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Psychosis following phenibut-assisted withdrawal
No full textPhenibut is less frequently used in the UK compared with heroin, cocaine, crack, cannabis, ketamine or alcohol but is currently not covered by the UK drugs legislation. It is widely available on the internet, and its popularity is increasing, particularly among younger, internet-savvy patients. This case describes a patient who developed psychosis during medically assisted withdrawal from phenibut. Copyright © 2024 Wiley Interface Ltd.https://wchh.onlinelibrary.wiley.com/doi/10.1002/psb.214
Using online methods to recruit participants into mental health clinical trials: Considerations and recommendations from the RE-MIND study
Get PDF© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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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/BACKGROUND: Ensuring diversity in clinical trials can be a challenge, which may be exacerbated when recruiting vulnerable populations, such as participants with mental health illness. As recruitment continues to be the major cause of trial delays, researchers are turning to online recruitment strategies, e.g. social media, to reach a wider population and reduce recruitment time and costs. There is mixed evidence for the use of online recruitment strategies; therefore, the REcruitment in Mental health trials: broadening the 'net', opportunities for INclusivity through online methoDs (RE-MIND) study aimed to identify evidence and provide guidance for use of online strategies in recruitment to mental health trials, with a focus on whether online strategies can enhance inclusivity. This commentary, as part of the RE-MIND study, focusses on providing recommendations for recruitment strategy selection in future research with the aim to improve trial efficiency. A mixed-methods approach was employed involving three work packages: (I) an evidence review of a cohort of 97 recently published randomised controlled trials/feasibility or pilot studies in mental health to assess the impact of online versus offline recruitment; (II) a qualitative study investigating the experiences of n = 23 key stakeholders on use of an online recruitment approach in mental health clinical trials; (III) combining the results of WP1 and WP2 to produce recommendations on the use of an online recruitment strategy in mental health clinical trials. The findings from WP1 and 2 have been published elsewhere; this commentary represents the results of the third work package. CONCLUSION: For external validity, clinical trial participants should reflect the populations that will ultimately receive the interventions being tested, if proven effective. To guide researchers on their options for inclusive recruitment strategies, we have developed a list of considerations and practical recommendations on how to maximise the use of online recruitment methods.https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-024-08435-
Characteristics of positive feedback provided by UK health service users: Content analysis of examples from two databases
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employer(s)) 2024. Re-use
permitted under CC BY-NC. No
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BMJ.BACKGROUND: Most feedback received by health services is positive. Our systematic scoping review mapped all available empirical evidence for how positive patient feedback creates healthcare change. Most included papers did not provide specific details on positive feedback characteristics. OBJECTIVE(S): Describe positive feedback characteristics by (1) developing heuristics for identifying positive feedback; (2) sharing annotated feedback examples; (3) describing their positive content. METHOD(S): 200 items were selected from two contrasting databases: (1) https://careopinion.org.uk/; (2) National Health Service (NHS) Friends and Family Test data collected by an NHS trust. Preliminary heuristics and positive feedback categories were developed from a small convenience sample, and iteratively refined. RESULT(S): Categories were identified: positive-only; mixed; narrative; factual; grateful. We propose a typology describing tone (positive-only, mixed), form (factual, narrative) and intent (grateful). Separating positive and negative elements in mixed feedback was sometimes impossible due to ambiguity. Narrative feedback often described the cumulative impact of interactions with healthcare providers, healthcare professionals, influential individuals and community organisations. Grateful feedback was targeted at individual staff or entire units, but the target was sometimes ambiguous. CONCLUSION(S): People commissioning feedback collection systems should consider mechanisms to maximise utility by limiting ambiguity. Since being enabled to provide narrative feedback can allow contributors to make contextualised statements about what worked for them and why, then there may be trade-offs to negotiate between limiting ambiguity, and encouraging rich narratives. Groups tasked with using feedback should plan the human resources needed for careful inspection, and consider providing narrative analysis training. Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.https://informatics.bmj.com/content/31/1/e10111
A protocol to assess antipsychotics prescribing and physical health monitoring in children and young people: A cohort study using primary care data from QResearch [in press]
No full textAntipsychotic medicines are prescribed to children and young people (CYP) with mental health conditions such as schizophrenia, bipolar disorder, behavioural disorders, autism spectrum disorder and tics. The physical side effects of these medicines require monitoring, and this responsibility can be transferred to primary care. This study will describe the trends in antipsychotic prescribing in CYP, identify the mental health conditions, symptoms and comorbidities associated with the prescriptions, and determine the extent of physical health monitoring in primary care both for CYP prescribed antipsychotics and those with mental health conditions without antipsychotic prescriptions. The study will use data from QResearch, a large, anonymised, UK primary care electronic health record database. Records will be linked to secondary care data from hospital episode statistics and socioeconomic deprivation information. People aged 5 to 17 years, who are registered with GPs in England contributing to QResearch between 1 January 2006 and 31 July 2021 will be included. Incidence and prevalence rates will be calculated over the study period, and Poisson regression will be used to estimate incidence rate ratios. Results from this study will identify where improvements to clinical practice or to treatment guidelines may be needed.https://www.medrxiv.org/content/10.1101/2024.07.18.24310326v
Real-world clinical effectiveness of ustekinumab in the treatment of Crohn's disease in the East Midlands UK.
Get PDFObjectives To evaluate the effectiveness of ustekinumab in treating Crohn’s disease (CD) in a UK real-world setting. Design This was a multicentre, retrospective observational study of patients (aged ≥18 years) with CD or inflammatory bowel disease of unclassified type (IBDU) starting ustekinumab between 11 November 2016 and 1 August 2020 across eight English hospitals. The primary objective was to determine the proportion of patients achieving corticosteroid-free remission at week 52 for patients with CD/IBDU following initiation with ustekinumab. Corticosteroid-free remission was defined as achieving a clinical Harvey-Bradshaw Index (HBI) score of ≤4 and corticosteroid-free status. Results The analysis included 422 patients with CD/IBDU. Corticosteroid-free remission was 41% (68/166) at week 16, 41% (47/115) at week 30 and 48% (38/80) at week 52. Clinical remission was 51% (85/166) at week 16 and 50% (40/80) at week 52. Clinical response was 34% (43/125) at week 16 and 32% (17/53) at week 52. Objective remission was 40% (4/10) at week 16 and 70% (7/10) at week 52. Corticosteroid-free remission at week 52 was achieved in patients with previous exposure to 1–2 biologics and/or small oral molecules (56%; 35/63), those without surgical history (64%; 16/25), and those without penetrating disease (54%; 29/54). Patients who achieved clinical remission at week 16 were more likely to achieve corticosteroid-free remission at week 52 (70%; 14/20) versus those who did not (20%; 4/20). In total, 37 adverse events occurred in 21 patients. Conclusion This multicentre study provides real-world experience of ustekinumab in patients with CD/IBDU in England.https://fg.bmj.com/content/15/5/359.citation-tool
Contribution of inflammation markers and quantitative sensory testing (QST) indices of central sensitisation to rheumatoid arthritis pain
Get PDFBackground: Pain, the primary complaint in rheumatoid arthritis (RA), is multifaceted, and may be driven by inflammatory disease activity and central sensitisation. We aimed to ascertain what proportion of RA pain severity is explained by markers of inflammation and quantitative sensory testing (QST) indices of central sensitisation. Methods: This was a cross-sectional analysis of data from individuals with clinically active RA. Pain severity was assessed using numerical rating scales and inflammation via 28-joint Disease Activity Score (DAS28) and Ultrasound (Greyscale, Power Doppler). Pain sensitivity was assessed by 'static' (tibialis anterior or brachioradialis pressure pain detection threshold-PPT-TA/PPT-BR) and 'dynamic' (temporal summation-TS, conditioned pain modulation-CPM) QST. Bivariate associations used Spearman's correlation coefficients, and multivariable linear regression models determined relative contributions to pain severity. Results: In bivariate analyses of N = 96 (age 65 ± 10y, 77% females) people with RA, pain severity was significantly associated with inflammation indices (r = 0.20 to 0.55), and CPM (r=-0.26). In multivariable models that included TS, CPM, age, sex, and body mass index, inflammation indices remained significantly associated with pain severity. Multivariable models explained 22 to 27% of pain variance. Heterogeneity was apparent for associations with pain between subscores for pain now, strongest or average over the past 4-weeks. Conclusions: In individuals with clinically active RA, markers of inflammatory disease activity best explain RA pain with only marginal contributions from QST indices of central sensitisation. Although inflammation plays a key role in the experience of RA pain, the greater proportion of pain severity remains unexplained by DAS28 and ultrasound indices of inflammation.https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-024-03407-
Dementia risk prediction modelling in low- and middle-income countries: Current state of evidence
Get PDF© 2024 Alshahrani, Sabatini, Mohan, Brain,
Pakpahan, Tang, Robinson, Siervo, Naheed
and Stephan. This is an open-access article
distributed under the terms of the Creative
Commons Attribution License (CC BY). The
use, distribution or reproduction in other
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author(s) and the copyright owner(s) are
credited and that the original publication in
this journal is cited, in accordance with
accepted academic practice. No use,
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which does not comply with these terms.Dementia is a leading cause of death and disability with over 60% of cases residing in low- and middle-income countries (LMICs). Therefore, new strategies to mitigate risk are urgently needed. However, despite the high burden of disease associated with dementia in LMICs, research into dementia risk profiling and risk prediction modelling is limited. Further, dementia risk prediction models developed in high income countries generally do not transport well to LMICs suggesting that context-specific models are instead needed. New prediction models have been developed, in China and Mexico only, with varying predictive accuracy. However, none has been externally validated or incorporated variables that may be important for predicting dementia risk in LMIC settings such as socio-economic status, literacy, healthcare access, nutrition, stress, pollutants, and occupational hazards. Since there is not yet any curative treatment for dementia, developing a context-specific dementia prediction model is urgently needed for planning early interventions for vulnerable groups, particularly for resource constrained LMIC settings.https://www.frontiersin.org/journals/epidemiology/articles/10.3389/fepid.2024.1397754/ful
Patient experiences with a smartphone application dedicated to postoperative recovery after elective arthroplasty
No full textIntroduction In the rapidly evolving landscape of digital health technologies, the widespread use of smartphones has paved the way for innovative applications designed to enhance healthcare experiences. This introduction underscores the global prevalence of smartphone users and their potential in healthcare, particularly exemplified by therapeutic apps such as the ‘Post Op’ smartphone application. Focused on postoperative support, this app prioritises user-friendly design, data recording, and adherence to national standards. The study aims to evaluate the app's success in achieving these objectives, highlighting its continuous improvement based on real user feedback and its potential impact on improving patient experiences and recovery processes. Methods and materials A cohort of elective joint arthroplasty procedure patients at Kettering General Hospital (KGH), spanning a timeframe of one to 12 months post-surgery were surveyed over the telephone regarding their experience of the ‘Post Op’ smartphone utilising a custom, well-structured standardised questionnaire. Results The study surveyed 42 consecutive patients who had undergone elective joint arthroplasty procedures at Kettering General Hospital, including 22 total hip replacement (THR) and 20 total knee replacement (TKR) patients. The respondents, with a median age of 66 years, provided overwhelmingly positive feedback about the ‘Post Op’ smartphone application. On a scale of 1–6, the mean ease-of-use score was 5.31, with only two THR patients providing lower scores due to difficulties with photography. However, the app's overall functionality, particularly in uploading photos, received a mean score of 4.78. Despite some technical issues, 97.6 % of respondents would recommend the app, emphasising its positive impact on confidence in the recovery and reducing unnecessary healthcare visits. Narrative responses highlighted the app's simplicity, support, and prompt communication with healthcare teams. Overall, the feedback indicates a high level of satisfaction with the ‘Post Op’ application among elective arthroplasty patients, showcasing its potential benefits for postoperative care. Conclusion The study provides valuable insights into the impact of the ‘Post Op’ smartphone application on postoperative care, acknowledging both its successes and areas for enhancement. Further research and iterative improvements are crucial for optimizing patient experiences and ensuring the app aligns effectively with healthcare needs
Metoclopramide for analgesia in renal colic: a narrative systematic review.
Get PDFMetoclopramide, a prokinetic antiemetic with activity at multiple receptor types, may be a useful treatment for renal colic pain. This review investigated whether metoclopramide is an effective analgesic in the management of adults with renal colic.Eligible studies were randomised, quasi-randomised or case-control trials of metoclopramide for the management renal colic pain. Electronic database searches were performed in November 2022. Screening was performed by two authors independently; disagreement was resolved by discussion or by adjudication by a third author. The Cochrane Collaboration Risk of Bias Tool v2.0 was used to assess bias.Two studies were included, enrolling 279 patients. Heterogeneity of primary outcome measurement and comparators rendered meta-analysis inappropriate; a narrative review is presented. Both studies showed some evidence of analgesic effect. The largest study had a low risk of bias in all assessed domains, whilst the smaller study was at a high risk of bias.There is limited evidence that metoclopramide may be an effective analgesic in the management of renal colic, with the highest quality study demonstrating analgesic properties similar to an intravenous non-steroidal anti-inflammatory medication.Protocol registration Prospero (CRD42022346618)
Prevalence of Emotional and Binge Eating Among Patients With Obesity Attending a Specialist Weight Management Service for Bariatric Surgery in the United Kingdom.
No full textBACKGROUND: Emotional eating (EE) is a tendency to consume food in response to positive or negative emotions, leading to obesity and an increased Body Mass Index (BMI). Evidence supports the positive association between EE and binge eating disorder (BED), but little is known about its prevalence among patients referred for bariatric surgery and the psychological characteristics of this patient population. We aim to examine (i) the prevalence of binge eating and EE, (ii) its association with the prevalence of anxiety, depression, diabetes and hypertension and (iii) the correlation between anxiety and depression with emotional and binge eating behaviours among patients attending a regional bariatric service in the UK. METHOD: A cross-sectional case file design involving 285 participants (mean age = 43.88 ± 11.5, female (80.7%) and male (19.3%)) was used. Outcome measures included body weight, BMI, the Weight Loss Readiness (WLR) Questionnaire, Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9) and Alcohol Use Disorders Identification Test- Consumption (AUDIT-C). RESULTS: Within this patient group, the prevalence of binge eating and EE were 28.8% and 22.1% respectively. Among these, 19.3% had diabetes mellitus, 24.8% hypertension, 21% harmful alcohol use, 65% had high anxiety score and 77% high depression scores. Most correlations between body weight and variables like AUDIT-C, GAD-7, PHQ-9 scores and WLR scores for hunger, binge eating and EE were not significant. A positive association was observed between depression and anxiety with binge eating, and EE behaviours. CONCLUSION: Patients awaiting bariatric surgery have a wide range of mental and physical health comorbidities, with evidence of positive associations between higher depression and anxiety levels with abnormal eating behaviours. These findings highlight the need for screening for comorbidities in this patient population to optimise patient outcomes postbariatric surgery