Work of the NHS England Youth Forum and its effect on health services.

©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.AIM: To examine the role of members of the NHS England Youth Forum (NHSEYF) and the strategies used to influence health service provision for children and young people. METHOD: An evaluative mixed-methods study was commissioned by NHS England and undertaken by the University of Hertfordshire between July 2015 and September 2016. Data collection comprised activity logs, a form of questionnaire, and semi-structured interviews. FINDINGS: The analysis of the activity logs revealed that the young people were undertaking a wide range of activities across England. Seven themes emerged from the interviews: the young people; motivation; commitment; community (the local area as well as a community spirit); knowledge experts; youth workers; and funding. In summary, the members of the NHSEYF were committed to their role and their work was having a positive effect on health service provision. CONCLUSION: The NHSEYF has developed rapidly and successfully. It is enabling the voice of young people to be heard.Peer reviewedFinal Published versio

Workplace-based interventions to promote healthy lifestyles in the NHS workforce : a rapid scoping and evidence map

Background:The health and well-being of staff working in the NHS is a significant issue for UK health care. We sought to identify research relevant to the promotion of healthy lifestyles among NHS staff on behalf of NHS England. Objectives:To map existing reviews on workplace-based interventions to promote health and well-being, and to assess the scope for further evidence synthesis work. Design:Rapid and responsive scoping search and evidence map. Participants:Adult employees in any occupational setting and in any role. Interventions:Any intervention aimed at promoting or maintaining physical or mental health and well-being. Early intervention initiatives and those addressing violence against staff, workplace bullying or harassment were also included. Main outcome measures:Any outcome related to the effectiveness, cost-effectiveness or implementation of interventions.Data sources:A scoping search of nine databases was conducted to identify systematic reviews on health and well-being at work. Searches were limited by publication date (2000 to January/February 2019). Review methods:The titles and abstracts of over 8241 records were screened and a total of 408 potentially relevant publications were identified. Information on key characteristics were extracted from the titles and abstracts of all potentially relevant publications. Descriptive statistics (counts and percentages) for key characteristics were generated and data from reviews and ‘reviews of reviews’ were used to produce the evidence map. Results:Evidence related to a broad range of physical and mental health issues was identified across 12 ‘reviews of reviews’ and 312 other reviews, including 16 Cochrane reviews. There also exists National Institute for Health and Care Excellence guidance addressing multiple issues of potential relevance. A large number of reviews focused on mental health, changing lifestyle behaviour, such as physical activity, or on general workplace health/health promotion. Most of the reviews that focused only on health-care staff addressed mental health issues, and stress/burnout in particular. Limitations:The scoping search process was extensive and clearly effective at identifying relevant publications, but the strategy used may not have identified every potentially relevant review. Owing to the large number of potentially relevant reviews identified from the scoping search, it was necessary to produce the evidence map using information from the titles and abstracts of reviews only. Conclusions: It is doubtful that further evidence synthesis work at this stage would generate substantial new knowledge, particularly within the context of the NHS Health and Wellbeing Framework published in 2018. Additional synthesis work may be useful if it addressed an identifiable need and it was possible to identify one of the following: (1) a specific and focused research question arising from the current evidence map; it may then be appropriate to focus on a smaller number of reviews only, and provide a more thorough and critical assessment of the available evidence; and (2) a specific gap in the literature (i.e. an issue not already addressed by existing reviews or guidance); it may then be possible to undertake further literature searching and conduct a new evidence review

Pornography use and sexting amongst children and young people : a systematic overview of reviews

BACKGROUND: Young people's use of pornography and participation in sexting are commonly viewed as harmful behaviours. This paper reports findings from a 'review of reviews', which aimed to systematically identify and synthesise the evidence on pornography and sexting amongst young people. Here, we focus specifically on the evidence relating to young people's use of pornography; involvement in sexting; and their beliefs, attitudes, behaviours and wellbeing to better understand potential harms and benefits, and identify where future research is required. METHODS: We searched five health and social science databases; searches for grey literature were also performed. Review quality was assessed and findings synthesised narratively. RESULTS: Eleven reviews of quantitative and/or qualitative studies were included. A relationship was identified between pornography use and more permissive sexual attitudes. An association between pornography use and stronger gender-stereotypical sexual beliefs was also reported, but not consistently. Similarly, inconsistent evidence of an association between pornography use and sexting and sexual behaviour was identified. Pornography use has been associated with various forms of sexual violence, aggression and harassment, but the relationship appears complex. Girls, in particular, may experience coercion and pressure to engage in sexting and suffer more negative consequences than boys if sexts become public. Positive aspects to sexting were reported, particularly in relation to young people's personal relationships. CONCLUSIONS: We identified evidence from reviews of varying quality that linked pornography use and sexting amongst young people to specific beliefs, attitudes and behaviours. However, evidence was often inconsistent and mostly derived from observational studies using a cross-sectional design, which precludes establishing any causal relationship. Other methodological limitations and evidence gaps were identified. More rigorous quantitative studies and greater use of qualitative methods are required

Using automation to produce a ‘living map’ of the COVID-19 research literature

The COVID-19 pandemic has disrupted life worldwide and presented unique challenges in the health evidencesynthesis space. The urgent nature of the pandemic required extreme rapidity for keeping track of research, andthis presented a unique opportunity for long-proposed automation systems to be deployed and evaluated. Wecompared the use of novel automation technologies with conventional manual screening; and Microsoft AcademicGraph (MAG) with the MEDLINE and Embase databases locating the emerging research evidence. We foundthat a new workflow involving machine learning to identify relevant research in MAG achieved a much higherrecall with lower manual effort than using conventional approaches

Adult specialist services for victim-survivors of sexual violence and abuse: a systematic map of evidence

EXECUTIVE SUMMARY Background Around one in five women and one in twenty-five men are estimated to have experienced sexual violence or abuse since the age of 16. When combined with rates of child sexual abuse this figure is even higher. Sexual violence is detrimental to an individual’s physical health, emotional wellbeing and relationships, and incurs huge social and economic costs. Appropriate support and care for victim-survivors can help to protect against these negative consequences. Around 90% of sexual offences are committed by someone known to the victim and for a variety of reasons, cases often remain unreported to the police. Many victim-survivors mistrust statutory services to respond to their needs. While underreporting is still common, the number of police records of sexual violence crimes has increased considerably over the last few years. There has also been an increase in demand for specialist support services. In part, these patterns are thought to be linked to improved police recording procedures and a growing awareness of sexual violence and abuse through high-profile cases and related social media campaigns. This surge in demand, and especially the need for support for non-recent sexual abuse, coincides with severe budget cuts, and where commissioning of support services has been devolved to local commissioning bodies. Commissioners require evidence-based guidance on which services they should be commissioning in order to best serve victim-survivors. Overall aims To provide a systematic map of available evidence on any specialist adult services for victim-survivors of sexual violence and abuse. We included: • studies of people’s views about services in the UK • evaluations of interventions (using controlled and before-and-after designs, and cost-effectiveness studies) from OECD countries, • systematic reviews containing these kinds of studies The map will signal where there are gaps in the evidence base and where there is potential for an in-depth review of evidence to guide decisions about services for victim-survivors. Review question What is known about the effectiveness and appropriateness (availability, acceptability and accessibility) of specialist adult services for people who have experienced sexual violence and abuse? Method We conducted searches of electronic databases; website searches; reference list harvesting and contacted topic experts to identify potentially relevant items. We applied exclusion criteria to screen all items on title and abstract alone, and then retrieved reports and screened the full-text of all records included at title and abstract stage. All studies included at full-text screening were coded to describe their main characteristics – for example, the study’s purpose (people’s views of services, evaluation to improve services, or reviewing other studies), its geographic setting, who had provided data, and which type of sexual violence and/or service was being explored. We held a stakeholder event to consult on the initial findings from the map with victim-survivor advocates, service providers and practitioners and policy representatives. Suggestions from this event informed further analysis and the structure for presenting the narrative about the studies identified. In addition to the narrative contained in this report, EPPI-Mapper software was used to produce online interactive maps to visually display the findings and allow users to see the detail of included studies. Stakeholder influence on the map The stakeholders’ feedback informed the later iterations of the coding tool – for example, the age categories and additional population and service characteristics that we captured. Discussions at the stakeholder event also helped us to distinguish between population subgroups when categorising the studies, and influenced the descriptive terms that we used to describe these sets. Stakeholders also highlighted forthcoming and recently published studies. Four were added to the review to be screened on full text, one of which was included in our map. Summary of findings Studies included in the map In total we included 163 studies in our systematic map: 36 views studies, 106 evaluation studies, and 21 systematic reviews. Studies of people’s views about services in the UK (n=36) Of the 36 UK views studies, 26 focused on targeted services for victim-survivors of sexual violence and 10 focused on adaptations that general services, such as maternity or health services, could make to meet victim-survivors’ needs. The studies which focused on targeted services (n=26) were further categorised into four groups: targeted services for a specific population subgroup (n=9); services for victim-survivors who have additional forms of disadvantage (n=8); services for any type of victim-survivor of sexual violence (n=5); and how victim-survivors needs are met by services across a broad range of provision (n=4). Specific victim-survivor population subgroup Studies in this group (n=9) focussed on services for: people who had experienced so-called ‘honour’ based violence (n=1); child sexual exploitation (n=1); childhood sexual abuse (n=1); ritual abuse (n=1); forced marriage (n=1); male rape (n=1); and female black and minority ethnic (BME) victim-survivors (n=3). Victim-survivors with additional disadvantage Eight studies (n=8) focused on populations with co-existing vulnerabilities or disadvantage, including: mental health and substance misuse problems; learning or physical disabilities; and women seeking asylum. Any victim-survivor Five studies (n=5) concentrated on specific types of services or roles that support all victim-survivors of sexual violence. These were mostly located in the statutory sector. Two addressed specialist provision in the criminal justice sector, and three addressed Sexual Assault Referral Centres (SARC), of which one was a comparison between SARCs and voluntary sector services. Victim-survivor needs in relation to broad provision of services Four studies (n=4) explored views on how any needs were met (or otherwise) by broader provision of services. Two of these were needs assessments across regional areas, one looked at ways to best deliver group work, and one explored the potential of co-production in Violence Against Women services in Wales. Adaptations (n=10) The remaining studies (n=10) addressed how general services, such as maternity, general healthcare, mental healthcare and the police could meet the needs of victim-survivors of sexual violence by way of adaptations. Evaluations of interventions to support victim-survivors of sexual violence (n=106) Evaluation studies were mainly US-based (n=62). Across all OECD countries, most evaluations aimed to assess a therapy for improving mental health outcomes (n=84). Other interventions included education for professionals (n=8) or victim-survivors (n=4), services such advocacy or police services (n=9) and secondary prevention of HIV among victim-survivors (n=1). Most evaluations reported quantitative findings about outcomes or impact (n=86), eight studies were qualitative evaluations of processes only, and 12 studies were evaluations of both outcomes and processes. All UK outcomes evaluations assessed types of therapies (n=4). We found eight UK-based process evaluations of: a national advocacy service in Scotland (two evaluations); a Rape Crisis Centre in Tyneside; training for mental health practitioners to improve practice around abuse histories; a pilot project to support victim-survivors of historic child sex exploitation in Leeds; a specialist sexual assault police investigation unit; and specialist services for female victim-survivors of childhood sexual abuse (two evaluations). Systematic reviews (n=21) The systematic reviews focused on four distinct population types of victim-survivors of sexual violence including those who had experienced: female genital mutilation (FGM) (n=8), sexual violence including rape and sexual assault (n=6), sexual abuse as a child (n=5) and human trafficking (n=2). Most reviews (n=16) examined the effectiveness of interventions. The types of interventions reviewed were predominantly mental health and psychological interventions to reduce post-traumatic stress disorder (PTSD) and improve psychosocial wellbeing (n=11). The other five intervention reviews addressed early intervention; non-surgical responses to FGM; the role of the forensic examiner; educational interventions to increase awareness of sex trafficking among healthcare professionals; and interventions to reduce HIV and sexually transmitted infections. Three reviews explored views and experiences of service-users and two explored the views of professionals about skills and attitudes. Included studies were conducted in different countries with the majority in the US, while only 15 out of 309 studies were conducted in the UK. Gaps in the evidence We identified no effectiveness or cost-effectiveness studies of UK specialist services for victim-survivors of sexual violence. UK views studies focussing on a range of perspectives and populations were included in the map. However, only one study looked at male victim-survivors. This study sought professionals’ views only, so we did not locate any studies which addressed male victim-survivors’ views. Stakeholder group Stakeholders described research conducted in the US as being of limited relevance to their own practice. Information on cost-effectiveness and cost-saving was highly sought after by stakeholders, although it was understood to be scarce. Service providers wanted to know the best way to spend their money, and indicated they would value a review examining which therapies, counselling or service referrals are most effective, in which contexts, and also the benefits of specialist service provision in the voluntary sector over those provided by a generic health provider. Stakeholders expressed their interest in evidence relating to pathways and referral, relationships between commissioners and providers, the effects of cuts to services, access to services, access to mental health services, suicide risk, and service waiting lists and “turn-away” rates. Outcome measurements relating to empowerment and feeling in control, relationships, and ability to work and study were all seen as important ways of assessing victim-survivors’ recovery. Implications and conclusion We identified a lack of evidence on the effectiveness (and cost-effectiveness) of UK statutory and voluntary specialist services for victim-survivors of sexual violence. However, a lack of evidence should not be interpreted to mean that these services are not effective. We identified eight process evaluations and a range of UK views studies which give insight into the views and experiences of victim-survivors and the professionals that support them. Some studies focus on services that serve all types of victim-survivor of sexual violence, whereas others focus on different subgroups of victim-survivor populations (BME women, people subjected to sex trafficking ‘honour’-based violence and forced marriage) and victim-survivors who have additional vulnerabilities or disadvantage (women with mental health or substance misuse problems, women who are disabled, women seeking asylum). These sets of UK studies warrant quality appraisal and in-depth synthesis or syntheses which could provide a nuanced understanding of UK victim-survivors’ service needs across a range and population subgroups and types of sexual violence

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Non-invasive muscle contraction assay to study rodent models of sarcopenia

<p>Abstract</p> <p>Background</p> <p>Age-related sarcopenia is a disease state of loss of muscle mass and strength that affects physical function and mobility leading to falls, fractures, and disability. The need for therapies to treat age-related sarcopenia has attracted intensive preclinical research. To facilitate the discovery of these therapies, we have developed a non-invasive rat muscle functional assay system to efficiently measure muscle force and evaluate the efficacy of drug candidates.</p> <p>Methods</p> <p>The lower leg muscles of anesthetized rats are artificially stimulated with surface electrodes on the knee holders and the heel support, causing the lower leg muscles to push isometric pedals that are attached to force transducers. We developed a stimulation protocol to perform a fatigability test that reveals functional muscle parameters like maximal force, the rate of fatigue, fatigue-resistant force, as well as a fatigable muscle force index. The system is evaluated in a rat aging model and a rat glucocorticoid-induced muscle loss model</p> <p>Results</p> <p>The aged rats were generally weaker than adult rats and showed a greater reduction in their fatigable force when compared to their fatigue-resistant force. Glucocorticoid treated rats mostly lost fatigable force and fatigued at a higher rate, indicating reduced force from glycolytic fibers with reduced energy reserves.</p> <p>Conclusions</p> <p>The involuntary contraction assay is a reliable system to assess muscle function in rodents and can be applied in preclinical research, including age-related sarcopenia and other myopathy.</p

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes