West Midlands Evidence Repository (WMER)

• Findings from a public engagement programme for school children aged 13-15 years about endocrinology

  Ali Baig, Shams; Malhotra, Kashish; Kowsik, Mukunth; Banerjee, Josh; Rahman, Fazna; Ashokkumar, Ashmethaa; Gillett, Caroline; Kempegowda, Punith; Kempegowda, Punith; Medicine; et al. (BioScientifica, 2024-11-14)

  Objectives: To investigate the utility and effectiveness of a school outreach programme in areas of lower socioeconomic status to improve understanding of common endocrine topics and the medical profession. Methods: Two secondary school outreach sessions were conducted in July 2022. Students were invited to attend lectures delivered by medical professionals and engage in poster-making sessions using the knowledge they had gained throughout the day. Participants completed anonymised pre- and post-session surveys. Outcomes were identified using Kirkpatrick's training evaluation model. Self-reported perceptions and beliefs (Kirkpatrick's level 2a) were compared using chi-square tests. Thematic analysis of team-led poster presentations was performed. Results: Of the 254 participants included, the response rates of pre- and post-session questionnaires were 75.6% and 56.2%, respectively. The outreach day increased students' understanding of obesity and diabetes, polycystic ovary syndrome, and Health Technology. The most well-received activities from the outreach day were voted to be the poster challenge (43.4%) and poster presentation (14.7%). Following the session, there was a trend towards an increased understanding of medical careers and interest in pursuing a medical career, although these did not reach statistical significance. Conclusions: Outreach programmes could be a practical and effective approach to engaging prospective medical applicants from areas of lower socioeconomic status. Further studies are required to expand outreach programmes and investigate the efficacy of school engagement programmes.
• Changes in peak oxygen consumption in Fabry disease and associations with cardiomyopathy severity

  Roy, Ashwin; Thompson, Sophie E; Hodson, James; van Vliet, Jan; Condon, Nicola; Alvior, Amor Mia; O'Shea, Christopher; Vijapurapu, Ravi; Nightingale, Tom E; Clift, Paul F; et al. (BMJ Pub. Group, 2024-11-25)

  This was a retrospective observational study of adults with FD undergoing cardiopulmonary exercise testing (CPEX) between September 2011 and September 2023 at a national referral centre in the UK. The primary outcome measure was peak oxygen uptake (V̇O2peak), with forced expiratory volume in 1 s (FEV1) used to quantify respiratory impairment. Age-normalised/sex-normalised values were additionally calculated, based on published normal ranges for subgroups of age and sex. The cardiomyopathy phase was classified on a 4-point scale by two FD experts using contemporaneous imaging and biochemistry results.
• Prevalence of invasive lung cancer in pure ground glass nodules less than 30 mm: A systematic review

  AlShammari, Abdullah; Patel, Akshay; Boyle, Mark; Proli, Chiara; Gallesio, Jose Alvarez; Wali, Anuj; De Sousa, Paulo; Lim, Eric (Pergamon Press, 2024-11-05)

  All published studies were retrospective (n = 28) and the majority conducted in Asia (n = 25). Baseline patient cohorts were mainly from published surgical series (n = 22) or lung cancer screening programs (n = 6). The proportion of minimally invasive and invasive cancer ranged from 0.9 % to 100 % with a pooled prevalence of 42.4 % [95 % CI: 0.28, 0.57]. Considerable heterogeneity was observed (I2 =99 %) and patient selection was the most significant contribution, accounting for 73 % of the observed heterogeneity (p < 0.0001). Meta-regression based on size selection and country of investigation revealed no significant contribution to effect size effect or heterogeneity.
• Sertraline for anxiety in adults with a diagnosis of autism (STRATA): study protocol for a pragmatic, multicentre, double-blind, placebo-controlled randomised controlled trial

  Rai, Dheeraj; Webb, Doug; Lewis, Amanda; Cotton, Leonora; Norris, Jade Eloise; Alexander, Regi; Baldwin, David S; Brugha, Traolach S; Cochrane, Madeleine; Del Piccolo, Maria Chiara; et al. (BioMed Central, 2024-01-11)

  Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects. Methods: STRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1-2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication. Discussion: Results from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population.
• Improving psychosocial assessment of children and young people in the emergency department: a service evaluation

  Doherty, Hannah Lisbeth (Nursing Standard Publications, 2024-11-19)

  Referrals to mental health services, and mental health-related presentations to emergency departments (EDs), among children and young people (CYP) have increased over the last decade. In the UK, national guidelines and standards recommend that CYP who present to an ED with mental health issues should receive a psychosocial assessment, while evidence suggests that the use of a psychosocial assessment tool can enhance the management of this patient cohort. However, it can be challenging for ED healthcare professionals to undertake a formal psychosocial assessment due to a range of factors. This article reports the results of a service evaluation, undertaken in two children's EDs in a large NHS trust in England. The evaluation involved a review of 308 ED clinical records of CYP who presented to the EDs with mental health issues, to assess the extent to which this cohort was receiving a structured psychosocial assessment. The results showed that only a small proportion (34%, n=104) of the clinical records contained evidence of some form of psychosocial assessment, while the use of a psychosocial assessment tool was documented in only 22 (7%) of these 104 clinical records. The results have informed a wider quality improvement project to enhance practice in this area.

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