Mothers’ experiences of their sons’ appearance-altering combat injuries: Distressed and unsupported

Emerging evidence indicates that combat injuries that change appearance, such as limb loss and physical scarring, can impact psychosocial wellbeing of injured military veterans. Parents of young children with a visibly different appearance may experience emotional distress and consequently have their own support needs, but less is known about the experiences of the parents of veterans with appearance-altering combat injuries. Using a qualitative individual interview design, this study aimed to understand the experiences and support needs of parents of military veterans who sustained appearance-altering combat injuries. Reflexive Thematic Analysis of interviews with six mothers identified two main themes “The distress of my son’s appearance-altering injury” and “I can’t express my distress”. The themes represent the emotional distress, guilt, and social difficulties experienced by the mothers following their sons’ appearance-altering injury, their experience of feeling they should supress their feelings of distress, the limited available support, and barriers to accessing support. This study highlights how the mothers of combat-injured veterans are often overlooked and provides emerging evidence that adjusting to a son’s changed appearance following combat-injury can create additional challenges for mothers, who could benefit from specific support

Energy Trends: September 2020

Energy Trends and Energy Prices are produced by the Department for Business, Energy and Industrial Strategy (BEIS) on a quarterly basis. Both periodicals are published concurrently in June, September, December and March. The September editions cover the second quarter of the current year

Pudendal nerve decompression in perineology : a case series

BACKGROUND: Perineodynia (vulvodynia, perineal pain, proctalgia), anal and urinary incontinence are the main symptoms of the pudendal canal syndrome (PCS) or entrapment of the pudendal nerve. The first aim of this study was to evaluate the effect of bilateral pudendal nerve decompression (PND) on the symptoms of the PCS, on three clinical signs (abnormal sensibility, painful Alcock's canal, painful "skin rolling test") and on two neurophysiological tests: electromyography (EMG) and pudendal nerve terminal motor latencies (PNTML). The second aim was to study the clinical value of the aforementioned clinical signs in the diagnosis of PCS. METHODS: In this retrospective analysis, the studied sample comprised 74 female patients who underwent a bilateral PND between 1995 and 2002. To accomplish the first aim, the patients sample was compared before and at least one year after surgery by means of descriptive statistics and hypothesis testing. The second aim was achieved by means of a statistical comparison between the patient's group before the operation and a control group of 82 women without any of the following signs: prolapse, anal incontinence, perineodynia, dyschesia and history of pelvi-perineal surgery. RESULTS: When bilateral PND was the only procedure done to treat the symptoms, the cure rates of perineodynia, anal incontinence and urinary incontinence were 8/14, 4/5 and 3/5, respectively. The frequency of the three clinical signs was significantly reduced. There was a significant reduction of anal and perineal PNTML and a significant increase of anal richness on EMG. The Odd Ratio of the three clinical signs in the diagnosis of PCS was 16,97 (95% CI = 4,68 – 61,51). CONCLUSION: This study suggests that bilateral PND can treat perineodynia, anal and urinary incontinence. The three clinical signs of PCS seem to be efficient to suspect this diagnosis. There is a need for further studies to confirm these preliminary results

Ozanimod for treating moderately to severely active ulcerative colitis [ID3841] A Single Technology Appraisal

This report was commissioned by the NIHR Systematic Reviews Programme as project number 13/54/43Executive Summary: This summary provides a brief overview of the key issues identified by the evidence review group (ERG) as being potentially important for decision-making. It also includes the ERG’s preferred assumptions and the resulting incremental cost-effectiveness ratios (ICERs). • Section 1.1 provides an overview of the key issues and the differences in the assumptions of the company and the ERG in economic analysis. • Section 1.2 provides an overview of key model outcomes and the modelling assumptions that have the greatest effect on the ICER. • Sections 1.3 to 1.5 explain the key issues in more detail. Background information on the condition, technology and evidence and information on non-key issues are in the main ERG report. • Sections 1.6 and 1.7 provide an overview of the ERG’s preferred base case and sensitivity analyses undertaken by the ERG. All issues identified represent the ERG’s view, not the opinion of the National Institute for Health and Care Excellence (NICE)

Partial diazoxide responsiveness in a neonate with hyperinsulinism due to homozygous ABCC8 mutation

We report a case of partial diazoxide responsiveness in a child with severe congenital hyperinsulinaemic hypoglycaemia (CHI) due to a homozygous ABCC8 mutation. A term baby, with birth weight 3.8 kg, born to consanguineous parents presented on day 1 of life with hypoglycaemia. Hypoglycaemia screen confirmed CHI. Diazoxide was commenced on day 7 due to ongoing elevated glucose requirements (15 mg/kg/min), but despite escalation to a maximum dose (15 mg/kg/day), intravenous (i.v.) glucose requirement remained high (13 mg/kg/min). Genetic testing demonstrated a homozygous ABCC8 splicing mutation (c.2041-1G>C), consistent with a diffuse form of CHI. Diazoxide treatment was therefore stopped and subcutaneous (s.c.) octreotide infusion commenced. Despite this, s.c. glucagon and i.v. glucose were required to prevent hypoglycaemia. A trial of sirolimus and near-total pancreatectomy were considered, however due to the significant morbidity potentially associated with these, a further trial of diazoxide was commenced at 1.5 months of age. At a dose of 10 mg/kg/day of diazoxide and 40 µg/kg/day of octreotide, both i.v. glucose and s.c. glucagon were stopped as normoglycaemia was achieved. CHI due to homozygous ABCC8 mutation poses management difficulties if the somatostatin analogue octreotide is insufficient to prevent hypoglycaemia. Diazoxide unresponsiveness is often thought to be a hallmark of recessively inherited ABCC8 mutations. This patient was initially thought to be non-responsive, but this case highlights that a further trial of diazoxide is warranted, where other available treatments are associated with significant risk of morbidity. Learning points: Homozygous ABCC8 mutations are commonly thought to cause diazoxide non-responsive hyperinsulinaemic hypoglycaemia. This case highlights that partial diazoxide responsiveness in homozygous ABCC8 mutations may be present. Trial of diazoxide treatment in combination with octreotide is warranted prior to considering alternative treatments, such as sirolimus or near-total pancreatectomy, which are associated with more significant side effects

Anterior anal sphincter repair can be of long term benefit: a 12-year case cohort from a single surgeon

BACKGROUND: Early surgical results of anterior sphincter repair for faecal incontinence can be good, but in the longer term are often disappointing. This study aimed to determine the short and long term outcomes from anterior sphincter repair and identify factors predictive of long term success. METHODS: Patients who underwent anterior sphincter repair between 1989 and 2001 in one institution were identified. Postal questionnaires were sent to patients, which included validated scoring systems for symptom severity and quality of life assessments for faecal incontinence. Patient demographics and risk factors were recorded as were the results of anorectal physiology studies and endoanal ultrasound. RESULTS: Eighty-five patients underwent repair by one consultant. The length of follow up ranged from 1 to 12 years. Most patients (96%) had early symptom improvement postoperatively. Of the 47 patients assessed long term (≥ 5 years), 28 (60%) maintained this success. Significant improvements in quality of life were observed (P < 0.001). Neither patient, surgical nor anorectal physiology study parameters were predictive of outcome. CONCLUSION: There were no predictive factors of outcome success and no changes in anal manometry identified, however anterior sphincter repair remains worthwhile. Changes in compliance of the anorectum may be responsible for symptom improvement

Systematic review of the economics of school-based interventions for dating violence and gender-based violence

Dating and relationship violence (DRV) and gender-based violence (GBV) among children and young people incur a high cost to individuals and society. School-based interventions present an opportunity to prevent DRV and GBV early in individuals’ lives. However, with school resources under pressure, policymakers require guidance on the economics of implementing interventions. As part of a large systematic review funded by the National Institute for Health and Care Research (NIHR), we searched for economic evaluations and costing studies of school-based interventions for DRV and GBV. No formal economic evaluations were identified. Seven studies reporting costs, cost savings, or resource use for eight interventions were identified. The largest costs of implementing interventions were related to staff training and salaries but savings could be made by implementing interventions on a large scale. The potential cost savings of avoided DRV and GBV far outweighed the costs of implementation

British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres

\ua9 The Author(s) 2024.An implantable left ventricular assist device (LVAD) is indicated as a bridge to transplantation or recovery in the United Kingdom (UK). The mechanism of action of the LVAD results in a unique state of haemodynamic stability with diminished arterial pulsatility. The clinical assessment of an LVAD recipient can be challenging because non-invasive blood pressure, pulse and oxygen saturation measurements may be hard to obtain. As a result of this unusual situation and complex interplay between the device and the native circulation, resuscitation of LVAD recipients requires bespoke guidelines. Through collaboration with key UK stakeholders, we assessed the current evidence base and developed guidelines for the recognition of clinical deterioration, inadequate circulation and time-critical interventions. Such guidelines, intended for use in transplant centres, are designed to be deployed by those providing immediate care of LVAD patients under conditions of precipitous clinical deterioration. In summary, the Joint British Societies and Transplant Centres LVAD Working Group present the UK guideline on management of emergencies in implantable LVAD recipients for use in advanced heart failure centres. These recommendations have been made with a UK resuscitation focus but are widely applicable to professionals regularly managing patients with implantable LVADs

Residual sleepiness after N(2)O sedation: a randomized control trial [ISRCTN88442975]

BACKGROUND: Nitrous oxide (N(2)O) provides sedation for procedures that result in constant low-intensity pain. How long do individuals remain sleepy after receiving N(2)O? We hypothesized that drug effects would be apparent for an hour or more. METHODS: This was a randomized, double blind controlled study. On three separate occasions, volunteers (N = 12) received 100% oxygen or 20% or 40% N(2)O for 30 min. Dependent measures included the multiple sleep latency test (MSLT), a Drug Effects/Liking questionnaire, visual analogue scales, and five psychomotor tests. Repeated measures analysis of variance was performed with drug and time as factors. RESULTS: During inhalation, drug effects were apparent based on the questionnaire, visual analogue scales, and psychomotor tests. Three hours after inhaling 100% oxygen or 20% N(2)O, subjects were sleepier than if they breathed 40% N(2)O. No other drug effects were apparent 1 hour after inhalation ceased. Patients did not demonstrate increased sleepiness after N(2)O inhalation. CONCLUSION: We found no evidence for increased sleepiness greater than 1 hour after N(2)O inhalation. Our study suggests that long-term effects of N(2)O are not significant

Re‐orientating systematic reviews to rigorously examine what works, for whom and how: Example of a realist systematic review of school‐based prevention of dating and gender violence

Conventional systematic reviews offer few insights into for whom and how interventions work. ‘Realist reviews’ examine such questions via examining ‘context‐mechanism‐outcome configurations’ (CMOCs) but are insufficiently rigorous in how evidence is identified, assessed and synthesised. We developed ‘realist systematic reviews’, addressing similar questions to realist reviews but using rigorous methods. We applied this to synthesising evidence on school‐based prevention of dating and relationship violence (DRV) and gender‐based violence (GBV). This paper reflects on overall methods and findings, drawing on papers reporting each analysis. Drawing on intervention descriptions, theories of change and process evaluations, we developed initial CMOC hypotheses: interventions triggering ‘school‐transformation’ mechanisms (preventing violence by changing school environments) will achieve larger effects than those triggering ‘basic‐safety’ (stopping violence by emphasising its unacceptability) or ‘positive‐development’ (developing students' broader skills and relationships) mechanisms; however, school transformation would only work in schools with high organisational capacity. We used various innovative analyses, some of which aimed to test these hypotheses and some of which were inductive, drawing on available findings to augment and refine the CMOCs. Overall, interventions were effective in reducing long‐term DRV but not GBV or short‐term DRV. DRV prevention occurred most effectively via the ‘basic‐safety’ mechanism. ‘School‐transformation’ mechanisms were more effective in preventing GBV but only in high‐income countries. Impacts on long‐term DRV victimisation were greater when working with a critical mass of participating girls. Impacts on long‐term DRV perpetration were greater for boys. Interventions were more effective when focusing on skills, attitudes and relationships, or lacking parental involvement or victim stories. Our method provided novel insights and should be useful to policy‐makers seeking the best interventions for their contexts and the most information to inform implementation