RSS 1.0Northamptonshire Healthcare NHS Foundation Trust
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Ambulatory, Therapy, Diabetes Services
Including Podiatry and Dental -
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Includes Child and Adolescent Mental Health Services and ADHD/Autism - child and adult -
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Includes: Innovation, Research and Clinical Effectiveness, Education and Training, Occupational Health and Wellbeing
Recent Submissions
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The experience and impact of a Fitbit-based physical activity and sleep hygiene intervention for older adults experiencing cognitive declineObjectives: This study aimed to understand the experience and impact of a physical activity and sleep wrist-worn tracker (Fitbit)-based healthy lifestyle intervention for older patients attending a memory assessment service, who are experiencing cognitive impairment but do not receive a dementia diagnosis. Methods: A qualitative design was employed. Semi-structured interviews were conducted with a purposeful sample of thirteen participants recruited from a memory assessment service. Thematic analysis, that was data driven and inductive, was undertaken to analyse the data. Results: Two global themes were developed. “Understanding exercise and sleep as part of my lifestyle” was made up of themes representing how participants viewed exercise and sleep as part of their lifestyles in terms of acknowledging the positive impacts and the barriers to exercise and sleep. The second global theme “Understanding my experience of the healthy lifestyle intervention” was made up of themes that identified the positive impact of the intervention regarding improving health and wellbeing, enabling validation of proactive behaviours and motivation to engage in healthy lifestyle behaviours, so promoting positive behaviour change. Conclusion: Patients experiencing age-related cognitive impairment, applied and benefited from a healthy lifestyle Fitbit-based intervention to facilitate and promote physical activity, better sleep hygiene and healthy lifestyles.
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Integrating a unique leg Strengthening Device (S-Press) into physiotherapy rehabilitation practice, a qualitative examinationMuscle deconditioning due to hospitalisation is problematic, causing delayed discharges, more nursing, carer, or social service support following discharge, and possible discharge to a care home rather than the patient’s own home. Muscle deconditioning is associated with increased mortality, infections, depression, and reductions in patient mobility and ability to engage in their activities of daily living. Preserving muscle strength and function should form part of patients’ rehabilitation plans. Progressive resistance training (PRE) offers the most cost-effective way of preserving muscle strength and function; however, it is not routinely carried out in hospitals. A leg strengthening device (the S-Press) has been developed with the aim of improving access to effective PRE for adults. Using a qualitative approach, thematic analysis of interviews with physiotherapists, patients, and relative carers about their experience of using the S-Press provided insight into integrating PRE into patients’ rehabilitation, what promoted or prevented its use, and the outcomes associated with its use. Four overall themes emerged from the data. “Experience of Users” described that the S-Press was accessible, convenient, time efficient, portable, and manoeuvrable, and it provided an objective measure of progress. “Facilitators” included findings around how the S-Press was easy to use, motivational, and comfortable when in use. “Barriers” comprised the inability of some patients to use the S-Press independently and the identification of obstacles that prevented consistent use. “Impact and Benefits” represented the perceptions of increased leg strength and psychological benefits. The S-Press is beneficial for patients’ rehabilitation by offering PRE that is simple and easy to use, acceptable to both patients and professionals, and can be integrated as part of patients’ rehabilitation plans.
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A qualitative study exploring the experience and value of flow Transcranial Direct Current Stimulation (tDCS) and behaviour therapy training software used at home for Community Mental Health Team (CMHT) patients with symptoms of depressionBackground: Flow FL-100 is a self-administered transcranial direct current stimulation (tDCS) device with evidence of effectiveness in treating symptoms of depression. The Flow intervention also provides access to software application delivered wellbeing behaviour therapy training. Flow was offered by a community mental health team (CMHT) to those who experienced depressive symptoms. Participants completed six weeks use of Flow. This study explored participants’ experiences and views on feasibility, acceptability, useability, and value of Flow. Methods: A qualitative methodological approach was employed, involving in-depth semi-structured interviews. Interpretative Phenomenological Analysis (IPA) was applied. Out of a sample of 27 participants using Flow, 14 participants, seven females and seven males consented to be interviewed. The age range was 21 - 63 years (M = 40.21, SD = 13.99). Results: There was support for the feasibility, acceptability, useability and value of Flow. Most participants used Flow as per standard protocol and described a positive impact on depressive symptoms, mood, motivation, and functioning. Conclusion: Flow has been successfully integrated into a CMHT depression treatment. It is important to offer CMHT patients an evidenced-backed alternative to existing depression treatments (anti-depressant medication and psychotherapies). The results support the use of Flow as a treatment option for CMHT patients with symptoms of depression.
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Palpation-Guided Intra-articular Injection of the First Metatarsophalangeal Joint: injection technique and safe practice for novice practitionersInjection of a glucocorticoid for the relief of vertebrogenic, arthritic and radiculopathic pain is widely accepted. Diarthrodial joints are especially well suited to intra-articular injection, and the local delivery of therapeutics in this fashion brings several potential advantages to the treatment of a wide range of arthropathies. Injectable glucocorticoids are used in the first metatarsophalangeal joint (1st MTP jt) to treat various forms of joint pathology such as osteoarthritis (hallux rigidus) and gout, but no standard protocol for injection of this joint exists. In their document 'Promoting Safer Use of Injectable Medicines' the National Patient Safety Agency identified a number of latent system risks and produced a series of templates for prescribing, preparing and administering injectable medicines. The two aims of this paper are to promote injection technique safety and to offer a palpation-guided 1st MTP jt injection technique, prior to further work which will be undertaken to validate injection placement accuracy. Copyright © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature.
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Impact of dualism on the perception of treatability in psychiatryBackground: A false division between mental and physical disorders is supported by dualism, contributing to mental health stigma. There is a widespread misconception about the prognosis and treatment options for psychiatric diseases. This is despite data supporting the effectiveness of psychiatric treatments for a variety of illnesses that have been proven by meta-analysis. In general, the efficacy of drugs used to treat physical problems and psychiatric disorders is comparable. Method(s): In this article, experts from a variety of fields-including psychiatry, primary care, and general medicine-highlight how the paradigms based on dualism play a crucial role in maintaining the myths regarding psychiatric disorders, particularly those that relate to their treatability in comparison to physical health conditions. Result(s): There are numerous similarities between mental and physical problems in terms of the causes and treatment. Healthcare, like other complex human systems, is rife with uncertainty. In actuality, the severity and treatability of both physical and mental diseases range widely. Treatment response varies from person to person. There are certain physical and mental health disorders that respond well to treatment, some that do not, and some for which there are currently no effective cures. Conclusion(s): We believe that dualism, which promotes the separation of mental and physical phenomena, is the core driving force behind these misconceptions. These fallacies, in our opinion, are primarily motivated by dualism, which advocates the division of mental from physical occurrences. Copyright © 2025 Latoo, Mistry, Alabdulla, Jan, Shariful Islam, Iqbal, et al.
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Guidelines to Assist in Autism Diagnostic Assessments with Females: A Delphi Study.Purpose: While growing evidence highlights the challenges faced by autistic females during diagnostic assessments, it remains unclear how well this research is applied in clinical practice. This study aimed to gather consensus among clinicians on recommendations for autism assessments to improve diagnostic validity for cis-gendered females. Method(s): A three-round Delphi study was conducted with registered healthcare professionals experienced in conducting autism diagnostic assessments with females. Result(s): Thematic analysis of Round 1 responses identified five themes: Attributes of the Assessor, Post-Clinical Qualification Education and Learning, Diagnostic Tools, Questions Asked, and Sources of Information. These themes produced 28 statements evaluated in Rounds 2 and 3. Eighteen reached 80% consensus in the final round. Experts emphasized the important of assessors having strong knowledge of research into autism in women, co-occurring conditions, other developmental conditions, and masking. Ongoing professional development on autism in women was considered essential and it was recommended that new assessors shadow female assessments. Experts agreed the ADOS-2 is not always useful for females, whereas screening tools can provide valuable narrative insights, though these need to be interpreted carefully due to potential male bias. Experts supported including more prompts to explore subtle differences in social communication and repetitive patterns of behaviour and stressed the importance of masking behaviours and experiences across different relationships. Masking should also be considered when interpreting informant information. Conclusion(s): Findings reveal inconsistencies in how clinicians consider sex-related factors in autism assessments, highlighting the need for formal guidance. The next steps will be to develop this guidance, incorporating research evidence, the perspectives of autistic women and girls, and Delphi results. This aims to improve the experience, and accuracy of diagnosis for girls and women undergoing autism assessment, increasing consistency across services, and supporting clinicians. Copyright 2025, Mary Ann Liebert, Inc., publishers.
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Post-COVID Rehabilitation Service: COVID-19 Yorkshire Rehabilitation Scale (C-19 YRS) and Health-Related Quality of Life EuroQol Five-Dimensional Five-Level Questionnaire (EQ-5D-5L) Outcomes.Background: In the United Kingdom (UK) long COVID symptoms are defined as symptoms that are unexplained by an alternative diagnosis and persist for more than 12 weeks after acute COVID-19. Long COVID services have been commissioned in the UK to respond to patient needs. Purpose/Aim: To investigate whether a post-COVID rehabilitation service and its interventions have a positive impact on patients’ outcomes as measured by the COVID-19 Yorkshire Rehabilitation Scale (C-19 YRS) and the EuroQol five-dimensional, five-level questionnaire (EQ-5D-5L) health-related quality of life scale. Methods: A retrospective investigation was conducted using routinely collected data (baseline and a 12-week follow-up) from service users of a post-COVID rehabilitation service. Twenty-one EQ-5D-5L and thirty C-19 YRS datasets were collected. Results: There was a significant improvement in symptom severity on the C-19 YRS score from baseline (M = 19.57, SD = 6.41) to 12-week follow-up (M = 17.13, SD = 7.60), with a medium effect size. There was a significant improvement in functional disability on the C-19 YRS score from baseline (M = 8.14, SD = 4.20) to 12-week follow-up (M = 7.17, SD = 4.38), with a small-medium effect size. There was an improvement in C-19 YRS “overall health”, but this was not statistically significant. The EQ-5D-5L dimension of “usual activities” improved, with a significant decrease in issues reported from baseline (M = 3.19, SD = 1.03) to follow-up (M = 2.86, SD = 1.24), with a small-moderate effect size. The EQ-5D-5L dimension “mobility issues” improved; participants reported mild to moderate issues (level 2) at baseline and no issues (level 1) at follow-up. Conclusion: The results show that a post-COVID rehabilitation service can have a significant positive impact on symptoms of long COVID and real-world functioning. It is essential that treating long COVID symptoms remains a healthcare priority. As there is a move away from specific long COVID services there is a need for effective services for tackling long-term conditions and symptoms that have occurred due to COVID-19.
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Automated virtual reality cognitive therapy versus virtual reality mental relaxation therapy for the treatment of persistent persecutory delusions in patients with psychosis (THRIVE): a parallel-group, single-blind, randomised controlled trial in England with mediation analysesBACKGROUND: Persecutory delusions are a major psychiatric problem that often do not respond sufficiently to standard pharmacological or psychological treatments. We developed a new brief automated virtual reality (VR) cognitive treatment that has the potential to be used easily in clinical services. We aimed to compare VR cognitive therapy with an alternative VR therapy (mental relaxation), with an emphasis on understanding potential mechanisms of action. METHODS: THRIVE was a parallel-group, single-blind, randomised controlled trial across four UK National Health Service trusts in England. Participants were included if they were aged 16 years or older, had a persistent (at least 3 months) persecutory delusion held with at least 50% conviction, reported feeling threatened when outside with other people, and had a primary diagnosis from the referring clinical team of a non-affective psychotic disorder. We randomly assigned (1:1) patients to either THRIVE VR cognitive therapy or VR mental relaxation, using a permuted blocks algorithm with randomly varying block size, stratified by severity of delusion. Usual care continued for all participants. Each VR therapy was provided in four sessions over approximately 4 weeks, supported by an assistant psychologist or clinical psychologist. Trial assessors were masked to group allocation. Outcomes were assessed at 0, 2 (therapy mid-point), 4 (primary endpoint, end of treatment), 8, 16, and 24 weeks. The primary outcome was persecutory delusion conviction, assessed by the Psychotic Symptoms Rating Scale (PSYRATS; rated 0-100%). Outcome analyses were done in the intention-to-treat population. We assessed the treatment credibility and expectancy of the interventions and the two mechanisms (defence behaviours and safety beliefs) that the cognitive intervention was designed to target. This trial is prospectively registered with the ISRCTN registry, ISRCTN12497310. FINDINGS: From Sept 21, 2018, to May 13, 2021 (with a pause due to COVID-19 pandemic restrictions from March 16, 2020, to Sept 14, 2020), we recruited 80 participants with persistent persecutory delusions (49 [61%] men, 31 [39%] women, with a mean age of 40 years [SD 13, range 18-73], 64 [80%] White, six [8%] Black, one [1%] Indian, three [4%] Pakistani, and six [8%] other race or ethnicity). We randomly assigned 39 (49%) participants assigned to VR cognitive therapy and 41 (51%) participants to VR mental relaxation. 33 (85%) participants who were assigned to VR cognitive therapy attended all four sessions, and 35 (85%) participants assigned to VR mental relaxation attended all four sessions. We found no significant differences between the two VR interventions in participant ratings of treatment credibility (adjusted mean difference -1.55 [95% CI -3.68 to 0.58]; p=0.15) and outcome expectancy (-0.91 [-3.42 to 1.61]; p=0.47). 77 (96%) participants provided follow-up data at the primary timepoint. Compared with VR mental relaxation, VR cognitive therapy did not lead to a greater improvement in persecutory delusions (adjusted mean difference -2.16 [-12.77 to 8.44]; p=0.69). Compared with VR mental relaxation, VR cognitive therapy did not lead to a greater reduction in use of defence behaviours (adjusted mean difference -0.71 [-4.21 to 2.79]; p=0.69) or a greater increase in belief in safety (-5.89 [-16.83 to 5.05]; p=0.29). There were 17 serious adverse events unrelated to the trial (ten events in seven participants in the VR cognitive therapy group and seven events in five participants in the VR mental relaxation group). INTERPRETATION: The two VR interventions performed similarly, despite the fact that they had been designed to affect different mechanisms. Both interventions had high uptake rates and were associated with large improvements in persecutory delusions but it cannot be determined that the treatments accounted for the change. Immersive technologies hold promise for the treatment of severe mental health problems. However, their use will likely benefit from experimental research on the application of different therapeutic techniques and the effects on a range of potential mechanisms of action. FUNDING: Medical Research Council Developmental Pathway Funding Scheme and National Institute for Health and Care Research Oxford Health Biomedical Research Centre. Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
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A thematic analysis of the impact of therapist attachment on intersubjectivity when working with clients with complex traumaAim The current study explored the influence of therapists' self-reported attachment strategies on their therapeutic relationships with clients. Methods Twelve therapists working with individuals with complex trauma were interviewed and Thematic Analysis was used to generate themes from the data. Results Key findings identified a distinction between the therapeutic alliance and a secure attachment, based on the relationship's capacity to tolerate rupture. The study found that therapists' own attachment strategies affected empathy towards clients and how the underlying process may be related to identification, where over-identification was unhelpful. The study also identified, how therapists responded to client anger was related to their attachment strategies. Whilst avoidant/dismissive therapists were better able to contain client anger, this had the potential to impact upon attunement. Findings challenged the widely accepted view of therapists needing a secure attachment, rather warmth and proximity elicited negative responses from some clients. An unexpected finding was therapists' motivations and identified the therapeutic relationship as meeting the needs of some therapists. Conclusions Findings reinforce the premise of counselling psychology for reflective functioning and recommend that therapists acknowledge their own attachment strategies and wounds. A better understanding into these processes may enhance the therapeutic relationship and improve treatment outcome.
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How to write an effective business caseFinances in the NHS are severely stretched, so it is essential that requests for funding are for clinically valuable, evidence-based and cost-effective initiatives that aim to improve patient care. Developing a robust business case can support nurses to present a proposed initiative to fundholders in a structured way. This article describes how to write an effective business case that can help ensure fundholders will consider a proposed initiative to be viable. • Using a structured format can enable the nurse to demonstrate their proposal in a concise, business-like manner that all stakeholders can understand. • Historically, nurses have not been supported to obtain the skills needed to develop business acumen and produce robust business cases, but they can access support provided by charities that fund NHS posts. • Writing a business case may involve several reviews to ensure the content is robust and relevant to the needs of the service and/or organisation. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might help you to write a business case relevant to your practice area. • How you could use this information to support your colleagues to write an effective business case.
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Evaluating the effectiveness of Improving Access to Psychological Therapies (IAPT) ‘Step 2’ interventions in addressing older people’s psychological distress: A service evaluation of one IAPT Service in the East MidlandsDespite evidence that Improving Access to Psychological Therapies (IAPT; now NHS Talking Therapies) interventions can be effective for older people, ageism and stigma appear to block access. This research evaluated ‘Step 2’ clinical outcomes for older people and explored ‘drop out’ and ‘stepped up’ rates in one IAPT service. Outcome measure data from 226 people who completed a Step 2 intervention in 2022 were analysed. Significance of changes of low mood and anxiety scores, and any correlation between age and degree of change were explored. Results showed Step 2 clients were significantly older than those in Step 3. For Step 2 interventions, anxiety and low mood scores were significantly lower post-therapy than pre-therapy, with large pre- to post-effect sizes. Older people showed a similar degree of change regardless of age. Disparities in access were suggested for the oldest older people, older clients from racialised backgrounds, those identifying as lesbian, gay, or bisexual, and males, with all appearing marginally under-represented in the service’s caseload. Step 2 interventions were deemed not appropriate for a significant minority. Overall, Step 2 interventions were effective for many older people, suggesting services should be promoting IAPT for adult clients, regardless of age. Future research could explore possible barriers for the oldest older people and minoritised clients, and whether alternative outcome measures may be beneficial.
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Facilitators and barriers to participation of patients with treatment resistant depression in a randomised controlled trial of two forms of personalised magnetic resonance imaging targeted transcranial magnetic stimulation (the BRIGhTMIND trial)BACKGROUND: Magnetic resonance imaging (MRI) can personalise the site of transcranial magnetic stimulation (TMS) delivered as a course of 20 sessions for treatment-resistant depression (TRD). Facilitators and barriers to a randomised controlled trial (RCT) of MRI personalised TMS is understudied. AIM: Qualitative analysis to explore facilitators and barriers behind RCT participants' experience of personalised MRI-targeted TMS in people with TRD. METHODS: Nineteen participants from the BRIGhTMIND RCT of two forms of MRI personalised TMS, completed semi-structured interviews exploring the reasons behind the uptake and experience of TMS. The sample included fifteen participants who completed the treatment course and four who declined to proceed before randomisation. Interviews were analysed using thematic analysis, co-produced between researchers and patients and public involvement contributors. RESULTS: Facilitators were "hope" regarding the treatment itself, the influence of research staff, interest in a new treatment, and altruism. Barriers were concerns about their ability to commit to the trial and the nature of the TMS itself. Throughout the themes, clinicians and researchers made a difference by explaining and setting realistic expectations of the treatment and building rapport through daily patient contact. CONCLUSION: The study highlights the importance of understanding patients' concepts and experiences of TMS. The provision of optimal information to patients twinned with offering TMS outside office hours and the most efficacious, acceptable regimes of TMS delivery may maximise participation (Trial registration number ISRCTN19674644, registered on 01/10/2018). TRIAL REGISTRATION: Trial registration: ISRCTN19674644|| http://www.isrctn.org/ ) registered on 01/10/2018. Trial Identifying numbers: CPMS 39297, IRAS 245025.
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“Well-Track” healthy lifestyle coaching in severe mental illness: a qualitative study exploring participant experience and impactBackground: Unhealthy lifestyle behaviours contribute to the poor physical health experienced by people with severe mental illness (SMI). Severe mental illness symptoms and the medications used in treatment make adopting a healthy lifestyle challenging. Intervention: Well-Track uses a wearable activity tracker and three sessions with a health coach to promote healthy lifestyle behaviour change. The tracker allows physical activity, sleep and calorie expenditure to be monitored. The coach provides personalised support and accountability through motivational interviewing, goal-setting, healthy lifestyle advice and feedback. Participants: Fifteen participants under the care of a community mental health team (CMHT) were interviewed following their completion of the intervention. They comprised 7 females, 7 males and 1 non-binary, with an age range of 21 to 62 years. Methods: Individual in-depth one-to-one interviews were conducted. The qualitative data collected were analysed using thematic analysis. Results: Participants benefitted from the combination of the activity tracker and health coaching. By setting personalised goals, monitored by the tracker and supported by the health coach, individuals increased physical activity and improved their sleep hygiene and eating habits. Participants described enhanced physical fitness and healthy weight management alongside improvements in mood, self-confidence, positive self-identity and reduced social isolation. Conclusion: Well-Track can enable healthy lifestyle changes to improve the physical and mental health and well-being of people with SMI.
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The impact of COVID-19 lockdown and post-lockdown period on acute psychiatric admissions for emotionally unstable personality disorderThe COVID-19 pandemic negatively impacted the mental health of people with emotionally unstable personality disorder (EUPD), with reports of maladaptive coping mechanisms, reduced mental health support and quality of life. In this study, the authors examine the impact of COVID-19 lockdown and post-lockdown period on acute psychiatric admission rates in an NHS Trust in people diagnosed with EUPD. In addition, the authors analyse whether patient profiles and the seasonal pattern of admission were impacted by COVID-19 in this population. The study highlights the need for preventative clinical care pathways with increased access and service responsiveness, adjusted to fit local needs at times of confinement policies and additionally more research into seasonal patterns of admission in those with EUPD.
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Thyroid dysfunction in early psychosis: improving quality of carePeople in EIP services are frequently prescribed antipsychotic medication, and often in combination with other psychotropics, all with increased risk of thyroid dysfunction. Undiagnosed and diagnosed thyroid dysfunction can have potential significant implications on both clinical outcomes and treatment for patients with early psychosis. Here, the authors present a clinical practice guideline for the management of thyroid dysfunction in EIP.
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Connectivity guided intermittent theta burst stimulation versus repetitive transcranial magnetic stimulation in moderately severe treatment resistant depression: the BRIGhTMIND RCTBackground Transcranial magnetic stimulation may lead to short-term improvement in depression symptoms. Pilot work suggested that personalised magnetic resonance imaging connectivity-guided intermittent theta burst stimulation might lead to sustained improvement in depression symptoms in treatment-resistant depression. Objectives To determine the efficacy, acceptability, and cost-effectiveness of connectivity-guided intermittent theta burst stimulation over 8, 16 and 26 weeks on depression symptoms (Hamilton Rating Scale for Depression-17) compared with repetitive transcranial magnetic stimulation. To explore the mechanism of action of transcranial magnetic stimulation through effective and functional connectivity, and gamma-aminobutyric acid and glutamate+glutamine in the prefrontal cortex, subgenual anterior cingulate cortex and right anterior insula. Design A multicentre parallel group, double-blind, randomised controlled trial, to test the efficacy of connectivity-guided intermittent theta burst stimulation versus repetitive transcranial magnetic stimulation without connectivity guidance, in patients with moderate to severe treatment-resistant major depressive disorder (treatment-resistant depression). Setting Secondary care mental health services across five study sites. Participants Aged 18 years or over with major depressive disorder, Massachusetts General Hospital Treatment Resistant Depression staging score ≥ 2, and Hamilton Rating Scale for Depression-17 score ≥ 16. Exclusions: bipolar disorder, secondary depression, suicidality, current substance abuse or dependence, neurological conditions, prior brain surgery, major unstable medical illness, standard contraindications to magnetic resonance imaging, change in prescribed medication or benzodiazepines or hypnotics ≥ 5 mgdiazepam equivalents daily in 2 weeks before baseline. Trial interventions In total 3000 pulses were delivered in each 37.5-minute repetitive transcranial magnetic stimulation or connectivity-guided intermittent theta burst stimulation session for 20 sessions over 4–6 weeks. Personalised transcranial magnetic stimulation stimulation targets were identified from magnetic resonance imaging (F3 site for repetitive transcranial magnetic stimulation, maximum effective connectivity from right anterior insula to left dorsolateral prefrontal cortex for connectivity-guided intermittent theta burst stimulation) using neuronavigation to deliver transcranial magnetic stimulation. Main outcome measures The primary outcome measure was mean change in depression symptoms from baseline and at 8, 16 and 26 weeks using the Grid version of the Hamilton Rating Scale for Depression-17. Secondary outcomes were response, remission, sustained response, self-rated depression (Patient Health Questionnaire-9, Beck Depression Inventory-II), generalised anxiety-7, function (Work and Social Adjustment Scale), quality of life (Euroqol five-dimension five line), overall improvement (Euroqol five-dimension five-line scale), acceptability, with cognition (THINC-it battery), resting state functional magnetic resonance imaging and magnetic resonance spectroscopy (baseline and 16 weeks) and costs from health and society perspectives. Results A total of 255 participants were randomised (128 connectivity-guided intermittent theta burst stimulation, 127 repetitive transcranial magnetic stimulation). There were no significant differences between repetitive transcranial magnetic stimulation and connectivity-guided intermittent theta burst stimulation in the Hamilton Rating Scale for Depression-17 score [intention-to-treat adjusted mean −0.31 (95% confidence interval −1.87 to 1.24)] nor on any secondary outcome. Sustained response rates at 26 weeks were 22/127 (17.3%) repetitive transcranial magnetic stimulation, and 29/128 (22.7%) connectivity-guided intermittent theta burst stimulation. Connectivity-guided intermittent theta burst stimulation was dominant over repetitive transcranial magnetic stimulation in cost-effectiveness (0.009 greater quality-adjusted life-year gain and £180 greater cost saving to health services per individual), albeit overlapping 95% confidence interval between treatment groups demonstrates uncertainties. One serious adverse event in each group (mania, psychosis) was attributable to transcranial magnetic stimulation. Both treatments were equally acceptable. Clinical improvement was associated with measures of effective or functional connectivity between left dorsolateral prefrontal cortex and right anterior insula, subgenual anterior cingulate cortex and left dorsomedial prefrontal cortex, and spectroscopy baseline gamma-aminobutyric acid. Limitations Participants may have benefited from > 20 transcranial magnetic stimulation sessions. There was no sham control group. Conclusion Connectivity-guided intermittent TBS was not superior in efficacy to standard repetitive transcranial magnetic stimulation. Magnetic resonance imaging neuronavigation personalised repetitive transcranial magnetic stimulation or intermittent theta burst stimulation are acceptable methods to reduce depression symptoms over 26 weeks in treatment-resistant depression alongside other reasons for improvement. Study registration Current Controlled Trials ISRCTN19674644. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 16/44/22) and is published in full in Efficacy and Mechanism Evaluation; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
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“Rediscovering what I need to do to give myself pleasure.” Trans women’s experiences of their sexualities during gender transition: an interpretative phenomenological analysisPrevious research highlights mixed findings regarding how trans people experience sexual satisfaction during and after transition. Qualitative research in particular reflects a process of psychosocial adjustment during and after transition, which reciprocally impacts sex and pleasure. The current research explores trans women’s experiences of their sexualities during gender transition. A phenomenological qualitative methodology was used, and 12 trans women aged 22–67 years old were individually interviewed about their experiences of their sexualities in 2023. Participants had varied sexualities, disabilities, and employment statuses, were mostly White, and had started hormone therapy. Interpretative phenomenological analysis was used to analyze the data. Two group experiential themes were developed, each with two subthemes: transition affords me with the confidence and comfort to explore my sexuality, and doing sexuality differently as a result of transitioning. The results have implications for supporting trans women navigating their identities during the transition by highlighting the psychosocial process of relearning and/or rediscovering their sexualities. Recommendations for future research and practitioners are discussed.
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‘We are not trained to do clinical work’: security staff providing physical restraint for NGT feeding in English paediatric wards—a qualitative multi-informant studyObjective To gain insights into the experience, and impact, of using security staff to facilitate physical restraints for nasogastric tube feeding. Design A cross-sectional design using 39 individual interviews, three online focus groups and three written submissions involving young people with lived experience (PWLE), parents/carers, paediatric staff and security staff involved in nasogastric feeding under restraint in paediatric settings in England. Qualitative semistructured interviews were transcribed and thematically analysed. Participants 53 individuals participated: seven security staff (all men); nine PWLE who experienced the intervention between the ages of 9 and 17 (all female); 20 parents (15 mothers, 5 fathers) and 20 paediatric staff (5 men, 15 women). Results Regarding the involvement of security staff, participants spoke in relation to two primary themes (1) short-term impact and (2) long-term impact. Short-term themes included that the intervention felt inappropriate and traumatic while also recognising its lifesaving nature and the fact that involving security guards preserved positive relationships with nursing staff. Longer-term themes included the development of trauma symptoms, while also acknowledging the skill development and improved professional relationships that could result from delivering the intervention. Conclusions This lifesaving clinical intervention can negatively impact security staff as much as the patient, parents/carers and paediatric staff. A prebrief and debrief should be seen as part of the ‘process’. Further research is needed to better understand what else can mitigate negative impacts.
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Nasogastric tube feeding under physical restraint: understanding the effects on parents and how to support themBackground Nasogastric tube (NGT) feeding under physical restraint is a clinical intervention that may be required when a child or young person is medically unstable secondary to restrictive eating. Aim To explore the experiences of parents when their child receives NGT feeding under physical restraint and understand the effects of this on them. Method This is a secondary analysis of data from two previous studies on NGT feeding under physical restraint – one in mental health wards and one in children’s wards – in which semi-structured interviews had been conducted with patients, staff and parents. For this secondary analysis, the authors thematically analysed 31 transcripts of interviews with parents. Findings Parents reported a range of emotions which could be conflicting in nature, notably relief and shame. In both studies, parents understood the necessity of NGT feeding under physical restraint but experienced the intervention as traumatic. They expressed empathy for staff facilitating the restraint. In the children’s wards study, some parents described conflict and damaged relationships with staff, and three parents had participated in physically restraining their child for NGT feeding. Conclusion Nursing staff should be aware that NGT feeding under physical restraint is distressing for parents. Adopting a trauma-informed framework may help to mitigate the traumatic effects on parents and, in turn, on their child.
