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  Switching from inhaled to intravenous general anaesthesia

  Fleming, Robert

  Inhalational and intravenous medications can be used to induce and maintain general anaesthesia. In recent years, the use of total intravenous anaesthesia (TIVA) has increased.1 Although both techniques are safe, TIVA has some clinical and environmental benefits when compared with inhalational anaesthesia.
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  Real-world clinical effectiveness of ustekinumab in the treatment of Crohn's disease in the East Midlands UK.

  Ahmad, Saqib; Ashraf, Fahad; Foley, Stephen (Frontline Gastroenterology, 2024)

  Objectives 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.
• Core20PLUS5: His Majesty’s Prison and Probation Service – an approach to address inequities in healthcare for people in contact with the criminal justice system

  Lad, Sunil (2023)

  People involved in the criminal justice system are one of the population target cohorts of Core20PLUS5, a national National Health Service (NHS) England approach to support reduction of healthcare inequalities. For the health and justice system to be socially equitable, fair and just, the leadership across the health landscape has a central role to play to ensure this vulnerable group has an equitable opportunity for improved healthy life expectancy, regardless of their multiple disadvantages. On the 75th year of the inception of the NHS, this article is a call to action to bring about sustainable change through data reporting, digital innovation, accelerating preventative programmes and system leadership in order to achieve equitable access, excellent experience and optimal outcomes. It acknowledges the detrimental impact of crime and the importance of improving a range of health and social outcomes for this group.
• Birth trauma: the elephant in the nursery

  Butterworth, Sarah (2023)

  Method The current study used a multiperspectival (dyadic) IPA approach to interview eight participants (N = 4 heterosexual couples) where one parent was help-seeking for the experience of birth trauma. Results Analysis resulted in four superordinate themes: (1) From perfect plan to shattered reality, (2) Trauma in the healthcare system, (3) Trauma in the family system and (4) The post-trauma family: Navigating the new normal. Discussion Parents described a shared experience of birth trauma during birth. However, fathers’ perceived trauma ended in the delivery room whilst mothers’ continued far beyond this. The dyadic focus showed a divergence of experience postnatally: differing levels of awareness to distress existed between partners, mothers experienced bonding difficulties and parents took to separate coping mechanisms. The trauma remained invisible and unspoken as couples avoided discussions about the birth, coped silently and separately. The parents identity changed following the trauma as individuals, couples and as a family. Conclusion The time following a traumatic birth is experienced differently by mothers and fathers. Parents seldom discuss the trauma, hold differing perceptions of roles and needs, and struggle to support each postnatally. Clinical implications and recommendations are discussed.
• A service evaluation of the Behavioural Treatment for Substance Abuse (BTSA) programme for forensic dual diagnosis populations

  Scarborough, Nadja (2023)

  Literature links mental health problems comorbid with substance abuse with increased recovery time. There is limited research evaluating the effectiveness of substance abuse treatments for dual-diagnosis patients. This project aimed to evaluate the effectiveness of the BTSA group with this population. Questionnaires measuring motivation, locus of control, confidence to abstain and self-efficacy were administered to six different cohorts of BTSA participants (N = 38) at baseline, post, and follow-up stages. In addition, participants from the most recent BTSA cohort (N = 4) attended a post-program focus group, to provide information about their experiences of the intervention. Statistical analyses revealed that participants’ confidence in their ability to manage substance abuse was significantly higher post group, but the hypotheses that there would also be significant improvements in participants’ self-efficacy, motivation, and locus of control following completion of the program were not supported. Thematic analysis identified three key themes relevant to participants, namely validation, psychoeducation and identifying progress. This project provided valuable insights into participants’ experiences of the group, highlighting what they had gained form the intervention, and the impact on them from having Recovery Champions working in conjunction with NHS staff to facilitate the intervention. Limitations are discussed, alongside recommendations for improving the program.

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