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What works well for people with dementia and their supporters from South Asian, African and Caribbean communities in the UK: A narrative synthesis systematic review and expert consultations
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© 2025 The Author(s). International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.OBJECTIVES: This review aims to synthesise the evidence regarding the use and provision of dementia services and support for people with dementia and/or supporters from South Asian, African or Caribbean backgrounds living in the UK. METHODS: A narrative synthesis systematic review of the original research articles published up to April 2024 was conducted. A lay summary of the initial review findings was evaluated by experts-by-experience (n = 15) for scrutiny and to enable further discussions, to produce key recommendations for further developing dementia services. RESULTS: A total of 18 studies (16 qualitative and 2 mixed methods studies) met the full inclusion criteria and were included in the review. The review findings and experts-by-experience consultations highlighted that: (1) dementia is not openly discussed or disclosed within many diverse ethnic communities. This can lead to family carers and people with dementia feeling isolated and unsupported. (2) Mainstream dementia support services and hospitals often do not meet diverse communities' cultural and religious needs, and (3) home-based care supported by external care agencies can be helpful but ensuring consistency of care staff in their culturally appropriate care can be extremely difficult to ensure. CONCLUSIONS: Encouraging South Asian, African and Caribbean communities to increase their dementia knowledge is important. However, mainstream dementia support services also need to incorporate their cultural and religious essentials into care packages to encourage their help seeking behaviours and tackle dementia stigma. Collaborative service developments between the diverse communities, Health and Social Care providers and policy makers are essential to ensure equitable and culturally appropriate dementia care for diverse community members in the future.https://onlinelibrary.wiley.com/doi/10.1002/gps.7004
Mechanical restraint in inpatient psychiatric settings : a systematic review of international prevalence, associations, outcomes, and reduction strategies
Get PDFBACKGROUND: There is increasing emphasis on reducing the use and improving the safety of mechanical restraint (MR) in psychiatric settings, and on improving the quality of evidence for outcomes. To date, however, a systematic appraisal of evidence has been lacking. METHODS: We included studies of adults (aged 18-65) admitted to inpatient psychiatric settings. We included primary randomised or observational studies from 1990 onwards that reported patterns of MR and/or outcomes associated with MR, and qualitative studies referring to an index admission or MR episode. We presented prevalence data only for studies from 2010 onwards. The risk of bias was assessed using an adapted checklist for randomised/observational studies and the Newcastle-Ottawa scale for interventional studies. RESULTS: We included 83 articles on 73 studies from 1990-2022, from 22 countries. Twenty-six studies, from 11 countries, 2010 onwards, presented data from on proportions of patients/admissions affected by MR. There was wide variation in prevalence (<1-51%). This appeared to be mostly due to variations in standard protocols between countries and regions, which dictated use compared to other restrictive practices such as seclusion. Indications for MR were typically broad (violence/aggression, danger to self or property). The most consistently associated factors were the early phase of admission, male sex, and younger age. Ward and staff factors were inconsistently examined. There was limited reporting of patient experience or positive effects. CONCLUSIONS: MR remains widely practiced in psychiatric settings internationally, with considerable variation in rates, but few high-quality studies of outcomes. There was a notable lack of studies investigating different types of restraint, indications, clinical factors associated with use, the impact of ethnicity and language, and evidence for outcomes. Studies examining these factors are crucial areas for future research. In limiting the use of MR, some ward-level interventions show promise, however, wider contextual factors are often overlooked.https://www.cambridge.org/core/journals/european-psychiatry/article/mechanical-restraint-in-inpatient-psychiatric-settings-a-systematic-review-of-international-prevalence-associations-outcomes-and-reduction-strategies/BC8E632C8E0673C9C405FA2BDE9D32B
Long-Term Improvements in Glycemia and User-Reported Outcomes Associated with Open-Source Automated Insulin Delivery Systems in Adults with Type 1 Diabetes in the United Kingdom: A Real-World Observational Study.
Get PDFObjective: To evaluate real-world outcomes in adults with type 1 diabetes initiating open-source automated insulin delivery systems (OS-AID). Methods: Adults with type 1 diabetes who commenced OS-AID, between May 2016 and April 2021, across 12 centers in the United Kingdom were included. Anonymized clinical data, collected during routine clinical care between December 2019 and November 2023, were submitted to a secure web-based tool within the National Health Service network. Outcomes included change in hemoglobin A1c (HbA1c), sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), user opinion of OS-AID, and event rates (hospital admissions, paramedic callouts, severe hypoglycemia, and adverse events) between baseline and follow-up. Results: In total, 81 OS-AID users were included (51.9% male; 90.1% White British; mean age 41.4 years; median diabetes duration 25 years [IQR 17-32]). Over a mean follow-up of 1.7 years, HbA1c reduced by 0.8% (9 mmol/mol) (7.3 ± 1.1% vs. 6.5 ± 0.7%; P < 0.001), and the percentage of individuals achieving HbA1c ≤ 7.0% (53 mmol/mol) increased from 48.6% to 75.7% (P < 0.001). Diabetes-related distress score reduced by 0.9 (95% confidence interval [CI] -0.3, -1.5; P = 0.006), and Gold score reduced by 0.7 (95% CI -0.1, -1.3; P = 0.022). The percentage of individuals with impaired hypoglycemia awareness (Gold score ≥4) reduced (27.8% at baseline vs. 8.3% at follow-up; P = 0.039). Of those asked, all participants stated that OS-AID had a positive impact on quality of life. The number of hospital admissions was low. Conclusions: The use of OS-AID is associated with long-term improvements in HbA1c, hypoglycemia awareness, and diabetes-related distress in type 1 diabetes. These benefits were achieved without increased rates of hospital admissions, diabetic ketoacidosis, or severe hypoglycemia
Value of endometrial biopsy in patients with hysteroscopically atrophic endometrium in patients with postmenopausal bleeding.
Get PDFPURPOSE: To determine the rate of precancer and cancer in women presenting with PMB who have a visually atrophic endometrium at hysteroscopy and assess the value of endometrial biopsy in this situation and the adequacy of the samples obtained. METHODS: Retrospective reviews of all patients with a visually atrophic endometrium at hysteroscopy who had presented with PMB and had an ET > / = 4 mm or ET 4 mm to have an inadequate sample (p < 0.001, 95% CI 1.61-3.16). 10 patients who had an inadequate sample at initial biopsy had a repeat inadequate sample (n = 23, 43.48%). CONCLUSIONS: The incidence of precancer/cancer in patients presenting with PMB with a visually atrophic endometrium at hysteroscopy is low. Many patients within this cohort have an inadequate sample at biopsy, and therefore, repeat sampling is of questionable value
Distal Triceps Tendon Ruptures: A Case Series Highlighting Diagnostic Challenges, Surgical Management, and Functional Outcomes
Get PDFTriceps tendon ruptures are uncommon but significant injuries, often presenting diagnostic challenges due to nonspecific clinical features. Delayed or missed diagnoses can result in prolonged functional impairment. We present a retrospective case series of five patients who sustained distal triceps tendon ruptures through various mechanisms, including direct trauma and heavy lifting. Clinical presentations ranged from elbow swelling and pain to palpable tendon gaps, with radiographic "flake signs" consistently observed. Ultrasonography effectively identified tendon ruptures and retraction in four cases, reinforcing its diagnostic value. All patients underwent surgical repair using suture anchor techniques, achieving satisfactory outcomes. This case series emphasises the importance of early recognition, timely imaging, and prompt surgical intervention in managing distal triceps tendon ruptures to optimise patient recovery
A retrospective comparison of open and arthroscopic surgery for elbow joint stiffness; a single centre pragmatic study over 15 years.
No full textBACKGROUND: There is ample evidence but conflicting reports to justify decision making for open versus arthroscopic elbow debridement and release for stiffness and pain once non-surgical measures have failed. The aim of this retrospective study is to report the clinical and functional outcomes of arthroscopic and open surgery for patients presenting with elbow pain, stiffness and loss of function. METHODS: A consecutive series of patients who had completed a minimum of 6 months of non-surgical treatment of elbow stiffness were identified over a 15-year period between July 2008 and January 2023 from a single centre. RESULTS: 96 patients were treated with arthroscopic surgery with 75 open surgery. Mean age was 51 years. Pre-operative pathology included osteoarthritis, inflammatory arthropathy and post-traumatic stiffness. Post-traumatic stiffness was more commonly treated with open surgery. The flexion-extension arc, pronosupination arc, pain score, Mayo elbow performance score (MEPS) and satisfaction scores improved in all patients (p 0.05) than the open group. CONCLUSIONS: Both arthroscopic and open surgical approaches for elbow stiffness improved elbow range of movement and function. Arthroscopic treatment was better than open surgery and may represent a more favorable approach. LEVEL OF EVIDENCE: Level 4 (case series)
The Association Between Psychosocial Factors and Decision Making Regarding Primary Treatment in Older Women With Early-Stage Breast Cancer.
Get PDFBackground: Breast cancer is increasingly prevalent among older adults, who are likely to have numerous comorbidities and unique psychosocial challenges. Aims: The aim of this study was to measure the prevalence of psychosocial factors in a cohort of older women diagnosed with early-stage operable breast cancer and the influence these factors may have on treatment decisions. Methods: As part of a prospective study in three UK centres, 199 patients with a new diagnosis of early-stage operable primary breast cancer, aged ≥ 70 years (mean 77, range 68-93) were recruited. A cancer-specific Comprehensive Geriatric Assessment (CGA) was conducted within 6 weeks of diagnosis. Association between treatment decision and psychosocial aspects (as measured by the 'psychosocial support', 'social activity' and 'social support' domains) of the CGA was determined. Treatment decision was not guided by this study and was determined usual conventional methods as per the breast multi-disciplinary team. Results: Scores for 'psychosocial support' averaged 82.1/102, 'social activity' averaged 13.5/24, and 'social support' averaged 43.3/72; with a higher score indicating a more positive outcome. There was no association between total scores in these domains and the type of treatment received. A lower score in three individual questions was associated with a higher likelihood of non-surgical treatment. Conclusions: While no direct link emerged between overall psychosocial scores and treatment decisions using CGA, specific sub-questions displayed associations with non-surgical treatment. This study is the only one of its kind to our knowledge. This may have implications for the design of a pre-CGA screening tool.https://onlinelibrary.wiley.com/doi/10.1002/pon.7024
The lasting impact of COVID-19 on forensic mental health : a review of shifts in patient profiles, service delivery, and legal considerations
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/)The COVID-19 pandemic has had a profound and lasting impact on forensic mental health, reshaping patient profiles, disrupting service delivery, and introducing new legal and ethical challenges. This narrative review examines the long-term implications of the pandemic on forensic psychiatric populations, mental health service provision, and the justice system. Evidence suggests that rates of severe mental illness, including psychosis, depression, and anxiety, have increased among forensic patients, exacerbated by isolation, stress, and reduced access to care. Additionally, substance use disorders, and co-occurring psychiatric conditions have become more prevalent, complicating treatment and rehabilitation efforts. The pandemic also accelerated the adoption of telepsychiatry in forensic settings, improving accessibility but raising concerns about the reliability of remote assessments for competency evaluations and risk assessments. Inpatient and prison-based forensic psychiatric services experienced staff shortages, increased patient aggression, and limited access to therapeutic programs, further straining the system. Court closures and legal case backlogs delayed forensic evaluations, raising human rights concerns for detained individuals. Ethical dilemmas emerged regarding involuntary hospitalization, treatment prioritization, and resource allocation. As the forensic mental health field transitions into a post-pandemic landscape, key lessons include the need for hybrid forensic assessment models, strengthened forensic infrastructure, and better integration of legal and clinical perspectives. Future research should focus on developing resilient forensic mental health policies and ensuring equitable access to care while maintaining legal and ethical standards.https://www.sciencedirect.com/science/article/pii/S1752928X2500121
Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT) : a randomised controlled trial evaluating the impact of a best practice resource kit used by teams managing crisis in dementia
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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
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licenses/by/4.0/.
© The Author(s) 2025People with dementia frequently experience mental health crisis requiring psychiatric hospital admission. In the UK, Teams Managing Crisis in Dementia (TMCDs) vary in structure and practice due to the absence of a standardized model. A pragmatic, randomised controlled trial (RCT) was designed to evaluate the AQUEDUCT Best Practice Tool and online Resource Kit (RK). Twenty-three TMCDs across England were randomised 1:1 To receive the RK plus usual care (intervention) or usual care alone (control) (www.isrctn.com/ISRCTN42855694). The primary outcome was the number of psychiatric hospital admissions for people with dementia at the primary endpoint of six months. Secondary outcomes included TMCD staff mental health (GHQ-12), psychological flexibility (WAAQ), and work engagement (UWES); and for people with dementia and carers, service satisfaction (CSQ-8) and mental wellbeing (GHQ-12). There was no significant difference in number of psychiatric admissions between groups (incident rate ratio: 0.74; 95% CI: 0.37-1.48; p = 0.397) and the primary endpoint was met. No significant differences were found for the secondary outcomes across staff or service user groups. Fidelity to the intervention varied; five TMCDs met or exceeded implementation criteria, while others reported structural barriers. Limited engagement was attributed to the absence of a learning collaborative and pandemic-related service pressures. Although the RK was valued by staff for guiding quality improvement, it did not significantly reduce hospital admissions or improve secondary outcomes. Future studies should prioritise implementation support and explore systemic barriers to service improvement in dementia crisis care.https://www.nature.com/articles/s41467-025-61537-
Video Narrative Exposure Therapy (NET) with children and young people who witnessed domestic violence : a naturalistic single case study series
Get PDF© The Author(s) 2025. his article is licensed under a Creative Commons Attri bution 4.0 International License, which permits use, sharing, adapta tion, 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/.This study investigated the potential effectiveness, feasibility, acceptability, and putative mechanisms of change of Narrative Exposure Therapy (NET) delivered via videoconferencing with young people who witnessed domestic violence. A naturalistic, mixed-method, AB, interventional single case design was used. Five female adolescents aged 13-17 years were recruited from a Child and Adolescent Mental Health Service in the United Kingdom and attended 4-10 video-sessions of the child-friendly NET protocol. Participants completed questionnaires assessing posttraumatic stress symptoms (PTSS), general psychological distress, and trauma memory quality, wore a heart rate (HR) monitor assessing habituation, and were offered a Change Interview. At post-intervention, three participants showed reliable improvement in PTSS, but only one showed clinically significant change. One participant also demonstrated reliable improvement in general psychological distress. Effect size estimates ranged from moderate to very large and indicated change in the desired direction for all but one participant; estimated effects for general psychological distress were more modest. Three participants showed reductions in trauma memory quality, indicating increased integration. Within-session habituation was observed for all participants with available HR data; between-session habituation was also recorded for two of them. The lifeline was mentioned as a helpful aspect of NET, the video delivery was considered both a barrier and a facilitator to engagement, and positive or mixed changes were reported by two participants. Future research with more control and larger samples is needed to answer questions on generality of findings and impact of online delivery; future studies may also include longer follow-up periods and investigate other outcomes. Trial registration number NCT04866511 (ClinicalTrials.gov).https://link.springer.com/article/10.1007/s40653-024-00681-