffing and clinical dysphagia experience across the geographical and clinical landscape in the North West of England. METHODS & PROCEDURES: A four-phase study involved a literature search; interviews with experts in the field of dysphagia; a survey to identify current practice; and a two-round Delphi process. OUTCOMES & RESULTS: Five themes emerged for dysphagia competency development: development of practical skills; supervision; clinical excellence networks; workforce planning; and postgraduate formal training. Challenges, and solutions to these, were identified through the phases of the study. A model for dysphagia competency development relevant to the North West context was achieved by consensus. CONCLUSIONS & IMPLICATIONS: There are many practical ways of developing dysphagia competency. The themes and model generated provide constructive support to services in adopting the most appropriate methods for their own settings.

Teatime Threats. Choking Incidents at the Evening Meal.

PURPOSE: To explore caregiver perceptions of the socio-environmental issues around evening meal ('teatime') which influence choking. Mealtime difficulties for people with intellectual disabilities and/or mental illness may be underdiagnosed. Difficulties affect quality of life with social aspects impacting on service-users and caregivers. Reporting of choking incidents has increased locally following widespread training. Analysis of reports showed most incidents were occurring around evening meal. METHODOLOGY: A qualitative study of caregivers witnessing a choking incident was undertaken. Semi-structured interviews explored perceptions of the causes. Data were analysed using thematic analysis. FINDINGS: Thematic analysis elicited individual service user characteristics, and social and contextual factors implicated in choking. The findings will facilitate risk assessment for service-users and inform mealtime practice. Staff familiarity is a key factor. Further research involving service-users is indicated to complement these findings. This study widens the focus of recent studies which have considered physical more than socio-environmental aspects of mealtime difficulties.

What do we know about grant peer review in the health sciences?

Background: Peer review decisions award an estimated >95% of academic medical research funding, so it is crucial to understand how well they work and if they could be improved. Methods: This paper summarises evidence from 105 papers identified through a literature search on the effectiveness and burden of peer review for grant funding. Results: There is a remarkable paucity of evidence about the efficiency of peer review for funding allocation, given its centrality to the modern system of science. From the available evidence, we can identify some conclusions around the effectiveness and burden of peer review. The strongest evidence around effectiveness indicates a bias against innovative research. There is also fairly clear evidence that peer review is, at best, a weak predictor of future research performance, and that ratings vary considerably between reviewers. There is some evidence of age bias and cronyism. Good evidence shows that the burden of peer review is high and that around 75% of it falls on applicants. By contrast, many of the efforts to reduce burden are focused on funders and reviewers/panel members. Conclusions: We suggest funders should acknowledge, assess and analyse the uncertainty around peer review, even using reviewers' uncertainty as an input to funding decisions. Funders could consider a lottery element in some parts of their funding allocation process, to reduce both burden and bias, and allow better evaluation of decision processes. Alternatively, the distribution of scores from different reviewers could be better utilised as a possible way to identify novel, innovative research. Above all, there is a need for open, transparent experimentation and evaluation of different ways to fund research. This also requires more openness across the wider scientific community to support such investigations, acknowledging the lack of evidence about the primacy of the current system and the impossibility of achieving perfection.

Understanding the relative valuation of research impact: a best-worst scaling experiment of the general public and biomedical and health researchers.

OBJECTIVES: (1) To test the use of best-worst scaling (BWS) experiments in valuing different types of biomedical and health research impact, and (2) to explore how different types of research impact are valued by different stakeholder groups. DESIGN: Survey-based BWS experiment and discrete choice modelling. SETTING: The UK. PARTICIPANTS: Current and recent UK Medical Research Council grant holders and a representative sample of the general public recruited from an online panel. RESULTS: In relation to the study's 2 objectives: (1) we demonstrate the application of BWS methodology in the quantitative assessment and valuation of research impact. (2) The general public and researchers provided similar valuations for research impacts such as improved life expectancy, job creation and reduced health costs, but there was less agreement between the groups on other impacts, including commercial capacity development, training and dissemination. CONCLUSIONS: This is the second time that a discrete choice experiment has been used to assess how the general public and researchers value different types of research impact, and the first time that BWS has been used to elicit these choices. While the 2 groups value different research impacts in different ways, we note that where they agree, this is generally about matters that are seemingly more important and associated with wider social benefit, rather than impacts occurring within the research system. These findings are a first step in exploring how the beneficiaries and producers of research value different kinds of impact, an important consideration given the growing emphasis on funding and assessing research on the basis of (potential) impact. Future research should refine and replicate both the current study and that of Miller et al in other countries and disciplines.

Returns on Research Funded Under the NIHR Health Technology Assessment (HTA) Programme: Economic Analysis and Case Studies.

The Department of Health (England) requested that RAND Europe conduct an economic analysis of the impact of the HTA Programme. This article describes the results of that work, which consisted of analysis of the potential economic benefits of a sample of HTA funded studies and comparison to programme costs, supplemented by a set of short case studies exploring the impacts of the HTA Programme on policy and practice. Based on our analysis, if 12 per cent of the potential net benefit of implementing the findings of this sample of 10 studies for one year was realised, it would cover the cost of the HTA Programme from 1993 to 2012. Drawing on the case studies and the economic analysis, we have also made a number of observations that could help ensure that the HTA Programme maximises the likelihood of findings being adopted.

A 'DECISIVE' Approach to Research Funding: Lessons from Three Retrosight Studies.

The Retrosight approach consists of looking at research that was conducted in the past and, using Payback case studies, tracing that research through to the present day to understand both the extent to which the research has had impacts, within academia and more widely, and how these impacts came about. RAND Europe has conducted three studies based on this approach in different research fields: arthritis research, cardiovascular research and mental health research. Each drew out a set of observations and recommendations for policymakers and research funders in those research fields. By reviewing and comparing the findings of the three studies, we have identified eight lessons which combine to provide a "DECISIVE" approach to biomedical and health research funding: Different skills: Fund researchers with more than just research skills-individuals are key when it comes to translation of research into wider impact. Engaged: Support your researchers to engage with non-academic stakeholders to help their work have a wider impact. Clinical: For greater impact on patient care within 10-20 years, fund clinical rather than basic research. Impact on society: If you want to have a wider impact, don't just fund for academic excellence. Size: Bigger isn't necessarily better when it comes to the size of a research grant. International: For high academic impact, fund researchers who collaborate internationally and support them to do so. Variety: Simple metrics will only capture some of the impact of your research. Expectations: Most broader social and economic impact will come from just a few projects.

The impact of the National Institute for Health Research Health Technology Assessment programme, 2003-13: a multimethod evaluation.

BACKGROUND: The National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme supports research tailored to the needs of NHS decision-makers, patients and clinicians. This study reviewed the impact of the programme, from 2003 to 2013, on health, clinical practice, health policy, the economy and academia. It also considered how HTA could maintain and increase its impact. METHODS: Interviews (n = 20): senior stakeholders from academia, policy-making organisations and the HTA programme. Bibliometric analysis: citation analysis of publications arising from HTA programme-funded research. Researchfish survey: electronic survey of all HTA grant holders. Payback case studies (n = 12): in-depth case studies of HTA programme-funded research. RESULTS: We make the following observations about the impact, and routes to impact, of the HTA programme: it has had an impact on patients, primarily through changes in guidelines, but also directly (e.g. changing clinical practice); it has had an impact on UK health policy, through providing high-quality scientific evidence - its close relationships with the National Institute for Health and Care Excellence (NICE) and the National Screening Committee (NSC) contributed to the observed impact on health policy, although in some instances other organisations may better facilitate impact; HTA research is used outside the UK by other HTA organisations and systematic reviewers - the programme has an impact on HTA practice internationally as a leader in HTA research methods and the funding of HTA research; the work of the programme is of high academic quality - the Health Technology Assessment journal ensures that the vast majority of HTA programme-funded research is published in full, while the HTA programme still encourages publication in other peer-reviewed journals; academics agree that the programme has played an important role in building and retaining HTA research capacity in the UK; the HTA programme has played a role in increasing the focus on effectiveness and cost-effectiveness in medicine - it has also contributed to increasingly positive attitudes towards HTA research both within the research community and the NHS; and the HTA focuses resources on research that is of value to patients and the UK NHS, which would not otherwise be funded (e.g. where there is no commercial incentive to undertake research). The programme should consider the following to maintain and increase its impact: providing targeted support for dissemination, focusing resources when important results are unlikely to be implemented by other stakeholders, particularly when findings challenge vested interests; maintaining close relationships with NICE and the NSC, but also considering other potential users of HTA research; maintaining flexibility and good relationships with researchers, giving particular consideration to the Technology Assessment Report (TAR) programme and the potential for learning between TAR centres; maintaining the academic quality of the work and the focus on NHS need; considering funding research on the short-term costs of the implementation of new health technologies; improving the monitoring and evaluation of whether or not patient and public involvement influences research; improve the transparency of the priority-setting process; and continuing to monitor the impact and value of the programme to inform its future scientific and administrative development.

How long does biomedical research take? Studying the time taken between biomedical and health research and its translation into products, policy, and practice.

BACKGROUND: The time taken, or 'time lags', between biomedical/health research and its translation into health improvements is receiving growing attention. Reducing time lags should increase rates of return to such research. However, ways to measure time lags are under-developed, with little attention on where time lags arise within overall timelines. The process marker model has been proposed as a better way forward than the current focus on an increasingly complex series of translation 'gaps'. Starting from that model, we aimed to develop better methods to measure and understand time lags and develop ways to identify policy options and produce recommendations for future studies. METHODS: Following reviews of the literature on time lags and of relevant policy documents, we developed a new approach to conduct case studies of time lags. We built on the process marker model, including developing a matrix with a series of overlapping tracks to allow us to present and measure elements within any overall time lag. We identified a reduced number of key markers or calibration points and tested our new approach in seven case studies of research leading to interventions in cardiovascular disease and mental health. Finally, we analysed the data to address our study's key aims. RESULTS: The literature review illustrated the lack of agreement on starting points for measuring time lags. We mapped points from policy documents onto our matrix and thus highlighted key areas of concern, for example around delays before new therapies become widely available. Our seven completed case studies demonstrate we have made considerable progress in developing methods to measure and understand time lags. The matrix of overlapping tracks of activity in the research and implementation processes facilitated analysis of time lags along each track, and at the cross-over points where the next track started. We identified some factors that speed up translation through the actions of companies, researchers, funders, policymakers, and regulators. Recommendations for further work are built on progress made, limitations identified and revised terminology. CONCLUSIONS: Our advances identify complexities, provide a firm basis for further methodological work along and between tracks, and begin to indicate potential ways of reducing lags.

Care staff perceptions of choking incidents: what details are reported?

BACKGROUND: Following a series of fatal choking incidents in one UK specialist service, this study evaluated the detail included in incident reporting. This study compared the enhanced reporting system in the specialist service with the national reporting and learning system. METHODS: Eligible reports were selected from a national organization and a specialist service using search terms relevant to adults with intellectual disability and/or mental ill health. Qualitative analysis was completed with comparison of themes identified in both sets of reports. FINDINGS: The numbers of choking incidents identified in national reports suggest underreporting compared with the specialist service and varying levels of severity. Themes included trends in timing, care setting and food textures as perceived by staff. CONCLUSIONS: This study demonstrates paucity of detail in reporting in systems without additional question prompts. Adding these questions requires staff to include greater detail which enables learning and risk mitigation to take place.

Estimating the returns to UK publicly funded cancer-related research in terms of the net value of improved health outcomes.

BACKGROUND: Building on an approach developed to assess the economic returns to cardiovascular research, we estimated the economic returns from UK public and charitable funded cancer-related research that arise from the net value of the improved health outcomes. METHODS: To assess these economic returns from cancer-related research in the UK we estimated: 1) public and charitable expenditure on cancer-related research in the UK from 1970 to 2009; 2) net monetary benefit (NMB), that is, the health benefit measured in quality adjusted life years (QALYs) valued in monetary terms (using a base-case value of a QALY of GB£25,000) minus the cost of delivering that benefit, for a prioritised list of interventions from 1991 to 2010; 3) the proportion of NMB attributable to UK research; 4) the elapsed time between research funding and health gain; and 5) the internal rate of return (IRR) from cancer-related research investments on health benefits. We analysed the uncertainties in the IRR estimate using sensitivity analyses to illustrate the effect of some key parameters. RESULTS: In 2011/12 prices, total expenditure on cancer-related research from 1970 to 2009 was £15 billion. The NMB of the 5.9 million QALYs gained from the prioritised interventions from 1991 to 2010 was £124 billion. Calculation of the IRR incorporated an estimated elapsed time of 15 years. We related 17% of the annual NMB estimated to be attributable to UK research (for each of the 20 years 1991 to 2010) to 20 years of research investment 15 years earlier (that is, for 1976 to 1995). This produced a best-estimate IRR of 10%, compared with 9% previously estimated for cardiovascular disease research. The sensitivity analysis demonstrated the importance of smoking reduction as a major source of improved cancer-related health outcomes. CONCLUSIONS: We have demonstrated a substantive IRR from net health gain to public and charitable funding of cancer-related research in the UK, and further validated the approach that we originally used in assessing the returns from cardiovascular research. In doing so, we have highlighted a number of weaknesses and key assumptions that need strengthening in further investigations. Nevertheless, these cautious estimates demonstrate that the returns from past cancer research have been substantial, and justify the investments made during the period 1976 to 1995.

Mental Health Retrosight: Understanding the Returns From Research (Lessons From Schizophrenia): Policy Report.

This study examines the impacts arising from neuroscience and mental health research going back 20-25 years, and identifies attributes of the research, researchers or research setting that are associated with translation into patient benefit, in the particular case of schizophrenia. The study combined two methods: forward-tracing case studies to examine where scientific advances of 20 years ago have led to impact today; and backward-tracing perspectives to identify the research antecedents of today's interventions in schizophrenia. These research and impact trails are followed principally in Canada, the UK and the USA. The headline findings are as follows: The case studies and perspectives support the view that mental health research has led to a diverse and beneficial range of academic, health, social and economic impacts over the 20 years since the research was undertaken.Clinical research has had a larger impact on patient care than basic research has over the 20 years since the research was undertaken.Those involved in mental health research who work across boundaries are associated with wider health and social benefits.Committed individuals, motivated by patient need, who effectively champion research agendas and/or translation into practice are key in driving the development and implementation of interventions.This study provides an overview of the methods and presents the full set of findings, with the policy provocations they raise, and an emerging research agenda. It has been written for funders of biomedical and health research and health services, health researchers, and policymakers in those fields. It will also be of interest to those involved in research and impact evaluation.