scholarly journals BARRIERS TO THE USE OF METHYLPHENIDATE IN PAEDIATRIC NEURO-ONCOLOGY SERVICES

2022 ◽  
Author(s):  
Alex Hagan ◽  
Simon Bailey ◽  
Sarah J. Verity
Keyword(s):  
Patient Group ◽  
Intellectual Development ◽  
Evidence Base ◽  
Primary Treatment ◽  
Clinical Findings ◽  
Clinical Population ◽  
Significant Treatment ◽  
Treatment Protocols ◽  
The Uk

Background The increasing effectiveness of childhood cancer treatment has resulted in a greater number of children surviving previously incurable central nervous system tumours. This growing population of survivors report significant treatment-related difficulties, including attentional impairment associated with poor long-term intellectual development, academic attainment, and health-related quality of life. Clinical findings show benefit to attention and executive functions following methylphenidate administration. The current project explored barriers associated with use of methylphenidate in paediatric neuro-oncology services in the UK. Method Qualitative data was gathered by semi-structured questionnaire sent to clinical psychologists/neuropsychologists in 19 of the 21 NHS primary treatment oncology centres in the UK in May 2018. Thematic analytic methods were used to explore the data. Results 11 responses were received from primary treatment centres. Knowledge of the evidence base for methylphenidate in paediatric brain injury was limited. This was primarily attributable to the inadequate resource of psychology into many primary treatment centres, limiting provision to service to a restricted proportion of the patient group. Psychologists reported an interest in exploring the utility of methylphenidate in their patient group. Respondents highlighted the need for provision of accessible research summaries and treatment protocols addressing the potential use of psychostimulants, stating that these would support their team to consider expanding the interventions offered. Conclusions The development of shared resources for clinicians will be important in supporting the application of research findings to clinical practice. We anticipate national collaboration will support the advancement of intervention for the growing clinical population of long-term survivors.

scholarly journals Early intervention in psychosis: obstacles and opportunities

2005 ◽  
Vol 11 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Swaran P. Singh ◽  
Helen L. Fisher
Keyword(s):  
Early Intervention ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Early Intervention Services ◽  
Department Of Health ◽  
Short And Long Term ◽  
Intervention Services ◽  
The Uk ◽  
Early Intervention In Psychosis

By focusing therapeutic effort on the early stages of psychotic disorders, effective early intervention should improve short- and long-term outcomes. Strategies include pre-psychotic and prodromal interventions to prevent emergence of psychosis, detecting untreated cases in the community and facilitating recovery in established cases of psychosis. The evidence base for each of these strategies is currently limited, although several international trials are under way. The Department of Health in the UK has announced the intention of setting up 50 early intervention services nationally, several of which are already operational. In this article, we briefly discuss the differing ways in which early intervention is conceptualised, summarise the evidence supporting it in established cases of psychosis, suggest appropriate service models and describe two early intervention services in south-west London.

Peatland-ES-UK: a long-term, deep and holistic look at climate and management impacts on grousemoor managed UK blanket bog peatlands - carbon, water, biodiversity

2021 ◽  
Author(s):  
Andreas Heinemeyer ◽  
Anthony Jones ◽  
Tom Holmes ◽  
Abby Mycroft ◽  
Will Burn ◽  
...  
Keyword(s):  
Ecosystem Services ◽  
Evidence Base ◽  
Treatment Monitoring ◽  
Ecosystem Functions ◽  
Short Term ◽  
Blanket Bog ◽  
Long Term Monitoring ◽  
The Uk ◽  
Term Monitoring

<p>Large parts of the rather cold and wet UK uplands are dominated by peatlands, specifically blanket bogs. During most of the Holocene, those peatlands have locked away carbon for many thousands of years due to water logged conditions leading to low decomposition rates and long-term accumulation of soil organic matter as peat. Importantly, this peat accumulation not just increases carbon but also water storage and provides many other associated and vital ecosystem services to societies across the UK, such as drinking water.</p><p>However, since around 1850, much of the UK uplands have been under grousemoor management to encourage red grouse populations as part of shooting estates, including controversial drainage, heather burning, and more recently, alternative cutting. Due to the rather weak and often conflicting evidence base around impacts of such management more research is needed to unravel climate and management impacts on ecosystem functions and associated ecosystem services. Much of the controversial evidence base is based on short-term monitoring of only a few years (potentially misinterpreting short-term disturbance effects as long-term impacts), single site studies (not capturing edaphic and climatic variability) and space-for-time studies, often with different treatments located at different sites (and thus limited in their ability or even unable to disentangle confounding variables such as site environmental conditions/history from actual management impacts).</p><p>We present long-term data from a previously government-funded, and currently multi-funded and to 10 years extended, peatland management project investigating ecosystem functions from plot-to-catchment scales on three grousemoor sites across Northern England. The <strong>Peatland-ES-UK</strong> project is part of the Ecological Continuity Trust’s long-term monitoring network and is based on a Before-After Control-Impact design approach. Each of three replicated field sites consist of two paired 10 ha catchments under previous burn rotation management and part of current peatland restoration work. After one year of pre-treatment monitoring, catchments were allocated either a continuation of burning or an alternative mowing post-treatment catchment management rotation (the latter containing several 5x5 m sub-treatment monitoring plots including no management). Monitoring includes assessing hydrology, water budgets, carbon cycling, greenhouse gas emissions, peat properties, vegetation composition and key biodiversity.</p><p>We shall provide new and sometimes surprising and even challenging insights into blanket bog ecosystem functioning in an ecosystem services and habitat status context, highlighting the importance of long-term monitoring, experimental design, spatio-temporal changes and remaining uncertainties. Specifically, we shall present findings about water storage (water tables and stream flow), long-term carbon accumulation rates (peat cores), recent carbon budgets (flux chambers) and net greenhouse gas emissions (including methane). We also present some peatland model predictions around various land use impacts on past, present and future carbon storage potential. Finally, we call for a joint funding commitment across research, policy and land user organisations to ensure the continuation of such joined-up ‘real-world’ experimental and long-term monitoring work, as part of a national applied research platform network, as it provides the “gold standard” to inform evidence-based policy directly related to practitioner needs.</p>

Innovation and pragmatism required to reduce seclusion practices

CNS Spectrums ◽  
2016 ◽  
Vol 21 (6) ◽  
pp. 424-429 ◽  
Author(s):  
John Tully ◽  
Leo McSweeney ◽  
Katie-Lynn Harfield ◽  
Cindie Castle ◽  
Mrigendra Das
Keyword(s):  
Occupational Therapy ◽  
Intervention Strategy ◽  
Potential Method ◽  
Evidence Base ◽  
Therapy Program ◽  
Team Working ◽  
High Dependency ◽  
Dynamic Risk Assessment ◽  
The Uk

Seclusion may be harmful and traumatic to patients, detrimental to therapeutic relationships, and can result in physical injury to staff. Further, strategies to reduce seclusion have been identified as a potential method of improving cost-effectiveness of psychiatric services. However, developing alternative strategies to seclusion can be difficult. Interventions to reduce seclusion do not lend themselves to evaluation using randomized controlled trials (RCTs), though comprehensive literature reviews have demonstrated considerable non-RCT evidence for interventions to reduce seclusion in psychiatric facilities. In the UK, a recent 5-year evaluation of seclusion practice in a high secure UK hospital revealed reduced rates of seclusion without an increase in adverse incidents. To assess the effect of a novel intervention strategy for reduction of long-term segregation on a high secure, high dependency forensic psychiatry ward in the UK, we introduced a pilot program involving stratified levels of seclusion (“long-term segregation”), multidisciplinary feedback and information sharing, and a bespoke occupational therapy program. Reduced seclusion was demonstrated and staff feedback was mainly positive, indicating increased dynamism and empowerment on the ward. A more structured, stratified approach to seclusion, incorporating multidisciplinary team-working, senior administrative involvement, dynamic risk assessment, and bespoke occupational therapy may lead to a more effective model of reducing seclusion in high secure hospitals and other psychiatric settings. While lacking an evidence base at the level of RCTs, innovative, pragmatic strategies are likely to have an impact at a clinical level and should guide future practice and research.

scholarly journals Recruiting individuals into the HTLV cohort study in the United Kingdom: clinical findings and challenges in the first six years, 2003 to 2009

2011 ◽  
Vol 16 (46) ◽  
Author(s):  
L J Brant ◽  
C Cawley ◽  
K L Davison ◽  
G P Taylor ◽  
collective the HTLV National Register Steering Group
Keyword(s):  
Cohort Study ◽  
United Kingdom ◽  
Blood Donation ◽  
Spastic Paraparesis ◽  
Clinical Findings ◽  
T Lymphotropic Virus ◽  
The United Kingdom ◽  
Multicentre Cohort Study ◽  
The Uk

Human T-lymphotropic virus (HTLV) infection is rare in the United Kingdom (UK) and few studies are available worldwide. Following introduction of blood donation testing in 2002, a cohort of individuals could be identified and prospectively recruited to describe progression and onset of disease. Here we describe baseline characteristics of participants, and evaluate recruitment into the UK HTLV National Register over the first six years, from July 2003 to June 2009. A multicentre cohort study recruited participants from the UK blood services (recipients and donors) and specialist HTLV clinics. Almost half of the 148 participants recruited were blood donors, nine were blood transfusion recipients, 40 contacts and 29 clinic attendees (nine asymptomatic and 20 symptomatic). Most participants were HTLV-1 positive (n=115); 11 had HTLV-2 and 22 were HTLV-negative. Baseline self-completion questionnaires were received for 83%. The most commonly reported condition was a past operation/serious illness (69%). Twenty-six participants reported four or more possible signs/symptoms of HTLV-1-associated myelopathy/tropical spastic paraparesis. Recruitment into a study of a rare, long-term infection is challenging. This cohort will enable descriptions of HTLV-associated disease progression amongst people recruited from varying sources; it is the first prospective study of its kind in Europe.

Long-Term Follow-Up of Recombinant Human Erythropoietin (epoetin)Induced Pure Red Cell Aplasia (PRCA): A Comparison of Data Collected through Active and Passive Pharmacovigilance Efforts.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5319-5319
Author(s):  
Charles L. Bennett ◽  
Kenneth R. Carson ◽  
June M. McKoy ◽  
Steven M. Belknap ◽  
Stephen A. Klinge ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Reporting Quality ◽  
Pure Red Cell Aplasia ◽  
Clinical Findings ◽  
Human Erythropoietin ◽  
Transfusion Independence ◽  
And Gender ◽  
The Uk

Abstract Background: Follow-up reports describing the long-term prognosis of 47 patients with epoetin induced PRCA have been confined to a single study from France, England, and Germany, investigated through active surveillance efforts. There is concern that reporting quality may differ between active versus voluntary reporting efforts. Methods: Investigators from the Research on Adverse Drug reactions And Reports (RADAR) program compared clinical findings for epoetin-associated PRCA cases reported by voluntary surveillance efforts (n= 47) versus active surveillance (n= 47). (Verhelst et at, Lancet 2004). Recovery from PRCA was defined as transfusion independence, normalized reticulocyte count, and/or disappearance of anti-erythropoietin antibody. Results: Baseline characteristics of age and gender were similar in both the MEDWatch and active surveillance groups. The two groups were similar with respect to median age similar (67 years) and gender (70%) and follow-up duration for patients who recovered (mean of 3 months). Median follow-up was shorter for passive surveillance patients who did not recover (6 versus 11 months). Recovery rates with immunosuppression differed (39.5% for MedWatch versus 21.6% for active surveillance). Conclusions: Follow-up of active versus passive pharmacovigilance differed markedly for epoetin-associated PRCA cases in France, Germany, and the UK, in part due to differences in follow-up time. Active pharmacovigilance efforts should be supported by national health authorities. Surveillance of Rx’ed patients Active N=37 (%) Passive N=38 (%) Patients with known follow-up (%) 100 100 Recovered w/transplant 16.2 18.4 Recovered w/Immunosuppression 62.2 42.1 No recovery 21.6 39.5

scholarly journals How are nature-based solutions contributing to priority societal challenges surrounding human well-being in the United Kingdom: a systematic map

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Jan Dick ◽  
Jonathan Carruthers-Jones ◽  
Steve Carver ◽  
Anne J. Dobel ◽  
James D. Miller
Keyword(s):  
Urban Environment ◽  
Full Text ◽  
Well Being ◽  
Evidence Base ◽  
Operational Experience ◽  
Systematic Map ◽  
Policy Makers ◽  
Societal Challenges ◽  
The Uk

Abstract Background The concept of nature-based solutions (NBS) has evolved as an umbrella concept to describe approaches to learning from and using nature to create sustainable socio-ecological systems. Furthermore, NBS often address multiple societal challenges that humans are facing in the medium to long-term and as such can enhance human well-being (HWB). This study was commissioned to fulfil the need for a targeted systematic evidence map on the linkage between NBS and HWB to support focused research going forward that addresses the key knowledge needs of policy makers in the UK and beyond. Methods A consultation with policy makers and government agency staff (n = 46), in the four component parts of the UK (England, Wales, Scotland, Northern Ireland) was conducted in spring 2019. This identified four key societal challenges of operational experience lacking a scientific evidence base. Three of these challenges related to management issues: NBS cost-efficacy, governance in planning, environmental justice. The fourth challenge related to the acoustic environment (soundscape). Using systematic methods, this study searched for and identified studies that assessed NBS on HWB with regard to these four selected societal challenges. Review findings A total of 7287 articles were returned from the systematic search and screened for suitability at the level of title and abstract. A total of 610 articles passed screening criteria to warrant full text screening. Of these, 115 studies met the full text criteria for eligibility in the final systematic map database. Included studies were coded for twelve NBS interventions and ten HWB related outcome categories. Most of the evidence reviewed referred to natural, blue or green infrastructure in the urban environment and focused on economic, material and health aspects of HWB. Less than 2% of studies identified in the searches robustly reported the role of NBS actions or interventions on HWB compared with non-NBS actions or interventions Conclusion This systematic map found the evidence base is growing on NBS-HWB linkages, but significant biases persist in the existing literature. There was a bias in favour of the urban environment and restoration studies focused on conservation aspects, with only a few studies investigating the full suite of advantages to HWB that can be delivered from NBS actions and interventions. The soundscape was the least studied of the societal challenges identified as being of key importance by policy makers, with cost-efficiency the most reported. There was a lack of robust long-term studies to clearly test the potential of NBS regarding the HWB outcomes compared with non-NBS alternatives. This lack of robust primary knowledge, covering all four key societal challenges identified, confirms that the knowledge gaps identified by the policy makers persist, and highlights a clear research need for long-term, transdisciplinary studies that focus on comparisons between NBS and non-NBS alternatives

Eating disorders

2019 ◽  
pp. 313-322
Author(s):  
Agnes Ayton
Keyword(s):  
Eating Disorders ◽  
Real Life ◽  
Evidence Base ◽  
Point Of View ◽  
Hospital Treatment ◽  
Increasing Demand ◽  
The Uk ◽  
Body Mass Indexes ◽  
Physical Morbidity

There is increasing demand for inpatient treatment of severe eating disorders, both in the UK and internationally. However, hospital treatment of severe eating disorders remains controversial, mainly because of poor long-term outcomes. This chapter provides a highly relevant and clinically focused review of the complex issues involved in inpatient care of people with severe eating disorders. The main guidelines and evidence base are critically reviewed from the point of view of a real-life clinical practice dealing with people with very low body mass indexes. Evidence, or lack of it, for a range of interventions is outlined, including artificial feeding and compulsory treatment. Practical issues regarding management of weight, physical morbidity, and psychological interventions are discussed.

Structured education for people with type 2 diabetes mellitus

2011 ◽  
pp. 1811-1818
Author(s):  
Simon R. Heller ◽  
Marian E. Carey
Keyword(s):  
Type 2 Diabetes ◽  
Long Term Care ◽  
Management Education ◽  
Evidence Base ◽  
Self Management ◽  
Term Care ◽  
Structured Education ◽  
The Uk

This chapter discusses how structured self-management education has become an integral component of the long-term care of type 2 diabetes in supporting individuals to initiate and sustain effective self-management. We will briefly explore the background and context for structured education, identify and discuss its defining characteristics, and briefly comment on the evidence base as reported in the last 10 years. Finally, drawing on currently active structured self-management programmes in the UK and Europe as exemplars, we will examine the benefits of structured education in terms of the patient outcomes reported in some key research studies.

scholarly journals Healthcare workers’ perceptions and attitudes towards the UK’s COVID-19 vaccination programme

2021 ◽  
Author(s):  
Louisa Manby ◽  
Anna Dowrick ◽  
Amelia Karia ◽  
Laura Maio ◽  
Caroline Buck ◽  
...  
Keyword(s):  
Vaccination Programme ◽  
Healthcare Workers ◽  
Evidence Base ◽  
List Type ◽  
Key Factors ◽  
Framework Analysis ◽  
Telephone Interviews ◽  
Perceptions And Attitudes ◽  
The Uk

AbstractObjectivesTo explore healthcare workers’ (HCWs) perceptions and attitudes towards the COVID-19 vaccination programme in the UK, including their expectations, concerns and views on whether to promote vaccination to others. To understand the key factors shaping HCWs’ attitudes towards COVID-19 vaccination in the UK.DesignThis study was designed as a rapid qualitative appraisal integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semi-structured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis.ParticipantsInterviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies and guidelines on the vaccination programme were reviewed.ResultsThe level of uncertainty about the vaccines’ long-term safety and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HCWs felt that government decisions on vaccine rollout had not been supported by evidence-based science and this impacted their level of trust and confidence in the programme. The spread of misinformation online also impacted HCWs’ attitudes towards vaccination, particularly among junior level and Black, Asian and Minority Ethnic (BAME) HCWs. Most HCWs felt encouraged to promote vaccination to their patients and the majority said they would advocate vaccination or engage in conversations about vaccination with others when relevant.ConclusionIn order to improve HCWs’ trust and confidence in the UK’s COVID-19 vaccination programme, there needs to be clarity about what is known and not known about the vaccines and transparency around the evidence-base supporting government decisions on vaccine rollout. Effort is also needed to dispel the spread of vaccine-related misinformation online and to address specific concerns, particularly among BAME and junior level HCWs.Strengths and limitations of this studyThis is the first qualitative study to understand the factors influencing healthcare workers’ (HCWs) attitudes towards COVID-19 vaccination in the UKThis study integrated interview and policy data and captured HCWs’ perceptions and attitudes in real-time as the vaccination programme was being rolled out in the UKOur interview study sample was limited in its representation of junior level HCWs and areas of the UKThis research may have been impacted by selection bias as those with stronger views on vaccination may have been more likely to participate in the study

scholarly journals The UK Government Two-Week Rule and its Impact on Melanoma Prognosis: An Evidence-Based Study

2007 ◽  
Vol 89 (6) ◽  
pp. 609-615 ◽  
Author(s):  
MD Pacifico ◽  
RA Pearl ◽  
R Grover
Keyword(s):  
Survival Data ◽  
Surgical Excision ◽  
Time Frame ◽  
Evidence Base ◽  
Control Group ◽  
Term Survival ◽  
Pigmented Lesion ◽  
Melanoma Patients ◽  
The Uk

INTRODUCTION In order to tackle increasing waiting lists the UK Government's ‘two-week rule’ was introduced for a number of cancers, including melanoma, in 2000. Whilst there is evidence that secondary prevention (i.e. early diagnosis) improves patient outcome, particularly in melanoma where early surgical excision is the only intervention to improve survival, there is as yet no evidence base for a 2-week limit. Any survival benefit from this Government target will not be demonstrable until long-term follow-up is available, realistically 10-year mortality figures in 2010. PATIENTS AND METHODS To investigate an evidence base for the two-week rule in melanoma, we performed a retrospective study on patients with suspected skin cancers referred to a rapid access Pigmented Lesion Clinic (PLC) over a 4-year period with long-term survival data, and compared them to a historical control group. RESULTS A total of 4399 patients attended the PLC from January 1993 to December 1996 and all were seen within 2 weeks. Ninety-six melanomas were diagnosed during this period with 96% treated within 2 weeks of GP referral, the majority (74%) excised on the day of PLC attendance. Melanoma patients (n = 78) diagnosed in the 2 years prior to the inception of the PLC waited 3–34 days for consultation and 4–74 days for treatment. Melanoma patients diagnosed in the PLC had significantly thinner tumours (Mann Whitney test, P < 0.001) and improved overall survival (χ2 18.1924; P < 0.001) compared with melanoma patients diagnosed before the inception of the clinic. CONCLUSIONS This is, to our knowledge, the first example that consultation within a 2-week time-frame of GP referral impacts patient survival and the first evidence base behind Government guidelines for this particular cancer.

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