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Disease-Specific Questionnaire

Condition-Specific Measure

Paediatric Bipolar Disorder

Paediatric bipolar disorder (PBD) is a serious mood disorder defined by episodes of mania or hypomania and depression. It is often associated with considerable functional impairment and suicidality. The symptom overlap between attention deficit hyperactivity disorder (ADHD) and PBD creates the greatest diagnostic problems. When using broader diagnostic criteria, including bipolar not otherwise specified (BP-NOS), the rates of PBD rose to 6.7% in the US, which was significantly higher than the 2.4% reported in other countries. The diagnosis of mania requires a distinct period of abnormally and persistently elevated or expansive mood. Bipolar disorder typically presents with depressive episodes after puberty. It is a risk factor for suicide. Suicide attempts are associated with female sex, older age, earlier illness onset, more severe/episodic PBD, mixed episodes, co-morbid disorders, past self-injurious behaviour, physical or sexual abuse, parental depression, family history of suicidality and poor family functioning.

European guidelines for hypertension in 2024: a comparison of key recommendations for clinical practice.

Hypertension is the most prevalent modifiable risk factor for cardiovascular disease and for cardiovascular and all-cause mortality globally. Suboptimal control of elevated blood pressure places a substantial burden on health-care systems worldwide. Several factors contribute to this suboptimal control, such as limited awareness of hypertension, lack of appropriate diagnosis and poor control of blood pressure among those with a diagnosis. These factors can be due to patient non-adherence to treatment, inertia among health-care professionals and low uptake and implementation of clinical guideline recommendations. From 2003 to 2018, the European Society of Hypertension and the European Society of Cardiology jointly published four sets of guidelines on hypertension. However, the two societies released separate guidelines on hypertension in 2023 and 2024, respectively. These two sets of European guidelines agree on most recommendations, but some differences have been identified. In this Expert Recommendation, we highlight the key consensus recommendations from the two guidelines; compare differing approaches to the definition, classification, diagnosis and treatment of hypertension; and aim to help health-care professionals in their decision-making to improve the management of hypertension and to reduce the burden of hypertension-associated outcomes and premature deaths.

Age-adjusted natriuretic peptide thresholds for a diagnosis of heart failure in the community: diagnostic accuracy study

Asking about drug allergies: Managing antimicrobial medicines-related risks in primary care in England and Sweden.

OBJECTIVE: Penicillins are the most common cause of drug-induced anaphylaxis worldwide, yet penicillin allergy status is seldom clinically tested and therefore reliant on patient report. Managing risk of harm is fraught with uncertainties: patients may not always be truly allergic and medical records may not be accurate. The aim of this study was to investigate how conversations about drug allergy risks unfold when prescribing for common infections. METHOD: We screened 156 acute primary care consultations for adult patients presenting with upper respiratory concerns in England and Sweden to identify all cases where drug allergies were raised. Data are in British English and Swedish. We used conversation-analytic methods to make systematic observations on how the topic was initiated; the activity context; the patient's response and any subsequent mention of drug allergy; identifying recurrent patterns within and across the two datasets. RESULTS: In both datasets, drug allergies were raised in just over one third of consultations most often via questions conveying a bias towards a 'no allergy' outcome. When asked during information-gathering, the question was sometimes misunderstood as asking about allergies in general. In the majority of cases, no allergies were reported, yet patients often qualified their 'no allergy' answers displaying uncertainty. Patients who did report allergies were seldom questioned about the nature of their symptoms. Where patient allergy status was contested or neglected by doctors and brought to the interactional surface, work was done by both parties to maintain neutrality or display cautiousness around different territories of knowledge. CONCLUSION: Our analysis reveals common interactional problems faced by prescribing professionals when managing the risk of patient harm from drug allergies when recommending antimicrobials. PRACTICE IMPLICATIONS: This study has provided pre-intervention evidence for how drug allergy checking can be improved. Other simple changes may help to identify low-risk individuals for future testing.

A systematic review and meta-analysis of digital interventions targeting lifestyle factors in patients with hypertension.

Hypertension is a major risk factor for cardiovascular disease, for which the management involves both lifestyle modification (diet, exercise etc) and medication. Digital interventions (mobile applications, websites, and SMS messages) are being developed to facilitate lifestyle change, but their effectiveness remains uncertain. This review aimed to establish whether digital interventions targeting lifestyle factors are effective in reducing blood pressure in individuals with hypertension. A systematic search was run through MEDLINE, EMBASE and the Cochrane Library. 5302 records were screened for eligibility and data on the primary outcome (systolic blood pressure (SBP)) and secondary outcomes (diastolic blood pressure (DBP) and change in lifestyle factors) were extracted from eligible papers. Where sufficient data were available, meta-analysis was undertaken using a random effects model. 17 randomised controlled trials were eligible for inclusion (3040 patients). 12 studies were suitable for meta-analysis. Lifestyle change mediated by digital interventions were associated with a larger SBP reduction than controls (mean difference (MD) -2.91 mmHg; 95% confidence interval (CI) -4.11, -1.71; p value (p) <0.0001). A significant difference was also seen in DBP reduction between groups (MD -1.13 mmHg; CI -1.91, -0.35; p = 0.005). Reporting of other secondary outcomes relating to lifestyle change was too heterogenous for meta-analysis. Digital interventions targeting lifestyle factors were associated with an improvement in blood pressure in patients with hypertension, but interpretation of the results is limited by significant heterogeneity between studies. Further research is required to understand which lifestyle factors, when targeted with digital interventions, result in maximal blood pressure reduction.

Implementation of link workers in primary care: Synopsis of findings from a realist evaluation.

BACKGROUND: Social prescribing link workers formed part of the Additional Roles Reimbursement Scheme introduced into primary care in England from 2019. Link workers assist patients experiencing issues affecting their health and well-being that are 'non-medical' (e.g. lack of social connections, financial difficulties and housing problems). They give patients space to consider these non-medical issues and, when relevant, connect them to support, often within the voluntary-community-social-enterprise sector. We conducted an earlier realist review on the link worker role in primary care. We then carried out a realist evaluation, described in this report, to address the question: When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances? AIM: To develop evidence-based recommendations to optimise the implementation of link workers in primary care and to enable patients to receive the best support possible. DESIGN: A realist evaluation, involving two work packages. SETTING: Data were collected around seven link workers in different parts of England. METHODS: For work package 1, researchers spent 3 weeks with each link worker - going to meetings with them, watching them interact with patients, with healthcare professionals and with voluntary-community-social-enterprise staff. During this time, researchers had a daily debrief with the link worker, inviting them to reflect on their working day, and they collected relevant documents (e.g. job descriptions and information on social prescribing given to patients). They also conducted interviews with 93 primary care/voluntary-community-social-enterprise staff and 61 patients. As part of this work package, data on patient contact with a general practitioner before and after being referred to a link worker were collected. Work package 2 consisted of follow-up interviews (9-12 months later) with patients; 41 were reinterviewed. In addition, link workers were reinterviewed. A realist logic of analysis was used to test (confirm, refute or refine) the programme theory we developed from our realist review. Analysis explored connections between contexts, mechanisms and outcomes to explain how, why and in what circumstances the implementation of link workers might be beneficial (or not) to patients and/or healthcare delivery. RESULTS: We produced three papers from the research - one on link workers 'holding' patients, one on the role of discretion in their job, and another exploring patient-focused data and readiness to engage in social prescribing. Data from these papers were considered in relation to Normalisation Process Theory - a framework for conceptualising the implementation of new interventions into practice (e.g. link workers into primary care). By doing so, we identified infrastructural factors required to help link workers to: (1) offer person-centred care; (2) develop patients' self-confidence, sense of hope and social capital; (3) facilitate appropriate general practitioner use; (4) foster job satisfaction among those delivering social prescribing. DISCUSSION: Our research highlighted the importance of a supportive infrastructure (including supervision, training, leadership/management, clarity about the role, link workers' ability to use existing skills and knowledge and having capacity to connect with providers in the voluntary-community-social-enterprise sector) in order to produce person-centred care, to nurture hope, self-confidence and social capital among patients, to ensure they receive the right support (medical or non-medical), and to promote link workers' job satisfaction. Data showed how link workers can contribute to the offer of holistic care beyond a purely medical lens of health and illness. FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.

School experiences and self-harm in the OxWell study

What Happens to Children's Mental Health and Peer Relationships During Periods of Restricted and Unrestricted Social Interactions? Results From the Co-SPACE Study in Primary School-Aged Children (vol 1, pg 128, 2023)

Cognitive Behavioural Therapy for Children and Adolescents

Cognitive behavioural therapy (CBT) is a treatment approach based on the general notion that a psychological disorder is caused or maintained by ‘dysfunctional’ thought patterns and lack of positively reinforced adaptive behavioural coping strategies. After decades of extensive research on CBT in adult populations, CBT is now well established as an effective treatment for psychological disorders in child and adolescent populations. CBT interventions seek to break the cascade of maladaptive thoughts and feelings that lie between the cognitive distortion and the destructive behaviour. This chapter shows how the cognitive behavioural model and its clinical application may differ for children and adolescents. Children's cognitions about their social world reflect developmental histories that shape behaviour. CBT is concerned with how these cognitive processes may be altered and, when altered, if there are consequential reductions in psychiatric symptoms and improvements in social functioning.

A whole-brain voxel-based analysis of structural abnormalities in PTSD: an ENIGMA-PGC study.

Impact of weight-loss interventions on psoriasis severity: a systematic review and meta-analysis

An intensive weight loss programme with behavioural support for people with type 2 diabetes at risk of eating disorders in England (ARIADNE): a randomised, controlled, non-inferiority trial.

BACKGROUND: There are concerns that low-energy total diet replacement (TDR) programmes could trigger eating disorders, given their focus on weight and rigid dietary rules. We aimed to assess the effect of a TDR programme on eating disorder symptoms in people living with overweight or obesity and type 2 diabetes at high risk of developing an eating disorder. METHODS: In this randomised, controlled, non-inferiority trial, participants with type 2 diabetes, overweight, and eating disorder symptoms across England were randomly assigned (1:1) to a low-energy TDR programme with formula products and behavioural support delivered remotely, or usual care. In brief, the intervention comprised 12 weeks of low-energy TDR in a nutritionally complete package of soups, shakes, and bars. After the 12 weeks, the intervention continued with stepped food reintroduction (around 8 weeks) based on a low-energy, nutrient-rich diet, followed by weight maintenance advice (around 4 weeks), personalised to an individual participant's circumstances and preferences. Participants allocated to the control group received usual care for their diabetes. The primary outcome was the change in eating disorder symptoms using the Eating Disorders Examination Questionnaire (EDE-Q) global score at 6 months (programme end). Safety was determined by the incidence of cases with high suspicion of a new eating disorder. The primary outcome analysis had an upper non-inferiority margin for EDE-Q of +1 SD (0·72). People with lived experience were involved throughout the trial and provided input on study conceptualisation, protocol development, delivery of the intervention, and intervention materials. The study was registered with ClinicalTrials.gov, NCT05744232. FINDINGS: Between March 8, 2023, and Sept 12, 2023, 56 participants were randomly assigned to the intervention group (28 participants) or control group (28 participants). Participants had a mean age of 49·9 years (SD 8·1). 35 (63%) of 56 participants were women, 20 (36%) were men, and one (2%) was non-binary. 54 (96%) of participants were White and two (4%) were Asian. Participants had a mean BMI of 39·6 kg/m2 (SD 7·8) and a mean EDE-Q global score of 3·3 (0·4). 49 (88%) of 56 participants provided outcome data at 6 months and 45 (80%) at 1 year. At completion of the programme at 6 months, the mean weight loss was -13·9 kg (SD 11·2) in the intervention group and -3·7 kg (7·9) in the control group, with a between-group difference of -10·2 kg (95% CI -14·2 to -6·2). The between-group difference in the EDE-Q score was -0·8 points (-1·4 to -0·3) at 6 months, indicating non-inferiority. At 12 months, weight change was not different between groups, but non-inferiority and superiority in EDE-Q remained. No participants were suspected of having developed an eating disorder. 13 adverse events were documented, of which one, a cholecystectomy, was serious. INTERPRETATION: Participation in a supported TDR programme did not worsen eating disorder symptoms in people with overweight or obesity and type 2 diabetes at high risk of developing an eating disorder. We found no evidence these programmes cause harm and a suggestion of benefit on eating disorder symptoms, independent of weight loss. FUNDING: Novo Nordisk UK Research Foundation.

GPs' perspectives on GLP-1RAs for obesity management: a qualitative study in England.

Background Effective treatments are needed for the increasing number of people living with obesity. General practitioners (GPs) are key in managing obesity within the NHS but report low confidence in available treatment options. Glucagon-like Peptide-1 receptor agonists (GLP-1RAs) have shown promise in weight management, but at the time of this study lacked commissioned primary care service pathways for this indication. Aim To explore the perspectives of NHS GPs in England on GLP-1RAs and their integration into primary care for weight management. Design and Setting Participants were GPs practising in England, recruited through purposive sampling to reflect diverse geographical and socioeconomic contexts. Method 25 semi-structured interviews, conducted April-July 2024, were thematically analysed. Results Participants generally held positive views about the implementation of GLP-1RAs for weight management in primary care, however this was joined by hesitations about resource limitations. Navigating consultations with patients asking for prescriptions, or support with private use, often posed difficulties. Concerns included that GLP-1RAs could detract from tackling the broader determinants of obesity. Participants also worried that the medications could be misused, ultimately becoming an overly simplistic solution for patients, practitioners, and the wider health system. Conclusion Our findings suggest that while GPs view GLP-1RA integration as a valuable therapeutic option for primary care obesity management, they have concerns about this being done well. To strengthen GP support for implementation, it is essential to recognise the need for adequate resources and ensure that GLP-1RAs are integrated into a holistic strategy for addressing obesity.

Severe Dietary Energy Restriction for Compensated Cirrhosis Due to Metabolic Dysfunction-Associated Steatotic Liver Disease: A Randomised Controlled Trial.

BACKGROUND: Compensated cirrhosis due to metabolic dysfunction-associated steatotic liver disease (CC-MASLD) increases morbidity and mortality risk but has no aetiology-specific treatment. We investigated the safety and efficacy signals of severe energy restriction. METHODS: In this randomised controlled trial, adults with CC-MASLD and obesity in a tertiary hepatology centre were randomised 2:1 to receive one-to-one remote dietetic support with a low-energy (880 kcal/day, 80 g protein/day) total diet replacement programme for 12 weeks and stepped food reintroduction for another 12 weeks or standard of care (SoC). Given the exploratory nature of the study, three pre-defined co-primary outcomes were used to assess safety and efficacy signals: severe increases in liver biochemistry, changes in iron-corrected T1, and changes in liver stiffness on magnetic resonance elastography. Changes in liver steatosis on magnetic resonance imaging, physical performance based on the physical performance test and liver frailty index, and changes in fat-free mass were secondary outcomes. Magnetic resonance outcomes were assessed blind. RESULTS: Between February 2022 and September 2023, 17 participants (36% female, median [IQR] age 58 [7.5] years) were randomised to SoC (n = 6) or intervention (n = 11). The trial stopped earlier than planned due to slow recruitment rate. 91% and 94% of participants completed the intervention and attended the 24-week follow-up, respectively. Compared with the SoC, the between-group weight change in the intervention was -11.9 kg (95% CI: -17.2, -6.6, p 

Stakeholder understanding of social prescribing in England: a qualitative study in primary care.

BackgroundSocial prescribing (SP) seeks to support patients' wider needs by connecting them to non-medical community resources. Link workers (LWs) facilitate SP's delivery across the National Health Service (NHS) in England. As a concept, SP may be perceived in different ways by various stakeholders. This study set out to explore how SP is understood among healthcare professionals (HCPs), voluntary and community sector (VCS) representatives, LWs, and patients (Ps) in England.MethodsA secondary qualitative analysis was conducted using interview data from a realist evaluation on the implementation of LWs in primary care. Interview data from 106 participants (HCPs, VCS representatives, LWs, Ps), across seven sites in England, were analysed using reflexive thematic analysis.ResultsAnalysis resulted in 127 codes. These were clustered into the following themes: (1) the need for system optimisation, (2) SP as a tool for personal empowerment, (3) SP's broad and inclusive nature, (4) community engagement through LWs, and (5) a holistic approach to well-being. These themes highlight SP's potential as an integrated and empowering ecosystem; requiring effective collaboration and clearer communication among stakeholders to enhance understanding of its purpose, streamline referral processes, and align expectations for greater impact. Understanding of SP could be related to five broad questions around how, who, what, where, and why; the themes produced from the analysis aligned with these questions, each exploring different dimensions of SP. Through this, we developed the 5Ws Framework, which is outlined in the paper.ConclusionsSP is not a standalone intervention; it is a complex system that requires optimisation and balance across its elements. Its effectiveness as an integrated empowerment ecosystem depends on addressing all facets of the 5Ws-how, who, what, where, and why it operates-engaging the right stakeholders, clearly defining its scope, and implementing it appropriately. Policymakers and commissioners could use the 5Ws Framework to guide decision-making, align health system priorities, and ensure the effective integration of SP within primary care.

Intervention development and optimisation of a multi-component digital intervention for the monitoring and management of hypertensive pregnancy: the My Pregnancy Care Intervention.

BACKGROUND: Hypertensive disorders of pregnancy affect around 10% of pregnancies and remain a major cause of maternal and foetal morbidity and mortality. Trials have shown that self-monitoring blood pressure during pregnancy is safe, but self-monitoring alone does not improve blood pressure control or pregnancy outcomes. This study aimed to develop and optimise a multicomponent intervention to support blood pressure monitoring, hypertension management and urine testing within current care pathways. METHODS: Relevant literature, input from patient and public contributors (PPI) and stakeholder groups, and the researcher's previous experience were used to develop an initial intervention. Think-aloud interviews and focus groups with women from diverse backgrounds with lived experience of hypertension in pregnancy and healthcare professionals provided feedback on the intervention prototype (n = 29). The MRC Framework for Developing Complex Interventions guided the processes to optimise the intervention's acceptability and maximise engagement. A detailed tabulation of participants' views and logic models was produced using the COM-B model of Behaviour Change. RESULTS: The prototype intervention was acceptable and viable to both pregnant women with experience of hypertensive pregnancy and healthcare professionals. Emerging themes centred on how the intervention could be optimised within current National Health Service care pathways and the lives of pregnant women to support behaviour change. Key target behaviours to support the intervention included increasing understanding of blood pressure management, engagement with the intervention, monitoring blood pressure and urine and taking appropriate actions based on those readings. This informed the development of recommendations involving clear action timelines for women and evidence-based guidance to support decision-making by healthcare professionals. The findings were used to produce the multi-component My Pregnancy Care intervention, consisting of a smartphone application and an information leaflet to support blood pressure self-monitoring and proteinuria self-testing, self-management of antihypertensive medication and smartphone application use. CONCLUSIONS: This research provided comprehensive insight into the needs of pregnant women with hypertension and their healthcare teams regarding self-monitoring and management of blood pressure. This supported the development of a tailored multi-component digital intervention that addresses barriers to blood pressure self-management by being user-friendly, persuasive and acceptable. It is hoped that the intervention will support the monitoring and management process, collaboration between healthcare professionals and women, clinical action and improved clinical outcomes.

Using qualitative research and the person-based approach to coproduce an inclusive intervention for postpartum blood pressure self-management.

OBJECTIVE: To coproduce an inclusive intervention for blood pressure (BP) self-management post partum. DESIGN: Using the person-based approach, an intervention was coproduced in three phases. Phase 1 entailed intervention coproduction with a diverse patient and public involvement panel and stakeholders (clinical, academic, government and third sector-based). Phase 2 involved intervention optimisation through think-aloud interviews with former patients and clinicians. Phase 3 was user-testing followed by semistructured interviews with current patients and their clinicians. SETTING: Patients and clinicians from primary and secondary care drawn from Southern and Northern England. PARTICIPANTS: Seven former patients and 11 clinicians participated in think-aloud interviews to provide their views of intervention prototypes (phase 2). Additionally, 23 patients and 9 of their clinicians participated in semistructured interviews after using the intervention for 2 weeks (phase 3). INTERVENTION: An interactive patient app-My BP Care-and accompanying leaflet to support BP self-monitoring. These were linked to a clinician dashboard with alerts and an emailing system to facilitate appropriate titration of patient medication. RESULTS: The intervention was codeveloped following these guiding principles to ensure it was accessible and inclusive: easily comprehensible, motivating, simple and quick to use. Interview findings indicated that patient adherence to the intervention was promoted by the initial patient training conducted by the midwives, the enhanced clinical oversight they felt they received as a result of the intervention, the free BP monitor they received, reassurance they received of the medication safety for them and their baby, the intervention's simplicity and the motivating reminders they received. CONCLUSIONS: Through coproduction with a diverse group of patients and stakeholders, and optimisation through testing among further diverse patients and clinicians, we developed a multicomponent intervention that is accessible and engaging for diverse patients, compatible with prevailing clinical practice and adaptable to different clinical contexts.

Incidence and Outcomes of Intraductal Oncocytic Papillary Neoplasm-Derived Pancreatic Cancer Compared with Tubular and Colloid Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: An International Multicenter Retrospective Study.

BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer was previously categorized into tubular, colloid, and oncocytic subtypes. Intraductal oncocytic papillary neoplasms (IOPN) has long been associated with superior prognosis/indolent behavior, however, there is discordant emerging evidence. This study aimed to investigate this conflicting literature. METHODS: Patients with resected IOPN-derived and IPMN-derived pancreatic cancer were identified from six international centers. Log-rank tests compared time to (TtR) and survival after (SAR) recurrence and five-year overall survival (OS). A multivariable mixed model was used to determine hazard ratios (HR) with confidence intervals (95%CI) for five-year survival. RESULTS: Of 879 patients, 20 (2%) had IOPN-derived pancreatic cancer. Most patients had T1 (55%) or N0 (70%) disease. IOPN and colloid IPMN-derived pancreatic cancers had similar recurrence rates (25% vs. 24%), while recurrence was more common in tubular IPMN-derived pancreatic cancer (42%, p