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Understanding the essential components and effectiveness of pre-assessment counselling (PAC) in providing a timely diagnosis according to NHS clinicians
Full text link© The Author(s) 2025. CC BY.This qualitative study explores the significance of Pre-Assessment Counselling (PAC) in supporting timely diagnoses for people with dementia from the perspectives of clinicians. Reflexive thematic analysis was employed to analyse in-depth interviews with a multidisciplinary team of clinicians specialising in dementia care. Three themes were identified: (1) The centrality of people with dementia in their diagnosis journey, (2) The importance of candid conversations in building therapeutic alliances, and (3) Recognising people with dementia are more than their diagnoses. These themes elucidate the multifaceted aspects of PAC and its implications for well-being and engagement in dementia care. The findings underscore the significance of timely diagnoses for the well-being of people with dementia while highlighting the nuanced nature of diagnosis delivery. Moreover, they emphasise the importance of empowering people with dementia in decision-making processes and fostering resilience through comprehensive support. The clinical and research implications of PAC implementation in dementia care are discussed.https://journals.sagepub.com/doi/10.1177/1471301225134592
Digital augmentation of aftercare for patients with anorexia nervosa : the TRIANGLE RCT and economic evaluation
Full text linkCopyright © 2025 Treasure et al. This work was produced by Treasure et al. under the terms of a commissioning contract issued by the Secretary of
State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0
licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly
attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals
Library, and the DOI of the publication must be cited.BACKGROUND: High-risk patients with complex anorexia nervosa are managed in inpatient/day patient care, but re-admission rates are high, and new treatments are needed. OBJECTIVE(S): To examine the effectiveness of a digital augmentation of aftercare (ECHOMANTRA). DESIGN: Transition Care In Anorexia Nervosa through Guidance Online from Peer and Carer Expertise was a multicentre, parallel-group, superiority randomised controlled trial. ECHOMANTRA augmented treatment as usual was compared with treatment as usual. Patient-carer dyads were randomised using minimisation on a 1 : 1 ratio into ECHOMANTRA + treatment as usual (ECHOMANTRA) or treatment as usual alone. SETTING: Specialised United Kingdom inpatient/day patient sites (n = 31) participated. PARTICIPANTS: Patient-carer dyads were randomised (n = 185 in ECHOMANTRA and n = 186 in treatment as usual). INTERVENTIONS: The digital ECHOMANTRA intervention included self-management tools (recovery tips videos) for patients and task-sharing materials for carers (skill-sharing video), supplemented with guided group chat sessions. All participants randomised to ECHOMANTRA + treatment as usual had access to the psychoeducational materials and joint patient/carer chat sessions were also offered. MAIN OUTCOME MEASURES: The primary outcome was patient distress at 12 months. Other outcomes included patient distress at 18 months, and eating disorder symptoms, social and work adjustment, and carer distress and skills at 12 and 18 months. RESULTS: There was no evidence of an intervention effect on the Depression Anxiety Stress Scale-21 outcome for patients (n = 370) at 12 months, estimated effect 0.48, 95% confidence interval -0.20 to 0.23, standardised estimate (0.02, p = 0.87). In the economic analysis, the intervention was dominated by treatment as usual from both a health system and wider societal perspective, as ECHOMANTRA cost more and resulted in fewer quality-adjusted life-years gained. However, the uptake of the interactive component of the intervention (i.e. the facilitated and moderated online groups) was limited, with only 20% of the dyad members attending the pre-set minimal adherence level (i.e. both the patient and carer attending at least four online forum group sessions). The feedback about the intervention was predominantly positive. For example, the group facilitators were rated highly. However, some feedback was that the intervention offered too little, too late, and that a more personalised intervention would be more helpful. LIMITATIONS: Participants were diverse (e.g. 20% were being treated under the Mental Health Act), and a large proportion had a range of comorbidities (depression, anxiety, obsessive-compulsive disorder and autistic spectrum disorders), all factors impacting prognosis. Although efforts were made to enhance inclusion, diversity in terms of gender, sexuality and race was limited, and technological barriers and/or lack of a carer may have led to exclusion. The high level of non-adherence to the group support (80% dyads) may have contributed to the non-significant findings. CONCLUSIONS: This guided self-management and task-sharing intervention was reviewed positively by some patients and supporters; however, there was no evidence that the intervention improved outcomes over usual aftercare. FUTURE WORK: Identifying mechanisms to increase engagement such as a more personalised approach to aftercare to address the diverse needs of this patient group are needed. Greater integration between intensive and step-down services with guidance from peer workers providing support may optimise care. TRIAL REGISTRATION: This trial is registered as ISRCTN14644379. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/68/09) and is published in full in Health Technology Assessment; Vol. 29, No. 31. See the NIHR Funding and Awards website for further award information. Transition Care In Anorexia Nervosa through Guidance Online from Peer and Carer Expertise aimed to examine whether offering a digital programme (ECHOMANTRA), containing information and online group support for patients with anorexia nervosa and their nominated supporters, could reduce patient distress and improve other outcomes in the 18-month period after leaving intensive treatment (inpatient or day care). The study also examined whether ECHOMANTRA is a good value for money to the National Health Service and the wider economy. Patients and a nominated supporter (371 pairs) were recruited and split into two groups at random: (1) usual treatment plus access to the ECHOMANTRA programme and (2) usual treatment alone. There were no differences between groups in the outcomes measured, which included patient distress, eating disorder symptoms, quality of life, social and work adjustment and carer distress and skills. ECHOMANTRA did not demonstrate good value for money. However, only 20% of participants allocated to ECHOMANTRA joined more than four online group sessions (the minimal recommended participation). Patients and their supporters reported inadequate planning and support following discharge from hospital. Patients reported low confidence in their ability to recover, and a need for more continuity in their care. Carers echoed the need for a supportive transition process. Several aspects of the ECHOMANTRA programme were welcomed, with the mixed patient/supporter online groups and online group facilitators experienced as particularly helpful. Participants were generally positive about the written and recovery tip videos. However, several suggested that more personalised content and access options were needed. ECHOMANTRA failed to show a benefit overall, which may reflect the limited uptake of the online groups and the broader access to carer support outside of the study. Together with participant feedback, these findings suggest that a more personalised programme, with more integration with clinical teams, may lead to increased engagement with the virtual elements of support offered by ECHOMANTRA. enghttps://www.journalslibrary.nihr.ac.uk/hta/ADLS367
Does the presence of single compared to multiple endometrial polyps alter the risk of cancer in post-menopausal women?
No full textOBJECTIVE: To evaluate the relative rates of malignancy in women with single and multiple polyps presenting to a UK Cancer Centre with postmenopausal bleeding (PMB). STUDY DESIGN: A retrospective review of patients treated at Royal Derby Hospital (RDH) for PMB who underwent outpatient hysteroscopy based on ultrasonographic suspicion of endometrial polyps between May 2014 to December 2019. The main outcome measure was the rates of precancerous and malignant histology for single or multiple polyps. The secondary outcomes assessed the influence of risk factors on the rates of malignancy within the single and multiple polyps groups. RESULTS: The study population was 851 women of which 533 were in the single polyp group and 318 in the multiple polyps group. The multiple polyps group (mean age 65.2 years) was older compared to the single polyp group (mean age 62.1 years), P = 0.0001. Elevated rates of cancer was driven most significantly by endometrioid cancer in the multiple polyps compared to single polyp group, with rates of 50/314 (16 %) and 28/512 (5.5 %) respectively, P= 0.05). Significantly more endometrial hyperplasia with atypia (AEH) was found in the multiple polyps compared to single polyp group, with rates of 18/314 (5.7 %) and 15/512 (2.9 %) respectively, P = 0.046. CONCLUSION: Our study found increased rates of endometrioid cancer and its precursor, AEH within the multiple polyps compared to the single polyps groups. Future risk predicting algorithms should consider incorporating single and multiple polyps as part of their risk model
Increased sensorimotor noise in Tourette syndrome
Full text link© The Author(s) 2025. Published by Oxford University Press on behalf of the Guarantors of Brain.
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 reuse,
distribution, and reproduction in any medium, provided the original work is properly cited.Tourette syndrome is a neurological disorder characterized by the occurrence of vocal and motor tics. The pathophysiology of Tourette syndrome has been linked to a substantial reduction in the number of inhibitory GABAergic interneurons found within the striatum, which may lead to increased neural 'noise' within the cortical-striatal-thalamic-cortical circuit implicated in movement production. In the current study, we used EEG to investigate increased neural noise in a group of 19 adults with Tourette syndrome compared to a matched neurotypical control group. We operationalized neural noise in this study as increased trial-by-trial variability in the magnitude and/or the timing of responses to a discrete somatosensory stimulation event. Specifically, we examined trial-by-trial variability in responses to a single pulse of median nerve electrical stimulation. Our results demonstrate that the P100 somatosensory evoked potential, which has been associated with conscious perception of tactile stimuli, was significantly increased in the Tourette syndrome group. Importantly, however, while the timing, temporal variability and spatial topography of early- and mid-latency somatosensory evoked potential components (e.g. N20, P45, N60, P100) did not differ in the Tourette syndrome group, when compared to matched controls, trial-by-trial variability was substantially increased in the Tourette syndrome group, but this was normalized in response to stimulation. These findings may indicate that the trial-by-trial recruitment of neuronal sensorimotor populations is less stable at rest in individuals with Tourette syndrome compared to controls but may normalize in response to stimulation.https://academic.oup.com/braincomms/article/7/4/fcaf247/816882
Management of Early-Onset Type 2 Diabetes in Adults: Current Evidence and Future Directions.
Full text linkThe global prevalence of early-onset type 2 diabetes (EOT2D) is rising rapidly. Adults with EOT2D represent a high-risk population characterised by increased rates of microvascular and macrovascular complications, adverse psychological wellbeing and psychiatric comorbidities such as depression, and premature mortality compared to those with later-onset type 2 diabetes mellitus. This emerging population faces unique challenges, including high levels of diabetes-related stigma, clinical inertia, and competing life demands, such as starting a family. This review synthesises current evidence on the clinical management of EOT2D. Key therapeutic targets include weight reduction, preservation of β-cell function, cardiometabolic risk management, and psychological support. Overall, there are few randomized controlled trials (RCTs) undertaken specifically in adults with EOT2D. However, we summarise early data from the few RCTs that do report outcomes specific in young adults, with bariatric surgery, tirzepatide and intensive lifestyle interventions emerging as particularly effective treatments. There is a strong rationale that technology-based inventions and structured education programs may prove to be effective treatments but data from RCTs is lacking. We provide broad recommendations for future research and clinical practice based on the current evidence. In conclusion, substantial further research is required to inform tailored, evidence-based guidelines and improve long-term outcomes in this underserved population
Mood Disturbances in a Patient on Statin Therapy: A Case Report.
Full text linkStatins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are widely used to treat hyperlipidaemia and significantly reduce the risk of cardiovascular events. While generally well tolerated, emerging evidence suggests that statins may, in rare cases, be associated with neuropsychiatric adverse effects, including mood disturbances and behavioural changes. We report the case of a 54-year-old woman with hypertension, but no personal or family history of psychiatric illness, who developed mood and behavioural changes shortly after initiating atorvastatin 10 mg following the detection of dyslipidaemia on routine blood testing. Her regular medications included bisoprolol and amlodipine, which she had been taking for eight years without any prior neuropsychiatric side effects. Symptoms resolved rapidly upon discontinuation and recurred upon rechallenge, prompting cessation and referral for psychological counselling. The Naranjo Adverse Drug Reaction (ADR) Probability Scale yielded a score of 8, indicating a probable relationship between the statin and the mood disturbances. Although uncommon, statin-induced neuropsychiatric symptoms have been documented in genetic studies and pharmacovigilance databases. Proposed mechanisms include reduced central nervous system cholesterol affecting serotonergic neurotransmission and statin-related modulation of cytokine signalling. This case highlights the importance of clinician awareness of potential mood-related side effects of statins, even in patients without prior psychiatric history or those receiving low doses. Early recognition and timely management can minimise patient distress and support safer long-term adherence to lipid-lowering therapy
Continuous glucose monitoring and automated insulin delivery systems in the management of diabetes among individuals with chronic kidney disease on dialysis.
No full textPURPOSE OF REVIEW: To describe the current evidence and emerging role of continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems in the management of diabetes among individuals with advanced chronic kidney disease (CKD) undergoing dialysis. RECENT FINDINGS: Recent studies have shown that CGM provides accurate and clinically useful glucose data in people with advanced CKD requiring dialysis. CGM enables the detection of glycaemic variability and hypoglycaemia patterns that are often missed by traditional monitoring methods, such as capillary blood glucose testing and haemoglobin A1c. While observational studies show benefits, randomised controlled trial data are limited. Early trials and case series suggest that AID, especially fully closed-loop systems, may improve glycaemia in dialysis-dependent individuals with diabetes, though evidence is currently sparse and primarily focused on type 2 diabetes. Several ongoing and planned studies aim to address these knowledge gaps. SUMMARY: CGM represents a valuable tool for improving glucose management and safety in people with diabetes and advanced CKD, but barriers to widespread use, such as cost, access, and healthcare provider familiarity, remain significant. AID technologies show promise but require further evaluation in this population. Future research should prioritise long-term outcomes, cost-effectiveness, and patient-reported outcomes to support the integration of these technologies into routine care for this high-risk group
Precision computerised cognitive behavioural therapy (cCBT) intervention for adolescents with depression (SPARX-UK) : protocol for the process evaluation of a pilot randomised controlled feasibility trial
Full text link© Author(s) (or their
employer(s)) 2025. Re-use
permitted under CC BY.
Published by BMJ Group.INTRODUCTION: While digital technologies can increase the availability and access to evidence-based interventions, little is known about how users engage with them and the mechanisms associated with effective outcomes. Process evaluations are an important component in understanding the aforementioned factors. The 'SPARX-UK' study is a randomised controlled pilot and feasibility trial evaluating personalised human-supported (from an 'eCoach') vs a self-directed computerised cognitive behavioural therapy intervention (cCBT), called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), aimed at adolescents with mild to moderate depression. We are comparing supported vs self-directed delivery of SPARX to establish which format should be used in a proposed definitive trial of SPARX. The control is a waitlist group. We will conduct a process evaluation alongside the trial to determine how the intervention is implemented and provide context for interpreting the feasibility trial outcomes. We will also look at the acceptability of SPARX and how users engage with the intervention. This protocol paper describes the rationale, aims and methodology of the SPARX-UK trial process evaluation. METHODS AND ANALYSIS: The process evaluation will use a mixed-methods design following the UK Medical Research Council's 2015 guidelines, comprising quantitative and qualitative data collection. This will include analysing data usage of participants in the intervention arms; purposively sampled, semi-structured interviews of adolescents, parents/guardians, eCoaches and clinicians/practitioners from the SPARX-UK trial; and analysis of qualitative comments from a survey from those who dropped out early from the trial. Quantitative data will be analysed descriptively. We will use thematic analysis in a framework approach to analyse qualitative data. Quantitative and qualitative data will be mixed and integrated to provide an understanding of how the intervention was implemented and how adolescents interacted with the intervention. This process evaluation will explore the experiences of adolescent participants, parents/guardians, eCoaches and clinicians/practitioners in relation to a complex digital intervention. ETHICS: Ethical approval was granted by the National Health Service (NHS) Health Research Authority South West - Cornwall & Plymouth Research Ethics Committee (Ethics Ref: 22/SW/0149). DISSEMINATION: Contextualising how the intervention was implemented, and the variations in uptake and engagement, will help us to understand the trial findings in greater depth. The findings from this process evaluation will also inform the decision about whether and how to proceed with a full randomised controlled trial, as well as the development of more effective interventions which can be personalised more precisely via varying levels of human support. We plan to publish the findings of the process evaluation and the wider project in peer-reviewed journals, as well as disseminate via academic conferences. TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN15124804. Registered on 16 January 2023, https://www.isrctn.com/ISRCTN15124804.https://bmjopen.bmj.com/content/15/8/e09248
Diabetes management during the end of life
No full textFor individuals with diabetes, maintaining optimal glycaemic control is essential to reduce the risk of long-term complications. However, as patients approach the end of life, the emphasis on tight glycaemic targets becomes less relevant. Instead, the primary goal shifts to maintaining blood glucose levels within a range that minimises the risk of hypoglycaemia and prevents symptomatic hyperglycaemia, thereby ensuring comfort and quality of life. This article explores the transition from disease-focused management to a person-centred approach grounded in comfort, dignity and ethical responsibility. It examines the adaptation of glycaemic targets, deprescribing, nutrition, and monitoring across the recognised phases of dying, and addresses the specific challenges of managing type 1, type 2 and steroid-induced diabetes in palliative contexts. Ethical principles including autonomy, non-maleficence, beneficence, and justice are critically applied to nursing practice, alongside recommendations for interdisciplinary communication and advance care planning. Nurses play a pivotal role in delivering proportionate, compassionate, and ethically sound care for people dying with diabetes.https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2025.033
Research advances and future directions in female ADHD : the lifelong interplay of hormonal fluctuations with mood, cognition, and disease
Full text link© 2025 Kooij, de Jong, Agnew-Blais, Amoretti,
Bang Madsen, Barclay, Bölte, Borg Skoglund,
Broughton, Carucci, van Dijken, Ernst, French,
Frick, Galera, Groenman, Kopp Kallner, Kerner
auch Koerner, Kittel-Schneider, Manor, Martin,
Matera, Parlatini, Philipsen, Ramos-Quiroga,
Rapoport, Remnélius, Sénéquier, Thorell,
Wittekoek and Wynchank. This is an open access article distributed under the terms of
the Creative Commons Attribution License
(CC BY). The use, distribution or reproduction
in other forums is permitted, provided the
original author(s) and the copyright owner(s)
are credited and that the original publication in
this journal is cited, in accordance with
accepted academic practice. No use,
distribution or reproduction is permitted
which does not comply with these terms.INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) in girls and women is under-recognised and under-researched, despite increasing awareness of clinical challenges and unmet needs. This review by the Eunethydis Special Interest Group on Female ADHD, addresses current knowledge and identifies research gaps for future work. Issues in women with ADHD across the lifespan such as late diagnosis, pubertal development, sexual health, hormonal birth control, executive function difficulties, and gynaecological disorders associated with ADHD are highlighted. METHODS: The review synthesises existing literature and self-reported experiences of women with ADHD to explore the impact of hormonal fluctuations [puberty, menstrual cycle, pregnancy, (peri)menopause] on ADHD symptoms and mood disturbances. It examines the interplay of oestrogen and progesterone with dopaminergic pathways, when periods of lower oestrogen may affect cognition, as well as the manifestation of executive function deficits, and the intersection of ADHD with reproductive health. RESULTS: Hormonal transitions exacerbate ADHD symptoms and mood disturbances, yet pharmacological research and tailored treatments are lacking. Executive function deficits manifest differently in girls and women with ADHD and are influenced by neuropsychological and neurobiological profiles. Diagnostic practices and sociocultural factors contribute to delayed diagnoses, increasing the risk of comorbidities, impaired functioning, and diminished quality of life. Undiagnosed women have increased vulnerability to premenstrual dysphoric disorder, postpartum depression, and cardiovascular disease during perimenopause. DISCUSSION: Longitudinal, sex-specific studies incorporating hormonal status and lived experience are needed. Individualised interventions should be developed to address the unique needs of girls and women with ADHD. Addressing these gaps will advance more equitable diagnosis, management, and support for girls and women with ADHD, improving outcomes across the female lifespan.https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2025.1613628/ful