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Selective Genicular Artery Embolisation for Recurrent Hemarthrosis Following Total Knee Arthroplasty: A Case Report
Get PDFRecurrent hemarthrosis following total knee arthroplasty (TKA) is an uncommon complication, with an incidence of less than 1%. It can lead to pain, swelling, joint stiffness, and functional impairment. Selective genicular artery embolisation (GAE) has emerged as a minimally invasive treatment for managing such cases. We report the case of a 79-year-old female with recurrent atraumatic hemarthrosis of the left knee following TKA, complicated by long-term anticoagulation with Edoxaban for unprovoked pulmonary embolism. Despite multiple aspirations and arthroscopic washouts, symptoms persisted. Angiography revealed synovial hypervascularity, and GAE was performed to reduce bleeding. Although the procedure initially improved symptoms, recurrence occurred while the patient was maintained on full-dose Edoxaban. Following a multidisciplinary review, the anticoagulant dose was reduced, resulting in complete resolution of haemarthrosis. GAE represents an effective, minimally invasive treatment for recurrent hemarthrosis post-TKA. Anticoagulation management and multidisciplinary coordination are essential to balance bleeding risk and thromboembolic protection in such patients
Put autistic women and girls at the heart: exploring the experiences of autistic women during diagnostic assessments in the UK
No full textPurpose It is suggested that autism assessments are not sensitive to the female autism presentation. Autistic women are often misdiagnosed or delayed in receiving their diagnosis. More guidance for assessing clinicians is required to improve the validity and effectiveness of autism diagnostic assessments of women. This study aims to explore the experiences of autistic women during their diagnostic assessments and understand what they considered important for diagnostic assessments of females. Design/methodology/approach A focus group with four adult autistic women was conducted, exploring their experiences and recommendations. Thematic analysis was used to identify overarching themes. Findings The main themes were 1) experience of the assessment; 2) gender-sensitive assessment content; and 3) clinician characteristics and skills. Participants made specific recommendations within these themes for how diagnostic assessments of females should be conducted. Originality/value This study differs from previous research by focusing on the experiences of autistic women specifically during diagnostic assessments and what they recommend for future assessments.https://www.emerald.com/aia/article-abstract/11/2/100/1242814/Put-autistic-women-and-girls-at-the-heart?redirectedFrom=fulltex
The use of the Structured Clinical Management (SCM) pathway in an inpatient setting: what has this meant for my recovery?
No full textBackground: Despite inpatient treatment not being recommended for those with a diagnosis of personality disorder, this may at times be necessary. One of the primary goals of the Structured Clinical Management (SCM) pathway is to reduce unnecessary hospital admissions. The SCM protocol attempts to reflect best generic practice for emotionally unstable personality disorder (EUPD) in the UK focused upon the organisation of care and provision of a therapeutic framework. The aim of the current study was to explore patient experiences of the use of SCM principles of care within an inpatient setting. = Method: Semi-structured interviews were conducted with seven participants under the care of Northamptonshire Healthcare Foundation Trust (NHFT) who were identified through purposeful sampling. All participants were female with a primary diagnosis of EUPD, or with established difficulties in this area, and with exposure to at least two hospital admissions within the previous 12 months. Data was then explored and analysed qualitatively using thematic analysis. Results: Analysis revealed six themes: ‘patient involvement’, ‘a template for care’, ‘shared understanding’, ‘person-centred care’, ‘holding the hope’ and ‘support’. Perception of the quality of care seeming to be contingent upon these factors. Conclusion: Patient experiences of the SCM principles of care and their impact upon recovery within an inpatient setting were influenced by several factors. This included the delivery of person-centred care rather than a more ‘blanket’ approach to implementation. Clinical and research implications are discussed.https://www.ingentaconnect.com/content/napicu/jpic/2025/00000021/00000001/art0000
Adverse events of mood monitoring and ambulatory assessment in depression and bipolar disorder : systematic review and meta-analysis
No full textBACKGROUND: Mood monitoring and ambulatory assessment offer improvements in measuring mood and behavior for mental health research and clinical practice. However, concerns about adverse effects and usability may hinder their implementation. OBJECTIVE: This systematic review and meta-analysis assessed the prevalence of adverse events, barriers and facilitators to use, and suggestions for improvement in quantitative mood monitoring studies involving people with depression and bipolar disorder. METHODS: We conducted a systematic review and meta-analysis of 77 quantitative studies that used mood monitoring or ambulatory assessment in depression and bipolar disorder, assessing adverse events, barriers and facilitators to use, and suggestions for improvement. Adverse events data were pooled to identify prevalence. RESULTS: Of the 77 studies, 15 (19%) reported adverse events, and 20 (26%) reported usability issues. Pooled prevalence of adverse events was 0.04 (95% CI 0.03-0.06; P<.001). Specific adverse effects included increased burden or stress (0.04, 95% CI 0.02-0.07; P<.001), mood worsening (0.02, 95% CI 0.01-0.02; P=.001), self-harm (0.05, 95% CI-0.02 to 0.10; P=.007), and hospitalization (0.06, 95% CI 0.04-0.09; P=.26). The top facilitators were perceived helpfulness and ease of use, the top barriers included technical challenges and the time-consuming nature of the interventions, and the top suggested improvement was personalization. CONCLUSIONS: A small number of mood monitoring or ambulatory assessment users experienced negative psychological effects; however, we were unable to infer causality. Due to the severe underreporting of adverse events as well as heterogeneity and publication bias in the included studies, there was limited certainty in the prevalence, duration, and severity of these adverse events. More systematic monitoring of adverse events is needed to optimize safety and usability. Many mood monitoring protocols may require additional development to decrease adverse events and improve acceptability.https://mental.jmir.org/2025/1/e7950
Compassion in healthcare : a narrative review of cross-cultural perspectives
Get PDF© 2025 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative CommonsBackground: Compassion is a critical component of effective, ethical healthcare, influencing patient care, provider well-being, and organizational culture. Its expression and support vary across cultures, yet little is known about how systemic and cultural factors shape compassionate care. This narrative review examines compassion’s impact on healthcare practices across cultural contexts. Methods: A narrative review of literature published since 2020, searching PubMed, PsycINFO, Scopus and Web of Science was performed. Fifteen studies met our inclusion criteria: peer-reviewed, English-language articles that explicitly examined compassion (or closely related constructs such as self-compassion or compassion fatigue) in healthcare settings and reported empirical, theoretical, or review evidence with attention to cultural or contextual factors. Excluded were articles published before 2020, non-English reports, conference abstracts, and opinion pieces lacking empirical or theoretical contribution. Results: Compassion-focused interventions reduced fatigue and improved self-compassion and satisfaction. Cultural and systemic factors influenced how compassion was understood and applied, from Buddhist-informed to Western models. Institutional culture, leadership, workload, and spiritual care affected practice, while mental health and community care showed benefits but faced systemic barriers. Conclusion: Compassion in healthcare is shaped by individual, cultural, organizational, and systemic factors. Embedding compassion across all these levels is essential for delivering effective, person-centered care. This review contributes by synthesizing recent cross-cultural evidence, highlighting how cultural, structural, and spiritual dimensions influence compassionate care, and identifying gaps in global research. Cross-cultural awareness and structural reform are critical for sustaining compassionate healthcare. Future research should explore underrepresented cultural contexts and evaluate systemic interventions that promote compassion in diverse health systems.https://www.dovepress.com/compassion-in-healthcare-a-narrative-review-of-cross-cultural-perspect-peer-reviewed-fulltext-article-JH
A randomised controlled trial to evaluate the clinical and cost-effectiveness of stimulant compared with non-stimulant medication for adults with attention-deficit/hyperactivity disorder and a history of Psychosis or biPolar disordER: SNAPPER
Get PDF© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0
International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or
parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To
view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder involving inattention, hyperactivity and impulsivity, which starts in childhood and frequently persists into adulthood. Stimulant and non-stimulant medication are the mainstay of treatment in adults. ADHD in adults is commonly comorbid in people with severe mental illness (SMI) such as bipolar disorder (bipolar) and psychosis. There is substantial uncertainty over the effectiveness of stimulant and non-stimulant medication in adult ADHD comorbid with SMI. There is also concern that they could trigger or worsen psychotic or manic symptoms. Whilst National Institute of Health and Care Evidence (NICE) ADHD guidelines indicate available evidence does not justify a deviation from their main recommendations of using stimulants first line, this is based on limited studies within this comorbid population. A randomised controlled trial (RCT) is needed to address this evidence gap. We present a protocol for a pragmatic, observer-blind, multi-centre, two-arm, RCT called SNAPPER that aims to investigate the clinical and cost-effectiveness of stimulant compared with non-stimulant medication for adults with ADHD and a history of SMI.https://link.springer.com/article/10.1186/s13063-025-09214-
Liraglutide in mild to moderate Alzheimer’s disease : a phase 2b clinical trial
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org/licenses/by/4.0/.
© The Author(s) 2025Liraglutide, a glucagon-like peptide 1 (GLP-1) agonist and antidiabetic drug, has shown neuroprotective effects in animal models. In this study, we aimed to evaluate the safety and efficacy of liraglutide in mild to moderate Alzheimer’s disease syndrome. ‘Evaluating liraglutide in Alzheimer’s disease’ (ELAD) is a multicenter, randomized, double-blind, placebo-controlled phase 2b trial in 204 participants with mild to moderate Alzheimer’s disease syndrome with no diabetes. Participants received daily injections of liraglutide or placebo for 52 weeks. They underwent fluorodeoxyglucose positron emission tomography, magnetic resonance imaging and detailed neuropsychometric evaluations. The primary outcome was a change in cerebral glucose metabolic rate. Secondary outcomes were safety and tolerability and cognitive changes. The primary outcome showed no significant differences in cerebral glucose metabolism (difference = −0.17; 95% confidence interval: −0.39 to 0.06; P = 0.14) between the two groups. The secondary outcome—score on the Alzheimer’s Disease Assessment Scale-Executive domain (ADAS-Exec)—performed better in liraglutide-treated patients compared to placebo (0.15; 95% confidence interval: 0.03−0.28; unadjusted P = 0.01). No significant differences were observed in Alzheimer’s Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) (−0.58; 95% confidence interval: −3.13 to 1.97; unadjusted P = 0.65) or Clinical Dementia Rating-Sum of Boxes (CDR-SoB) (−0.06; 95% confidence interval: −0.57 to 0.44; unadjusted P = 0.81) scores. Liraglutide was generally safe and well tolerated in non-diabetic patients with Alzheimer’s disease. ClinicalTrials.gov identifier: NCT01843075.https://www.nature.com/articles/s41591-025-04106-
A 10-week remote monitoring study of sleep features and their variability in individuals with and without ADHD
Get PDF© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0
International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you
give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the
licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the
material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or
exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati
vecommons.org/licenses/by-nc-nd/4.0/BACKGROUND: People with attention deficit hyperactivity disorder (ADHD) often report disturbed sleep, as well as co-occurring symptoms of anxiety and depression. Yet studies employing objective assessments often do not show as many sleep disturbances compared to subjective measures. These discrepancies may relate to subjective reports capturing problematic nights, which may not be captured in a single night's sleep or by averaging objective measurements over several nights. Given that variability in behaviours is in general strongly linked to ADHD, individuals with ADHD could have greater sleep variability than individuals without ADHD. Using active and passive remote monitoring, we investigate differences in the level and variability of daily sleep behaviours between individuals with and without ADHD and explore if sleep is associated with changes in anxiety and depressive symptoms across a 10-week remote monitoring period. METHODS: Forty individuals (20 with ADHD, 20 without) took part in a 10-week remote monitoring study. Active monitoring involved participants completing questionnaires on ADHD and co-occurring psychiatric symptoms at weeks 2, 6 and 10. Passive monitoring involved participants wearing a wearable device (Fitbit) that measured sleep each night. RESULTS: Individuals with and without ADHD were similar in the levels of sleep recorded each night. However, compared to those without ADHD, participants with ADHD had more variable sleep duration, sleep onset and offset, and sleep efficiency over 10 weeks. Within-individual associations of co-occurring anxiety and depressive symptoms with the sleep features were non-significant. CONCLUSIONS: In a 10-week remote monitoring study of sleep using a wearable device, we show that what distinguishes individuals with ADHD from those without is their greater variability in sleep features: participants with ADHD had a more variable sleep duration, sleep onset and offset, and sleep efficiency. Inconsistency and high variability are hallmarks of ADHD, and we show that this characteristic extends also to sleep among adolescents and adults with ADHD. TRIAL REGISTRATION: Clinical trial number: not applicable
Microbiological profiles of infectious corneal ulcers in Derbyshire and North Nottinghamshire-a 10-year analysis.
No full textPURPOSE: To assess the spectrum of organisms causing microbial keratitis and their in-vitro anti-microbial sensitivities out of 2 hospitals in the East Midlands Region of the United Kingdom. METHODS: A retrospective review was undertaken of all patients who underwent corneal scrapes for infectious keratitis between 2011 and 2021 at Royal Derby Hospital (RDH) in Derby and between 2009 and 2021 at King's Mill Hospital in Mansfield. RESULTS: In total, the results of 645 corneal scrapes (from 622 patients) were analysed after exclusions. Of these, 307 (47.6%) yielded positive cultures. The mean patient age was 52.6 ± 22.1 years (Mean ± St Dev) across both sites and 332 (51.4%) were from female patients. At RDH, there were 195 positive corneal scrape cultures, from which 250 species of organisms were isolated. At RDH, 64% (160/250) were Gram-positive bacteria, 32% (81/250) were Gram-negative bacteria, 2.4% (6/250) were Acanthamoeba species and 1.2% were fungi (3/250). At KMH, there were 112 positive cultures, from which 128 species of organisms were isolated. 14 corneal scrapes from KMH were polymicrobial. At KMH, 96% (123/128) were bacterial (51% Gram positive, 45% Gram negative), 3/128 (2.3%) were fungi and 2/128 (1.6%) were Acanthamoeba. Sensitivity testing confirmed that the fluoroquinolone class of antibiotics appeared to be effective against the majority isolates across the two hospital sites. CONCLUSION: There are differences in microbiological profiles between these neighbouring hospitals covering neighbouring populations. Despite these differences, reassuringly, the current first-line fluoroquinolone monotherapy treatment is an appropriate first-line treatment for both hospital sites
A feasibility study of a physical activity intervention for people with severe mental illness in medium secure psychiatric services in the United Kingdom
Get PDFCopyright © 2025 Roden-Lui, Faulkner, Lucock, Gibbon, Hewitt, Hughes, Khan, Lewis, Singh, Walters, Watson and Walker. 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.BackgroundIn the UK, there are approximately 3500 individuals detained in medium secure service. Service users in such settings have complex and severe mental illness (SMI), often with co-morbid physical health problems, shorter life expectancy and low levels of physical activity (PA). However, there are few studies about PA interventions for medium secure service users in the United Kingdom. Therefore, the aim of the study was to co-produce, with medium secure service users and staff, the content and delivery of an intervention to increase PA.MethodsA feasibility and acceptability study were conducted to test the PA intervention using the Capability, Opportunity, Motivation Behaviour Change Model (COM-B model) as the underpinning theoretical model. Both female and male service users, with personality disorder and/or mental illness, were recruited from two medium secure services in the UK.Outcome measures were collected at baseline, after the intervention and at follow up (3-months after intervention), and included PA levels, mental well-being, data on recruitment and retention and causes of drop out.ResultsA total of 33 participants were recruited. Seven participants withdrew during the intervention period and 26 participants completed the PA intervention. During the follow up stage, three participants withdrew. Following the intervention participants increased PA and improved physical health and wellbeing. Overall, there was good retention for the PA interventionConclusionRetention rates and completeness of data at both study sites indicate that it is feasible and acceptable to co-produce, deliver and maintain commitment to a PA intervention in such settings for service users with SMI. A future pilot randomised controlled trial (RCT) will allow further understanding about the effectiveness of the PA intervention in medium secure psychiatric services.Clinical trial registrationhttps://doi.org/10.1186/ISRCTN15546527, ISRCTN Registry – ISRCTN15546527.https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.155860