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The REDUCE Intervention: The Development of a Person-Centred Cognitive Behavioural Intervention to Improve Ulcer Outcomes in People at Risk of Diabetic Foot Ulceration.
No full textINTRODUCTION: Diabetic foot ulcers (DFUs) affect approximately one-quarter of people living with diabetes. They are chronic, recur frequently and are associated with significant psychological distress and behavioural challenges. The REDUCE intervention is a person-centred, cognitive behavioural intervention designed to reduce the risk of DFU recurrence and support ulcer healing. Here, we describe the iterative development and optimisation of REDUCE, from its inception as a group-based intervention to an individually tailored intervention delivered via video call or telephone. We outline key stages of the intervention development, including the integration and modification of a digital maintenance intervention (DMI) designed to support long-term behaviour change and a mixed-methods external pilot trial which informed a full-scale clinical and cost-effectiveness trial. METHODS: After initial development, the DMI was the subject of nine 'think-aloud' interviews with patient and public contributors. We conducted an external pilot randomised controlled trial, involving 20 patients with recently healed DFUs randomised in a 2:1 ratio (REDUCE + Usual Care vs. Usual Care only). Data collection included patient-reported outcome measures (baseline and 6 weeks and 3 months post-randomisation) and qualitative interviews with participants and facilitators. RESULTS: Think-aloud interviews informed key refinements to the DMI to enhance usability and engagement. The pilot trial demonstrated high acceptability of the intervention format and delivery. Patient-reported outcomes suggested positive trends in psychological well-being, footcare behaviours and mood among intervention participants. Qualitative findings highlighted the value of individualised delivery, the importance of facilitator support and varied engagement with the DMI. These insights informed further refinements to REDUCE ahead of a full-scale effectiveness trial. CONCLUSION: We provide a comprehensive account of the evolution of the REDUCE intervention and share broader learnings regarding the development of complex behavioural health interventions. The example of REDUCE highlights the value of iterative, multidisciplinary methods and patient involvement in intervention design and offers practical insights for designing digital and remote health interventions. PATIENT OR PUBLIC CONTRIBUTION: Patient and public contributors were involved throughout the research described in this manuscript. Key areas of involvement included co-creation of all patient-facing materials, intervention development and informing trial methods
Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences : a qualitative study
Full text link© The Author(s), 2025. Published by Cambridge University Press
on behalf of Royal College of Psychiatrists. This is an Open
Access article, distributed under the terms of the Creative
Commons Attribution licence (https://creativecommons.org/lice
nses/by/4.0/), which permits unrestricted re-use, distribution
and reproduction, provided the original article is properly cited.BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is more commonly missed or diagnosed later in females than in males. One explanation is that diagnostic criteria have been informed by research primarily based on male samples and may not adequately capture the female presentation of ADHD. AIMS: This study used a qualitative approach to better understand female ADHD in childhood, from the perspective of young women and non-binary adults with ADHD. METHOD: Twelve young adults (10 women and 2 non-binary individuals assigned female at birth, aged 18-25 years) with ADHD were interviewed to describe their lived experiences of ADHD throughout childhood. Interviews were transcribed verbatim and qualitatively analysed using the framework method, a codebook approach to thematic analysis. RESULTS: Participants reported experiencing a range of ADHD symptoms, some of which are not included in current diagnostic criteria. Four core themes were identified: (a) socially oriented and internalised symptoms, (b) social impacts, (c) masking and compensation and (d) the importance of context. Theme one describes how girls with ADHD may experience symptoms as more socially oriented (e.g. losing track of thoughts in a conversation), non-disruptive (e.g. doodling) and internalised (e.g. feeling frustrated) than those described by current diagnostic criteria. Theme two highlights the importance of social impacts of ADHD on friends, home and school. Theme three describes the desire to 'fit in' socially, behaviours and strategies used to mask symptoms and associated unfavourable consequences. Theme four highlights variability in symptoms across different environmental contexts. CONCLUSIONS: This study suggests that the presentation of ADHD symptoms in girls may be socially oriented, internalised and especially influenced by the social context. Also, female ADHD symptoms may be less visible due to scaffolding, masking and context. Future research should consider whether current ADHD diagnostic criteria require adjustment, to aid earlier recognition and diagnosis of ADHD in children and young people, especially in females.https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/reflections-on-the-manifestation-of-attentiondeficit-hyperactivity-disorder-in-girls-from-young-adults-with-lived-experiences-a-qualitative-study/48D36D61CE528010442AFD6B32ACD6A
Guidelines to Assist in Autism Diagnostic Assessments with Females: A Delphi Study.
No full textPurpose: While growing evidence highlights the challenges faced by autistic females during diagnostic assessments, it remains unclear how well this research is applied in clinical practice. This study aimed to gather consensus among clinicians on recommendations for autism assessments to improve diagnostic validity for cis-gendered females. Method(s): A three-round Delphi study was conducted with registered healthcare professionals experienced in conducting autism diagnostic assessments with females. Result(s): Thematic analysis of Round 1 responses identified five themes: Attributes of the Assessor, Post-Clinical Qualification Education and Learning, Diagnostic Tools, Questions Asked, and Sources of Information. These themes produced 28 statements evaluated in Rounds 2 and 3. Eighteen reached 80% consensus in the final round. Experts emphasized the important of assessors having strong knowledge of research into autism in women, co-occurring conditions, other developmental conditions, and masking. Ongoing professional development on autism in women was considered essential and it was recommended that new assessors shadow female assessments. Experts agreed the ADOS-2 is not always useful for females, whereas screening tools can provide valuable narrative insights, though these need to be interpreted carefully due to potential male bias. Experts supported including more prompts to explore subtle differences in social communication and repetitive patterns of behaviour and stressed the importance of masking behaviours and experiences across different relationships. Masking should also be considered when interpreting informant information. Conclusion(s): Findings reveal inconsistencies in how clinicians consider sex-related factors in autism assessments, highlighting the need for formal guidance. The next steps will be to develop this guidance, incorporating research evidence, the perspectives of autistic women and girls, and Delphi results. This aims to improve the experience, and accuracy of diagnosis for girls and women undergoing autism assessment, increasing consistency across services, and supporting clinicians. Copyright 2025, Mary Ann Liebert, Inc., publishers.https://www.liebertpub.com/doi/10.1089/aut.2024.032
Novel insights into pulmonary embolism with negative D-dimer results
No full textA patient in his mid-40s presented with exertional dyspnoea and pleuritic chest pain persisting for 6 weeks. Despite repeated normal investigations, including D-dimer tests, chest X-rays, serial troponins and ECGs, a CT pulmonary angiogram (CTPA) was performed to rule out pulmonary embolism (PE) or other pulmonary abnormalities, revealing a left main pulmonary artery thrombus with no evidence of right ventricular strain. The patient was managed with oral rivaroxaban 15 mg two times per day for 21 days followed by 20 mg once daily for 6 months. The patient showed full recovery at the 6-month follow-up. This case highlights the diagnostic challenges in patients with persistent symptoms, low risk of venous thromboembolisms (VTEs) and normal initial investigations. It is novel because previous case reports of PE with negative D-dimer results have predominantly involved patients with identifiable risk factors, such as prior VTEs, malignancy or other conditions that increase the likelihood of PE. In contrast, this case demonstrates that PE can occur even in the absence of these risk factors, emphasising the importance of clinical diligence and the use of advanced imaging in diagnosing PE in atypical presentations.https://casereports.bmj.com/content/18/3/e26499
Uncovering the neural correlates of the urge-to-blink : a study utilising subjective urge ratings and paradigm free mapping
Full text link© 2025 The Authors. Published under a Creative Commons
Attribution 4.0 International (CC BY 4.0) license.Neuroimaging plays a significant role in understanding the neurophysiology of Tourette syndrome (TS), in particular the main symptom, tics, and the urges associated with them. Premonitory urge is thought to be a negative reinforcer of tic expression in TS. Tic expression during neuroimaging is most often required as an overt marker of increased urge-to-tic, which can lead to considerable head movement, and thus data loss. This study aims to identify the brain regions involved in urge in healthy subjects using multi-echo functional magnetic resonance imaging (fMRI) and a timing-free approach to localise the blood-oxygen level-dependent (BOLD) response associated with the urge-to-act without information of when these events occur. Blink suppression is an analogous behaviour that can be expressed overtly in the MRI scanner which gives rise to an urge like those described by individuals with TS. We examined the urge-to-blink in 20 healthy volunteers with an experimental paradigm including two conditions, "Okay to blink" and "Suppress blinking", to identify brain regions involved in blink suppression. Multi-echo fMRI data were analysed using a novel approach to investigate the BOLD signal correlated with the build-up of the urge-to-blink that participants continuously reported using a rollerball device. In addition, we used the method of multi-echo paradigm free mapping (MESPFM) to identify these regions without prior specification of task timings. Subjective urge scores were correlated with activity in the right posterior and ventral-anterior insula as well as the mid-cingulate and occipital cortices. Whereas blink suppression was associated with activation in the dorsolateral prefrontal cortex, cerebellum, right dorsal-anterior insula, mid-cingulate cortex, and thalamus. These findings illustrate that different insula subregions contribute to the urge-for-action and suppression networks. The MESPFM approach showed co-activation of the right insula and cingulate cortex. The MESPFM activation maps showed the highest overlap with activation associated with blink suppression, as identified using general linear model analysis, demonstrating that activity associated with suppression can be determined without prior knowledge of task timings.https://direct.mit.edu/imag/article/doi/10.1162/IMAG.a.84/13159
Are patients aged 18-25 reviewed after one week of starting a selective serotonin reuptake inhibitor in a primary care setting?
No full textAims: The National Institute for Health and Care Excellence (NICE) recommends that individuals aged 18-25 or those at increased risk of suicide should be reviewed within one week of initiating or increasing a selective serotonin reuptake inhibitor (SSRI) dose. This study aimed to assess compliance with these guidelines in primary care, identify barriers to timely reviews, and evaluate changes following a previous audit. Method(s): A retrospective review was conducted using SystmOne to identify patients aged 18-25 who started an SSRI between 1 December 2023 and 15 July 2024 in a Nottingham GP surgery. Data collected included the time from SSRI initiation to a booked and completed review, as well as instances of non-attendance (DNA). Findings were compared with a prior audit (1 August-24 November 2023) to assess improvements and ongoing challenges. Following the first audit cycle, results were shared and discussed within the practice, prompting greater awareness from all members of the multidisciplinary team (MDT) upon current guidance and performance. Result(s): In the initial audit, none of the 21 eligible patients had a review booked within one week, with an average booking time of 20 days and 30 days to an actual review. In the re-audit, 36 eligible patients were identified, with a slight improvement in booking time (19 days) and review completion (23 days). Three patients (8.3%) had a review scheduled within the recommended one-week timeframe. The main barrier remained appointment availability, with a shortage of GP slots limiting one-week follow-ups. High DNA rates persisted, with 14 patients missing their reviews in the re-audit. No standardised approach to DNAs was implemented, with some patients receiving multiple recall attempts and medication re-issues, while others had no further action documented. Conclusion(s): Over this one-year period, noticeable improvements were observed in both booked and actual SSRI review times. However, most patients still did not receive a timely review. Limited appointment availability and inconsistent follow-up for DNAs remained significant challenges. Expanding the role of other healthcare professionals, such as pharmacists, to conduct initial medication reviews could improve guideline compliance and reduce GP workload. Establishing a standardised protocol for DNAs, ensuring a set emergency medication supply and a timely follow-up, is essential to improving patient safety and treatment outcomes.https://www.cambridge.org/core/journals/bjpsych-open/article/are-patients-aged-1825-reviewed-after-one-week-of-starting-a-selective-serotonin-reuptake-inhibitor-in-a-primary-care-setting/584AD1808414398502F158E676915C9
More than roll, move and multiple-choice questions: Application of tabletop game mechanics in anatomy education.
No full textAnatomy is a challenging topic, and educators have used games as a tool to teach the content. The three-dimensional aspects of anatomy provide unique advantages and challenges for presentation in a tabletop game format. Games are built on mechanics, which include the actions players take, such as rolling dice to move a pawn. Integration of the game mechanics with learning goals can lead to better outcomes by allowing players to explore the content through gameplay. We hypothesize that educators making games for anatomy education will have adopted tabletop game mechanisms that facilitate this integration of the educational content with the gameplay. To explore this a body of games for anatomy education was generated from online sources of games and the literature. Online and literature content, including game rules or videos when available, were reviewed, and mechanisms were categorized by the framework in Building Blocks of Tabletop Game design. Thirty-two games with sufficient information for analysis were identified, and the relation of the game mechanics to the educational content is described. The most common mechanics connected to the learning goals were question and answers, communication limits and set collection. Strongly integrated examples included using tabletop mechanics to travel through neuroanatomy, collecting related sets of anatomic components and tracing pathways for the spread of oral infections. We have found designers of games for anatomy education have adopted variable tabletop game mechanics based on the content area being presented, ranging from games as a framework for quiz questions to more robustly integrated educational content
Expert opinion on a safe same day discharge strategy as standard of care after leadless pacemaker implantation
Full text link© 2025 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Introduction Leadless pacemaker (LPs) is a safe and effective alternative to conventional transvenous pacing. There is currently no guidance on which patients could be safely discharged the same day post-procedure. Purpose To provide guidance to medical teams regarding safe same day discharge (SDD) after LP implantation. Methods An Advisory Board (AB) of 6 expert Micra™ implanters was formed. Interviews were conducted with each member to understand their experience on patient selection, care pathway, complications, and follow-up of Micra™ implanted patients. This information was used to develop a patient pathway for safe SDD after Micra™ implantation. A further survey was conducted to obtain consensus regarding decision points within the pathway. Results The SDD after Micra™ Implantation Patient Pathway consists of four phases: Pre-procedure assessment: Social factors are key in deciding suitability of SDD (6/6 AB members agreed, 100%). Patient’s comorbidities, frailty status and timing of procedure are also important in decision-making for SDD. Micra™ implant: Ultrasound-guidance reduces vascular access-related complications, increasing the likelihood for SDD (100%). Post-procedure observation: Peri-procedural complications such as pericardial effusion, severe vascular complications, bleeding from access site and device complications would prevent SDD (100%). Patients should complete 6 h of observation prior to discharge (100%). Follow-up: First follow-up should be in-person, 1–4 weeks post-procedure (84 %). Long-term follow-up should be organised as per Micra™ standard of care at each centre (100 %). Conclusions SDD after Micra™ Implantation Patient Pathway was developed via expert consensus. Adoption of the pathway in clinical practice may facilitate safe SDD after Micra™ Implantation.https://www.sciencedirect.com/science/article/pii/S2352906725000521?via%3Dihu
The Microbiota-Human Health Axis
No full textTrillions of microorganisms play a pivotal role in maintaining health and preventing disease in humans. Their presence influences daily life, habits, energy levels, and pathologies. The present narrative review synthesized recent studies of microbial diversity across organ systems. The composition of the microbiota regulates the intestinal barrier, modulates the immune response, influences metabolism, and produces essential compounds such as short-chain fatty acids and neurotransmitters. Dysbiosis is associated with numerous pathologies, including metabolic, autoimmune, neurodegenerative, and cardiovascular diseases. The microbiota is key to maintaining physiological balance and reducing disease risk. Therapeutic interventions, such as probiotics, prebiotics, postbiotics, and microbiome transplantation, offer promising perspectives in restoring microbial homeostasis and preventing chronic diseases.https://www.mdpi.com/2076-2607/13/4/94
The activity of Protectin DX, 17 HDHA and Leukotriene B4 is correlated with Interleukin-1beta (IL-1beta) and Interleukin-1 Receptor Antagonist (IL-1Ra) in the early subacute phase of stroke
No full textIschemic stroke is a leading cause of mortality and disability in adults. The inflammatory cascade is driven by various inflammatory molecules, such as interleukin-1β (IL-1β), and counteracted by its antagonist, interleukin-1 receptor antagonist (IL-1Ra). Eicosanoids are inflammatory derivatives of free fatty acids. Arachidonic acid (AA) derivatives exhibit pro-inflammatory activity, while eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) derivatives, known as specialized pro-resolving mediators, have anti-inflammatory properties. This study aimed to analyze potential associations between eicosanoids and key inflammatory molecules, including IL-1β and its antagonist IL-1Ra. In this prospective study, we investigated inflammatory molecules in 73 ischemic stroke patients. We analyzed interactions between IL-1β, IL-1Ra, and eicosanoids as follows: resolvin E1, prostaglandin E2, resolvin D1, lipoxin A4 (5S, 6R, 15R), protectin DX, maresin 1, leukotriene B4, 18RS-HEPE, 13S-HODE, 9S-HODE, 15S-HETE, 17 HDHA, 12S-HETE, 5-oxo-ETE, and 5-HETE. In 73 ischemic stroke patients, mean IL-1β was 1.31 ± 1.54 pg/mL and IL-1Ra 810.8 ± 691.0 pg/mL. Spearman correlations showed positive associations between IL-1β and protectin DX (ρ = 0.56, p < 0.001), and 17 HDHA (ρ = 0.26, p < 0.05) and 5-oxo-ETE (ρ = 0.27, p < 0.05). IL-1Ra correlated negatively with protectin DX (ρ = −0.58, p < 0.001) and 17 HDHA (ρ = −0.29, p < 0.05), and positively with leukotriene B4 (ρ = 0.34, p < 0.005). After multivariable adjustment, associations with IL-1β lost statistical significance, whereas the inverse relationships between IL-1Ra and protectin DX/17 HDHA remained significant (p < 0.005). Despite the known anti-inflammatory roles of protectin DX and 17 HDHA, and the pro-inflammatory role of leukotriene B4, their activity in the early subacute phase of ischemic stroke appears to be influenced by complex interplays, possibly mediated by IL-1β and IL-1Ra. The activity of protectin DX, 17 HDHA, and leukotriene B4 is correlated with IL-1β and IL-1Ra levels in the early subacute phase of stroke.https://www.mdpi.com/1422-0067/26/18/908