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A multi-center, prospective, single-arm, open label, 13-month intervention study of a plant-based, high energy and protein enteral tube feed in home enterally tube fed patients.
Get PDFINTRODUCTION: There is an emerging need for plant-based options for home enteral tube feeding (HETF) patients, however their long-term efficacy and safety needs to be established. METHODS: Forty-one HETF patients (age: 51 years (SD 23); range 19-84 years; 54% male) participated in a multi-center, prospective, single-arm, open label, 13-month intervention study of a plant-based, high energy, high protein (2 kcaL/mL and 10 g protein/100 mL) enteral tube feed with or without added fiber (1.5 g/100 mL). Seventeen patients continued on the plant-based feed beyond day 28 (28 D) with a 6- and 13-month follow-up (6 M and 13 M). Outcomes included gastrointestinal tolerance (GI), anthropometrics, muscle strength and function (handgrip strength, 30-s chair stand test (30SCST)), dietary intake, total daily feed volume and time for feeding, and safety. RESULTS: Compared to patient's baseline feeding regimen, patients using the plant-based feed reported: greater absence of GI symptoms at all time points (+7-12%, p ≤ 0.04); a reduced incidence and intensity of GI symptoms: bloating, burping at 28 D (p < 0.05) and constipation, flatulence at 13 M (p < 0.05); improved physical function between 6 M and 13 M (+2 30SCST repetitions, p = 0.02), with maintenance of body weight, calf circumference and handgrip strength; total protein intake increased at all time points (+0.2-0.3 g/kg/day, p < 0.05); and total daily feed volume (-225 to -264 mL/day, p < 0.05) and estimated time for pump feeding (-2 h/day, p < 0.05) reduced at all time points. DISCUSSION: This longitudinal study highlights that a plant-based (vegan-suitable) high energy, high protein enteral tube feed has good tolerance in HETF patients, positive long-term effects on protein intake and potential benefits on physical function
Programmes for people who are homeless and have severe mental illness in low-income and middle-income countries : a systematic review
No full textHomelessness and severe mental illness are inter-related issues, the co-occurrence of which leads to poor outcomes for affected individuals. Evidence for effective interventions in high-income countries is accruing, but little is known about how to intervene in the diverse sociocultural contexts of low-income and middle-income countries (LMICs). The aim of this systematic review was to synthesise peer-reviewed and grey literature on programmes for people experiencing homelessness and severe mental illness in LMICs. We synthesised effects, programme components, and implementation strategies. We identified 80 sources describing 45 programmes across ten LMICs. Programme components spanned seven domains: service models, basic needs, health care, outreach, empowerment, community level, and macro level. Most programmes were multicomponent and included diverse delivery agents. Evaluation studies (n=21), although few in number and quality, reported clinical improvements; family reintegration ranged from 6% to 69%. Frequently reported implementation strategies included network weaving, educational meetings, and involvement of patients and family members. We identified programmes that show promise and can serve as starting points for local adaptation. This systematic review identifies common domains of programmatic interventions that are important to include in combination for future programme design, while considering local contexts and population-specific needs. Future research should prioritise rigorous evaluations, with particular emphasis on programme effects and cost benefits.https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00206-8/abstrac
Post-ERCP clearance of bile duct stones: should the gallbladder be left in-situ?
No full textBACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has become the gold standard management for patients who present with common bile duct stone (CBDS). Although laparoscopic cholecystectomy is generally recommended for patients who have CBDS clearance, there is still a significant proportion of patients who are managed expectantly. Our study aimed to evaluate the outcomes of expectant management (EM) versus prophylactic cholecystectomy after initial endoscopic removal of CBDS., METHOD: We performed a retrospective review of all patients who underwent ERCP for choledocholithiasis from 1st January 2017 to 31st December 2019. Patients were further classified into young or elderly group using age 60 years as the cut-off. Primary outcomes measured biliary-related complications in each interventional group whereas secondary outcomes measured all-cause mortality., RESULTS: 136 patients (51.3%) had EM whereas 129 patients (48.7%) were initially planned for LC. There was 20.6% of recurrence of biliary events in EM group as compared to 3.9% in LC group. The median time from first ERCP to recurrence of biliary events in the EM group was 14 months. Overall complications of LC group was low (5.4%) with nil operative-related mortality. However, there was a significant higher proportion of elderly patients in EM group in comparison to LC group (88.2% vs 31%) and 51.4% of EM group died during follow-up period with only one biliary-related death., CONCLUSION: Prophylactic cholecystectomy should be recommended for patients who have undergone ERCP clearance of CBDS. A watch-and-wait approach may be justified for elderly populations who are not ideal surgical candidates and a follow-up duration of up to 2 years is recommended. Copyright ┬® 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.https://link.springer.com/article/10.1007/s00464-024-11510-
Duchenne muscular dystrophy gene product expression is associated with survival in head and neck squamous cell carcinoma
Get PDFThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, 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 changes were made. 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/4.0/.Mutation of the Duchenne muscular dystrophy (DMD) gene causes neuromuscular disorders, but increasing evidence has implicated DMD in the development and progression of several major cancer types. This study investigates the prognostic and biological significance of DMD expression in head and neck squamous cell carcinoma (HNSCC). Analysis of The Cancer Genome Atlas (TCGA) data revealed that high DMD expression correlates with improved overall (median survival difference: 22 months, p = 0.0083) and progression-free (p = 0.0237) survival. The Dp71ab transcript is most strongly associated with better outcomes (median overall survival: 42 months, p = 0.0007). Notably, DMD expression levels stratify HPV-positive patients, identifying a DMD low/HPV-positive subgroup with poor outcomes. Immunohistochemical analysis of 50 HNSCC tissue cases confirmed dystrophin localisation in the nucleus and cytoplasm, with high nuclear expression linked to longer overall survival (mean difference: 31 months, p = 0.0497). Functional assays in HNSCC cells showed that Dp71ab overexpression disrupts nuclear morphology and reduces proliferation. Differential gene expression analysis additionally identified 388 upregulated and 30 downregulated genes, with pathways linked to muscle processes, ribosome biogenesis and non-coding RNA regulation. These findings highlight DMD as a potential biomarker and/or therapeutic target in HNSCC, warranting further mechanistic studies of Dp71 isoforms.https://www.nature.com/articles/s41598-025-94221-
Temporal dynamics in the association between depression and dementia : an umbrella review and meta-analysis
Get PDF© 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/)BACKGROUND: Identifying modifiable risk factors is crucial for dementia prevention, a global health concern. Depression is considered a risk factor for dementia, but the temporal dynamics across the life course remain inconclusive. Therefore, we aimed to systematically assess the relationship between the timing of depression assessment and risk of all-cause late-life dementia. METHODS: We conducted an umbrella review and meta-analysis to assess incident dementia in individuals with non-current history of depression. PubMed and Ovid Embase, MEDLINE, and PsycInfo were searched from inception up to February 17, 2025. Systematic reviews with meta-analyses investigating the association between depression and incident late-life dementia were included. From eligible reviews, we also extracted data from studies reporting dementia risk as hazard ratios (HRs), analysing the timing of depression measurement using random-effects models for meta-analysis. This study is registered with PROSPERO, CRD42021249706. FINDINGS: Of the 7763 records identified, nine reviews were eligible for inclusion of the umbrella review. One review was judged to be of moderate quality, while the others were either low (n = 3) or critically low (n = 5). For our meta-analyses, 18 studies reporting depression onset in later life (n = 901,762 participants, n = 7595 incident dementia cases) and seven studies on depression assessed during midlife (n ≥ 2,501,269 participants, n ≥ 276,929 incident dementia cases) were included. All studies in the meta-analyses were deemed to be of good quality, with no strong evidence of publication bias. Pooled HRs indicated depression present in late-life (HR 1.95, 95% CI: 1.68-2.26; I (2) = 77.5%) and midlife (HR 1.56, 95% CI: 1.12-2.18; I (2) = 97.5%) significantly increased risk of all-cause dementia. INTERPRETATION: The findings suggest that depression across the life course may increase dementia risk; however, substantial heterogeneity and review quality should be considered when interpreting the strength of this evidence. A life course approach to the treatment and prevention of depression may help reduce the burden of dementia, but this will require scaling up access to effective mental health care for vulnerable populations. Further research is needed to clarify if the stronger late-life association reflects depression as an immediate risk factor or an early manifestation of neurodegenerative processes. FUNDING: National Institute for Health and Care Research, UK Research and Innovation, and Saudi Arabian Cultural Mission.https://www.sciencedirect.com/science/article/pii/S258953702500198
Enhancing cross-cultural applicability in recovery colleges : a global Delphi study protocol
Get PDF© 2025 Kotera 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: Recovery Colleges (RCs) offer an innovative model of mental health support that blends co-production with adult learning to promote personal recovery and social inclusion. While evidence supports their effectiveness, most RC research and practice have been developed in Western contexts, raising concerns about cross-cultural applicability. The RECOLLECT Change Model (RCM) and RECOLLECT Fidelity Measure (RFM) were developed in England to characterise RC mechanisms and assess fidelity. Our previous studies have identified cultural influences on the RC operational model, however how to address these influences remains unknown. Given the increasing global interest in RCs, the aims of this study are to (a) identify the level of cultural influence on the RCM mechanisms and RFM items, and (b) provide recommendations to inform cross-cultural applicability of RCM and RFM. METHODS: This global Delphi study follows Belton's six-step methodology and uses a decentring approach to cross-cultural research that seeks to extend the relevance of tools developed in a single culture to multiple cultural contexts. Experts will be recruited via the RECOLLECT International Research Consortium, covering 31 countries across six continents. We aim to recruit approximately 100 panellists with at least three years' RC experience. Data collection will occur via Microsoft Forms across iterative Delphi rounds. Panellists will rate the importance and cultural difficulty of RCM and RFM items, provide feedback on culturally aligned response types, and suggest revisions for improved cultural fit. Quantitative data will be analysed using non-parametric statistics and a collapsed three-point Likert scale to address cross-cultural response bias. Qualitative responses will be analysed using descriptive content analysis informed by Hofstede's cultural dimension theory. Member checking will be conducted after the final round to enhance trustworthiness. DISCUSSION: This study will identify which RCM and RFM components are cross-culturally applicable and which require adjustment, contributing to the balance between fidelity and fit in mental health approaches. By developing culturally informed recommendations, this study aims to expand the accessibility and relevance of RC frameworks across diverse settings. Findings will benefit RC practitioners, researchers, and policymakers seeking to improve service delivery and recovery outcomes in culturally meaningful ways.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.033272
Neurogenic tongue swelling from skull base tumour: Bulk without strength
No full textAvailable to read at the publisher's website here: https://doi.org/10.1136/pn-2024-004444.https://doi.org/10.1136/pn-2024-00444
Chronic Kidney Disease as a Relevant Comorbidity in the Association Between Chronic Postsurgical Pain and Dementia Risk.
No full textNo Abstracthttps://onlinelibrary.wiley.com/doi/10.1002/ejp.70053?af=
Identifying digital markers of attention-deficit/hyperactivity disorder (ADHD) in a remote monitoring setting: Prospective observational study
Get PDF© Heet Sankesara, Hayley Denyer, Shaoxiong Sun, Qigang Deng, Yatharth Ranjan, Pauline Conde, Zulqarnain Rashid,
Philip Asherson, Andrea Bilbow, Madeleine J Groom, Chris Hollis, Richard J B Dobson, Amos Folarin, Jonna Kuntsi.
Originally published in JMIR Formative Research (https://formative.jmir.org), 29.01.2025. This is an open-access articleBACKGROUND: The symptoms and associated characteristics of attention-deficit/hyperactivity disorder (ADHD) are typically assessed in person at a clinic or in a research lab. Mobile health offers a new approach to obtaining additional passively and continuously measured real-world behavioral data. Using our new ADHD remote technology (ART) system, based on the Remote Assessment of Disease and Relapses (RADAR)-base platform, we explore novel digital markers for their potential to identify behavioral patterns associated with ADHD. The RADAR-base Passive App and wearable device collect sensor data in the background, while the Active App involves participants completing clinical symptom questionnaires. OBJECTIVE: The main aim of this study was to investigate whether adults and adolescents with ADHD differ from individuals without ADHD on 10 digital signals that we hypothesize capture lapses in attention, restlessness, or impulsive behaviors. METHODS: We collected data over 10 weeks from 20 individuals with ADHD and 20 comparison participants without ADHD between the ages of 16 and 39 years. We focus on features derived from (1) Active App (mean and SD of questionnaire notification response latency and of the time interval between questionnaires), (2) Passive App (daily mean and SD of response time to social and communication app notifications, the SD in ambient light during phone use, total phone use time, and total number of new apps added), and (3) a wearable device (Fitbit) (daily steps taken while active on the phone). Linear mixed models and t tests were employed to assess the group differences for repeatedly measured and time-aggregated variables, respectively. Effect sizes (d) convey the magnitude of differences. RESULTS: Group differences were significant for 5 of the 10 variables. The participants with ADHD were (1) slower (P=.047, d=1.05) and more variable (P=.01, d=0.84) in their speed of responding to the notifications to complete the questionnaires, (2) had a higher SD in the time interval between questionnaires (P=.04, d=1.13), (3) had higher daily mean response time to social and communication app notifications (P=.03, d=0.7), and (4) had a greater change in ambient (background) light when they were actively using the smartphone (P=.008, d=0.86). Moderate to high effect sizes with nonsignificant P values were additionally observed for the mean of time intervals between questionnaires (P=.06, d=0.82), daily SD in responding to social and communication app notifications (P=.05, d=0.64), and steps taken while active on the phone (P=.09, d=0.61). The groups did not differ in the total phone use time (P=.11, d=0.54) and the number of new apps downloaded (P=.24, d=0.18). CONCLUSIONS: In a novel exploration of digital markers of ADHD, we identified candidate digital signals of restlessness, inconsistent attention, and difficulties completing tasks. Larger future studies are needed to replicate these findings and to assess the potential of such objective digital signals for tracking ADHD severity or predicting outcomes.https://formative.jmir.org/2025/1/e5453
Reviewing the effect of needle size on outcomes of Vacuum-Assisted excision of Breast lesions
No full textWe are writing to highlight methodological concerns regarding the study Effect of Needle Size on Outcomes of Vacuum-Assisted Excision of Breast Lesions, published in the European Journal of Radiology [1]. While the study provides valuable insights into the comparative effectiveness of 7G and 10G needles, certain methodological issues may impact the validity of its conclusions.https://www.ejradiology.com/article/S0720-048X(25)00125-1/abstrac