Midlands Evidence Repository
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In children and adolescents (ages 6-17) with attention deficit hyperactivity disorder (ADHD), how does viloxazine extended-release (ER) compare with placebo or other ADHD medications in terms of improving ADHD symptoms, adverse events and treatment discontinuation rates? A systematic review
No full textAims: In this systematic review, the effectiveness and safety of viloxazine ER in the treatment of ADHD in children and adolescents aged between 6-17 years will be assessed. Method(s): This review identified articles through a systematic approach using PubMed, EMBASE, and the Cochrane Library. Randomized controlled trials with viloxazine ER in an active comparator condition versus placebo or other stimulant/nonstimulant ADHD drugs were included. The first set of outcomes for assessing efficacy was a decrease in the severity of ADHD symptoms as measured by the ADHD-RS-5 and CGI-I scales. Safety outcomes comprised comparability in the rates of adverse events and treatment discontinuation rates. Result(s): A meta-analysis showed that viloxazine ER is effective in managingADHDsymptoms compared with placebo at 10-12 weeks. Very few side effects were reported with this medication and those reported were mostly mild to moderate in nature. Mild side effects were noted to be decreased appetite, somnolence, and headache. The rates of treatment disappearance were similar compared with other oral ADHD drugs. Conclusion(s): The research implies that viloxazine ER may be useful to paediatric patients with ADHD as a new treatment approach. We hypothesize that its profile of being an NRI and 5-HT2B antagonist may be beneficial for patients who have not shown sufficient improvement with more common treatments. The use of once daily dosing of the extended release formulation may enhance compliance compared with drugs taken more than once per day. In a general manner, viloxazine ER seems to be a safe and efficacious therapy in children and adolescents affected by ADHD. Because it has a unique mechanism of action and can be taken once daily, it complements other ADHD medications well. More prospective, multicentre trials of longer duration are, therefore, required to determine the success and risks of the technique in the long run.https://www.cambridge.org/core/journals/bjpsych-open/article/in-children-and-adolescents-ages-617-with-attention-deficit-hyperactivity-disorder-adhd-how-does-viloxazine-extendedrelease-er-compare-with-placebo-or-other-adhd-medications-in-terms-of-improving-adhd-symptoms-adverse-events-and-treatment-discontinuation-rates-a-systematic-review/F7948C6FD9A76F09600D3385D66907E
Surgical site infections in the head and neck: a multicentre retrospective cohort study.
No full textOBJECTIVES: Surgical site infections (SSIs) are one of the most common post-operative complications and can be associated with significant morbidity and mortality. They place a significant burden on healthcare system. Existing guidelines are based on non-head and neck procedures. This study aims to investigate factors affecting SSIs in the head and neck. METHODS: A multi-centre retrospective cohort across otolaryngology departments in Yorkshire (Bradford, Doncaster, Hull, Leeds). All patients undergoing an operation requiring a skin incision in the year 2021 were included. Electronic patient notes were used as the data source. Data on demographics, comorbidities, smoking and alcohol use, operation undertaken, diagnosis, closure material and use of antibiotic prophylaxis were recorded. RESULTS: 827 patients were included. The mean age was 51.4 years. The rate of SSI was 4.2% (n = 34/827). 30-day mortality was 0.6% (n = 5/827). There was no significant difference in development of SSI depending on antiseptic preparation choice. Diabetes significantly increased the risk of SSI. Suture choice did not affect rate of SSI. Intravenous drug use and cardiovascular disease were not significantly associated with 30-day mortality. CONCLUSION: This is the only study that assessed the rate of SSIs in the head and neck region. The NICE guidance for antiseptic preparation choice is not applicable in the head and neck. Absorbable sutures should be used when appropriate. Peri-operative comorbidities should be optimised. For more robust evidence, a larger cohort would be recommended or a randomised controlled trial assessing individual factors can be considered. LEVEL OF EVIDENCE: - Level 3
Weighing the impact of evidence in orthopaedic trauma registries: a systematic review of national and international registry data.
Get PDFOBJECTIVES: Worldwide, there are 15 established trauma databases collecting data to better understand the patterns of injury and effectiveness of interventions, but interpreting the information is hampered by the varied approaches. The aim of this study was to determine the impact, practices, evolution in design and methods of analysis that are standardised and comparable within registries. DESIGN: A thematic analysis using a narrative synthesis was used to develop threads for future study and identify the limitations in current practice. DATA SOURCES: PubMed, Ovid, Scopus and EMBASE were searched on the 2 October 2025. At the same time, ChatGPT (Open artificial intelligence) identified the most cited articles in orthopaedic trauma registries, cross-referencing lists as a form of triangulation to aid in snowballing references. ELIGIBILITY CRITERIA: The review included 174 papers from trials and observational studies that analyse data from established trauma orthopaedic registries published in English. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included studies assessing the papers using the Strengthening the Reporting of Observational Studies in Epidemiology checklist to assess the observational and cohort studies and the Downs and Black Quality Criteria for the remaining papers. RESULTS: Outcome measures other than mortality are poorly collected, undermining the value of registries. Trauma patients reported considerable impairment 6 and 12 months after injury. Association between level of trauma care and mortality is evident for major trauma populations, but does not hold for general trauma populations. Level I trauma centres produce improved survival in severely injured, but this association could not be proven for non-fatal outcomes in general populations. There is a disparity between resources allocated to save and salvage cases within major trauma units, and hence, routine cases often have lower priority and delayed care. CONCLUSIONS: There is a need to develop a standardised and reproducible method to evaluate data quality in trauma registries. National performance guidelines and trauma centre audits are integral steps towards optimum results. Routine collection of postinjury outcome measures beyond mortality will enable the development of quality improvement metrics that better reflect patient outcomes.https://bmjopen.bmj.com/content/15/11/e10675
Navigating dementia care: a systematic review of young and young adult carers' needs and support solutions
No full textObjectives: This systematic review aimed to explore the available support and identify the unique needs of young and young adult carers of individuals with dementia. Method: A systematic review following PRISMA guidelines was conducted. Electronic databases, including PubMed, Web of Science, PsycINFO, CINAHL, and Ovid, along with Google Scholar for grey literature, were searched. A narrative synthesis approach was used to analyse the findings of the included studies. The quality of the articles was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Seven studies met the predefined inclusion criteria and were included in the narrative synthesis. Findings revealed that young and young adult carers often lack knowledge of available support services and face challenges navigating the healthcare system. Caregiving responsibilities were found to hinder educational and career aspirations, leading to social isolation and strained relationships. The support received from family, friends, and teachers was often inconsistent and inadequate. A significant finding was the lack of differentiation between young and young adult carers in the existing research, despite their distinct social care support needs. Conclusion: The limited research highlights a critical gap in the literature regarding the support and needs of young and young adult carers of people with dementia. The lack of distinction between these two groups, who receive different social care support, emphasises the need for further research to better understand their unique experiences. There is an urgent need for targeted education and support programmes that address the distinct developmental needs and challenges of this population, promoting their well-being and safeguarding their personal and educational aspirations.https://www.tandfonline.com/doi/full/10.1080/13607863.2025.256471
“Hospital at home” mental health psychiatric hospital return to the community transition support: impact on self-reported wellbeing
No full textBackground: People who are discharged from mental health psychiatric hospitals often have low average levels of wellbeing and require support to improve wellbeing, enable mental health recovery, and facilitate successful transition back into the community to prevent mental health crisis and readmission. Low levels of wellbeing are linked to worse mental health symptoms, anxiety, and depression. Intervention: Hospital at Home is a two-week intervention that provides at-home support for people who are discharged from a mental health hospital or who are at risk of a mental health crisis and hospital admission. It is a trauma-informed, behaviour-change, and strengths-based approach; staff provide individualised practical and emotional support, identifying needs and goals to help individuals stabilise, build confidence, develop and apply coping strategies, recover, self-manage, connect with community-based services and resources, and reconnect with previous social contacts and activities. Purpose/aim: This study investigated the impact of Hospital at Home on wellbeing. The study addressed the question: “What is the impact of Hospital at Home transition support on self-reported psychological wellbeing?” Methods: An open-label patient cohort design with no control group was used. Pre- and post-intervention assessments were conducted using the self-report measure, the Short Warwick–Edinburgh Mental WellBeing Scale (WEMWBS). Participants were 102 Hospital at Home clients, 28 (27.5%) males and 74 (72.5%) females. The average age of the participants was 50.1 years (range 25 to 95 years; SD = 14.8). Results: Prior to the start of participation in Hospital at Home, 89% of participants reported low wellbeing, with only 11% reporting in the normal range of wellbeing. At the end of participation in Hospital at Home, 54% reported in the normal range of wellbeing and 2% in the high range of wellbeing. SWEMWBS scores significantly improved by 5.52 points (SD = 4.05) with a very large effect size (Cohen’s d = −1.36). SWEMWBS scores significantly improved in participants with a primary diagnosis of anxiety by 5.44 points (SD = 4.14) with a very large effect size (Cohen’s d = −1.31). SWEMWBS scores significantly improved in participants with a primary diagnosis of depression by 5.28 points (SD = 3.76) with a very large effect size (Cohen’s d = −1.40). SWEMWBS scores significantly improved in participants with a primary diagnosis of schizophrenia by 6.60 points (SD = 3.79) with a very large effect size (Cohen’s d = −1.74). Conclusion: Hospital at Home was found to be beneficial in terms of improving wellbeing, which is linked to improvements in mental health. The SWEMWBS results indicate improvements in optimism, self-efficacy, calmness, coping, clarity of thinking, closer connections with others, and personal agency, which can enhance a successful return to the community, mental health recovery, and reduce the risk of relapse and readmission. Hospital at Home is relatively low-cost and can be offered by all mental health providers. Further research is justified to support roll-out.https://www.scirp.org/journal/paperinformation?paperid=14699
Peer-delivered hepatitis C testing and health screening provided in a community pharmacy setting: proof of concept
No full textIn order to reach and maintain hepatitis C virus (HCV) elimination goals, it is imperative to reach marginalized people who do not engage with traditional testing and treatment. Peer-led interventions are effective in engaging such individuals. Studies have demonstrated community pharmacy as a low-threshold setting for HCV testing, but pharmacy teams’ competing demands are a barrier to maximizing potential. This pilot project aimed to assess whether a pharmacy-based peer-led model of HCV testing was implementable, deliverable, able to engage marginalized people, and overcome pharmacy staff constraints. We implemented a peer-led HCV testing service in one community pharmacy in the Midlands, England, providing four focused phases of testing, totalling 198 h, over two years. In total, 591 tests for antibodies or RNA were undertaken, identifying 24 active infections. Subsequent phases retested 20%, 16%, and 11% of those tested in combined preceding phases. In response to feedback, phases 3 and 4 included health screening (blood pressure, cholesterol, diabetes, and nurse-performed Fibroscans®). We demonstrate engagement and the ability to identify and refer those with abnormal results to appropriate healthcare. This pilot shows that peer-led testing in the pharmacy setting can be implemented and warrants further scale up and evaluation.https://www.mdpi.com/2226-4787/13/6/15
Guillain-Barre syndrome with asymmetrical weakness in a patient with Charcot-Marie-Tooth disease type 1A
No full textA man in his 60s presented with acute, progressive right lower limb weakness, low back pain, and paraesthesia. Neuroimaging ruled out spinal cord and central pathology. Cerebrospinal fluid analysis revealed albumin-cytological dissociation, and nerve conduction studies confirmed Guillain-Barré syndrome (GBS) superimposed on Charcot-Marie-Tooth disease type 1A (CMT1A). There was no preceding infection or ganglioside antibody positivity. His weakness progressed rapidly, resulting in flaccid paralysis of the right leg. He received intravenous immunoglobulin with marked clinical improvement and regained independent mobility by follow-up. This case is notable for its atypical, asymmetrical presentation of GBS in the context of pre-existing hereditary neuropathy, posing diagnostic challenges. It contributes to the limited literature on overlapping GBS and CMT1A and reinforces the importance of early investigation and immunotherapy in non-classical cases. The case highlights that reflex loss and chronic neuropathy should not preclude consideration of acute treatable causes.https://www.cureus.com/articles/373591-guillain-barr-syndrome-with-asymmetrical-weakness-in-a-patient-with-charcot-marie-tooth-disease-type-1a#!
Reversible bradycardia and transient loss of consciousness with undiagnosed hypothyroidism: a case report
No full textHypothyroidism, or an underactive thyroid, is a common endocrine disorder characterized by insufficient production of thyroid hormones by the thyroid gland. It typically presents with non-specific symptoms and sometimes leads to serious cardiac and neurological symptoms. Due to the subtle onset, clinical recognition can be delayed. We present a case of a 62-year-old lady diagnosed with hypothyroidism presenting with bradyarrhythmia precipitating a syncopal attack. Extensive investigations were carried out to rule out a primary neurological or cardiac disorder, leading to diagnostic delays. A diagnosis of hypothyroidism is primarily established through blood tests showing an elevated thyroid-stimulating hormone (TSH) and low free thyroxine (T4) levels. Management involves long-term thyroid hormone replacement therapy, most commonly with levothyroxine, which effectively restores euthyroid status and alleviates symptoms in the majority of patients. Treating hypothyroidism in this patient led to complete symptom resolution, highlighting the importance of broadening our diagnostic approach in cases presenting with unexplained cardiovascular and neurological symptoms and emphasizes the importance of early detection and appropriate management to prevent complications.https://www.cureus.com/articles/415856-reversible-bradycardia-and-transient-loss-of-consciousness-with-undiagnosed-hypothyroidism-a-case-report#!
Patterns of antibiotic resistance in community-acquired infections: a study from a tertiary care hospital
No full textBackground: Antibiotic resistance in community-acquired infections (CAIs) has emerged as a growing global concern with serious clinical and public health implications. Rising resistance to first-line therapies is reducing treatment effectiveness, increasing healthcare costs, and contributing to higher morbidity and mortality. Objective: The objective is to evaluate the patterns of antibiotic resistance among bacterial isolates from CAIs in patients presenting to a tertiary care hospital and to assess their associated clinical outcomes to inform empirical therapy and support antimicrobial stewardship initiatives. Methodology: A descriptive observational study was conducted at the Microbiology Department of Gujranwala Medical College, Gujranwala, Pakistan, from February 11, 2024, to February 11, 2025. The study included 560 individuals with suspected CAIs who tested positive for bacterial infection. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method in accordance with Clinical and Laboratory Standards Institute guidelines. Data analysis was conducted using Statistical Package for the Social Sciences version 26 (IBM Corp., Armonk, NY). Results: Of the 560 patients, 314 (56.07%) were men and 246 (43.93%) were women; 188 patients (33.57%) were aged 18-40 years. The most common specimen was urine (n = 234, 41.79%), followed by blood (n = 112, 20.00%). The predominant pathogens were Escherichia coli (n = 216, 38.57%) and Staphylococcus aureus (n = 104, 18.57%). Among E. coli isolates, 169 (78.24%) showed resistance to ciprofloxacin and 153 (70.83%) to ceftriaxone. Methicillin-resistant S. aureus (MRSA) was identified in 67 of 104 isolates (64.42%). Multidrug-resistant (MDR) organisms were detected in 188 patients (33.57%) and were significantly associated with treatment failure (38.30%), prolonged hospital stay (53.72%), antibiotic escalation (68.62%), and inhospital mortality (11.17%). Carbapenem-resistant infections were found in 32 patients (5.71%), with a mortality rate of 28.13% (n = 9). Conclusion: This study demonstrates a high burden of MDR organisms in CAIs, with poor clinical outcomes, particularly in carbapenem-resistant and MRSA infections. These findings emphasize the urgent need for strengthened antimicrobial stewardship, continuous surveillance of resistance trends, and locally tailored empirical treatment guidelines in community healthcare settings.https://www.cureus.com/articles/408054-patterns-of-antibiotic-resistance-in-community-acquired-infections-a-study-from-a-tertiary-care-hospital#!
Perceived training needs of mental health professionals to identify and respond to domestic abuse: a qualitative study
No full textPurpose This study aims to understand the training needs of mental health professionals in early access services to inform the development of evidence-based, inclusive and trauma-informed training for identifying and responding to domestic abuse (DA) within mental health settings. Design/methodology/approach A qualitative design was used, with semi-structured interviews (n = 20) and two focus groups (n = 8; n = 4) with professionals from two National Health Service Trusts. Reflexive thematic analysis was conducted from a constructionist perspective, with themes co-developed by researchers and a lived experience advisory panel. Findings There are six key themes that were identified: (1) knowledge about diverse service users; (2) recognising signs of DA, including subtle and non-physical forms; (3) sensitive questioning techniques; (4) preference for in-person, interactive learning; (5) accessible, regular and up-to-date training; and (6) the value of lived experience in training design and delivery. Professionals expressed a need for culturally competent, skills-based training that fosters confidence in identifying and responding to DA in complex clinical contexts. Practical implications Findings provide actionable insights for service leaders and educators in developing and embedding effective DA training within mental health services. Originality/value To the best of the authors’ knowledge, this is the first UK-based qualitative study to detail the training needs of mental health professionals in relation to identification and responding to DA in mental health settings. It highlights the importance of co-designed, experiential training that integrates lived experience and contextual nuance, addressing current gaps in both content and delivery format.https://www.emerald.com/jmhtep/article-abstract/doi/10.1108/JMHTEP-09-2025-0095/1330000/Perceived-training-needs-of-mental-health?redirectedFrom=fulltex