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Lessons from the PROTECT-CH COVID-19 platform trial in care homes
Full text linkThis is an Open Access article
distributed in accordance with the terms of the Creative
Commons Attribution (CC BY 4.0) licence, which permits
others to distribute, remix, adapt and build upon this work,
for commercial use, provided the original work is properly
cited. See: https://creativecommons.org/licenses/by/4.0/.
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changes to the original text.BACKGROUND: Coronavirus disease-2019 was associated with significant mortality and morbidity in care homes in 2020-1. Repurposed antiviral drugs might reduce morbidity and mortality through reducing viral transmission, infection, replication and inflammation. We aimed to compare the safety and efficacy of potential antiviral drugs in care home residents. METHODS: We designed a cluster-randomised, open-label, blinded end-point platform trial to test drugs in a postexposure prophylaxis paradigm. Participants aged 65+ years from United Kingdom care homes, with or without nursing, were eligible for participation. Care homes were to be allocated at random by computer to administer 42 days of antiviral agent (ciclesonide or niclosamide) plus standard care versus standard care alone to residents. The primary outcome at 60 days after randomisation comprised the most serious outcome, which was defined as all-cause mortality, all-cause hospitalisation, severe acute respiratory syndrome coronavirus 2 infection or no infection. Analysis would be by intention to treat using ordinal logistic regression. Other outcomes included individual components of the primary outcome, transmission, plus health economic and process evaluation outcomes. The planned sample size was 300 care homes corresponding to 9600 residents. With ~40% of care homes predicted to develop an outbreak during the trial, we needed to recruit 750 homes/24,000 residents. RESULTS: We initiated the trial including protocol, approvals, insurance, website, database, data algorithms, intervention selection and training materials. We built a network of principal investigators and staff (91) and care homes (299) to support the trial. However, we never contracted care homes or general practitioners since the trial was stopped in September 2021, as vaccination in care homes had significantly reduced infections. Multiple delays significantly delayed the start date, such as: (1) reduced prioritisation of pandemic trials in 2021; (2) cumbersome mechanisms for choosing the investigational medicinal products; (3) contracting between National Institute for Health and Care Research and the investigational medicinal product manufacturers; (4) publicising the investigational medicinal products; (5) identification of sufficient numbers of care homes; (6) identification and contracting with several thousand general practitioners; (7) limited research nurse availability and (8) identification of adequate insurance to cover care homes for research. Generic challenges included working across the four home nations with their different structures and regulations. LIMITATIONS: The feasibility of contracting between the sponsor and the principal investigators, general practitioners and care homes; screening, consent and treatment of care home residents; data acquisition and the potential benefit of postexposure prophylaxis were never tested. CONCLUSIONS: The success of vaccination meant that the role of postexposure prophylaxis of coronavirus disease-2019 in care home residents was not tested. Significant progress was made in developing the infrastructure and expertise necessary for a large-scale clinical trial of investigational medicinal products in United Kingdom care homes. FUTURE WORK: The role of postexposure prophylaxis of coronavirus disease-2019 in care home residents remains undefined. Significant logistical barriers to conducting research in care homes need to be removed urgently before future studies are possible. Further work is required to develop the infrastructure for clinical trials of investigational medicinal products in care homes. Serious consideration should be given to building and then hibernating a pandemic-ready platform trial suitable for care home research. FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR133443.https://www.journalslibrary.nihr.ac.uk/hta/published-articles/MTRS883
Online peer support for people with dementia : a scoping review protocol
Full text linkCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on Behalf of JBI. This is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use, distri bution, and reproduction in any medium, provided the original work is
properly cited.OBJECTIVE: The objective of this scoping review is to gain insights into the different online peer support opportunities available for people with dementia. INTRODUCTION: People with dementia use a variety of online platforms for peer support, such as social networking sites or videoconferencing platforms. Online peer support can offer a variety of benefits, such as overcoming geographical barriers and the opportunity to choose a platform and mode of communication that suits a person's needs and preferences. However, there is currently no synthesis of the different online peer support opportunities available to people with dementia. INCLUSION CRITERIA: Participants in this review will include people living with a self-reported diagnosis of any form of dementia. The concept is peer support through online platforms, while the context is online peer support that is accessible in English. METHODS: The review will be conducted according to the JBI methodology for scoping reviews. A 3-step strategy will be used to search 4 data sources: (1) scholarly and gray literature databases, (2) Google search engine, (3) social media and websites of dementia organizations, and (4) consultations with people with dementia and professionals. The review will be managed in Covidence and Excel. The study selection and data extraction will be conducted by 2 independent reviewers and a third reviewer will be consulted if needed. For the data extraction a draft data extraction instrument will be used, following the recommendations of JBI. Data will be extracted on platform, online peer support, and study characteristics. The findings will be presented in tables and a narrative summary. DETAILS OF THIS REVIEW PROJECT CAN BE FOUND IN OPEN SCIENCE FRAMEWORK: https://doi.org/10.17605/OSF.IO/8JTQC.https://journals.lww.com/jbisrir/fulltext/2025/07000/online_peer_support_for_people_with_dementia__a.5.asp
A qualitative exploration into the experience of mindfulness in moderate-severe persistent depression
Full text link© 2025 Sweeney et al. This is an
open access article distributed under the terms
of the Creative Commons Attribution License,
which permits unrestricted use, distribution,
and reproduction in any medium, provided the
original author and source are credited.Depression is a common and growing mental health problem, with around 5% of the world's population experiencing an episode of depression during their lifetime. Relapse rates are high, with around half experiencing more than one depressive episode and a further 10-20% experiencing a chronic and persistent depression. Mindfulness has been incorporated into treatments for depression and several studies have explored the impact of mindfulness training on depressive symptomatology and recurrence. However, to date no studies have looked at the changing relationship between mindfulness and depression in those naïve to mindfulness training. 20 participants with moderate-to-severe persistent depression were interviewed to explore their experience of mindfulness in the context of low mood. Thematic analysis captured six themes highlighting changes in mindfulness relating to the onset of depression. Themes included: behavioural withdrawal; perceptual detachment from one's experience; intentional reduction in awareness; increased self-criticism; mind racing; impaired cognitive performance. Thematic analysis suggested that mindfulness reduces in the context of moderate-to-severe persistent depression. This appears to occur indirectly as the consequence of depression-related processes, e.g., rumination and experiential avoidance, but also arises as a deliberately instigated self-protective strategy. However, findings seemed to indicate that reduced mindfulness maintains and intensifies depressive experience. Despite growing evidence of the value of mindfulness approaches for those with more chronic and severe depression, study findings suggest that introducing mindfulness to this population may be particularly challenging due to the intensity of symptomatology potentially obstructing access to a mindful perspective. Findings bear important implications for the treatment of depression and can inform future intervention development and delivery.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.032329
Recovery-oriented psychiatry : oxymoron or catalyst for change? [In Press]
No full textArticle in pressThis Personal View provides a normative and conceptual analysis of the intersection between the recovery movement and psychiatry. Although recovery emerged as a grassroots social justice movement emphasising empowerment and systemic change, psychiatry remains rooted in the medical paradigm. We aim to develop a nuanced conceptual framework that fosters academic debate and meaningful implementation, while avoiding superficial or tokenistic adoption of recovery principles. Our analysis explores the contrasting values, ontologies, and epistemologies of these perspectives, identifying points of tension and areas of compatibility. We examine and discuss integrative and non-integrative pluralistic approaches, and we conclude with actionable recommendations for transformation at different organisational levels.https://www.sciencedirect.com/science/article/abs/pii/S221503662500092
Debate : are we overpathologising young people's mental health? Research shows otherwise - mental health conditions are not being recognised or diagnosed in healthcare settings
Full text link2025 The Author(s). Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child andAdolescent Mental Health.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Child and Adolescent Mental Health 30, No. 3, 2025, pp. 305–307 doi:10.1111/camh.70019Over recent years, there have been increasing societal, political and media concerns in relation to the 'over-diagnosis' and 'self-diagnosis' of common mental health conditions or emotional disorders, such as depression and anxiety. Using two large research projects as illustrative examples, we highlight that there is a mismatch between concern about 'over-pathologising' young people's mental health and the recognition and diagnosis of emotional mental health conditions in health and care settings. Concerns around labelling risks us losing a shared understanding and language around mental health and mental health care, within services, between sectors, and for young people and families.https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/camh.7001
Optimising access to vocational rehabilitation through multiple sclerosis charities : protocol for a feasibility randomised controlled trial
Full text linkCopyright: © 2025 De Dios Pérez et al. This is
an open access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium,
provided the original author and source are
credited.BACKGROUND: People with multiple sclerosis (MS) often leave the workforce prematurely due to MS symptoms and difficulties managing workplace relationships and performance. Vocational rehabilitation (VR) can improve job retention outcomes for people with MS, but there is a lack of evidence on the effectiveness of these interventions. METHODS: A multicentre, feasibility, parallel-group randomised controlled trial (RCT) comparing a job retention VR intervention plus usual care (n = 30) with usual care alone (n = 30). This study includes an embedded mixed-methods process evaluation. People with MS, aged 18-65 years, in paid employment will be recruited from MS charities. Participants with MS will be able to include their employers in the intervention to receive information about MS and employment. The intervention involves an initial interview and up to 10 hours of employment support for people with MS and up to four hours of support for employers, over six months. Employees from MS charities will be recruited and trained to deliver the MSVR intervention. Participants will be followed up by postal/telephone/online questionnaires at 6-, 9-, and 12-months post-randomisation. The aim is to ascertain the feasibility and acceptability of delivering the intervention within MS charities, and to determine parameters for future trial and explore the acceptability of the study intervention and procedures. DISCUSSION: This novel study will provide insight into how existing services from MS charities can fill a service gap by providing employment support to people with MS. Findings will inform the design of a future fully powered RCT. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT06966115.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.032557
The power of words : respectful language in ADHD research
No full textLanguage is powerful. It reflects and shapes our understanding of the difficulties people face, the paradigms in which researchers and clinicians conduct research and practice while also influencing public perceptions and the expectations of people with lived experiences. Here, we aim to start a constructive dialogue around language use (ie, language that is respectful, not stigmatising, or discriminatory) related to ADHD, to encourage researchers, clinicians, and others to consider the potential impact of their words. A greater awareness of the impact of language and a much-needed shift towards more compassionate and respectful language can positively affect individuals with ADHD, clinical practice, and research, by fostering a more accurate and nuanced understanding of ADHD and associated needs of people with ADHD.https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00167-1/abstrac
Randomized Control Trial Comparing Effects of Tourniquets on Neurology and Functional Outcomes after Total Knee Arthoplasty.
No full textINTRODUCTION: Total knee arthroplasty (TKA) often uses a tourniquet to enhance surgical visualization and reduce intraoperative blood loss. Despite its benefits, tourniquet use is associated with several complications such as skin blistering, nerve palsy, and deep vein thrombosis. The literature reveals a divided opinion on whether TKA should be performed with or without a tourniquet, with conflicting results on post-operative pain, blood loss, and functional outcomes.. MATERIALS AND METHODS: This study included patients aged 65 to 90 years undergoing elective unilateral TKA for osteoarthritis. Exclusion criteria included patients with a Body mass index ≥35, rheumatoid arthritis, peripheral vascular disease, diabetes, prior knee surgery, and on anticoagulation medication. The study focused on comparing the neurology through nerve conduction studies and functional outcomes of TKA performed with and without a tourniquet. Some key metrics included intraoperative blood loss, surgical duration, post-operative pain, analgesic use, and range of motion (ROM). RESULTS: The study recruited 55 patients aged ranging from 65 to 90 years who were randomized into two groups.22 patients were excluded, and the final analysis involved 23 patients. Tourniquet use resulted in lower blood loss (140 mL vs. 215 mL) and shorter operative times (87 min vs. 95 min) compared to the non-tourniquet group. However, the tourniquet group had higher incidences of nerve palsy in the immediate post-operative period as compared to the other group. Both the groups showed significant improvements in post-operative ROM, but the tourniquet group had higher post-operative pain and analgesic requirements, and this was statistically significant. CONCLUSION: Tourniquet use in TKA reduces intraoperative blood loss and operative time but is associated with a higher risk of nerve-related complications and increased post-operative pain. The findings suggest that avoiding tourniquet use may lead to better overall clinical outcomes and early post-operative ROM
Evaluation and uptake of an online ADHD psychoeducation training for primary care health care professionals : implementation study
Full text link© Blandine French, Hannah Wright, David Daley, Elvira Perez Vallejos, Kapil Sayal, Charlotte L Hall. Originally published
in JMIR Medical Education (https://mededu.jmir.org), 11.07.2025. This is an open-access article distributed under the terms
of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Education, is
properly cited. The complete bibliographic information, a link to the original publication on https://mededu.jmir.org/, as well as
this copyright and license information must be included.BACKGROUND: Health care professionals seldom receive training on neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD). An online training was co-developed to address some of the gaps in knowledge and understanding in primary care. A randomized controlled trial demonstrated that the training increased knowledge and confidence and improved practice. OBJECTIVE: This report highlights the implementation of the training in practice and follow-up 4 years post evaluation. METHODS: The online ADHD training comprises 2 modules: "Understanding ADHD" and "The Role of the GP," each taking approximately 45 minutes to complete. The training targets general practitioners primarily but is open to other health care professionals and parents. Feedback was collected through a survey at the end of the training, and the training has been widely adopted by various organizations internationally and nationally. RESULTS: Between December 2019 and January 2024, the "Understanding ADHD" module was accessed more than 13,486 times, while the "Role of the GP" module was accessed 7018 times, primarily by users from the United States and the United Kingdom. Survey results from both modules showed positive feedback with high ratings for usefulness, likelihood to inform practice, and recommendation to colleagues. Some suggestions for improvement included reducing the negative focus on ADHD consequences and incorporating more positive aspects of ADHD. CONCLUSIONS: This ADHD online training program, despite facing implementation challenges, has seen positive outcomes, including international translation and high user ratings. Suggestions for improvement were received, but some were not feasible due to regional variations in ADHD pathways. The training's impact extended beyond GPs to other health care professionals, although the COVID-19 pandemic posed obstacles to dissemination efforts. Nonetheless, ongoing plans aim to expand the training's implementation globally.https://mededu.jmir.org/2025/1/e5936
The Peritoneal Cancer Index as a Predictor of Cytoreductive Surgery Outcomes and Heatmapping of Ovarian Cancer Distribution: A Retrospective Analysis.
Full text linkOBJECTIVE: This study aimed to evaluate the association between the Peritoneal Cancer Index (PCI) and the completeness of cytoreductive surgery (CRS) in patients undergoing surgery for advanced ovarian cancer (AOC). Secondary objectives included identifying a PCI cut-off predictive of incomplete cytoreduction, assessing the relationship between PCI and surgical complexity via the Aletti Surgical Complexity Score (SCS), and exploring disease distribution to better understand ovarian cancer distribution. METHODS: A retrospective review of 227 patients undergoing primary or interval debulking surgery for AOC from January 2017 to September 2024 at University Hospitals of Derby and Burton was conducted. PCI was recorded intra-operatively, and procedures were classified using the SCS. ROC analysis identified PCI thresholds for incomplete CRS, logistic regression predicted CRS outcomes, and heat mapping visualised disease distribution. RESULTS: Complete CRS of visible disease (R0) was achieved in 90.75% of patients, while 9.25% had incomplete CRS. Median PCI was significantly higher in incomplete CRS cases (28, IQR 21-32) compared to complete CRS (15, IQR 8-23, p 25.5 increased the odds of incomplete cytoreduction by 12.65 times (p 25.5 indicating a high risk of incomplete cytoreduction. The study underscores PCI's role in surgical planning and calls for multi-centre studies to validate these findings and further examine disease distribution