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The Role Of Combined Renin-Angiotensin-Aldosterone System Inhibitors (RAASi) Plus Beta Blocker Therapy For Cardiotoxicity Prevention In Patients Under Chemotherapy For Breast Cancer: A Meta-analysis Of Randomized Controlled Trials.
No full textIntroduction: Anti-neoplastic agents, including anthracyclines and trastuzumab, frequently employed in breast cancer treatment carry on considerable cardiotoxic effects impairing both cardiac chamber and cardiac fiber parameters leading to incident heart failure. In response to this challenging side effect, numerous randomized controlled trials (RCTs) have investigated the cardioprotective efficacy of RAASi and beta-blockers (BBs) in patients undergoing anthracycline and trastuzumab chemotherapy. We aim to perform an updated meta-analysis to elucidate the potential cardioprotective properties of these medications in patients undergoing chemotherapy for breast cancer.Methods: A comprehensive search of the literature was performed through April 2024 on PubMed, EMBASE and Clinicaltrials.gov. In total, data from 4 randomized studies were extracted and analyzed. The primary analysis was the effect of RAASi and BBs on LVEF as well as global longitudinal strain (GLS). Data were analyzed using a random-effects model to derive weighted mean differences (WMDs) and 95% confidence intervals for both LVEF and GLS. Data was analyzed using Review Manager 5.3 (RevMan 5.3) software.Results: In total, data from 248 patients (N = 124 on cardioprotection; N = 124 without cardioprotection) undergoing treatment with anti-neoplastic agents for breast cancer were included. At the end of treatment, patients undergoing cardioprotective therapy demonstrated improved LVEF preservation compared to the control group, (mean difference 2.14 [0.03, 4.25]; P=0.05; I2 = 79%). In addition, patients undergoing dual RAASi + BB therapy showed better GLS preservation compared to control group (mean difference –1.37 [-2.01, -0.72]; P < 0.0001; I2 = 0%).Conclusion: In breast cancer patients undergoing anti-neoplastic regimens comprising anthracycline and trastuzumab, the concomitant administration of RAASi and BBs demonstrated better LVEF as well as GLS preservation upon completion of treatment over those without cardioprotective therapy. These findings shed light on the potential benefit derived from the synergistic effects of RAASi and BBs therapy in safeguarding both cardiac chamber and fiber functions amidst aggressive anti-cancer regimens, although further investigations still need to be conducted.https://www.sciencedirect.com/science/article/abs/pii/S107191642400561X#:~:text=Conclusion,over%20those%20without%20cardioprotective%20therapy
The impact of age and sex on the expression and severity of borderline symptoms in individuals with borderline personality disorder: An Iranian study
Full text link© 2025 John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited.Reports of sex and age differences in the presentation of borderline symptoms have been limited to the Western literature and have not systematically compared adolescents with emerging and older adults with borderline personality disorder (BPD). This study aimed to examine the impact of age and sex on the expression of borderline symptoms in adolescents, young adults, and older adults with BPD. A sample of 493 Iranian individuals with a confirmed diagnosis of BPD was segregated into 2 age groups: 134 young people aged 12-25 (mean = 17.60), and 142 adults aged 26 and older (mean = 31.69). Young people were divided into: 241 adolescents (mean = 15.59) and 100 young adults (mean = 22.45). Older groups compared with their younger counterparts showed significantly greater severity of borderline symptoms and greater difficulties with emotion regulation, but younger groups showed greater emotional and behavioral dysregulation. Sex differences generally mirrored those reported in the Western literature. Despite being limited by its cross-sectional design, this study suggests that adolescents, young adults, and older adults differ significantly in the way their borderline symptoms are expressed. The development of gender identity in adolescents with BPD and a disturbed sense of self is a neglected but potentially fruitful area of future research.https://onlinelibrary.wiley.com/doi/full/10.1002/pmh.7000
The impact of motivation on sustained attention in very preterm and term-born children: An ERP study
Full text link© The Author(s) 2025.
Creative Commons License (CC BY 4.0)
This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).OBJECTIVE: To compare the effect of motivational features on sustained attention in children born very preterm and at term. METHOD: EEG was recorded while 34 8-to-11-year-old children born very preterm and 34 term-born peers completed two variants of a cued continuous performance task (CPT-AX); a standard CPT-AX with basic shape stimuli, and structurally similar motivating variant, with a storyline, familiar characters, and feedback. RESULTS: Higher hit rates, quicker response times and larger event-related potential (ERP) amplitudes were observed during the motivating, compared with the standard, task. Although groups did not differ in task performance, between-task differences in ERPs associated with orienting were larger in term-born than very preterm children. CONCLUSION: The findings add to previous evidence of disruption to the brain networks that support salience detection and selective attention in children born preterm. Manipulations that increase intrinsic motivation can promote sustained attention in both term-born and very preterm children.https://journals.sagepub.com/doi/10.1177/1087054725131388
Oculomotor function in children and adolescents with autism, ADHD or co-occurring autism and ADHD
Full text link© The Author(s) 2025
Open Access This 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
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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/Oculomotor characteristics, including accuracy, timing, and sensorimotor processing, are considered sensitive intermediate phenotypes for understanding the etiology of neurodevelopmental conditions, such as autism and ADHD. Oculomotor characteristics have predominantly been studied separately in autism and ADHD. Despite the high rates of co-occurrence between these conditions, only one study has investigated oculomotor processes among those with co-occurring autism + ADHD. Four hundred and five (n = 405; 226 males) Australian children and adolescents aged 4 to 18 years (M = 9.64 years; SD = 3.20 years) with ADHD (n = 64), autism (n = 66), autism + ADHD (n = 146), or neurotypical individuals (n = 129) were compared across four different oculomotor tasks: visually guided saccade, anti-saccade, sinusoidal pursuit and step-ramp pursuit. Confirmatory analyses were conducted using separate datasets acquired from the University of Nottingham UK (n = 17 autism, n = 22 ADHD, n = 32 autism + ADHD, n = 30 neurotypical) and University of Kansas USA (n = 29 autism, n = 41 neurotypical). Linear mixed effect models controlling for sex, age and family revealed that children and adolescents with autism + ADHD exhibited increased variability in the accuracy of the final saccadic eye position compared to neurotypical children and adolescents. Autistic children and adolescents demonstrated a greater number of catch-up saccades during step-ramp pursuit compared to neurotypical children and adolescents. These findings suggest that select differences in saccadic precision are unique to autistic individuals with co-occurring ADHD, indicating that measuring basic sensorimotor processes may be useful for parsing neurodevelopment and clinical heterogeneity in autism.https://link.springer.com/article/10.1007/s10803-024-06718-
COLOFIT: Development and internal-external validation of models using age, sex, faecal immunochemical and blood tests to optimise diagnosis of colorectal cancer in symptomatic patients
Full text linkBackground: Colorectal cancer (CRC) is the third most common cancer in the United Kingdom and the second largest cause of cancer death. Aim(s): To develop and validate a model using available information at the time of faecal immunochemical testing (FIT) in primary care to improve selection of symptomatic patients for CRC investigations. Method(s): We included all adults (>= 18 years) referred to Nottingham University Hospitals NHS Trust between 2018 and 2022 with symptoms of suspected CRC who had a FIT. Predicted 1-year CRC diagnosis were calculated, and externally validated, using Cox proportional hazards modelling with selected multiple fractional polynomial transformations for age, faecal haemoglobin concentration (f-Hb) value, mean corpuscular volume (MCV), platelet count and sex. Result(s): At a CRC risk threshold of 0.6% (equivalent to f-Hb = 10 mug Hb/g (mug/g)) overall performance of the validated model across age strata using Harrell's C index was >= 0.91% (overall C-statistic 93%, 95% CI 92%-95%) with acceptable calibration. Using this model yields similar numbers of detected and missed cancers, but requires ~20% fewer investigations than a f-Hb >= 10 mug/g strategy. For approximately 100,000 people per year with symptoms of suspected CRC, we predict it might save > 4500 colonoscopies with no evidence that more cancers would be missed if we used our model compared to using FIT f-Hb >= 10 mug/g. Conclusion(s): Including age, sex, MCV, platelets and f-Hb in a survival analysis model to predict the risk of CRC yields greater diagnostic utility than a simple binary cut off f-Hb >= 10 mug/g.Copyright © 2025 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.https://doi.org/10.1111/apt.1845
Building a pan-European network to bridge gaps in geriatric medicine education: The PROGRAMMING COST Action 21,122-a call for endorsement
Full text linkBackground: The growing challenges of population aging create a pressing need for specialized geriatric medicine services to effectively address the complex health needs of older adults and influence supportive healthcare policies. Older patients may present clinical complexity with multimorbidity, disability, and/or frailty, necessitating a shift from the traditional organ-oriented clinical approach to a holistic, patient-centered care model. Rationale of the action: Despite recommendations from the World Health Organization and scientific and professional societies, geriatric medicine is not universally recognized as a distinct specialty in Europe, and education in this field remains heterogeneous. A notable discrepancy in the availability of geriatric services and education in this field across European countries can be found. Many healthcare professionals lack basic training in geriatric medicine, contributing to fragmented care and poorer health outcomes. To address these challenges, it is essential to integrate geriatric medicine into undergraduate and postgraduate curricula for all healthcare professionals. Expected outcomes: The COST Action 21,122 PROGRAMMING (PROmoting GeRiAtric Medicine in countries where it is still eMergING) initiative aims to promote geriatric medicine by developing targeted educational goals and programs and fostering interdisciplinary collaboration. This initiative aims to assess the current state of geriatric medicine education and identify both global and local educational needs for developing clinical skills among healthcare professionals. In addition, it seeks to establish consensus on core curricula tailored to local contexts and disseminate findings and recommendations to stakeholders, policymakers, and the public. By uniting diverse stakeholders, PROGRAMMING aspires to create sustainable changes in geriatric care across Europe.Copyright © The Author(s) 2025.https://doi.org/10.1007/s41999-024-01137-
Connectivity guided intermittent theta burst stimulation versus repetitive transcranial magnetic stimulation in moderately severe treatment resistant depression: the BRIGhTMIND RCT
Full text linkCopyright © 2025 Morriss et al. This work was produced by Morriss 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 Transcranial magnetic stimulation may lead to short-term improvement in depression symptoms. Pilot work suggested that personalised magnetic resonance imaging connectivity-guided intermittent theta burst stimulation might lead to sustained improvement in depression symptoms in treatment-resistant depression. Objectives To determine the efficacy, acceptability, and cost-effectiveness of connectivity-guided intermittent theta burst stimulation over 8, 16 and 26 weeks on depression symptoms (Hamilton Rating Scale for Depression-17) compared with repetitive transcranial magnetic stimulation. To explore the mechanism of action of transcranial magnetic stimulation through effective and functional connectivity, and gamma-aminobutyric acid and glutamate+glutamine in the prefrontal cortex, subgenual anterior cingulate cortex and right anterior insula. Design A multicentre parallel group, double-blind, randomised controlled trial, to test the efficacy of connectivity-guided intermittent theta burst stimulation versus repetitive transcranial magnetic stimulation without connectivity guidance, in patients with moderate to severe treatment-resistant major depressive disorder (treatment-resistant depression). Setting Secondary care mental health services across five study sites. Participants Aged 18 years or over with major depressive disorder, Massachusetts General Hospital Treatment Resistant Depression staging score ≥ 2, and Hamilton Rating Scale for Depression-17 score ≥ 16. Exclusions: bipolar disorder, secondary depression, suicidality, current substance abuse or dependence, neurological conditions, prior brain surgery, major unstable medical illness, standard contraindications to magnetic resonance imaging, change in prescribed medication or benzodiazepines or hypnotics ≥ 5 mgdiazepam equivalents daily in 2 weeks before baseline. Trial interventions In total 3000 pulses were delivered in each 37.5-minute repetitive transcranial magnetic stimulation or connectivity-guided intermittent theta burst stimulation session for 20 sessions over 4–6 weeks. Personalised transcranial magnetic stimulation stimulation targets were identified from magnetic resonance imaging (F3 site for repetitive transcranial magnetic stimulation, maximum effective connectivity from right anterior insula to left dorsolateral prefrontal cortex for connectivity-guided intermittent theta burst stimulation) using neuronavigation to deliver transcranial magnetic stimulation. Main outcome measures The primary outcome measure was mean change in depression symptoms from baseline and at 8, 16 and 26 weeks using the Grid version of the Hamilton Rating Scale for Depression-17. Secondary outcomes were response, remission, sustained response, self-rated depression (Patient Health Questionnaire-9, Beck Depression Inventory-II), generalised anxiety-7, function (Work and Social Adjustment Scale), quality of life (Euroqol five-dimension five line), overall improvement (Euroqol five-dimension five-line scale), acceptability, with cognition (THINC-it battery), resting state functional magnetic resonance imaging and magnetic resonance spectroscopy (baseline and 16 weeks) and costs from health and society perspectives. Results A total of 255 participants were randomised (128 connectivity-guided intermittent theta burst stimulation, 127 repetitive transcranial magnetic stimulation). There were no significant differences between repetitive transcranial magnetic stimulation and connectivity-guided intermittent theta burst stimulation in the Hamilton Rating Scale for Depression-17 score [intention-to-treat adjusted mean −0.31 (95% confidence interval −1.87 to 1.24)] nor on any secondary outcome. Sustained response rates at 26 weeks were 22/127 (17.3%) repetitive transcranial magnetic stimulation, and 29/128 (22.7%) connectivity-guided intermittent theta burst stimulation. Connectivity-guided intermittent theta burst stimulation was dominant over repetitive transcranial magnetic stimulation in cost-effectiveness (0.009 greater quality-adjusted life-year gain and £180 greater cost saving to health services per individual), albeit overlapping 95% confidence interval between treatment groups demonstrates uncertainties. One serious adverse event in each group (mania, psychosis) was attributable to transcranial magnetic stimulation. Both treatments were equally acceptable. Clinical improvement was associated with measures of effective or functional connectivity between left dorsolateral prefrontal cortex and right anterior insula, subgenual anterior cingulate cortex and left dorsomedial prefrontal cortex, and spectroscopy baseline gamma-aminobutyric acid. Limitations Participants may have benefited from > 20 transcranial magnetic stimulation sessions. There was no sham control group. Conclusion Connectivity-guided intermittent TBS was not superior in efficacy to standard repetitive transcranial magnetic stimulation. Magnetic resonance imaging neuronavigation personalised repetitive transcranial magnetic stimulation or intermittent theta burst stimulation are acceptable methods to reduce depression symptoms over 26 weeks in treatment-resistant depression alongside other reasons for improvement. Study registration Current Controlled Trials ISRCTN19674644. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 16/44/22) and is published in full in Efficacy and Mechanism Evaluation; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.https://www.journalslibrary.nihr.ac.uk/eme/WVNY5029#g
Close to the comfort zone : stakeholders' perspectives on implementing leisure activities in dementia and eldercare
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: This study aimed to explore stakeholders' perspectives on implementing non-digital leisure activities to promote social interaction in dementia and eldercare settings. METHODS: A secondary analysis of online semi-structured interviews was conducted, focusing on nine stakeholders with expertise in dementia and eldercare. The data collected were analyzed using inductive qualitative thematic analysis to identify key themes and insights. RESULTS: Three key themes emerged, emphasizing inclusivity, usability, and context. Stakeholders highlighted the importance of tailored activities, ease of use, and privacy. Challenges included resource allocation and availability. The findings underscore the significance of supporting innovations in both digital and non-digital leisure activities within dementia and eldercare settings. Clinicians and policymakers should consider integrating inclusive activities into care plans to enhance social interaction for older adults. Future research should focus on identifying optimal levels of engagement and evaluating the effectiveness of leisure activities in promoting well-being among older adults in diverse settings. CONCLUSION: Despite current limitations, stakeholders affirmed the value of non-digital leisure activities, such as board games, for enhancing social interaction and well-being in dementia and eldercare settings. Integrating non-digital and digital activities was seen as promising for meeting diverse needs.https://www.mdpi.com/2076-328X/15/3/347#:~:text=Conclusion%3A%20Despite%20current%20limitations%2C%20stakeholders,promising%20for%20meeting%20diverse%20needs
Black psychiatrists' experience of discrimination and related behaviours in the workplace : UK survey
Full text link© The Author(s), 2025. Published by
Cambridge University Press on behalf of
Royal College of Psychiatrists. This is an
Open Access article, distributed under
the terms of the Creative Commons
Attribution licence (http://creative
commons.org/licenses/by/4.0/),
which permits unrestricted re-use,
distribution and reproduction, provided
the original article is properly cited.AIMS AND METHOD: In the UK, Black doctors experience higher levels of discrimination, bullying and harassment compared with other doctors. This study aims to explore the impact of this on perceived well-being and mental health. A UK survey of 109 Black psychiatrists asked about racism, othering, microaggressions, bullying and harassment, plus any links to career progression or mental well-being. RESULTS: Sixty-three survey participants (57.8%) had faced workplace microaggressions, 44 (40.4%) had experienced workplace bullying and 41 (37.6%) had faced workplace harassment. Forty-seven (43.1%) participants reported a detrimental impact on their mental health, with 35 (32.1%) considering quitting and 24 (22%) reporting a poorer work performance. CLINICAL IMPLICATIONS: These experiences are unacceptable and can be traumatic. The impact of racism and discrimination can also undermine effective service delivery. Barriers to reporting can prolong mistreatment and deter professional aspirations among Black psychiatrists. Collective action is needed to drastically improve the workplace environment, including the widespread institutional adoption of an anti-discriminatory stance.https://www.cambridge.org/core/journals/bjpsych-bulletin/article/black-psychiatrists-experience-of-discrimination-and-related-behaviours-in-the-workplace-uk-survey/BB841B0888F794840686F2E548E39D7
A conceptual framework outlining the use of compassionate mind training following incidents of moral injury within forensic mental health services
No full textPurpose: Forensic mental health professionals often face challenging situations that can lead to moral injury. This occurs when individuals' experiences or actions conflict with their values and moral beliefs, leading to psychological distress or discomfort. Moral injury has been shown to be linked with a plethora of adverse psychological health outcomes, and can impair both occupational and personal functioning, including the quality of care delivered to service users. Design/methodology/approach: This paper details how forensic mental health professionals can respond to threat-based thinking, emotions and self-criticism using compassion following incidents of moral injury with compassionate mind training (CMT). Finding(s): CMT has been found to alleviate psychological distress and support development of soothing capabilities (Gilbert and Procter, 2006). Practical implications: This paper describes the central tenets of CMT and how it supports the balancing of three motivational systems: threat, drive and soothing systems. Originality/value: It further highlights the three flows of compassion: compassion from others, compassion towards others and compassion for self and how this can influence staff well-being in relation to moral injury. Copyright © 2025, Emerald Publishing Limited.https://www.emerald.com/insight/content/doi/10.1108/jfp-11-2024-0067/full/htm