scholarly journals Characteristics of patients expressing an interest in ketamine treatment: results of an online survey

BJPsych Open ◽  
2018 ◽  
Vol 4 (5) ◽  
pp. 389-392 ◽  
Author(s):  
Jolien K. E. Veraart ◽  
Sanne Y. Smith-Apeldoorn ◽  
Hayley Trueman ◽  
Marrit K. de Boer ◽  
Robert A. Schoevers ◽  
...  
Keyword(s):  
Online Survey ◽  
Treatment Resistance ◽  
Target Population ◽  
Evidence Base ◽  
Treatment Algorithms ◽  
Off Label ◽  
Antidepressant Effects ◽  
Randomised Controlled ◽  
Therapy Resistant Depression ◽  
Chronic Course

BackgroundOff-label ketamine treatment has shown acute antidepressant effects that offer hope for patients with therapy-resistant depression. However, its potential for integration into treatment algorithms is controversial, not least because the evidence base for maintenance treatment with repeated ketamine administration is currently weak. Ketamine is also a drug of misuse, which has raised concerns regarding the target population. Little is known about which patients would seek ketamine treatment if it were more widely available.AimsTo explore some of the characteristics of the patients actively seeking ketamine treatment.MethodAn online survey containing questions about duration of current depressive episode, number of antidepressants used and other comments was completed by patients who were exploring the internet regarding the possibility of ketamine for depression.ResultsOf the 1088 people who registered their interest, 93.3% reported depression, 64.3% reported a chronic course of their symptoms and in the past 10 years, 86.3% had tried at least two antidepressants. Desperation was a common theme, but this appeared to be competently expressed. A small minority (<8%) reported experience of illegal ketamine use.ConclusionsIt cannot be ruled out that patients with different degrees of treatment resistance and comorbidities will seek treatment with ketamine. This stresses the urgency to perform larger randomised controlled trials as well as to systematically monitor outcomes and adverse effects of ketamine, that is currently prescribed off-label for patients in need.Declaration of interestR.M. is consulting and is Principal Investigator for Janssen trials of esketamine and is consulting for Eleusis.

scholarly journals 48 Do Exercise Programmes for Older People with Sarcopenia or Frailty Deliver An Evidence-Based Service? Findings From A UK Survey

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
M Chawner ◽  
S De Biase ◽  
N J Offord ◽  
O Todd ◽  
A Clegg ◽  
...  
Keyword(s):  
Resistance Training ◽  
Older People ◽  
Outcome Measures ◽  
Online Survey ◽  
Balance Training ◽  
Target Population ◽  
Exercise Programme ◽  
Median Number ◽  
Evidence Base ◽  
Exercise Programmes

Abstract Background Awareness of sarcopenia and frailty is growing and both are known to be potentially reversible with effective resistance training. We aimed to establish whether existing exercise programmes offered to people with sarcopenia or frailty adhere to the known evidence base. Methods We conducted a national on-line survey of practitioners delivering exercise programmes to older people with sarcopenia or frailty. The link to the online survey was distributed through the British Geriatrics Society, Chartered Society of Physiotherapy Special Interest Group for Older People (AGILE), the NHS England Future Collaboration Platform “Supporting People Living with Frailty” forum and social media. Questions covered target population and aims of the exercise programme, type, duration and frequency of exercise, progress assessment and outcome measures. Descriptive analyses were conducted using SPSS v24. Results 136 responses were received from respondents who worked for NHS Trusts, clinical commissioning groups, private practices, and third sector providers. 94% of respondents reported prescribing or delivering exercise programmes to people with sarcopenia or frailty. Most programmes (81/135 [60%]) were primarily designed to prevent or reduce falls. Resistance training was reported as the main focus of the programme in only 11/123 (9%); balance training was the main focus in 61/123 (50%) and functional exercise in 28/123 (23%). Exercise was offered once a week or less by 81/124 (65%) of respondents; the median number of sessions offered was 8.5 (IQR 6 to 12). Outcome measures suitable for assessing the effect of resistance training programmes were reported by fewer than half of respondents (hand grip: 13/119 [11%]; chair stands: 55/119 [46%], short physical performance battery: 4/119 [3%]). Conclusions Current exercise programmes offered to older people with sarcopenia or frailty lack the frequency, duration or specificity of exercise likely to improve outcomes for this group of patients.

scholarly journals Antiepileptic drug treatment of rolandic epilepsy and Panayiotopoulos syndrome: clinical practice survey and clinical trial feasibility

2014 ◽  
Vol 100 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Louise C Mellish ◽  
Colin Dunkley ◽  
Colin D Ferrie ◽  
Deb K Pal
Keyword(s):  
Antiepileptic Drug ◽  
Online Survey ◽  
Management Practice ◽  
Low Frequency ◽  
Evidence Base ◽  
Rolandic Epilepsy ◽  
Antiepileptic Drug Treatment ◽  
Randomised Controlled ◽  
The Uk ◽  
Panayiotopoulos Syndrome

BackgroundThe evidence base for management of childhood epilepsy is poor, especially for the most common specific syndromes such as rolandic epilepsy (RE) and Panayiotopoulos syndrome (PS). Considerable international variation in management and controversy about non-treatment indicate the need for high quality randomised controlled trials (RCT). The aim of this study is, therefore, to describe current UK practice and explore the feasibility of different RCT designs for RE and PS.MethodsWe conducted an online survey of 590 UK paediatricians who treat epilepsy. Thirty-two questions covered annual caseload, investigation and management practice, factors influencing treatment, antiepileptic drug preferences and hypothetical trial design preferences.Results132 responded (22%): 81% were paediatricians and 95% at consultant seniority. We estimated, annually, 751 new RE cases and 233 PS cases. Electroencephalography (EEG) is requested at least half the time in approximately 70% of cases; MRI brain at least half the time in 40%–65% cases and neuropsychological evaluation in 7%–8%. Clinicians reported non-treatment in 40%: main reasons were low frequency of seizures and parent/child preferences. Carbamazepine is the preferred older, and levetiracetam the preferred newer, RCT arm. Approximately one-half considered active and placebo designs acceptable, choosing seizures as primary and cognitive/behavioural measures as secondary outcomes.ConclusionsManagement among respondents is broadly in line with national guidance, although with possible overuse of brain imaging and underuse of EEG and neuropsychological assessments. A large proportion of patients in the UK remains untreated, and clinicians seem amenable to a range of RCT designs, with carbamazepine and levetiracetam the preferred active drugs.

scholarly journals Updated Review and Meta-Analysis of Probiotics for the Treatment of Clinical Depression: Adjunctive vs. Stand-Alone Treatment

2021 ◽  
Vol 10 (4) ◽  
pp. 647
Author(s):  
Viktoriya L. Nikolova ◽  
Anthony J. Cleare ◽  
Allan H. Young ◽  
James M. Stone
Keyword(s):  
Meta Analysis ◽  
Clinical Depression ◽  
Controlled Clinical Trial ◽  
Reactive Protein ◽  
Treatment Type ◽  
Antidepressant Effects ◽  
Clinical Trial Evidence ◽  
Randomised Controlled ◽  
Trial Evidence ◽  
Insight Into

Recent years have seen a rapid increase in the use of gut microbiota-targeting interventions, such as probiotics, for the treatment of psychiatric disorders. The objective of this update review was to evaluate all randomised controlled clinical trial evidence on the efficacy of probiotics for clinical depression. Cochrane guidelines for updated reviews were followed. By searching PubMed and Web of Science databases, we identified 546 new records since our previous review. A total of seven studies met selection criteria, capturing 404 people with depression. A random effects meta-analysis using treatment type (stand-alone vs. adjunctive) as subgroup was performed. The results demonstrated that probiotics are effective in reducing depressive symptoms when administered in addition to antidepressants (SMD = 0.83, 95%CI 0.49–1.17), however, they do not seem to offer significant benefits when used as stand-alone treatment (SMD = −0.02, 95%CI −0.34–0.30). Potential mechanisms of action may be via increases in brain-derived neurotrophic factor (BDNF) and decreases in C-reactive protein (CRP), although limited evidence is available at present. This review offers stronger evidence to support the clinical use of probiotics in depressed populations and provides an insight into the mode of administration more likely to yield antidepressant effects.

scholarly journals Reamed intramedullary nailing versus circular frame external fixation for segmental tibial fractures (STIFF-F): a mixed methods feasibility study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Caroline B. Hing ◽  
Elizabeth Tutton ◽  
Toby O. Smith ◽  
Molly Glaze ◽  
Jamie R. Stokes ◽  
...  
Keyword(s):  
Mixed Methods ◽  
External Fixation ◽  
Intramedullary Nailing ◽  
Feasibility Study ◽  
Online Survey ◽  
Tibial Fracture ◽  
Tibial Fractures ◽  
Circular Frame ◽  
Pilot Rct ◽  
Randomised Controlled

Abstract Background Segmental tibial fractures are fractures in two or more areas of the tibial diaphysis resulting in a separate intercalary segment of the bone. Surgical fixation is recommended for patients with segmental tibial fractures as non-operative treatment outcomes are poor. The most common surgical interventions are intramedullary nailing (IMN) and circular frame external fixation (CFEF), but evidence about which is better is of poor quality. An adequately powered randomised controlled trial (RCT) to determine optimum treatment is required. STIFF-F aimed to assess the feasibility of a multicentre RCT comparing IMN with CFEF for segmental tibial fracture. Methods STIFF-F was a mixed-methods feasibility study comprising a pilot RCT conducted at six UK Major Trauma Centres, qualitative interviews drawing on Phenomenology and an online survey of rehabilitation. The primary outcome was recruitment rate. Patients, 16 years and over, with a segmental tibial fracture (open or closed) deemed suitable for IMN or CFEF were eligible to participate. Randomisation was stratified by site using random permuted blocks of varying sizes. Participant or assessor blinding was not possible. Interviews were undertaken with patients about their experience of injury, treatment, recovery and participation. Staff were interviewed to identify contextual factors affecting trial processes, their experience of recruitment and the treatment pathway. An online survey was developed to understand the rehabilitation context of the treatments. Results Eleven patients were screened and three recruited to the pilot RCT. Nineteen staff and four patients participated in interviews, and 11 physiotherapists responded to the survey. This study found the following: (i) segmental tibial fractures were rarer than anticipated, (ii) the complexity of the injury, study setup times and surgeon treatment preferences impeded recruitment, (iii) recovery from a segmental tibial fracture is challenging, and rehabilitation protocols are inconsistent and (iv) despite the difficulty recruiting, staff valued this research question and strived to find a way forward. Conclusion The proposed multicentre RCT comparing IMN with CFEF is not feasible. This study highlighted the difficulty of recruiting patients to an RCT of a complex rare injury over a short time period. Trial registration The study was registered with the International Standard Randomised Controlled Trials Number Registry: ISRCTN11229660

scholarly journals A systematic review of interventions to increase breakfast consumption: a socio-cognitive perspective

2021 ◽  
pp. 1-16
Author(s):  
Jessica A Harris ◽  
Julia E Carins ◽  
Sharyn Rundle-Thiele
Keyword(s):  
Empirical Studies ◽  
Eating Behaviour ◽  
Target Population ◽  
Evidence Base ◽  
Dietary Quality ◽  
Entire Study ◽  
Breakfast Consumption ◽  
Breakfast Skipping ◽  
Breakfast Eating ◽  
Theory Use

Abstract Objective: Regular breakfast skipping is related to unhealthy dietary behaviours, such as consuming an overall poorer quality diet and lower rates of physical activity, both of which are linked to a higher BMI. Adolescent breakfast skippers struggle with mental focus, sleep issues and lower grades. Solutions that can be implemented to overcome breakfast skipping are needed. Design: A systematic literature review was undertaken to identify programmes that aimed to increase breakfast eating. Following the PRISMA framework, studies were sourced to examine details of behaviour change, evidence of theory use and other important programme learnings and outcomes. Setting: Breakfast consumption empirical studies published from 2000 onwards. Participants: Nineteen empirical studies that aimed to improve breakfast eating behaviour. Results: Out of the nineteen studies examined, ten studies reported an increase in breakfast consumption frequency for the entire study group or subgroups. Seven studies found no change, one was inconclusive and one observed a decrease in breakfast frequency. Positive changes to the dietary quality of breakfast were observed in five of the studies that did not observe increased frequency of breakfast consumption. Only six studies reported using theory in the intervention. Conclusions: This evidence review points needed to extend theory application to establish a reliable evidence base that can be followed by practitioners seeking to increase breakfast eating rates in their target population.

scholarly journals Social marketing to address attitudes and behaviours related to preventable injuries in British Columbia, Canada

2018 ◽  
Vol 24 (Suppl 1) ◽  
pp. i52-i59 ◽  
Author(s):  
Jennifer Smith ◽  
Xin Zheng ◽  
Kevin Lafreniere ◽  
Ian Pike
Keyword(s):  
Public Health ◽  
British Columbia ◽  
Social Marketing ◽  
Online Survey ◽  
Public Attitudes ◽  
Target Population ◽  
Public Health Issue ◽  
Conscious Thought ◽  
Marketing Campaign ◽  
Social Marketing Campaign

BackgroundSocial marketing is a tool used in the domain of public health for prevention and public education. Because injury prevention is a priority public health issue in British Columbia, Canada, a 3-year consultation was undertaken to understand public attitudes towards preventable injuries and mount a province-wide social marketing campaign aimed at adults aged 25–55 years.MethodsPublic response to the campaign was assessed through an online survey administered to a regionally representative sample of adults within the target age group between 1 and 4 times per year on an ongoing basis since campaign launch. A linear regression model was applied to a subset of this data (n=5186 respondents) to test the association between exposure to the Preventable campaign and scores on perceived preventability of injuries as well as conscious forethought applied to injury-related behaviours.ResultsCampaign exposure was significant in both models (preventability: β=0.27, 95% CI 0.20 to 0.35; conscious thought: β=0.24, 95% CI 0.13 to 0.35), as was parental status (preventability: β=0.12, 95% CI 0.03 to 0.21; conscious thought: β=0.18, 95% CI 0.06 to 0.30). Exposure to the more recent campaign slogan was predictive of 0.47 higher score on conscious thought (95% CI 0.27 to 0.66).DiscussionThis study provides some evidence that the Preventable approach is having positive effect on attitudes and behaviours related to preventable injuries in the target population. Future work will seek to compare these data to other jurisdictions as the Preventable social marketing campaign expands to other parts of Canada.

scholarly journals Clinically, what ought we to believe?

2018 ◽  
Vol 27 (1) ◽  
pp. 72-74 ◽  
Author(s):  
John D Little ◽  
Lorraine Davison ◽  
Robert D Little
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Relevant Information ◽  
Evidence Base ◽  
Social Interventions ◽  
Hierarchy Of Evidence ◽  
Differences Of Opinion ◽  
The Status ◽  
Randomised Controlled ◽  
Clinical Strategy

Objective: To question the status of the randomised controlled trial (RCT) in the hierarchy of evidence. Conclusions: The RCT provides important and clinically relevant information, particularly in psychopharmacology. However, and as with other methodologies, RCTs too are flawed and automatic abdication to their conclusions, especially in complex social interventions, is unwise. A clinical example with conflicting and polarising views, each with their evidence base, is described alongside a suggested clinical strategy for resolving differences of opinion.

scholarly journals Patient advocacy group involvement in health technology assessments: an observational study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ann Single ◽  
Ariana Cabrera ◽  
Simon Fifer ◽  
Jane Tsai ◽  
Jin-Young Paik ◽  
...  
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Patient Involvement ◽  
Patient Advocacy ◽  
Health Technology ◽  
Access To Medicines ◽  
Evidence Base ◽  
Lack Of Information ◽  
Local Setting ◽  
Patient Advocacy Group

Abstract Background In some jurisdictions, patients and patient groups may be invited to provide input when Health Technology Assessment (HTA) is used to inform decisions about which medicines should be subsidised or funded. This input can help frame the evidence from a patient perspective, address uncertainties in the evidence and interpret it for the local setting. However, there is currently no evidence linking patient involvement with positive reimbursement decisions. Aim We aimed to understand the expectations of patient involvement in the reimbursement process, especially among cancer patient advocacy groups (PAGs) in New Zealand (Aotearoa), South Korea and Taiwan. Methods We developed an online survey to help understand the role that cancer PAGs play in reimbursement processes and identify knowledge gaps about the processes that might impact the efforts of PAGs. The survey elicited the views of staff and patients affiliated with PAGs (n = 43) on current practices and how the assessment and reimbursement of new cancer drugs might be improved. Results There was variability in knowledge of the HTA assessment processes and in experience of being involved in them. Those with HTA experience were more likely to have confidence in the process. Those who had not been involved tended to have little awareness of, or frustration with, decision-making processes. Most identified cost, finances and economic assessments as key considerations in current processes. Some respondents had clear ideas about how their knowledge and involvement could improve processes to determine the value of new medicines. However, for many, a lack of information about the basis for decision making and opportunities to be involved was a barrier to identifying process improvement. Conclusions HTA is implemented primarily in countries seeking to have fair and equitable processes for funding medicines. PAGs often recognise the financial challenges of funding new medicines and share the desire for procedural fairness. The connection PAGs make between patient involvement and improved access to new medicines may be based on the belief they can add information to the evidence base, help solve problems, ensure fairness through transparency and/or influence the culture towards increased access to medicines they value.

scholarly journals Exploring corporate engagement with carbon management techniques

2021 ◽  
Vol 3 ◽  
pp. 9
Author(s):  
Katherine Piper ◽  
James Longhurst
Keyword(s):  
Online Survey ◽  
Evidence Base ◽  
Annual Review ◽  
Carbon Management ◽  
Carbon Neutrality ◽  
Sequential Mixed Methods ◽  
Management Hierarchy ◽  
Management Techniques ◽  
Sustainability Initiatives ◽  
The Uk

This paper explores the different ways of managing carbon in organisational settings.  It uses a sequential mixed methods approach – literature review, discussions with sustainability thought leaders, and online survey and interviews with company sustainability leaders – to consider and critique the use of the carbon management hierarchy (CMH) by selected corporate bodies in the UK. The derived empirical evidence base enables a triangulated view of current performance and potential improvements. Currently, carbon management models are flawed, being vague in relation to the operational reductions required prior to offsetting and making no mention of Science Based Targets nor the role corporations could play in wider sustainability initiatives. An amended CMH is proposed incorporating wider sustainability initiatives, varying forms of offsets, the inclusion of accounting frameworks and an annual review mechanism to ensure progress towards carbon neutrality. If such a model were to be widely used, it would provide more rapid carbon emissions reductions and mitigation efforts, greater certainty in the authenticity of carbon offsets, wider sustainability impacts and a faster trajectory towards carbon neutrality.

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