RSS 1.0Northamptonshire Healthcare NHS Foundation Trust
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Ambulatory, Therapy, Diabetes Services
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Children’s Services
Includes Child and Adolescent Mental Health Services and ADHD/Autism - child and adult -
Support Services
Includes: Innovation, Research and Clinical Effectiveness, Education and Training, Occupational Health and Wellbeing
Recent Submissions
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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.
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Enteral Tube Nutrition in anorexia nervosa and Atypical Anorexia Nervosa and outcomes: a systematic scoping reviewBackground: Anorexia nervosa and atypical anorexia nervosa require refeeding as a core part of their treatment, and enteral tube nutrition (ETN) may be needed in some individuals either to supplement or replace oral nutrition. This scoping review aimed to explore outcomes associated with phases of ETN, including initial nutrition, transition from enteral nutrition to oral intake, and to overall nutrition; Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist was used. A systematic search was performed using the Ovid and the Web of Science databases, using relevant search terms identifying 37 studies to be included in the review. Quantitative and qualitative data were synthesised and presented; Results: ETN resulted in similar or higher weight gain than oral nutrition. Refeeding syndrome parameters were comparable between ETN and oral nutrition with some indication that prophylactic phosphate supported mitigation of hypophosphataemia. Global psychological parameters related to the eating disorder improved with nutrition; however, there was an indication that weight and shape concerns did not improve during this period. There was a lack of evidence related to transition from ETN to oral intake. Qualitative data indicated meanings attached to the tube, suggesting that additional support may be needed for the transition away from the tube. Furthermore, consideration may be required to support individuals in mitigating trauma related to ETN under restraint; Conclusions: ETN, when required, is a viable alternative to oral intake. Results indicated the need for further research, especially in the transition from ETN to oral intake with regard to strategies of transition and support, and outcomes related to these strategies.
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Transcranial Direct Current Stimulation (tDCS) and online wellbeing training used at home for perinatal and maternal loss patients with adiagnosis of depression: depression, real world-functioning, and quality of life outcomesBackground: There is a high prevalence of depression in the perinatal period and for women who experience maternal loss, which is linked to worse real-world functioning and quality of life. Research evidence indicates that transcranial direct current stimulation (tDCS) can reduce symptoms of depression. Flow FL-100 is a tDCS device self-administered by a patient at home in combination with a software application-delivered wellbeing behaviour therapy training. Training modules include: “Behaviour activation”, “Mindfulness”, “Exercise for your brain”, “An anti-depression diet”, and “Therapeutic sleep”. Purpose/Aim: This study is the first to introduce Flow FL-100 tDCS in combination with a software application-delivered wellbeing behaviour therapy training into a Specialist Perinatal Mental Health Service and Maternal Mental Health Service. In addition to the support and interventions provided by these services, this study investigated the impact on depression, real-world functioning, and health-related quality of life for patients diagnosed with depression. Methods: An open-label patient cohort design with no control group. Baseline and 6-week follow-up assessments were completed using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Results: Twenty-five female patients completed six weeks of tDCS treatment. Their average age was 36 years, and their ages ranged from 27 to 42 years. Reliable improvement and remission rates for PHQ-9 were 64% and 52%, respectively. PHQ-9 and WSAS scores significantly improved, with large effect sizes. EQ-5D-5L results showed significant improvements in the EQ health index score and EQ-VAS score, with medium effect sizes. Conclusion: tDCS and online wellbeing behaviour therapy training can be successfully integrated into Perinatal Mental Health Service and Maternal Mental Health Service depression treatment offer. This study’s findings provide evidence that tDCS and online wellbeing behaviour therapy training delivered in conjunction with the interventions provided by Specialist Perinatal Mental Health and Maternal Loss Psychology Services for patients with depression diagnosis can provide improvements in depression symptoms, functioning and quality of life. It is important to be able to offer an evidence-based addition and/or alternative to existing depression treatments (antidepressant medication and psychotherapies).
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Opportunities and challenges to delivering a trial for depressive symptoms in primary care during the COVID-19 pandemic: Insights from the Alpha-Stim-D randomised controlled trialBACKGROUND: Randomised controlled trials (RCTs) are widely regarded as the most powerful research design for evidence-based practice. However, recruiting to RCTs can be challenging resulting in heightened costs and delays in research completion and implementation. Enabling successful recruitment is crucial in mental health research. Despite the increase in the use of remote recruitment strategies and digital health interventions, there is limited evidence on methods to improve recruitment to remotely delivered mental health trials. The paper outlines practical examples and recommendations on how to successfully recruit participants to remotely delivered mental health trials. METHODS: The Alpha Stim-D Trial was a multi-centre double-blind randomised controlled trial, for people aged 16 years upwards, addressing depressive symptoms in primary care. Despite a 6-month delay in beginning recruitment due to the COVID-19 pandemic, the trial met the recruitment target within the timeframe and achieved high retention rates. Several strategies were implemented to improve recruitment; some of these were adapted in response to the COVID-19 pandemic. This included adapting the original in-person recruitment strategies. Subsequently, systematic recruitment using postal invitations from criteria-specific search of the sites' electronic health records was added to opportunistic recruitment to increase referrals in response to sub-target recruitment whilst also reducing the burden on referring sites. Throughout the recruitment process, the research team collaborated with key stakeholders, such as primary care clinicians and the project's Patient and Public Involvement and Engagement (PPI/E) representatives, who gave advice on recruitment strategies. Furthermore, the study researchers played a key role in communicating with participants and building rapport from study introduction to data collection. CONCLUSIONS: Our findings suggest that trial processes can influence recruitment; therefore, consideration and a regular review of the recruitment figures and strategies is important. Recruitment of participants can be maximised by utilising remote approaches, which reduce the burden and amount of time required by referring sites and allow the research team to reach more participants whilst providing participants and researchers with more flexibility. Effectively communicating and working collaboratively with key stakeholders throughout the trial process, as well as building rapport with participants, may also improve recruitment rates.
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Polyarthralgia with oral risperidone.Risperidone is a commonly used antipsychotic. Due to its widespread use, health professionals are well aware of its common side-effects. However, there are some side-effects (though rare in practice) that are disabling, distressing and cause severe suffering to patients, and these can have the potential of being missed. Here the authors report one such side-effect of risperidone, namely polyarthralgia.
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“Flow” Transcranial Direct Current Stimulation (tDCS) for depression treatment in a Community Mental Health Team (CMHT) service: depression, functioning, and health-related quality of life outcomesBackground: People who experience severe mental illness (SMI) have a high prevalence of depression symptoms, which is linked to worse functioning and quality of life. Research evidence indicates that transcranial direct current stimulation (tDCS) can reduce symptoms of depression. Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application that delivered wellbeing behaviour therapy training. Purpose/Aim: This study investigates if Flow can be introduced to a Community Mental Health Team (CMHT) service and the impact of Flow in treating depression. The study addresses the questions: “what are the depression reliable improvement and remission rates?” and “can Flow significantly reduce depressive symptoms and improve real world functioning (everyday, social and occupational functioning) and health-related quality of life?”. Methods: An open-label patient cohort design with no control group. Pre-intervention and 6-week follow-up intervention assessments using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Participants were 31 CMHT patients, 15 males and 16 females, with an age range of 21 to 64 years, and average age of 42 years. Results: PHQ-9 reliable improvement and remission rates were 51.61% and 12.9%, respectively. PHQ-9 scores significantly improved, from 20.9 (SD 5.55) to 14.6 (SD 7.33) at 6 weeks, with large effect size. WSAS scores improved from 31.3 (SD 6.02) to 22.5 (SD 11.43) at 6 weeks, with large effect size. EQ-5D-5L results showed significant improvements in the health index score, and three EQ-5D-5L dimensions (“mobility”, “self-care”, and “pain”). Conclusion: Flow tDCS treatment was integrated into a CMHT service and was found to be beneficial in terms of improving functioning and quality of life and reducing depression symptoms. Flow FL100 tDCS and wellbeing behaviour therapy training could be offered through all CMHT services to people with SMI to treat depression, enable better functioning, and improve quality of life.
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Recommendations for occupational therapy interventions for adults with ADHD: a consensus statement from the UK adult ADHD networkBackground ADHD is neurodevelopmental disorder which persists into adulthood. Presently, therapeutic approaches are mainly pharmacological and psychological whilst the role, scope and approaches of occupational therapists have not been adequately described. Results In this consensus statement we propose that by assessing specific aspects of a person’s occupation, occupational therapists can deploy their unique skills in providing specialist interventions for adults with ADHD. We also propose a framework with areas where occupational therapists can focus their assessments and give practice examples of specific interventions. Conclusions Occupational therapists have much to offer in providing interventions for adults with ADHD. A unified and flexible approach when working with adults with ADHD is most appropriate and further research on occupational therapy interventions is needed.
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Breaking the silence: addressing domestic abuse in mental health settings—identification, screening, and respondingIndividuals experiencing domestic abuse (DA) struggle to disclose victimization, but as frequent users of mental health services, this is a pivotal setting for identification and addressing DA. This systematic review of 20 studies investigates DA identification, screening, and responses within mental health settings. Three databases were searched using these inclusion criteria: adults aged 18 and older accessing mental health services, samples comprising mental health professionals (or combination). No geographical restrictions were applied. All studies were peer-reviewed and published in English between January 2000 and December 2023. Studies had to incorporate screening for DA between (ex-)partners and/or response to disclosure within mental health settings. The findings revealed considerable variation in DA screening methods from direct screening tools to retrospective analyses of patient files. Professionals report barriers in identifying DA, including uncertainty about their role, time constraints, and the importance of building trust with service users. Nonetheless, many highlight the importance of routinely asking about DA. A small number of interventions have been effective in enhancing professionals’ readiness to address DA, but it remains unclear what format of training is most effective. Service users report feelings of shame and fear of not being believed when disclosing DA, but are aided by therapeutic engagement and enhanced professional awareness. There is a lack of diverse inclusion in the research. In summary, there is considerable scope to develop good practice to support mental health professionals’ ability to identify and respond to DA across assessment tool and training, but also in understanding what facilitates service users to disclose.
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Telehealth autism diagnostic assessments with children, young people, and adults: qualitative interview study with England-wide multidisciplinary health professionalsBackground: Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. Objective: This study explored health professionals’ experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. Methods: A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. Results: Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals’ experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. Conclusions: A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods.
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Alpha-Stim AID Cranial Electrotherapy Stimulation (CES) anxiety and depression treatment for adults in a social prescribing service: anxiety and depression outcomesBackground: Generalised anxiety disorder (GAD) is common and can negatively impact people’s wellbeing and functioning. GAD treatment includes psychotherapy and/or anti-anxiety medication, which are not acceptable to or effective for many people experiencing GAD. Alpha-Stim AID cranial electrotherapy stimulation (CES) has evidence of effectiveness in the treatment of anxiety and depression. Purpose: Evaluation of Alpha-Stim AID on anxiety and depression for adults with GAD symptoms using a social prescribing service. Methods: An open-label patient cohort design with no control group. Twenty-six adult patients, 22 females and 4 males, with an age range of 24 to 68 years and an average age of 49 years, completed 6 weeks of Alpha-Stim AID use. Pre- and post-intervention assessments were undertaken using participant self-report measures: Generalised Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9). Results: Reliable improvement and remission rates were 42% and 19% for GAD-7; 38% and 27% for PHQ-9. GAD-7 and PHQ-9 significantly improved with large effect sizes. Conclusions: A social prescribing service can offer, and patients will choose to use Alpha-Stim AID, which may be useful in the treatment of anxiety and depression. This study addresses the need for real-world data on Alpha-Stim AID in relation to response rates. It contributes to how Alpha-Stim Aid can be used in social prescribing services, including through a group-based pathway.
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The effectiveness of systemic antibiotics for osteomyelitis of the foot in adults with diabetes mellitus: a systematic review protocolBackground Osteomyelitis of the foot is a major complication of diabetes that can be limb and life threatening. Systemic antibiotic pharmacotherapy is often used first line to eradicate infection and allow restoration of devitalised bone. The aim is to conduct a systematic review of the effectiveness of systemic antibiotics on osteomyelitis of the foot in adults with diabetes mellitus. Methods A systematic review of all interventional studies treating osteomyelitis with systemic antibiotics in participants with diabetes mellitus and an ulcer of the foot below the malleoli will be conducted. Studies not available in English and in people below the age of 18 will be excluded. Study selection will follow the Patient Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P guidelines). The quality of the studies will be assessed using the Cochrane risk-of-bias tool (RoB 2) for all randomised controlled trials and the Newcastle–Ottawa Scale (NOS) will be used for non-randomised controlled trials. Electronic databases will be searched with no timeline restrictions. Data Extraction All identified references will be imported to the Rayyan Application. Studies for eligibility will be screened by two reviewers. One reviewer will perform the data extraction and quality appraisal will be conducted by two authors. If sufficient data is available, the quality will be analysed and a meta-analysis will be performed. Data synthesis will be conducted, and meta-analysis undertaken using RevMan 5.4.1 Meta-analysis software. Non-parametric data may be compared between selective intervention and outcomes. Discussion The results of this systematic review will identify the effectiveness of systemic antibiotic therapy on osteomyelitis of the foot in people with diabetes based on the set outcome measure criteria. The findings will establish if there are existing consistent standards or variation in practice when treating diabetic foot osteomyelitis (DFO). The study may establish if guidelines are required to standardise practice when treating DFO with systemic antibiotic therapy. This systematic review protocol will synthesise the existing evidence on the effectiveness of systemic antibiotic therapy for treating DFO. Trial registration International Prospective Register for Systematic Reviews (PROSPERO) number CRD42021245424.
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Surgical excision of complex lipoma from the foot: A case reportMalignant soft tissue tumors of the foot and ankle are rare but diagnostic imaging and/or interventional biopsy are vital to establish the nature and grading of a suspicious tumor prior to definitive surgical intervention. The purpose of the study is to provide an account on how a symptomatic mass of the plantar aspect of the foot warranted a referral to a sarcoma center, highlighting the importance of having access to diagnostic imaging and a pathway to refer suspected cases to specialist centers. A single patient with a symptomatic soft tissue tumor of the plantar foot was referred from our service to the regional sarcoma center who considered to be benign, and therefore, open surgical resection was performed by our team. Histopathological analysis identified the excised mass as a lipoma. At 2 years, postoperatively there was no recurrence, and the patient presented with an asymptomatic foot. United Kingdom (UK) guidelines suggest that all soft tissue masses of suspicious nature, greater than 50 mm, deep seated irrespective of size, or fast growing lesions should be referred to a sarcoma unit prior to surgical management. European guidance identifies a threshold of 15 mm for a mass in the foot. Patients presenting with red flag symptoms irrespective of size of mass should be referred to a sarcoma center. Advanced imaging and multidisciplinary input to enable appropriate surgical planning is recommended for suspicious soft tissue tumors that present to the foot and ankle surgeon.
