Presenting Symptoms Define Time to Diagnosis in Degenerative Cervical Myelopathy: Process Mapping From a Musculoskeletal Triage Unit in the UK.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Tackling delayed diagnosis in degenerative cervical myelopathy (DCM) is a global research priority. On average, it takes 2-5 years, leading to worse outcomes from surgery and greater disability. Many countries in the UK use interface triage units run by specialist physiotherapists that sit between primary and secondary care termed musculoskeletal services. Their role in the efficient diagnosis of DCM is unknown. The aim of this study was to map the journey of the patient in the musculoskeletal service and to establish the presenting signs and symptoms. METHODS: A retrospective review of 2.5 years of clinical notes was performed in a musculoskeletal service. Process mapping was utilised to visualise the patient's journey and identify delays to diagnosis and presenting signs and symptoms. RESULTS: Twenty-seven cases were reviewed. Patients spent an average of three months in the service. There was a wide variety of presenting symptoms. DCM was more often suspected if patients had both upper limb symptoms and gait disturbance or pathological reflexes. Delays occurred when patients had no gait disturbance or a normal or incomplete neurological assessment. Longest delays occurred when patients received electrophysiology tests for differential diagnosis of peripheral neuropathies. Delays were also seen with incorrect triaging of MRI results. CONCLUSIONS: Where DCM is the principal differential diagnosis, diagnosis was faster. Incomplete examination, misinterpretation of MRI findings or delays in other investigations contributed to delays. Improved awareness and protocols of care within musculoskeletal services represent an opportunity to accelerate diagnosis in DCM.https://onlinelibrary.wiley.com/journal/1557068

Psychological detachment from work predicts mental wellbeing of working-age adults: Findings from the 'Wellbeing of the Workforce' (WoW) prospective longitudinal cohort study

© 2025 Blake et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.BACKGROUND: There is an urgent need to better understand the factors that predict mental wellbeing in vocationally active adults during globally turbulent times. AIM: To explore the relationship between psychological detachment from work (postulated as a key recovery activity from work) in the first national COVID-19 lockdown with health, wellbeing, and life satisfaction of working age-adults one year later, within the context of a global pandemic. METHODS: Wellbeing of the Workforce (WoW) was a prospective longitudinal cohort study, with two waves of data collection (Time 1, April-June 2020: T1 n = 337; Time 2, March-April 2021: T2 = 169) corresponding with the first and third national COVID-19 lockdowns in the UK. Participants were >18 years, who were employed or self-employed and working in the UK. Descriptive and parametric (t-tests and linear regression) and nonparametric (chi square tests) inferential statistics were employed. RESULTS: Risk for major depression (T1: 20.0% to T2: 29.0%, p = .002), poor general health (T1: 4.7% to T2: 0%, p = .002) and poor life satisfaction (T1: 15.4% to T2: 25.4%, p = .002) worsened over time, moderate-to-severe anxiety remained stable (T1: 26.1% to T2: 30.2%, p = .15). Low psychological detachment from work was more prevalent in the first wave (T1: 21.4% and T2: 16.0%), with a moderate improvement observed from T1 to T2 (t (129) = -7.09, p < .001). No differences were observed with work status (employed/self-employed), except for self-employed workers being more likely to report poor general health at T1 (16.1%, p = .002). Better psychological wellbeing, lower anxiety and higher life satisfaction at T2 were observed in those who reported better psychological detachment from work at T1 (β = .21, p = .01; β = -.43, p < .001; β = .32, p = .003, respectively), and in those who improved in this recovery activity from T1 to T2 (β = .36, p < .001; β = -.27, p < .001; β = .27, p = .008, respectively), controlling for age, gender and ethnicity. CONCLUSION: The ability to psychologically detach from work during the first pandemic lockdown, and improvement in this recovery activity over time, predicted better mental wellbeing and quality of life in vocationally active adults after one year of a global crisis, irrespective of work status. Interventions to encourage workers to psychologically detach from work may help to support employee wellbeing at all times, not only in the extreme circumstances of pandemics and economic uncertainty.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.031267

Subthreshold Autism and ADHD: A Brief Narrative Review for Frontline Clinicians.

Background: Epidemiological studies have shown that neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are more prevalent in the general childhood population, compared to cases that are formally diagnosed in clinical cohorts. This suggests that many children and youths have NDD which are never diagnosed clinically, causing impairments in some domains of their daily life. There is increasing recognition of the concept of a “subthreshold” condition, sometimes used to describe the presence of potentially impairing variations in the neurodevelopmental profile that do not meet criteria for a diagnosis. The aim of this narrative review is to appraise the published literature about common themes regarding subthreshold conditions in relation to autism and ADHD, identifying any practical lessons that may be applicable to frontline neurodevelopmental clinicians. Methods: We searched electronic databases including PMC and PubMed using various combinations of keywords, including “Subthreshold”, “subclinical”, “neurodevelopmental”, “childhood”, “ADHD” and “ASD”. Results: The identified themes include definitions, prevalence, assessment tools, lifetime impairments, NDD classification models, management, raising public awareness, and future research directions. Conclusions: The authors propose that a “subthreshold condition” should be recorded when NDDs do not meet current diagnostic criteria if there is evidence of significant, persisting impairment in at least one setting.https://www.mdpi.com/2036-7503/17/2/4

Hormonal Treatment Effects on Imaging Phenotypes in AI Breast Cancer Detection.

No Abstracthttps://www.academicradiology.org/article/S1076-6332(25)00514-8/abstrac

Magnetic resonance imaging of inner ear and internal auditory canal structures in the presence of a cochlear implant

OBJECTIVE: To determine whether the internal auditory canal (IAC) can be visualized using magnetic resonance imaging (MRI) in users of a cochlear implant (CI) model that can safely undergo MRI at 3 T. PATIENTS: Four normally hearing controls and three individuals unilaterally implanted with a HiRes Ultra 3D (Advanced Bionics LLC, California, USA). INTERVENTIONS: Participants underwent 3 T MRI using sequences appropriate for the postoperative surveillance of the IAC. Images in normally hearing individuals were acquired after placing a fully functional, unpowered, CI underneath a swimming cap at each of eight candidate scalp positions, four on each side of the head. Images were compared to a control condition without a CI present. and CI users were imaged with similar sequences. MAIN OUTCOME MEASURES: In normally hearing controls, the likely impact of the artifact on detection of pathology for multiple neuroradiological locations as rated by two independent radiologists. In CI users, a qualitative assessment of the diagnostic usability of images. RESULT(S): Visibility of the ipsilateral IAC and cochlea varied among the three CI users, with images from one participant deemed largely usable, while those from the other two participants exhibited less diagnostic certainty, likely due to differences in implant locations and cranial/neuroanatomical variations. Ratings of images in normally hearing participants showed that more middle-to-anterior CI locations were associated with reduced likelihood of overlooking gross abnormalities. CONCLUSION(S): Through meticulous surgical placement, bilateral IAC visualization may be achievable for monitoring chronic health conditions such as tumor surveillance in high-risk patients, and as a safety monitoring outcome measure in clinical trials.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc.https://doi.org/10.1097/mao.000000000000444

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 trial

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/BACKGROUND: 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.https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-08772-

Microbiological profiles of infectious corneal ulcers in Derbyshire and North Nottinghamshire-a 10-year analysis.

Purpose: To assess the spectrum of organisms causing microbial keratitis and their in-vitro anti-microbial sensitivities out of 2 hospitals in the East Midlands Region of the United Kingdom. Methods: A retrospective review was undertaken of all patients who underwent corneal scrapes for infectious keratitis between 2011 and 2021 at Royal Derby Hospital (RDH) in Derby and between 2009 and 2021 at King's Mill Hospital in Mansfield. Results: In total, the results of 645 corneal scrapes (from 622 patients) were analysed after exclusions. Of these, 307 (47.6%) yielded positive cultures. The mean patient age was 52.6 ± 22.1 years (Mean ± St Dev) across both sites and 332 (51.4%) were from female patients. At RDH, there were 195 positive corneal scrape cultures, from which 250 species of organisms were isolated. At RDH, 64% (160/250) were Gram-positive bacteria, 32% (81/250) were Gram-negative bacteria, 2.4% (6/250) were Acanthamoeba species and 1.2% were fungi (3/250). At KMH, there were 112 positive cultures, from which 128 species of organisms were isolated. 14 corneal scrapes from KMH were polymicrobial. At KMH, 96% (123/128) were bacterial (51% Gram positive, 45% Gram negative), 3/128 (2.3%) were fungi and 2/128 (1.6%) were Acanthamoeba. Sensitivity testing confirmed that the fluoroquinolone class of antibiotics appeared to be effective against the majority isolates across the two hospital sites. Conclusion: There are differences in microbiological profiles between these neighbouring hospitals covering neighbouring populations. Despite these differences, reassuringly, the current first-line fluoroquinolone monotherapy treatment is an appropriate first-line treatment for both hospital sites.https://link.springer.com/article/10.1007/s10792-025-03432-

Mental health services for serious mental illness: Scoping review of randomised controlled trials

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Nursing Open published by John Wiley & Sons LtdAIMS: This review aims to classify the evidence from randomised controlled trials (RCTs) on mental health services (MHS) for people with serious mental illness (SMI) available in the Cochrane Schizophrenia Group's (CSzG) specialised register. DESIGN: Scoping review. METHODS: We retrieved and screened RCTs of service-level interventions considering non-pharmacological approaches for mental healthcare of the CSzG register. We classified and collected the main characteristics of the RCTs using a customised data extraction and charting form based on DESDE-LTS classification. RESULTS: We included 233 out of 262 total trial registries. Most of the studies were conducted in China, 136 (58%), 57 (24%) North America and 26 (11%) Europe. We classified the studies as ambulatory assistance 80 (34%), day services/out-patient care 38 (16%), residential services 44 (19%), accessibility to care 19 (8%), information/assessment 39 (17%), self-help and voluntary help 10 (4%), e-health 52 (22%), and discharge services 17 (7%). CONCLUSIONS: We found a large number of trials that investigated the effects of mental health services for people with SMI. Trials classification was difficult due to the poor report of the characteristics of these complex interventions. This database can be used to plan and prioritise systematic reviews according to the needs of stakeholders. RELEVANCE STATEMENT: The study is of interest to mental health nursing because it studies the different services in which nurses play a fundamental role with implications in the nursing practice, education, research or leadership and management.https://onlinelibrary.wiley.com/doi/10.1002/nop2.7010

Is geographical variation in emergency epilepsy admissions related to variation in new epilepsy diagnoses among children and young people across England? An observational study using linked datasets.

Introduction Previous studies have reported widespread unexplained geographical variations in emergency paediatric admissions for epilepsy. Objectives Our aim was to investigate the extent to which geographical variation in epilepsy admissions among children and young people (CYP) aged 0–18 years, in England, reflects variation in new epilepsy diagnoses. Design and setting A retrospective secondary analysis of Hospital Episode Statistics data for emergency admissions between April 2018 and March 2019, and Epilepsy12 audit data for new epilepsy diagnoses in England, between July and November 2018. Outcome measures The ratios of observed to expected epilepsy admissions and new diagnoses were calculated for each hospital Trust, based on their catchment population, and adjusted for age, sex and deprivation. Standardised ratios of observed to expected epilepsy admissions were plotted against standardised ratios of observed to expected new diagnoses of epilepsy at Trust level and the Pearson correlation coefficient was calculated. Results There were 9246 emergency admissions for CYP to 134 Trusts with a primary diagnosis of epilepsy in England during the study period. 60 Trusts (44.4%) had either significantly lower or higher than expected standardised admission ratios for a primary diagnosis of epilepsy. There were 960 new diagnoses of epilepsy between July and November 2018 for 74 Trusts. 14 Trusts (18.9%) had either lower or higher standardised diagnosis ratios for a new diagnosis of epilepsy. There was no correlation between standardised emergency epilepsy admissions ratios and standardised new epilepsy diagnoses ratios at Trust level (Pearson r −0.06, p 0.63). Conclusions Widespread unexplained variation in epilepsy admissions cannot be explained by variation in new epilepsy diagnosis. This raises concerns about the equity and accessibility of epilepsy services. Unit-level benchmarking data on new diagnoses and admissions for epilepsy can inform strategies to improve access to care and health outcomes.https://bmjopen.bmj.com/content/15/2/e08263

Improving collateral history taking in the geriatric population.

Introduction The geriatric population has a high incidence of dementia, delirium and frailty meaning often these patients cannot give comprehensive histories themselves. We are left with missing pieces of the puzzle; we might not know their ‘normal’ and frequently ask: ‘Are they always like this?’ A collateral history becomes a valuable tool, contributing to a Comprehensive Geriatric Assessment and assisting the whole MDT to make informed decisions for patient-centred care. The primary aim of this project was to improve the quality of collateral histories taken for patients admitted to the geriatric wards, with content measured against 8 domains. A secondary aim was to encourage timely collateral histories within 48 hours of admission to the ward. Method Using PDSA methodology, collateral histories were analysed before and after implementation of a poster and teaching session. Results At baseline each domain was covered a mean of 40.5% of the time (range 9%—81%). Following intervention this increased by 22% to 62.5% (range 18%—89%), demonstrating a significant improvement (paired t-test, P < 0.05). It was already common practice to take collateral histories within 48 hours of admission to the ward (91%) which was sustained post-intervention (88%). Conclusion Use of a poster as a prompt, and delivering teaching, led to more thorough collateral histories. This suggests two barriers are knowing what to ask and perceived importance, elements which could be integrated into early postgraduate education. The impact on patient care has the potential to be significant and multidimensional but further work would be needed to understand this.https://academic.oup.com/ageing/article-abstract/54/Supplement_1/afae277.052/7985005?login=tru