The Mental Health Treatment Requirement (MHTR) is a sentencing option for offenders where mental health is linked to offending and is delivered by clinical psychologists. An interpretative phenomenological analysis of interviews with 14 MHTR service users explored factors promoting engagement and perceived change. Three superordinate themes were identified: experiences of safety, support, and personal fit facilitating engagement; mechanisms of change through developing tools, insight, and emotional regulation; and shifts in identity, relationships, and lifestyle. Findings highlight the importance of a strong therapeutic alliance, individualized and flexible delivery, and suggest MHTRs can improve mental health, self-worth, and reduce reoffending.

OBJECTIVES: Death occurs within the emergency department (ED) sadly not infrequently. There is limited evidence exploring the demographics of these patients and the experience they have in the ED when they die or are approaching the end of life (EOL). METHODS: A retrospective review of patients aged 18 years and over who died in our major trauma centre was conducted. Data collected included demographics, frailty scores, time of arrival, time of death, time of EOL decision, cause of death in the ED and who wrote do not attempt cardiopulmonary resuscitation (DNACPR) forms. RESULTS: From January to December 2023, 326 patients died in the ED. 76% of patients were aged 65 years or over, with 69% having a clinical frailty score of 5 or more. The average time from arrival to death was 5 hours 56 min, with the average time from EOL decision to death being 1 hour and 53 min. 60% of all patients had a DNACPR, with 75% of those being written by ED clinicians. CONCLUSION: EOL is becoming ever more important in the ED. Further work is needed to see if our local experience matches other EDs.

BACKGROUND:   Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder of autonomic regulation characterised by unexplained orthostatic tachycardia in the absence of postural hypotension. POTS is a complex and challenging diagnosis owing to the non-specific nature of the presentations, which frequently overlap with other medical conditions. There is limited availability of data and research describing the spectrum of clinical presentations, diagnostic pathways, comorbidities, and management outcomes. This study aims to describe the above in a single-centre district general hospital setting. METHODS:   We conducted a retrospective case series study of 37 patients diagnosed with POTS at Queen's Hospital Burton (QHB) between August 2023 and August 2024. We used electronic health records to acquire relevant data. This included demographics, presenting complaints, associated conditions, time to diagnosis, specialist involvement, management strategies, and treatment outcomes. 'Time to diagnosis' was defined as the period between the first symptom onset and obtaining a confirmed diagnosis with a positive tilt-table test. Microsoft Excel (Redmond, USA) was utilised for descriptive statistical analysis. RESULTS AND CONCLUSION:   The cohort was predominantly female (n = 36, 97%) with a mean age of 28.2 years (SD, 8.3; range, 18-48). The most common presenting complaints were presyncope (49%) and presyncope with syncope (41%). These were often associated with palpitations and chest discomfort. Systemic conditions coexisting with POTS included anxiety/depression, hypermobility spectrum disorders (notably Ehlers-Danlos Syndrome), fibromyalgia, autoimmune diseases, and migraine. The median time to diagnosis was one year (IQR 1-4). However, delays of up to 20 years were observed. Speciality referrals involved cardiology (65%), neurology (13%), and internal medicine (10%). Management strategies included non-pharmacological therapy alone (19%), additionally pharmacological monotherapy (62%), and combination therapy with multiple drugs (19%). Symptomatic improvement was reported in 65% overall, with the highest rates observed in the multi-drug therapy group.   This study highlights the demographic profile, burden of comorbidities, and diagnostic challenges in patients with POTS. Our single-centre study has demonstrated meaningful progress towards reducing the average time to diagnose POTS with varying treatment outcomes across therapeutic strategies. Multi-drug therapy in conjunction with non-pharmacological therapy proved to be the most efficacious in this cohort. These findings emphasise the importance of early recognition, streamlined referral pathways, and the need for further large-scale multi-centre research into patient-tailored, evidence-based management of POTS.

BACKGROUND: Hypertension and diabetes remain major contributors to cardiovascular morbidity and mortality in Canada. Monitoring their trends is critical to evaluating public health progress in prevention and disease management. OBJECTIVE: To descriptively summarize published Canadian Health Measures Survey (CHMS) estimates on the prevalence, awareness, treatment, and control of hypertension and diabetes among Canadian adults aged 20-79 years across the 2008-2019 survey cycles. METHODS: Descriptive analysis was conducted using aggregated CHMS combined-cycle data (2008-2011, 2012-2015, and 2016-2019). Weighted proportions and absolute counts published by Statistics Canada were organized and analyzed in Stata version 18. Data were stratified by sex and age group, and graphical visualization was applied to highlight temporal and demographic patterns. RESULTS: Hypertension prevalence remained stable over time, accompanied by modest improvements in treatment and control rates. Conversely, diabetes prevalence continued to rise, with limited gains in glycemic control. These patterns suggest differential progress in managing cardiometabolic conditions among Canadian adults. CONCLUSION: National strategies appear to have improved hypertension outcomes but less effectively addressed diabetes control. Strengthening preventive interventions, enhancing primary care integration, and improving access to chronic disease management resources remain essential for advancing cardiometabolic health in Canada.

Introduction: Dementia is a leading cause of disability worldwide, and its prevalence is expected to rise significantly by the year 2050. Assistive technologies (AT) have emerged as promising tools to promote independence and quality of life. The COVID-19 pandemic prompted an increased uptake of AT among people with dementia, exposing important limitations in digital literacy, accessibility, and support.MethodsThis pan-European study mapped recent research initiatives involving digital technology use by people with dementia during the pandemic and synthesised a set of recommendations for supporting the use of AT by people with dementia, and its development, using the Delphi method.ResultsThe mapping exercise identified 28 relevant projects, highlighting the types of technologies used during the pandemic and the settings in which they were implemented. Video-conferencing platforms were the most reported projects. More than half of the projects and initiatives (n = 17) were adapted to include digital technologies due to the pandemic. The subsequent Delphi consensus study incorporated input from experts by experience and produced 18 evidence-based recommendations, adapted from this mapping exercise and a previous scoping review.DiscussionKey findings emphasise involving people with dementia in technology design, ensuring equitable access, and providing adequate training and support. The recommendations offer a practical, consensus-based framework to improve the efficacy of AT adoption, with implications extending beyond pandemic contexts to improve dementia care globally.

Introduction Tourette syndrome is a common, disabling childhood-onset condition. Exposure and response prevention (ERP) is an effective treatment for tics, yet access remains limited due to a shortage of trained therapists and uneven geographical distribution of services. The ORBIT trial demonstrated that internet-delivered ERP is both clinically and cost-effective, but was developed on a university research platform, not suitable for widescale roll-out. To enable adoption by the National Health Service (NHS) in England, ORBIT has been redeveloped on an NHS compliant platform. This study will evaluate the usability, acceptability and preliminary outcomes of ORBIT on the new platform within an NHS tic disorder service.Methods and analysis This single-cohort usability study will recruit 20 children and young people (aged 9–17) with tics and their chosen supporters (parents/carers). Participants will receive a 10-week online ERP intervention supported by trained coaches. Outcomes include uptake, adherence, system usability, satisfaction and clinical measures such as the Yale Global Tic Severity Scale, Parent Tic Questionnaire and Goal-Based Outcomes. Qualitative feedback will be collected via semi-structured exit interviews. Usability metrics and adverse events will be monitored throughout.Ethics and dissemination The study has received ethical approval from North West Greater Manchester Research Ethics Committee (ref: 25/NW/0107). The findings from the study will inform future NHS adoption. The results will be submitted for publication in peer-reviewed journals.Trial registration number ISRCTN82718960. Registered 10 July 2025. https://doi.org/10.1186/ISRCTN82718960

BACKGROUND: Mood monitoring is widely used by people with depression and bipolar disorder (BD) to prevent relapse and improve insight into their condition, but it is unclear if these interventions have an impact on symptoms and for whom. As the capacity for passive mood monitoring increases, it is vital to improve our understanding of frequent mood assessment. OBJECTIVE: This systematic review and meta-analysis assessed the effect of mood monitoring interventions in people with depression and BD to decrease relapse risk and symptoms of depression and mania. METHODS: We conducted a systematic review and meta-analysis (PROSPERO, International Prospective Register of Systematic Reviews: CRD42023396473) and reported results according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Randomized controlled trials with clinically important follow-up periods were identified via multiple database searches and rated for risk of bias using the Cochrane Risk of Bias tool. The primary outcomes were symptoms of depression and mania. Available data were pooled to calculate standardized mean differences (SMDs) for the primary outcomes: severity of depression, bipolar depression, and mania/hypomania. RESULTS: We included 8 trials of 1230 participants and 6 different mood monitoring protocols. In BD, meta-analysis found a small but not statistically significant effect of mood monitoring interventions on decreasing mania symptoms (6 comparisons, n=873; SMD 0.16, 95% CI-0.34 to 0.01; P=.06) and no effect on bipolar depression (6 comparisons, n=873; SMD -0.08, 95% CI -0.31 to 0.15; P=.02). In depression, we found a small effect in decreasing symptoms of depression of borderline statistical significance at 12 months (2 comparisons, n=262; SMD -0.25, 95% CI -0.49 to 0.00; P=.05) but not at 6 months (2 comparisons, n=268; SMD -0.21, 95% CI -0.54 to 0.12; P=.21). There was an absence of evidence on the effect of mood monitoring on decreased relapse rates or readmission rates. Studies had a low risk of bias. There was no evidence on mood monitoring through ecological momentary assessment. CONCLUSIONS: Overall mood monitoring interventions do not increase or decrease mood symptoms in people with BD, nor is there robust evidence of such effects in people with unipolar depression. Further research is merited on different forms of mood monitoring and to determine under what circumstances mood monitoring might have beneficial or adverse effects. These results initially suggest that ambulatory assessment does not induce large placebo effects or significantly negatively or positively affect mood, and thus that mood monitoring may be an appropriate outcome measure for research or for clinical practice.

Background Acute upper gastrointestinal bleeding (AUGIB) is a medical emergency associated with significant morbidity and mortality. Prognosis and management are typically determined by the patient's clinical features and findings on endoscopy. Objective This study aimed to evaluate the demographic characteristics, risk stratification, endoscopic findings, and therapeutic interventions in patients presenting with AUGIB at Queens Hospital, Burton, United Kingdom, in 2024. Methods A retrospective analysis was performed of all inpatients who underwent upper gastrointestinal endoscopy for hematemesis and/or melena from January to December 2024. Data on demographics, Glasgow-Blatchford Score (GBS), hemodynamic status, endoscopic diagnoses, interventions, and outcomes were obtained from electronic medical records and analyzed using SPSS Version 23 (IBM Corp., Armonk, NY, USA). Results Sixty-four patients (mean age 72.1±15.8; 71% male) were included. Nonvariceal bleeding accounted for 92% of cases, with duodenal ulcers (17%) and gastric ulcers (11%) as leading etiologies. All patients were risk-assessed using the GBS on admission. Twenty-five percent of patients with nonvariceal bleeding required therapeutic endoscopy, primarily using dual or triple modalities. Variceal bleeds (8%) were managed with terlipressin, antibiotics, and band ligation based on endoscopic grade. Re-bleeding occurred in 3.1% of patients, necessitating further interventions. Conclusion AUGIB predominantly affected elderly males, with nonvariceal etiologies, particularly peptic ulcers, being most common. Universal risk stratification and timely endoscopic intervention in line with best practices helped improve outcomes. The study recorded a low re-bleeding rate.

INTRODUCTION: Pelvic floor reconstruction (PFR) in elderly women remains underutilised due to perceived surgical risk. With increasing life expectancy and functional demands, it is essential to evaluate contemporary outcomes in this population. This study aimed to review the perioperative morbidity and short-term outcomes of PFR in women aged ≥70 years and to contextualise results against recognised clinical benchmarks. METHODS: We conducted a single-centre retrospective cohort review of all women aged ≥70 years who underwent PFR at Royal Derby Hospital (RDH) between September 2022 and August 2024 (n=86). Patient demographics, comorbidities, risk factors, type of procedure, complications, and recurrence within one year were analysed. Functional outcomes were assessed using patient-reported symptom status informed by International Consultation on Incontinence Questionnaire (ICIQ) documentation, with analysis focused on completion rates and categorical postoperative symptom outcomes. Complication rates were presented with 95% confidence intervals (CIs) and contextualised against national benchmark data to evaluate the quality of care and surgical safety. Statistical analyses were descriptive and exploratory. RESULTS: The mean age was 77.3±5.2 years, and the mean body mass index (BMI) was 27.8±4.3 kg/m², with 36% (n=31) classified as overweight. Most patients were multiparous (median parity 3, range 1-7). Hypertension (68.6%, n=59), constipation (45.3%, n=39), musculoskeletal disorders (38.4%, n=33), diabetes (32.6%, n=28), respiratory disease (27.9%, n=24), cardiac disease (25.6%, n=22), endocrine disorders (16.3%, n=14 ), and mental problems (10.5%, n=9 ) were the most prevalent comorbidities. Combined procedures, such as vaginal hysterectomy with anterior/posterior repair ± sacrospinous fixation, were performed in 84.9% of cases (n=73), while 15.1% of cases (n=13) involved isolated procedures, including four cases of colpocleisis in patients with multiple comorbidities and no requirement for sexual function. No intraoperative complications occurred. Postoperative morbidity was low: Urinary or wound infection occurred in 4.6% (95% CI 1.8-11.4%), readmission within 30 days in 4.6% (95% CI 1.8-11.4%), and ileus, failed trial without catheter (TWOC), vaginal adhesion, and persistent postoperative pain each in 1.1% (95% CI 0.2-6.3%). No cases required return to theatre or resulted in death (95% CI 0.0-4.3%). Symptomatic improvement was reported by 72.1% (95% CI 61.8-80.5%, n=62) of patients, while 17.4% (95% CI 10.9-26.8%, n=15) had persistent and 10.5% (95% CI 5.6-18.7%, n=9) developed new urinary urgency or frequency. One unrelated death occurred within five months after surgery. CONCLUSION: PFR in women aged ≥70 years appears to be safe and associated with favourable short-term morbidity and patient-reported outcomes in appropriately selected, well-optimised patients when performed in a structured multidisciplinary urogynaecology service. Observed complication rates were low and comparable to national benchmarks, supporting surgical management following individualised assessment and optimisation. However, given the exploratory design and limited follow-up, results should be interpreted cautiously, and prospective multicentre studies incorporating frailty assessment and longer-term follow-up are required to evaluate durability, recurrence, and quality-of-life outcomes.

Basal osteoarthritis of the thumb is extremely common and causes pain and difficulty with essential 'pinching' tasks such as writing and dressing. It has been shown, in high-quality studies, that physiotherapy can result in clinically important improvements in pain and function, but the delivery of nonoperative treatment currently varies considerably throughout the NHS in the UK. Trapeziectomy is an effective, simple, and low-cost procedure, and the most common of surgical treatment for basal osteoarthritis of the thumb in the UK. However, recovery can be lengthy and complications include subsidence of the thumb metacarpal, instability, and weakness. New designs of thumb carpometacarpal joint arthroplasty (CMCJA) show promising early results with low complication rates and a quick return to function, but the implants are expensive and high-quality evidence about the outcome is lacking. The Surgery versus Conservative OsteOarthritis of Thumb Trial (SCOOTT) is a multicentre, three-arm, randomized controlled trial which is currently being undertaken, comparing the clinical outcomes and cost-effectiveness of an enhanced package of non-surgical management, trapeziectomy, and thumb CMCJA.