Objectives This study aimed to evaluate the feasibility of delivering a vocational rehabilitation intervention (Return to Work After Trauma—ROWTATE), remotely to individuals recovering from traumatic injuries. The primary objectives were to assess therapists’ training and competence, adapt the intervention and training for remote delivery and assess the feasibility and fidelity of remote delivery to inform a definitive randomised controlled trial.Design A mixed-methods feasibility study incorporating (1) telerehabilitation qualitative literature review, (2) qualitative interviews preintervention and postintervention with therapists and patients, (3) a team objective structured clinical examination to assess competency, (4) usefulness of training, attitudes towards (15-item Evidence-Based Practice Attitude Scale) and confidence in (4-item Evidence Based Practice Confidence Scale) evidence-based practice, intervention delivery confidence (8-bespoke questions) and intervention behaviour determinants (51-items Theoretical Domains Framework) and (5) single-arm intervention delivery feasibility study.Setting The study was conducted in two UK Major Trauma Centres. The intervention and training were adapted for remote delivery due to the COVID-19 pandemic.Participants Therapists: Seven occupational therapists (OTs) and clinical psychologists (CPs) were trained, and six participated in competency assessment. Seven OTs and CPs participated in preintervention interviews and surveys; six completed post-intervention interviews and four completed post-training surveys. Patients: 10 patients were enrolled in the single-arm feasibility study and 4 of these participated in postintervention qualitative interviews. Inclusion criteria included therapists involved in vocational rehabilitation delivery and patients admitted to major trauma centres. Exclusion criteria included participation in other vocational rehabilitation trials or those who had returned to work or education for at least 80% of preinjury hours. Intervention: The ROWTATE vocational rehabilitation intervention was delivered remotely by trained OTs and CPs. Training included competency assessments, mentoring and adaptation for telerehabilitation. The intervention was delivered over multiple sessions, with content tailored to individual patient needs.Results Therapists found the training useful, reported positive attitudes (Evidence-Based Practice Attitude Scale mean=2.9 (SD 0.9)) and high levels of confidence in delivering evidence-based practice (range 75%–100%) and the ROWTATE intervention (range 80%–100%). Intervention barriers identified pretraining became facilitators post-training. Half the therapists needed additional support post-training through mentoring or additional training. The intervention and training were successfully adapted for remote delivery. High levels of fidelity (intervention components delivered: OTs=84.5%, CPs=92.9%) and session attendance rates were found (median: OT=97%, CP=100%). Virtually all sessions were delivered remotely (OT=98%, CP=100%). The intervention was acceptable to patients and therapists; both considered face-to-face delivery where necessary was important.Conclusions The ROWTATE intervention was delivered remotely with high fidelity and attendance and was acceptable to patients and therapists. Definitive trial key changes include modifying therapist training, competency assessment, face-to-face intervention delivery where necessary and addressing lower fidelity intervention components.Trial registration number ISRCTN74668529.Data are available on reasonable request. The data that participants have consented to share will become available to potential researchers at the end of the ROWTATE research programme. Requests detailing the research aims and use of the data should be sent to the research team via email: ROWTATE@nottingham.ac.uk.

Background and objective Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC. Methods A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model. Results Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade. Conclusion IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.

Node-first Kawasaki disease (NFKD) is an atypical variant of Kawasaki disease (KD), presenting with fever and cervical lymphadenopathy before other classical features appear. This presentation often mimics bacterial cervical lymphadenitis (BCL), leading to misdiagnosis and treatment delays. We report a toddler initially treated for presumed BCL after presenting with a febrile convulsion and isolated lymphadenopathy. Failure to respond to antibiotics and the later appearance of rash, conjunctivitis and a small coronary artery aneurysm on echocardiography led to the diagnosis of incomplete NFKD. This case underscores the importance of early consideration of incomplete or atypical KD criteria in children with persistent fever and lymphadenopathy unresponsive to antibiotics. Delaying diagnosis until full clinical criteria develop may increase the risk of coronary complications. Early use of cardiac biomarkers, echocardiography and awareness of incomplete KD criteria can help distinguish KD from BCL, enabling timely diagnosis and treatment to improve outcomes.

While recovery orientation is national policy in many countries, evidence remains limited for the effectiveness at a service level. This paper describes the protocol for implementing a pro-recovery training intervention (REFOCUS-RETAFORM) in specialist mental health services across France. The aim is to evaluate whether REFOCUS-RETAFORM plus usual care leads to improved outcomes for adolescent and adult mental health service users compared with usual care alone.

Community nurses play a significant role in the identification, assessment and treatment of rashes and associated skin conditions. It is important for them to be familiar with the location, pattern, appearance and feel of different types of rashes for timely diagnoses and escalation, if required. This article explores the processes of inspection, palpation, diagnostic tools and management strategies relevant to community nursing practice.

Gav Oxby reflects on his decade-long career journey in the NHS, going from a band 2 to become an enhanced clinical practitioner apprentice.

Measuring Formal Thought Disorder (FTD), a common, cross-diagnosed symptom dimension across mental disorders, is plagued by numerous inconsistencies. Clinicians use either FTD-specific scales or items from generic scales. While these tools are based on extensive clinical observations, they suffer from inconsistent terminology. Different scales may use the same term for distinct concepts or different terms for the same concept. This lack of conceptual standardization prevents the identification of underlying FTD subconstructs. By using natural language processing, we compared the definitions, labeling and overlap of FTD symptoms, i.e., the definitions of single items, across psychopathological scales. We used a three-pronged validation approach to analyze semantic clusters of single definitions of FTD scale psychopathological items. First, we used sentence-BERT to divide 30 Thought and Language Disorder scale (TALD) items into positive or negative FTD clusters, validating this approach by checking for correspondence with published factor-analytic divisions (approach validation). Second, we created a sparse item-to-item similarity matrix from 103 items across seven scales to identify semantically converging cross-scale FTD items; a clinician-researcher described the resulting four clusters, and we compared our automated classification with that of six blinded experts to establish expert-machine semantic correspondence. Finally, we analyzed data from 98 participants (49 healthy controls and 49 schizophrenia/affective psychosis), identifying the highest-correlating Clinical Language Disorder Scale (CLANG) item for each Thought, Language and Communication (TLC) scale item and mapping these to our BERT-derived clusters to establish data-level correspondence. When assigning TALD items to BERT-derived positive or negative FTD groupings, we observed a 73% match with prior factor analyses. The BERT-informed clustering of cross-scale items highlighted four coherent FTD groupings: (1) muddled communication & incomprehension, (2) abrupt topic shifts, (3) inconsistent narrative structure, (4) restricted speech. Expert raters showed moderate-to-high overlap (Fleiss’ kappa = 0.617) with computational clusters. A binomial test indicated that at the level of individual participants, correlations among CLANG-TLC item pairs were significantly more likely than chance to fall into the expected semantic cluster (p < 0.001). FTD rating scales measure overlapping, semantically related constructs that drive item-level correlations. Semantic clustering acts as a novel method to harmonize multi-scale data and pinpoint discrepancies between expert and machine classifications. Computational linguistics has the potential to improve consistency across rating scales especially when measuring complex constructs such as FTD.

Background Between March 2020 and September 2021, 11.7 million employee jobs were furloughed through the UK Coronavirus Job Retention Scheme (JRS). Imposed work absence shielded workers from job loss, but furloughed workers had increased risk of poor mental health compared to those who stayed working. Understanding the factors that mitigate psychological distress during imposed work absence can inform actions to be taken in future crises. Aims To explore the relationships between (a) work and home demands with well-being outcomes, and (b) personal and organisational resources with well-being outcomes, during periods of imposed prolonged absence and uncertainty. Methods We analysed online survey data collected with furloughed workers in the UK ‘Wellbeing of the Workforce Study’. Measures included psychological well-being, anxiety, life satisfaction, job insecurity, home demands (quantitative and emotional), organisational support for work-family balance, and personal resources (resilience, purpose, and coping ability). Results Psychological well-being was associated positively with quantitative home demands (β = 0.24, p < 0.05) and personal resources (β = 0.45, p < 0.001). Life satisfaction was associated negatively with emotional demands at home (β = –0.26, p < 0.05) and positively with personal resources (β = 0.30, p < 0.05). Perceived job insecurity was positively associated with anxiety (β = 0.36, p < 0.001). Conclusions Job-related factors are less influential during periods of employment uncertainty compared to personal and home resources. Decision-makers should provide psychological support during periods of job uncertainty and bolster the essential benefits of personal and home resources. Moving forwards, these findings may have broader applicability to other challenges and crises, such as suspension from work, or role changes resulting from organisational restructuring.

BACKGROUND: Adaptations are frequently reported when delivering therapy to people with an intellectual disability, including the involvement of carers. This review aimed to understand the experience of carer involvement from the perspective of the person, therapist and caregiver. METHODS: A systematic search of six databases and of reference lists was conducted. The quality of the included studies was assessed using an adapted version of the Critical Appraisal Skills Programme qualitative checklist. Data was synthesised using meta-ethnography. RESULTS: Sixteen studies were included but their quality varied. Five third-order constructs were identified: safety, therapeutic process, relationships, personal impact on carer and improving the experience. CONCLUSION: Findings suggest that carer involvement can be a positive experience and aid the therapy process. However, this depended on several factors including carer motivation and consistency. Confidentiality issues were highlighted. Limitations of studies included poor reporting on participant demographics and small samples. Future research and clinical implications are suggested.

Background: We report UK findings from Music Interventions for Depression and Dementia in Elderly care (MIDDEL), a cross-national, clustered, randomised trial undertaken in 2018–2023 to evaluate the effectiveness of music interventions for depression symptoms in care home residents living with dementia (NCT03496675, clinicaltrials.gov (accessed on 1 December 2024)). The trial compared the effects of Group Music Therapy (GMT) with Recreational Choir Singing (RCS); GMT and RCS combined; and treatment as usual (TAU). Methods: In the intervention arms, the protocolized music interventions were delivered in care home units twice per week for three months, then once per week for three months. The primary outcome was depressive symptoms after six months, measured by MADRS. Secondary outcomes included well-being—EQ-5D-5L, Visual Analogue Scale (VAS); quality of life—QOL-AD; symptoms of dementia—SIB-8, NPI-Q; and caregiver distress—NPI-Q. The change in MADRS score from baseline to 6 months was assessed using a linear mixed-effects model. We report the multivariate model having both treatments as predictors, both unadjusted and adjusted, for the interaction between the treatments. Results: The UK trial started in 2022 after the pandemic lockdown, when 16 care home units were recruited and randomised, four per arm; 192 residents aged over 65 with depression and dementia participated. An ITT analysis of 146 participants retained at 6 months found neither intervention had a significant positive effect on any outcome. Significant unfavourable effects were found for RCS participants on MADRS, NPI symptom severity, and EQ-VAS. The combination of RCS + GMT had a detrimental effect on caregiver distress. Conclusions: MIDDEL UK findings do not support the use of GMT or RCS to alleviate depression in care home residents with dementia.