Cric-guide – A review of an innovative scalpel designed for adult surgical cricothyroidotomy

This is a review of the design, development and peer evaluation of Cric-Guide – an innovative scalpel device for emergency front of neck access in adults. The Cric-Guide is designed to replace the standard scalpel blade in the scalpel-bougie-tube technique and improve its success by guiding the bougie into the airway. The handle incorporates two depth guards which impact on the skin each side of the incision to limit insertion depth and reduce posterior damage to the airway. Five research evaluations of Cric-Guide during simulated cricothyroidotomy have been completed. Four compared the performance of Cric-Guide with the standard scalpel in the scalpel-bougie-tube technique, in manikins using porcine larynxes made more difficult with simulated obesity or bleeding or both. Cric-Guide had a lower failure rate on the first attempt particularly with the bleeding simulation and a lower false passage rate in the obese simulations. The other study evaluated Cric-Guide during cricothyroidotomy on intact human cadavers and was successful in all 12 cadavers on the first attempt with no false passages. The Cric-Guide performs surgical cricothyroidotomy effectively in human cadavers and porcine models and is presented as a possible alternative to the standard scalpel for emergency front of neck access.</p

Psychological wellbeing and quality-of-life among siblings of paediatric CFS/ME patients:a mixed-methods study

Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a disabling condition known to have a negative impact on all aspects of a child’s life. However, little is understood about the impact of CFS/ME on siblings. A total of 34 siblings completed questionnaires measuring depression (Hospital Anxiety and Depression Scale (HADS)), anxiety (HADS and Spence Children’s Anxiety Scale (SCAS)) and European Quality-of-life-Youth (EQ-5D-Y). These scores were compared with scores from normative samples. Siblings had higher levels of anxiety on the SCAS than adolescents of the same age recruited from a normative sample; however, depression and quality-of-life were similar. Interviews were undertaken with nine siblings of children with CFS/ME who returned questionnaires. Interview data were analysed using a framework approach to thematic analysis. Siblings identified restrictions on family life, ‘not knowing’ and lack of communication as negative impacts on their family, and change of role/focus, emotional reactions and social stigma as negative impacts on themselves. They also described positive communication, social support and extra activities as protective factors. Paediatric services should be aware of the impact of CFS/ME on the siblings of children with CFS/ME, understand the importance of assessing paediatric CFS/ME patients within the context of their family and consider providing information for siblings about CFS/ME

Destination Europe?:Understanding the dynamics and drivers of Mediterranean migration in 2015

Politicians and policymakers across Europe have largely talked about the arrival of refugees and migrants in 2015 as an unprecedented ‘event’, a single coherent flow of people that came ‘from nowhere’, suddenly and unexpectedly pressing against the continent’s southern border.There has been little or no interest in the ‘back stories’ of those arriving; instead the gap between someone leaving their home country and his or her or arrival in Europe has been filled with generalisations and assumptions. We are now several years into the ‘crisis’ and there is still no sign of a coherent long-term response.Understanding the dynamics of migration to Europe and why some people might decide to risk their lives crossing the Mediterranean remains a pressing concern.The total number of people recorded as dead or missing in the Mediterranean in 2016 is higher than the total for 2015. Since the beginning of 2016 the rates of death have increased from 1 in 54 to 1 in 46 people among those crossing via the Central Mediterranean route and from 1 death in every 1,063 arrivals to 1 death in every 409 arrivals via the Eastern Mediterranean route.Both the reception infrastructure and the asylum system in Greece have failed to adapt to the needs of the refugees and migrants. This is partly a Greek failure but it is also a failure of the EU. Meanwhile escalating conflicts in Syria, Yemen, Afghanistan and Iraq continue to displace hundreds of thousands of people from their homes every day.And the assault on Mosul (Iraq) which began in mid-October 2016 is expected to displace 1.5 million people, many of whom are likely to cross the border into Eastern Turkey just a few hours away.Our final report of the ESRC-funded MEDMIG project shines new light on the dynamics of migration to Europe across the Mediterranean Sea drawing on a rich dataset from the first large-scale, systematic and comparative study of the backgrounds, experiences, routes and aspirations of refugees and migrants in three EU Member States – Italy, Greece and Malta – and Turkey

“It’s personal to me”:A qualitative study of depression in young people with CFS/ME

Background: Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has a prevalence of 0.4–2.4% and is defined as ‘generalised disabling fatigue persisting after routine tests and investigations have failed to identify an obvious underlying cause’. One-third of young people with CFS/ME have probable depression. Little is known about why depression develops, the relationship between depression and CFS/ME, or what treatment might be helpful. Methods: We conducted nine semi-structured interviews with young people with CFS/ME (aged 13–17 years, 8/9 female) and probable depression, covering perceived causes of depression, the relationship between CFS/ME and depression, and treatment strategies. Results: Most thought CFS/ME caused depression. Many discussed a cyclical relationship: low mood made CFS/ME worse. A sense of loss was common. CFS/ME restricted activities participants valued and changed systemic structures, causing depression. There was no single helpful treatment approach. Individualised approaches using combinations of cognitive behavioural therapy (CBT), medication, activity management and other strategies were described. Conclusion: This study suggests that depression may be secondary to CFS/ME in young people because of the impact of CFS/ME on quality of life. Clinicians treating young people with CFS/ME need to consider strategies to prevent development of depression, and research is needed into approaches that are effective in treating CFS/ME with co-morbid depression. </jats:sec

Adult patients’ experiences of NHS specialist services for chronic fatigue syndrome (CFS/ME):a qualitative study in England

Abstract Background Few studies have explored patients’ experiences of treatment for CFS/ME. This study aims to fill this gap by capturing the perspective of patients who have been treated by NHS specialist CFS/ME services in England. Methods Semi-structured interviews were conducted during the period June–September 2014 with 16 adults who were completing treatment at one of three outpatient NHS specialist CFS/ME services. Interviews were analysed thematically using constant comparison techniques, with particular attention paid to contrasting views. Results Three themes were identified: ‘Journey to specialist services’; ‘Things that help or hinder treatment’; and ‘Support systems’. Within these themes nine sub-themes were identified. A wide range of factors was evident in forming participants’ experiences, including personal characteristics such as perseverance and optimism, and service factors such as flexibility and positive, supportive relationships with clinicians. Participants described how specialist services played a unique role, which was related to the contested nature of the condition. Many participants had experienced a lack of validation and medical and social support before attending a specialist service. Patients’ experiences of life before referral, and the concerns that they expressed about being discharged, highlighted the hardship and obstacles which people living with CFS/ME continue to experience in our society. Conclusions The experiences of CFS/ME patients in our study showed that NHS specialist CFS/ME services played a vital role in patients’ journeys towards an improved quality of life. This improvement came about through a process which included validation of patients’ experiences, acceptance of change, practical advice and support, and therapeutic outcomes

Specialist treatment of chronic fatigue syndrome/ME:a cohort study among adult patients in England

Abstract Background NHS specialist chronic fatigue syndrome (CFS/ME) services in England treat approximately 8000 adult patients each year. Variation in therapy programmes and treatment outcomes across services has not been described. Methods We described treatments provided by 11 CFS/ME specialist services and we measured changes in patient-reported fatigue (Chalder, Checklist Individual Strength), function (SF-36 physical subscale, Work & Social Adjustment Scale), anxiety and depression (Hospital Anxiety & Depression Scale), pain (visual analogue rating), sleep (Epworth, Jenkins), and overall health (Clinical Global Impression) 1 year after the start of treatment, plus questions about impact of CFS/ME on employment, education/training and domestic tasks/unpaid work. A subset of these outcome measures was collected from former patients 2–5 years after assessment at 7 of the 11 specialist services. Results Baseline data at clinical assessment were available for 952 patients, of whom 440 (46.2%) provided 1-year follow-up data. Treatment data were available for 435/440 (98.9%) of these patients, of whom 175 (40.2%) had been discharged at time of follow-up. Therapy programmes varied substantially in mode of delivery (individual or group) and number of sessions. Overall change in health 1 year after first attending specialist services was ‘very much’ or ‘much better’ for 27.5% (115/418) of patients, ‘a little better’ for 36.6% (153/418), ‘no change’ for 15.8% (66/418), ‘a little worse’ for 12.2% (51/418), and ‘worse’ or ‘very much worse’ for 7.9% (33/418). Among former patients who provided 2- to 5-year follow-up (30.4% (385/1265)), these proportions were 30.4% (117/385), 27.5% (106/385), 11.4% (44/385), 13.5% (52/385), and 17.1% (66/385), respectively. 85.4% (327/383) of former patients responded “Yes” to “Do you think that you are still suffering from CFS/ME?” 8.9% (34/383) were “Uncertain”, and 5.7% (22/383) responded “No”. Conclusions This multi-centre NHS study has shown that, although one third of patients reported substantial overall improvement in their health, CFS/ME is a long term condition that persists for the majority of adult patients even after receiving specialist treatment

Health care resource use by patients before and after a diagnosis of chronic fatigue syndrome (CFS/ME):a Clinical Practice Research Datalink study

Abstract Background Our aim was to investigate patterns of health care resource use by patients before and after a diagnosis of CFS/ME, as recorded by Clinical Practice Research Datalink (CPRD) GP practices in the UK. Methods We used a case–control study design in which patients who had a first recorded diagnosis of CFS/ME during the period 01/01/2001 to 31/12/2013 were matched 1:1 with controls by age, sex, and GP practice. We compared rates of GP consultations, diagnostic tests, prescriptions, referrals, and symptoms between the two groups from 15 years (in adults) or 10 years (in children) before diagnosis to 10 years after diagnosis. Results Data were available for 6710 adult and 916 child (age <18 years) matched case–control pairs. Rates of GP consultations, diagnostic tests, prescriptions, referrals, and symptoms spiked dramatically in the year when a CFS/ME diagnosis was recorded. GP consultation rates were 50% higher in adult cases compared to controls 11–15 years before diagnosis (rate ratio (RR) 1.49 (95% CI 1.46, 1.52)) and 56% higher 6–10 years after diagnosis (RR 1.56 (1.54, 1.57)). In children, consultation rates in cases were 45% higher 6–10 years before diagnosis (RR 1.45 (1.40, 1.51)) and 62% higher 6–10 years after diagnosis (RR 1.62 (1.54, 1.70)). For adults and children, rates of tests, prescriptions, referrals, and symptoms were higher in cases compared to controls for up to 10 years before and after diagnosis. Conclusions Adults and children with CFS/ME have greater health care needs than the rest of the population for at least ten years before their diagnosis, and these higher levels of health care resource use continue for at least ten years after diagnosis