Guidance
The HRCS Guidance Topics contain advice about concepts which can be encountered when coding using the HRCS. They describe how codes are applied in practise under a variety of different circumstances. They are also intended to answer frequently asked questions about the system and indicate how the different parts of the HRCS relate to each other.
The guidance topics are listed in alphabetical order. We also recommend using the search function for additional terms. Remember that HRCS is not a keyword system, so consider including alternative acronyms and synonyms as part of your searches if you don’t find what you need first time.
As with Health Categories and Research Activities, each HRCS Guidance Topics have official full name, short name and unique identifier. See our official terminology document for more details.
A
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Ageing
Advice on research activities
Studies of the normal ageing process should be coded within the 1 Underpinning code group.
Studies investigating diseases or conditions associated with ageing should not be coded within the 1 Underpinning code group.
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Alcohol consumption
Advice on health categories
The coding for studies on alcohol will depend on the nature of the research.
Use Mental Health for any studies of alcohol addiction/misuse and resulting behavioural problems.
Use Oral and Gastrointestinal for studies of cirrhosis following alcohol misuse.
Only use the following standardised breakdown of health categories and percentages for general studies on alcohol consumption where there is no other indication of disease area:
Health Category Percentage Cancer and neoplasms 25 Cardiovascular 25 Oral and Gastrointestinal 25 Stroke 25 The standardised breakdown choices select the four main health categories that will be most affected by alcohol consumption. If the study aim relates to these (or any other health category) individually, then the normal rules of HRCS apply:
e.g. “Alcohol misuse and risk of breast cancer” would be 100% Cancer.
e.g. “Reducing health burden by a new alcohol advice service” would use the standardised breakdown (unless the abstract / application text indicates otherwise).Advice on research activities
Alcohol consumption is considered a risk factor for other diseases. Therefore, interventions to reduce alcohol consumption should be coded as 3 Prevention, even if the person already drinks. Use 5 Treatment Development or 6 Treatment Evaluation for studies focussed on treatment of an existing alcohol-related disease and in cases of secondary prevention.
Additional guidance on differentiating secondary and primary prevention is also available.
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Animal welfare and replacing animals in research
Advice on health categories
In general studies of animal welfare should be assigned the Disputed Aetiology and Other category. This applies to studies with direct focus on laboratory animals and the use of animals in human health research. The wider field of veterinary research is outside the scope of HRCS.
However, if developing models or new techniques with the aim of replacing or reducing animals in research, the Health Category should reflect the subject area of the research.
e.g. a new assay replacing an animal model used in respiratory infection studies should be coded as Infection.
Advice on research activities
General studies of animal welfare and the development of models or new techniques with the aim of replacing or reducing animals in research should be coded to the infrastructure code appropriate to the nature of the study.
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Atherosclerosis
Advice on health categories
Some cardiovascular conditions such as atherosclerosis arise from involvement of the immune system but they should be coded as 100% Cardiovascular and not coded to Inflammatory and Immune System, even if the research is, for example, focused on transformation of macrophages to foam cells.
This is in line with the coding guidance to assign health categories based on the main disease and not pathogenesis or site of action.
B
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Biomarkers and screening
Advice on research activities
The term ‘biomarker’ in general refers to a specific molecule, gene or characteristic from which a physiological process can be identified. Biomarkers are typically coded in one of three research activity groups:
2 Aetiology: Where markers may be first identified in epidemiology studies or further assessed to determine how the molecule/gene/etc. contribute to the cause, risk or development of disease.
4 Detection and Diagnosis: Where studies of biomarker discovery and biomarkers screening for the purposes of disease diagnosis or prognosis are usually within 4 Detection and Diagnosis.
5 Treatment Development: Specifically where markers are used to develop treatments. However if looking at pharmacogenetic studies in pre-clinical settings or model systems, most commonly in pharmacogenetic studies (5.1) it should be classified in 5 Treatment Development. Identification of receptor pathways should be classified in 2 Aetiology.
Examples:
- The initial discovery of BRCA1 gene mutations as potential risk factors for breast cancer in epidemiology studies and would be coded in 2 Aetiology.
- Characterisation of BRCA1 gene, protein and pathway in cancer would likewise be coded in 2 Aetiology.
- The pre-clinical development and subsequent clinical application of techniques for screening for BRCA1 mutations to determine diagnosis or prognosis would be coded 4 Detection & Diagnosis.
- Assessment of BRCA1 expression for pharmacogenetics in drug development would be coded 5.1 Treatment Development – Pharmaceuticals.
C
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Cachexia in chronic diseases and chemotherapy
Advice on health categories
Cachexia is the term used for the weight loss, muscle wastage (atrophy), and fatigue associated with late stage, long term and/or chronic conditions (e.g. Cancer, HIV/AIDS, muscular sclerosis). Cachexia is also used in association with the effects of chemotherapy medication in cancer treatment.
Studies of patients with cachexia should be coded based on the underlying causal condition, but follow the rules for sequelae and side effects as appropriate.
e.g. Assessment of cancer patients with cachexia should be coded as 100% Cancer and neoplasms.
e.g. Assessment of depression in cancer patients with cachexia should be coded as 50% Mental Health, 50% Cancer.
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Cancer and conditions predisposing to cancer
Advice on health categories
In studies of cancer, only the Cancer category should be used – do not code for the site. This is in line with the coding guidance to assign health categories based on the main disease and not pathogenesis or site of action. However if the research involves studying a condition that predisposes to cancer, it may be appropriate to also code for the condition.
e.g. studies of Barrett’s oesophagus in relation to cancer would be 50% Oral and Gastrointestinal and 50% Cancer.
e.g. studies of pathogens and their association with the development of cancer, such as Human Papilloma Virus (HPV) or Helicobacter pylori, should be coded 50% Infection and 50% Cancer.
Studies of the normal role of oncogenes and tumour suppressor genes in a non diseased cell may be coded as 50% Generic Health Relevance and 50% Cancer.
Advice on research activities
Cancer is not a ‘normal’ process and hence studies that specifically relate to the cause of cancer are rarely coded within the 1 Underpinning code group.
In particular studies of abnormal cell cycle or DNA repair in relation to cancer should not be coded within the 1 Underpinning code group.
Studies of the normal role of oncogenes and tumour suppressor genes in a non diseased cell should be coded as 50% 1.1 Biological and 50% 2.1 Endogenous risks.
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Case studies, exemplars or tracer conditions
Advice on health categories
The term ‘case study’ is used in a variety of contexts in biomedicine, such as a clinical case study chronicling the treatment of a single patient. However in this context we use ‘case study’ to describe where patients with a particular condition may be used as a proxy / exemplar / tracer condition in studies evaluating models, services or systems that are applicable to other (or a wider range of) conditions.
In these circumstances the specific condition used in the patient group (the ‘case study’) may not be the main aim of carrying out the study, but is used purely to demonstrate a broader argument. Therefore in this specific context the appropriate health category for the condition used as the case study may not be relevant to this wider study aim.
e.g. If the study examines prescriptions for a specified condition, but the wider aim is to assess prescriptions across all areas of health or wellbeing, it would may be more appropriate to ignore the exemplar condition and use the Generic Health Relevance health category instead.
However in many cases the health category of the case study / proxy / exemplar / tracer condition will still be intrinsically linked to the wider study being addressed. In this case, dual coding of both example condition and wider topic would be appropriate.
e.g. Asthma is routinely coded as Respiratory in HRCS, but if it is used as an example of allergenic reactions, it would be appropriate to add the Inflammatory & Immune System health category to the coding of the project.
This approach of when to apply dual coding is similar to the approach taken when considering sequelae (one disease as a consequent of another), studies of cachexia and in co-morbidity research.
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Cell cycle and DNA repair
Advice on health categories
Studies of normal cell cycle and DNA repair should be coded as Generic Health Relevance unless they relate to a specific cell type in which case the appropriate Health Category should be used. These studies should not be coded as Cancer or Congenital Disorders.
Advice on research activities
Studies of normal cell cycle and DNA repair should be coded within the 1 Underpinning code group.
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Cerebral palsy and spina bifida
Advice on health categories
Cerebral palsy is a neurological disorder which can be acquired as a result of conditions in pregnancy, birth or childhood and is therefore coded as Neurological and not Congenital Disorders.
Spina bifida is a developmental birth defect involving the neural tube and is usually coded as Neurological.
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Cholesterol
Advice on health categories
Elevated blood lipids and high cholesterol levels are considered to be a disorders of metabolic regulation and studies in this area are classified as Metabolic and Endocrine. This includes studies of HDL (high density lipoprotein), LDL (low density lipoprotein) and triglycerides.
Studies on nutrition, diet and obesity specifically aimed at reducing cholesterol levels should be coded as Metabolic. However such studies are often context based and should only be coded as Metabolic if they relate to metabolism.
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Co-morbidities
Advice on health categories
Co-morbidities – the incidence of two or more diseases simultaneously – is common in medicine and has impact on treatments depending on whether they are coincidental, synergistic or one is clinically dominate.
Studies of co- or multi-morbidities should be coded to reflect all contributory diseases/conditions with the appropriate health categories, in alignment with the guidance on sequelae, consequences and side effects. If this were to exceed the limit of five health categories, use 100% Generic Health Relevance instead.
There is also additional guidance for diseases used as case studies and tracer examples for wider health conditions, which is a common theme in co-morbidity studies.
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Congenital disorders and inherited syndromes
Advice on health categories
Congenital Disorders should be used to code physical abnormalities and congenital syndromes that are associated with multiple diseases and conditions e.g. cystic fibrosis.
Inherited disorders associated with a single disease or condition should be coded under the appropriate Health Category and not as Congenital Disorders.
e.g. heart defects present at birth should be coded as Cardiovascular.
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Developmental biology
Advice on health categories
If it is a basic, normal developmental study that does not focus on a specific type of cell or system it should be coded as Generic Health Relevance.
If the investigation is directed to the normal development of a particular cell or system it should be coded to the appropriate Health Category.
Advice on research activities
If it is a basic, normal developmental study or is focused on a specific type of cell or system it should be coded 1.1 Biological.
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Diet, obesity and nutrition
Advice on health categories
The coding for studies on obesity, diet and nutrition will depend on the nature of the research.
Use Metabolic and Endocrine for investigation of metabolic disorders or dietary metabolism. Mental Health is appropriate for studies of eating disorders and Oral and Gastrointestinal should be used to code for studies of absorption from the gut.
Only use the following standardised breakdown of health categories and percentages for general studies on nutrition, obesity or poor diet where there is no other indication of disease area:
Health Category Percentage Cancer and neoplasms 20 Cardiovascular 20 Metabolic and Endocrine 20 Oral and Gastrointestinal 20 Stroke 20 Note that this standardised breakdown is shared with research on physical activity and exercise.
Advice on research activities
Obesity is considered a risk factor for other diseases. Therefore, interventions to reduce obesity should be coded as 3 Prevention, even if the person is already obese. Use 5 Treatment Development or 6 Treatment Evaluation for studies focussed on treatment of an existing obesity-related disease and in cases of secondary prevention (additional guidance on differentiating secondary and primary prevention is also available).
There are three main research activity code groups typically associated with diet and nutrition research:
- 3 Prevention for studies focussed on preventing ill health or promoting well being.
- Use 3.1 Primary Prevention for interventions that aim to modify behaviour or lifestyle
- Use 3.3 Nutrition Prevention for studies on the chemopreventative / health protective effect of nutrients, probiotics and nutritional supplements.
- For studies where nutrition, diet or exercise is used to treat established diseases/conditions. Use 5 Treatment Development for pre-clinical research and 6 Treatment Evaluation for clinical/applied research.
- Use 5.1 or 6.1 (Pharmaceuticals) for direct use of nutritional supplements as therapeutics
- Use 5.2 or 6.2 (Cellular / Gene Therapy) for microbiota transplantation therapy
- Use 5.7 or 6.7 (Physical) for dietics (nutrition and dietary advice) and exercise/physical therapy
- Use 5.8 or 6.8 (Complementary) for studies of homeopathy
- 3 Prevention for studies focussed on preventing ill health or promoting well being.
E
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Ear and hearing
Advice on health categories
Normal development and function, or conditions causing damage to the ear should be coded to Ear. Studies of brain regions responsible for hearing should be coded as Neurological and not Ear. If the research involves the transmission of signals from the ear to the brain it may be appropriate to code for both the organ and the brain.
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Economic evaluation components in trials
Advice on research activities
Economic evaluation is an essential component of trials and health technology assessments. However the main aim of these studies is usually to evaluate the effect or suitability of the intervention.
Unless one of the primary aims of a trial is health economics, just code for the therapy under investigation and not also to code 8.2 Health and welfare economics for the economic evaluation. The 8.2 Economics code should be used for research where those aspects are the main focus of the study.
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Education
Advice on research activities
Education is not just in 3 Prevention – educational interventions are also found in 4 Detection and Diagnosis and 7 Disease Management.
There are a number of research areas that are repeated in different parts of the Research Activity Codes. Classification of research is context dependent and the coding guidance for assigning research activities is to identify the appropriate main code group first, then to assigning a code within it.
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Eye and vision
Advice on health categories
Normal development and function, or conditions causing damage to the eye should be coded to Eye. Studies of brain regions responsible for vision should be coded as Neurological and not Eye. If the research involves the transmission of signals from the eye to the brain it may be appropriate to code for both the organ and the brain.
F
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Foetal development, pregnancy and ‘in utero’ studies
Advice on health categories
If the subject of a study is the foetus or the new born it should be coded as Reproductive Health and Childbirth and also the condition being investigated, if relevant.
If the investigation involves examining the effects of exposure to agents in utero or more generally during pregnancy on children or adults, code the research to the condition under investigation and not to Reproduction.
e.g. potential increased risk of cardiovascular disease in adults as a result of maternal malnutrition should be coded 100% Cardiovascular.
Advice on research activities
Pregnancy is considered normal function and coded within the 1 Underpinning code group but investigation of factors impacting on pregnancy should be coded elsewhere.
I
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Immunology and the immune system
Advice on research activities
Basic studies of the normal immune response are considered as normal function and should be coded within the 1 Underpinning code group.
However if a study of the immune system is associated with the cause, development, prevention, detection or treatment of a specific disease it should be assigned to the appropriate Research Activity code.
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Infectious diseases
Advice on health categories
In general, research involving infection by a pathogenic agent should only be coded as Infection and not coded to the affected target site in the body.
e.g. studies of malaria should be coded as 100% Infection and not Blood
e.g. respiratory infections should be coded as 100% Infection and not Respiratory.
This is in line with the coding guidance on assigning health categories to base coding on the main disease – not pathogenesis or site of action.
Studies involving the acute immune response to infection should be coded as Infection. However natural tolerance or host immunity to infection should be coded as Inflammatory and Immune System.
In circumstances where the research is focused only on a downstream consequence of the infection it may be coded to the appropriate Health Category.
e.g. surgery on diseased liver from Hepatitis C infection can be coded as 50% Infection and 50% Oral and Gastrointestinal.
Studies that involve infection of a specific target patient group should be coded as 50% Infection and 50% to the appropriate Health Category.
e.g. respiratory infection in people with cystic fibrosis should be coded as 50% Infection 50% Congenital Disorders.
Infection excludes TSEs, CJD and prion studies which should be coded as Neurological regardless of whether the study is investigating transmission or mechanism of disease.
Advice on research activities
If the studies involve investigating infectious agents which cause disease they should not be coded in the 1 Underpinning code group.
If the aim of the research is to study the transmission, life cycle or biochemistry of the agent it should be coded as 2.2 Physical risks. If the research involves studying host responses to infection it should be coded 2.1 Endogenous risks. Studies of resistance to therapeutics, including the characterisation of antibiotic resistance genes and mechanisms in bacteria, should be coded 5.1 Pharmaceuticals.
Studies on 3 Prevention of infection, 4 Detection and Diagnosis or 6 Treatment Evaluation should be allocated within those code groups.
Studies on bacteria or yeast can fall into 1 Underpinning if they are being studied as model systems examining conserved genes or proteins e.g. DNA repair, cell cycle.
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Informatics, bioinformatics and ‘big data’
Advice on research activities
‘Bioinformatics’ is a relatively new interdisciplinary field focusing on interpretation of complex biological data. Studies using bioinformatics will therefore be usually coded in:
- 1 Underpinning for fundamental biology – particularly 1.1 Biological and 1.4 Methodology
- 2 Aetiology if assessing disease cause, risk or development – particularly 2.1 Endogenous risks and 2.5 Design
Evidence obtained via bioinformatics research may also lead to biomarkers for diagnostic applications (4 Detection and Diagnosis), and development of new therapeutics (5 Treatment Development). However these are often potential future applications and not the main objective of the current research.
The wider topic of ‘Informatics’ – the science of processing, interpretation and storing of vast quantities of data – can often refer to significant resources with wide-reaching applications in health research. As such the guidance for Resources and Infrastructure should be followed when awards support the creation of ‘big data’ repositories. However, the onward use of informatics data should be treated as any other database or resource used in research, with awards coded based on the main research objective.
L
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Liver
Advice on health categories
In general, normal function and conditions affecting the liver (e.g. cirrhosis) should be coded as Oral and Gastrointestinal. Otherwise follow the guidance associated with other health categories appropriately.
e.g. Studies of liver cancer should be coded as 100% Cancer and neoplasms.
e.g. Studies of liver infections (e.g. infectious hepatitis) should be coded as 100% Infection.
e.g. Conditions relating to blood vessels of the liver, such as hepatic vein thrombosis, should be coded as 100% Cardiovascular.
Many conditions of the liver are associated with an inflammatory or metabolic response, e.g. non-infectious hepatitis. However only the disease under investigation should be coded and not to the accompanying inflammatory/metabolic response.
Studies focused on alcohol should follow the separate guidance on alcohol consumption, and use the standardised breakdown only where there is no other indication of disease area.
M
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Methodologies, measurements and research designs
Advice on research activities
There are three codes for classification of methodologies, measurements and research designs:
- 1.4 Methodologies and measurements (underpinning)
- 2.5 Research design and methodologies (aetiology)
- 8.4 Research design and methodologies (health services)
The choice of appropriate code will depend on the overall nature of the research.
- 1.4 Methods is frequently used for statistical genomic analysis
- 2.5 Design for epidemiological research
- 8.4 Design to cover design and methodologies for all types of health care
The methodology codes should be used for the development of novel methodologies, measurements and research designs and not simply for application or assessment of existing methods and measures as part of the research.
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Multiple diseases and categories
Advice on health categories
The Generic Health Relevance category should be used in cases where research is directly applicable to more than five health categories.
There are also a number of research topics that are of relevance to a particular subset of diseases and conditions where these diseases and conditions may not be specifically referred to within the research abstract. In circumstances where the research is not focused on a named disease or condition, refer to the following answers for standardised lists of relevant Health Categories and appropriate percentage weightings:
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Muscle and neuromuscular junction
Advice on health categories
Diseases of the neuromuscular junction (such as myasthenia gravis) fall into the Neurological category but primary muscle disorders (muscular dystrophies) should be coded under Musculoskeletal.
N
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Neuropsychology
Advice on health categories
Studies mapping normal behaviour or cognitive processes to brain regions should be coded 50% Neurological and 50% Mental Health.
Studies of abnormal behaviour and psychology will generally be coded as Mental Health.
Studies of abnormal brain and neural structures will generally be coded as Neurological.
Advice on research activities
Studies mapping normal behaviour or cognitive processes to brain regions should be coded 50% 1.1 Biological and 50% 1.2 Psychological.
Studies of abnormal behaviour and psychology will generally be coded as 2.3 Psychological risks.
Studies of abnormal brain and neural structures will generally be coded as 2.1 Endogenous risks.
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Nutritional and vitamin supplements
Advice on research activities
Following changes in EU legislation, nutritional and vitamin supplements are treated as pharmaceuticals. Therapeutic studies involving these substances should be coded as 5.1 Pharmaceuticals or 6.1 Pharmaceuticals.
Studies of the preventive effects of nutritional supplements should be coded as 3.3 Nutrition.
P
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Pain
Advice on health categories
Studies of pain in a particular system should be coded using the appropriate Health Category.
e.g. gastrointestinal pain should be coded as Oral and Gastrointestinal.
e.g. fibromyalgia should be coded as Musculoskeletal.
Studies focussed on pain pathways in the nervous system should be coded as Neurological. Other psychological studies of pain perception should be coded as Mental Health.
Advice on research activities
Basic studies on the mechanism of acute pain should be coded within the 1 Underpinning code group. However if the research is addressing pain from a specific condition or injury (including chronic pain) it would be appropriate to use other Research Activity codes.
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Pharmaceuticals outside the therapeutic context
Advice on research activities
Pharmaceuticals are not always used in a therapeutic context – and therefore research involving pharmaceuticals will not always be coded to 5.1 Pharmaceuticals or 6.1 Pharmaceuticals.
Established pharmaceutical compounds may be used in studies investigating mechanisms of action or aetiology (e.g. by disrupting pathways or blocking transmission) and it would then be appropriate to code as 1.1 Biological or 2.1 Endogenous risks.
Pharmaceuticals may also be used in chemopreventative studies, which should be coded as 3.3 Nutrition and chemoprevention.
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Physical activity and exercise
Advice on health categories
Only use the following standardised breakdown of health categories and percentages for general studies on physical activity and exercise where there is no other indication of disease area:
Health Category Percentage Cancer and neoplasms 20 Cardiovascular 20 Metabolic and Endocrine 20 Oral and Gastrointestinal 20 Stroke 20 Note this standardised breakdown is shared with research on diet, obesity and nutrition.
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Policy
Advice on research activities
Policy is not just in 8.3 Policy, ethics and research governance. For example, research on public health policy aimed at preventing disease should be coded to:
- 3.1 Primary prevention if related to changing individual or group behaviours/lifestyles.
- 3.2 Environmental prevention if related to the environment, e.g. banning smoking in public places.
There are a number of research terms (e.g. Policy, Education, Trial) that are repeated in different parts of the Research Activity codes. Classification of research is context dependent and the coding guidance for assigning research activities is to identify the appropriate main code group first, then assigning a sub-code within it.
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Pollution, radiation and environmental hazards
Advice on health categories
If there is no other indication of the health effects of air pollution, code 50% Respiratory for the direct effects on the lungs and 50% Generic Health Relevance for other effects.
Studies of the effects of environmental radiation exposure should be coded 33.3% Cancer, 33.3% Congenital Disorders and 33.3% Generic.
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Prevention – differentiating primary and secondary
Advice on research activities
The 3 Prevention code group should be used for primary prevention studies only and not for secondary prevention.
e.g. anti-smoking education in adolescence should be coded as 3.1 Primary prevention.
Prevention of the re-occurrence of a condition or prevention of a closely related condition arising from the pre-existing disease (secondary prevention) should not be coded within the 3 Prevention code group.
e.g. use of aspirin to prevent further adverse cardiovascular events or stroke in cardiovascular patients should be coded as 6.1 Pharmaceuticals and not 3.3 Nutrition prevention.
Prevention of a disease or condition within a specific patient group where the preventable disease is either unrelated to or may be a future sequela of the patient’s current condition can be coded as primary 3 Prevention.
e.g. prevention of cardiovascular disease in diabetic patients with no current cardiovascular disease diagnosis.
In circumstances where a study is focussed on preventing the side effects of a treatment, it would be appropriate to code to 3 Prevention and code to either 5 Treatment Development or 6 Treatment Evaluation.
e.g study of a substance preventing side effects after chemotherapy for cancer would be coded 50% 3.3 Nutrition prevention and 50% 6.1 Pharmaceuticals.
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Prions – studies of TSEs, BSE, CJD and prion protein
Advice on health categories
Studies of transmissible spongiform encephalopathies (TSEs) – including Bovine Spongiform Encephalopathy (BSE) and Creutzfeldt-Jakob Disease (CJD) – and prion proteins should always be coded as Neurological. Even when such a study is investigating transmission or mechanism of disease, it should not be coded as Infection.
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Pulmonary hypertension
Advice on health categories
Pulmonary hypertension should be coded as Cardiovascular and not Respiratory.
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Quality of life components in trials
Advice on research activities
Therapeutic clinical trials in the 6 Treatment Evaluation code group will often include an assessment of quality of life. However the main aim of these studies is usually to evaluate the effect or suitability of the intervention.
Unless one of the primary aims of a trial is investigating quality of life, just code for the therapy under investigation and not also to 7.1 Individual care needs for the quality of life component.
The 7.1 individual care needs code should only be used for research where assessments of quality of life are the main focus of the study.
R
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Resources and infrastructure
Advice on research activities
The Resources and infrastructure code within every research activity code group is used to categorise three types of funding:
- Generation of resources for distribution to and/or use by the wider community e.g. DNA banks. This category is distinct from ‘resources’ that are developed for use within individual research awards e.g. informatics programmes that may be published on the internet.
- Funding to support the infrastructural component of networks, research centres and consortia.
- Large units containing multiple projects covering diverse research aims that cannot be captured within the limit of four research activity codes.
Note that if an award is focused directly on the research carried out by a network or centre, it should be coded to the appropriate research activity code(s) that reflects the aim(s) of the research and not to the Resources and infrastructure code. There may be circumstances where it is suitable to assign both a research code and a Resources and infrastructure code.
- 1.5 Resources and infrastructure (underpinning)
- 2.6 Resources and infrastructure (aetiology)
- 3.5 Resources and infrastructure (prevention)
- 4.5 Resources and infrastructure (detection and diagnosis)
- 5.9 Resources and infrastructure (treatment development)
- 6.9 Resources and infrastructure (treatment evaluation)
- 7.4 Resources and infrastructure (disease management)
- 8.5 Resources and infrastructure (health services)
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Sepsis
Advice on health categories
Sepsis should be coded 50% Infection and 50% Inflammatory and Immune System. This includes all forms of sepsis. Other codes should only be added in exceptional circumstances (see sequelae).
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Sequelae, consequences and side effects
Advice on health categories
Research aimed at investigating sequelae of a specific pre-existing disease should be assigned equal percentage weighting to the primary existing condition and to the condition under investigation.
e.g. Cardiovascular disease in diabetic patients should be coded as 50% Cardiovascular and 50% Metabolic and Endocrine.
Studies of the side effects of a disease, where the condition under study is a downstream consequence of an original condition, are treated similarly.
e.g. A study into depression as a result of cancer should be coded 50% Mental Health and 50% Cancer.
e.g. Studies of post natal depression should be coded as 50% Mental Health and 50% Reproduction.
Studies of the direct side effects of a disease treatment are usually coded in the same way.
e.g. A study of bowel injury resulting from radiotherapy for cancer is coded 50% Cancer and 50% Oral and Gastrointestinal.
In some cases, however, it may not be appropriate to code for the pre-existing disease.
e.g. If a particular disease is being used as an exemplar for studying the side effects of a treatment, such as studies of generalisable anti-nausea drugs.
There is also additional guidance available for diseases used as case studies and co-morbidities.
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Sexual health
Advice on health categories
If a study is on sexual health but doesn’t specify any particular disease, the research should be coded as 50% Reproductive health and childbirth (for risk of pregnancy) and 50% Infection (for risk of sexually transmitted infections).
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Sleep and studies of sleep disorders
Advice on health categories
Studies of sleep follow the same guidance as neuropsychology:
- Studies mapping normal behaviour or cognitive processes to brain regions should be coded 50% Neurological and 50% Mental Health.
- Studies of abnormal behaviour and psychology will generally be coded as Mental Health.
- Studies of abnormal brain and neural structures will generally be coded as Neurological.
- Studies of circadian rhythm are often but not always Neurological.
Sleep disorders refer to studies which investigate sleep disturbances. They are divided into six main categories:
- Insomnia – should be coded as Neurological.
- Sleep related breathing disorders – e.g. sleep apnoea – should be coded as Respiratory.
- Hypersomnias – e.g. narcolepsy – should be coded as Neurological.
- Circadian rhythm sleep disorders – should be coded as Neurological.
- Parasomnias – e.g. sleepwalking – usually involve motor and verbal elements and should be coded as Neurological.
- Sleep related movement disorders – e.g. restless leg syndrome – should be coded as 50% Neurological and 50% Musculoskeletal.
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Smoking and tobacco
Advice on health categories
The coding for studies on smoking and tobacco will depend on the nature of the research.
Use Mental Health for studies of tobacco and nicotine addiction and associated behavioural problems.
Only use the following standardised breakdown of health categories and percentages for general studies on smoking and tobacco where there is no other indication of disease area:
Health Category Percentage Cancer and neoplasms 25 Cardiovascular 25 Respiratory 25 Stroke 25 Advice on research activities
Smoking is considered a risk factor for other diseases. Therefore, interventions to reduce smoking should be coded as 3 Prevention, even if the person already smokes. Use 5 Treatment Development or 6 Treatment Evaluation for studies focussed on treatment of an existing smoking-related disease and in cases of secondary prevention.
Additional guidance on differentiating secondary and primary prevention and distinguishing between preventative and treatment interventions are also available.
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Stem cells
Advice on research activities
The coding for stem cell research will depend on the intention and nature of the research.
Basic developmental biology or a study of normal stem cell differentiation should be coded within the 1 Underpinning code group.
Stem cell research involving development, differentiation or transplantation of stem cells directly associated with therapeutic application (one of the main components of Regenerative Medicine) should be coded as 5.2 Cellular and gene therapies or 6.2 Cellular and gene therapies.
e.g. the development of stem cell lines for potential therapeutic studies should be coded as 5.2 Cell therapy.
In general codes for 5.4 Surgery and 6.4 Surgery do not apply to studies of cell therapy transplantation. An exception to this is surgical transplantation of bone marrow stem cells for cancer treatment, which is considered a similar process to organ transplantation, and should therefore should be coded as 5.4 Surgery or 6.4 Surgery.
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Stratified medicine, precision medicine and personalised medicine
Advice on research activities
Classification of research is context dependent and the coding guidance for assigning research activities is to identify the appropriate main code group first, then assigning a sub-code within it.
If the work relates to diagnostic or prognostic testing to inform treatment decisions, it would be more appropriate to code to 4 Detection and Diagnosis; in most cases using 4.1 Discovery for pre-clinical development and 4.2 Evaluation for clinical use.
If the work is development of new treatments in a pre-clinical or model setting, it would be more appropriate to code to 5 Treatment Development. This includes studies of pharmacogenetics for new therapeutics, which shold be coded as 5.1 Pharmaceuticals.
If it is clinical research using a precision medicine approach then it would be more appropriate to code to 6 Treatment Evaluation for the intervention being evaluated.
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Substance misuse and addiction
Advice on health categories
Both smoking and alcohol have their own specific guidance topics relating to misuse and addiction.
Other substances should be classified depending on the nature of the research.
- All studies of addiction are treated as psychological conditions and should be coded as Mental Health.
- Any study of substance abuse / misuse that relates to a specific disease or condition should be coded to the appropriate health category:
- e.g. intravenous drug use and risk of infection should be coded Infection.
- The Disputed Aetiology and Other health category also includes some types of social services research for specific ‘healthy’ at risk groups that is not relevant to the general population, e.g. young people or minorities at risk of developing substance misuse problems. Note that in these cases Other should only be used if there is no other disease/condition of focus presented.
Advice on research activities
Substance misuse is considered a risk factor for other diseases. Therefore, interventions to reduce substance misuse should be coded as 3 Prevention, even if the person is already misusing. Use 5 Treatment Development or 6 Treatment Evaluation for studies focussed on treatment of an existing substance-misuse-related disease and in cases of secondary prevention.
Additional guidance on differentiating secondary and primary prevention is also available.
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Surgical procedures
Advice on research activities
The Surgery categories 5.4 Surgery and 6.4 Surgery include invasive mechanical procedures such as angioplasty and catheterisation.
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Systematic reviews
Advice on research activities
Systematic reviews are increasing in importance for evidence-based medicine. Systematic reviews tend to involve meta-analysis of a given set or sub-set of treatments for purposes of evaluation, and as such will normally be coded in 6 Treatment Evaluation, using appropriate sub-code(s) for the particular treatments being assessed. If the review involves such a range of treatments that more than four sub-codes (the maximum allowed under HRCS) is required, use 100% 6.9 Resources and Infrastructure.
However some systematic reviews have a scope beyond treatment comparisons and may involve an assessment of delivery of 8 Health Services. Such broad, organisational systematic reviews should be coded as 8.1 Organisation and delivery of services.
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Thromboses and embolisms
Advice on health categories
In general clotting disorders should be coded as Blood; this includes deep vein thromboses (DVTs) and venous embolisms.
Diseases of the vasculature such as thrombophlebitis should be coded as Cardiovascular.
It may be appropriate to code for both Blood and Cardiovascular where the study overlaps both areas.
While general studies of clotting and thromboses should be coded as Blood, research involving blood flow to brain should be coded as Stroke. Therefore ischaemic stroke will generally be coded as 100% Stroke unless there is a clear pre-existing condition, in which case the guidance on sequelae should be followed.
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Treatment effectiveness
Advice on research activities
Studies evaluating measures of treatment effectiveness and side effects in patients should be coded within the 6 Treatment Evaluation code group.
The development of measures of treatment responses can be coded within 5 Treatment Development.
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Trials
Advice on research activities
Trials are not just in 6 Treatment Evaluation – there can be trials in 4 Detection and Diagnosis, 3 Prevention and 8 Health Services.
There are a number of research topics (e.g. Policy, Education, Trial) that are repeated in different parts of the Research Activity codes. Classification of research is context dependent and the coding guidance for assigning research activity codes is to identify the appropriate main code group first, then assign a sub-code within it.
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Vasculitis
Advice on health categories
Vasculitis is a group of diseases featuring inflammation of the wall of blood vessels which can affect several organ systems and have widespread systemic effects.
Studies of vasculitis will usually focus on the inflammation and damage to blood vessels and hence should be coded as 100% Cardiovascular.
Where vasculitis is a secondary condition that arises as a consequence of a specific immune condition it may be appropriate to code 50% Inflammatory and Immune System and 50% Cardiovascular.
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Vertigo and disorders of balance
Advice on health categories
Studies of inner ear vestibular function or disorders are classified as Ear.
Other studies of balance, dizziness and vertigo involving a specific central nervous component should be classified as Neurological.
If there is a specific cognitive/perceptual aspect it may be appropriate to classify as Mental Health.
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Wounds and healing
Advice on health categories
Wounds (including fractures) may result from surgery, disease or trauma / assault.
Only code to Injuries and Accidents if the wounds were a result of accident or injury. Otherwise apply the relevant Health Category if the wound tissue type is specified or Generic Health Relevance if the abstract doesn’t specify a tissue type.
Advice on research activities
Basic cellular mechanisms of wound healing are normal function i.e. 1 Underpinning. However investigation of the cause, diagnosis, treatment and management of wound healing should be assigned to the appropriate Research Activity code.