Midlands Evidence Repository
Not a member yet
9653 research outputs found
Sort by
In adults with severe psychiatric disorders, how does the option of assisted dying compared with standard psychiatric care or palliative care impact patient autonomy, quality of life, and ethical considerations : a comprehensive meta review
No full textAims: This systematic review sought to compare the effect of assisted dying options on self-determination, patients' quality of life, and specific/ethical concerns including suicidality for adults with severe psychiatric disorders and psychiatric or palliative care. Method(s): The data sources gathered for this review were PubMed, EMBASE, CINAHL and Cochrane databases. The search terms consisted of different forms of assisted dying to which various forms of psychiatric and mental health-related terms were added. The papers were restricted to systematic reviews and meta-analyses as these give high-quality evidence. Out of 343 studies after strict criteria such as ROBINS 1, ROB2 and AMSTAR, only 3 studies qualified for the review. The review centred on adults with severe psychiatric disorders, specifically patients with eating disorders who had assisted dying between 2012 and 2024. Result(s): The present review estimated that at least 60 individuals with eating disorders who received assisted dying between 2012 and 2024 were reported across 10 peer-reviewed studies and 20 government reports. Clinical rationales for granting assisted dying requests fall into three main domains: non-treatability, prognosis and request of the patient. Most of the reports highlighted two aspects: that the patients had a terminal or untreatable disease, as well as sufficient decision-making abilities. Still, only a few reports were available for the government and many of them failed to provide adequate data on psychiatric conditions. The review showed that there were significant gaps in reporting assisted deaths for psychiatric patients and ministers questioned accountability and patient safety. Some clinical justifications were void of rigour or evidence indicating the plausibility of the irremediability or lack of decisional capacity in psychiatric relatedness. Conclusion(s): The findings of this systematic review can be concluded as indicating the lack of procedural clarity and strengthened precaution measures for assisted dying in the field of psychiatry. The results imply the applicability of the ethical principles as well as clinical considerations call for incremental case-by-case analyses. The study should be extended to propose improved reporting systems for assisted dying and to confirm clinical justification for several patients who received help in psychiatric practices, with the consideration of patient rights and safety.https://www.cambridge.org/core/journals/bjpsych-open/article/in-adults-with-severe-psychiatric-disorders-how-does-the-option-of-assisted-dying-compared-with-standard-psychiatric-care-or-palliative-care-impact-patient-autonomy-quality-of-life-and-ethical-considerations-a-comprehensive-meta-review/4899873ED0E8D42DA11DEC9306F017E
Working Diagnoses : a pilot study
No full textAims: Mental Health and Neurodevelopment Resource Group (MHNRG) are planned to replace Mental Health Clustering. However, they are broad diagnostic groupings which will potentially have limited benefit in relation to evaluating outcomes, health inequalities, pathways, and interventions. In addition to mandatory completion of MHNRG, local services have the option to collect additional categorical data which led to the introduction of Working Diagnoses. This is a pilot study to trial Working Diagnoses to test its functionality and feasibility. Method(s): The aim of the Working Diagnoses is to create an accessible form on the electronic patient record allowing assessors to select a list of up to four working diagnoses via a drop-down menu. Following consultation with clinicians from differing psychiatric specialities, a list of 53 separate working diagnoses were agreed upon which were individually mapped to their respective ICD-11 diagnostic codes and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) to make it future proof. The pilot was conducted within the local Crisis Resolution and Home Treatment and Primary Care Mental Health teams. A live and secure Microsoft Excel document with a list of the working diagnoses through a drop-down menu was created. Assessors consisting of both doctors of various grades and psychiatric nurses within the teams were briefed on the aims and objectives of the pilot study. At this stage, it is not intended for the diagnostic data to flow into the Mental Health Services Data Set (MHSDS). Result(s): 127 patients referred to the teams between November to December 2023 were included in the pilot study and allocated their working diagnosis; 66 received one diagnosis, 52 received two and 9 received three diagnoses and none received four. All presentations were able to be satisfactorily described by the Working Diagnoses options. The general feedback from assessors who participated in the study reported that it was simple and easy to use despite having limited formal training. Conclusion(s): We believe that mental health services require granular details of a person's presentation if we are to effectively commission, transform and manage our services. Though other options could be utilised, implementing a limited categorical diagnostic list appears to be an acceptable, effective, and efficient method of gathering the information that has been missing in mental health services locally. The next steps will be to trial this to other services within the wider trust.https://www.cambridge.org/core/journals/bjpsych-open/article/working-diagnoses-a-pilot-study/CEDB2453A1E35BD41AC8B41B68F8184
Antibiotic stewardship in lower urinary tract infections among the elderly at a district general hospital
No full textObjectives: We aimed to evaluate the management of lower urinary tract infections (LUTIs) in elderly inpatients, to determine the prevalence of inappropriate treatment of asymptomatic bacteriuria (ASB), and to assess the impact of targeted educational interventions on antibiotic prescribing accuracy. Settings: An acute general hospital in the East Midlands of the United Kingdom. Participants: A total of 77 patients aged 65 years and older who underwent urine culture for suspected lower urinary tract infection were included in the study. Design: This was a prospective case series of emergency hospital admissions collected over eight months in acute elderly medicine wards, with two educational interventions implemented during the second and third months of the study period. Methods: Data relating to demographics, catheterization status, presenting symptoms, urine dipstick usage, culture collection methods, and antibiotic prescription patterns were obtained from electronic and paper records as part of audit number 1688 registered at the hospital trust. Interventions included the display of an informational poster based on NICE guidelines and a dedicated educational teaching session for clinicians. In total, 19 patients were involved pre-intervention. A total of 58 patients were involved post-intervention. Among the post-intervention cohort, 32 patients were involved after the poster intervention, and 17 patients were involved following the teaching intervention. Several months following the intervention, nine patients were involved in the study. Results: Initial findings revealed suboptimal adherence to national guidelines, with 50% (n=5) of asymptomatic patients with negative cultures inappropriately prescribed antibiotics. Following the poster intervention, prescribing was found to be three-and-a-half times more appropriate for LUTIs than the pre-intervention period (OR=3.61, 95% CI: 1.08-12.03, Ꭓ2=4.56, p=0.033). Compared to the pre-intervention period, antibiotic prescribing was found to be five times more appropriate (OR=5.05, 95% CI: 0.96-26.66, Ꭓ2=3.91, p=0.048) after all educational interventions were implemented. Catheter-associated infections also showed a significant reduction, albeit with poor statistical correlation. Conclusion: Targeted educational interventions, including informational posters and teaching sessions, improved appropriate diagnosis and antibiotic prescribing for LUTIs and ASB in elderly hospitalized patients within the scope of this study.https://www.cureus.com/articles/418343-antibiotic-stewardship-in-lower-urinary-tract-infections-among-the-elderly-at-a-district-general-hospital#!
Reliability of manual pulse checks versus emerging techniques in pediatric resuscitation: a systematic review
No full textThe accurate and rapid assessment of circulation is critical during pediatric cardiac arrest. Current guidelines recommend manual pulse checks, yet concerns remain regarding their reliability, as delays and inaccuracies may lead to inappropriate interruptions of cardiopulmonary resuscitation (CPR). Emerging techniques, such as point-of-care ultrasound (POCUS), offer potential objective alternatives. This systematic review aimed to synthesize the available evidence on the reliability of manual pulse checks compared with emerging techniques in pediatric resuscitation. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic search of PubMed, Web of Science, Scopus, and Embase was conducted without date restrictions. Eligible studies compared manual pulse palpation with techniques such as POCUS or auscultation in pediatric populations, either in simulated or clinical settings. Data on study characteristics, diagnostic accuracy, time to decision, and clinical outcomes were extracted, and the risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies - Version 2 (QUADAS-2) tool. A narrative synthesis was performed due to heterogeneity among studies. Six studies met the inclusion criteria. Overall, the evidence indicated notable limitations of manual pulse checks, while POCUS demonstrated greater reliability and faster decision-making, in addition to providing supplementary diagnostic information such as confirmation of cardiac activity. However, most of the available studies were based on simulations or small case series, underscoring the need for larger prospective trials. Manual pulse palpation appears to be an unreliable method for assessing circulation in pediatric cardiac arrest. POCUS shows promise as a more accurate and efficient alternative, with potential to improve the quality of resuscitation. Further research in real-world clinical settings is warranted to establish its impact on survival and neurological outcomes.https://www.cureus.com/articles/424097-reliability-of-manual-pulse-checks-versus-emerging-techniques-in-pediatric-resuscitation-a-systematic-review#!
Atypical case of Lemierre's syndrome secondary to cellulitis of the orofacial region
No full textLemierre's syndrome is a rare condition associated with infection of the oropharynx. We present an atypical case in a young healthy female who developed the condition secondary to a skin infection of the lip and chin. She also developed sepsis and chest pain. She was commenced on broad-spectrum antibiotics early and was fortunate to avoid aggressive surgical treatment. This case highlights the need for clinicians to consider this rare condition in addition to recognising its manifestations.https://www.sciencedirect.com/science/article/pii/S266714762400028
Impact of music interventions on depression in care home residents with dementia : UK results from music interventions for depression and dementia in elderly care RCT
Full text link© 2025 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license
(https://creativecommons.org/
licenses/by/4.0/).Background: We report UK findings from Music Interventions for Depression and Dementia in Elderly care (MIDDEL), a cross-national, clustered, randomised trial undertaken in 2018–2023 to evaluate the effectiveness of music interventions for depression symptoms in care home residents living with dementia (NCT03496675, clinicaltrials.gov (accessed on 1 December 2024)). The trial compared the effects of Group Music Therapy (GMT) with Recreational Choir Singing (RCS); GMT and RCS combined; and treatment as usual (TAU). Methods: In the intervention arms, the protocolized music interventions were delivered in care home units twice per week for three months, then once per week for three months. The primary outcome was depressive symptoms after six months, measured by MADRS. Secondary outcomes included well-being—EQ-5D-5L, Visual Analogue Scale (VAS); quality of life—QOL-AD; symptoms of dementia—SIB-8, NPI-Q; and caregiver distress—NPI-Q. The change in MADRS score from baseline to 6 months was assessed using a linear mixed-effects model. We report the multivariate model having both treatments as predictors, both unadjusted and adjusted, for the interaction between the treatments. Results: The UK trial started in 2022 after the pandemic lockdown, when 16 care home units were recruited and randomised, four per arm; 192 residents aged over 65 with depression and dementia participated. An ITT analysis of 146 participants retained at 6 months found neither intervention had a significant positive effect on any outcome. Significant unfavourable effects were found for RCS participants on MADRS, NPI symptom severity, and EQ-VAS. The combination of RCS + GMT had a detrimental effect on caregiver distress. Conclusions: MIDDEL UK findings do not support the use of GMT or RCS to alleviate depression in care home residents with dementia.https://www.mdpi.com/2308-3417/10/6/16
Analysis of conceptual overlap among formal thought disorder rating scales in psychosis : a systematic semantic synthesis [Article in press]
No full textMeasuring Formal Thought Disorder (FTD), a common, cross-diagnosed symptom dimension across mental disorders, is plagued by numerous inconsistencies. Clinicians use either FTD-specific scales or items from generic scales. While these tools are based on extensive clinical observations, they suffer from inconsistent terminology. Different scales may use the same term for distinct concepts or different terms for the same concept. This lack of conceptual standardization prevents the identification of underlying FTD subconstructs. By using natural language processing, we compared the definitions, labeling and overlap of FTD symptoms, i.e., the definitions of single items, across psychopathological scales. We used a three-pronged validation approach to analyze semantic clusters of single definitions of FTD scale psychopathological items. First, we used sentence-BERT to divide 30 Thought and Language Disorder scale (TALD) items into positive or negative FTD clusters, validating this approach by checking for correspondence with published factor-analytic divisions (approach validation). Second, we created a sparse item-to-item similarity matrix from 103 items across seven scales to identify semantically converging cross-scale FTD items; a clinician-researcher described the resulting four clusters, and we compared our automated classification with that of six blinded experts to establish expert-machine semantic correspondence. Finally, we analyzed data from 98 participants (49 healthy controls and 49 schizophrenia/affective psychosis), identifying the highest-correlating Clinical Language Disorder Scale (CLANG) item for each Thought, Language and Communication (TLC) scale item and mapping these to our BERT-derived clusters to establish data-level correspondence. When assigning TALD items to BERT-derived positive or negative FTD groupings, we observed a 73% match with prior factor analyses. The BERT-informed clustering of cross-scale items highlighted four coherent FTD groupings: (1) muddled communication & incomprehension, (2) abrupt topic shifts, (3) inconsistent narrative structure, (4) restricted speech. Expert raters showed moderate-to-high overlap (Fleiss’ kappa = 0.617) with computational clusters. A binomial test indicated that at the level of individual participants, correlations among CLANG-TLC item pairs were significantly more likely than chance to fall into the expected semantic cluster (p < 0.001). FTD rating scales measure overlapping, semantically related constructs that drive item-level correlations. Semantic clustering acts as a novel method to harmonize multi-scale data and pinpoint discrepancies between expert and machine classifications. Computational linguistics has the potential to improve consistency across rating scales especially when measuring complex constructs such as FTD.https://www.nature.com/articles/s41537-025-00712-
Febrile convulsion and cervical lymphadenopathy as initial presentation of incomplete node-first Kawasaki disease.
No full textNode-first Kawasaki disease (NFKD) is an atypical variant of Kawasaki disease (KD), presenting with fever and cervical lymphadenopathy before other classical features appear. This presentation often mimics bacterial cervical lymphadenitis (BCL), leading to misdiagnosis and treatment delays. We report a toddler initially treated for presumed BCL after presenting with a febrile convulsion and isolated lymphadenopathy. Failure to respond to antibiotics and the later appearance of rash, conjunctivitis and a small coronary artery aneurysm on echocardiography led to the diagnosis of incomplete NFKD. This case underscores the importance of early consideration of incomplete or atypical KD criteria in children with persistent fever and lymphadenopathy unresponsive to antibiotics. Delaying diagnosis until full clinical criteria develop may increase the risk of coronary complications. Early use of cardiac biomarkers, echocardiography and awareness of incomplete KD criteria can help distinguish KD from BCL, enabling timely diagnosis and treatment to improve outcomes.https://casereports.bmj.com/content/18/12/e26949
Implementing Mental Practice in Postgraduate Surgical Training for Minimally Invasive Surgery: A Systematic Review and Thematic Analysis.
No full textBACKGROUND: Unprecedented pressure on the National Health Service (NHS) has meant that there are increasing obstacles to surgical training. Simulation training is an option to improve surgical performance but is limited due to availability, accessibility and financial constraints. Mental practice (MP) has been proposed as a potential solution to supplement the traditional method of apprenticeship-style learning. Despite increasing evidence that MP may be a useful tool to improve surgical performance and reduce surgeon anxiety, it is not widely adopted. This systematic review and thematic analysis aims to identify key themes that would allow for the successful implementation of MP in postgraduate surgical training. METHODS: Medline, Embase and PsycINFO databases were systematically searched to identify articles that investigate the role of MP in improving surgical performance amongst surgical trainees. Retrieved papers were studied to inform thematic analysis of their content and studies were assessed for bias. RESULTS: A total of 321 studies were retrieved, of which 11 met the inclusion criteria. Overall risk of bias was assessed to be between critical and moderate for seven nonrandomized studies and between fair and good for four randomized studies. Key themes were identified and discussed using a thematic analysis approach. CONCLUSION: This study has identified that attaining high quality mental imagery is fundamental to success in mental practice and this can be augmented by the use of relaxation therapy and/or motivational imagery. Future research should focus on the application of MP in real-world surgical practice and breaking down complex procedures into fewer operative steps
A deep learning approach to case prioritisation of colorectal biopsies.
No full textAIMS: To create and validate a weakly supervised artificial intelligence (AI) model for detection of abnormal colorectal histology, including dysplasia and cancer, and prioritise biopsies according to clinical significance (severity of diagnosis). MATERIALS AND METHODS: Triagnexia Colorectal, a weakly supervised deep learning model, was developed for the classification of colorectal samples from haematoxylin and eosin (H&E)-stained whole slide images. The model was trained on 24 983 digitised images and assessed by multiple pathologists in a simulated digital pathology environment. The AI application was implemented as part of a point and click graphical user interface to streamline decision-making. Pathologists assessed the accuracy of the AI tool, its value, ease of use and integration into the digital pathology workflow. RESULTS: Validation of the model was conducted on two cohorts: the first, on 100 single-slide cases, achieved micro-average model specificity of 0.984, micro-average model sensitivity of 0.949 and micro-average model F1 score of 0.949 across all classes. A secondary multi-institutional validation cohort, of 101 single-slide cases, achieved micro-average model specificity of 0.978, micro-average model sensitivity of 0.931 and micro-average model F1 score of 0.931 across all classes. Pathologists reflected their positive impressions on the overall accuracy of the AI in detecting colorectal pathology abnormalities. CONCLUSIONS: We have developed a high-performing colorectal biopsy AI triage model that can be integrated into a routine digital pathology workflow to assist pathologists in prioritising cases and identifying cases with dysplasia/cancer versus non-neoplastic biopsies