The Implementation of Connecting People in Community Mental Health Teams in England: A Quasi-Experimental Study

Abstract Loneliness and social isolation have become significant concerns in many countries, particularly amongst people experiencing mental health problems. A social intervention—Connecting People—has been found to increase their access to social capital, though it has been difficult to implement with high fidelity in community mental health teams (CMHTs) in England. This study aimed to evaluate outcomes for mental health service users of a practitioner-led implementation of Connecting People in CMHTs. It used a pragmatic non-randomised two-group pre-post study to evaluate the implementation process in CMHTs. Implementation materials co-produced with service users were provided to the intervention teams for practitioners to use with the support of a senior social worker in each mental health National Health Service Trust (n = 5). Service users were interviewed at baseline (n = 151) and at six-month follow-up (n = 127), and their outcome and cost data were analysed on an intention-to-treat basis. Analysis of primary and secondary outcome variables found no differences between the intervention and control groups. The economic evaluation found no significant differences between groups in mean costs or outcomes. The findings suggest that it could be difficult for social workers to implement Connecting People in CMHTs or that it does not improve outcomes for CMHT users

Association of hypoglycaemia and risk of cardiac arrhythmia in patients with diabetes mellitus: A systematic review and meta-analysis

AIMS: Hypoglycaemia is associated with increased cardiovascular risk among individuals with diabetes mellitus. It has been hypothesized that hypoglycaemia may trigger autonomic changes leading to increased cardiac arrhythmia risk. We conducted a systematic review and meta-analysis to explore this association. MATERIALS AND METHODS: Ovid Medline, Embase, Scopus, Web of Science and Cochrane were searched from inception to October 10, 2017. We included studies of adults with diabetes (Type 1 or Type 2) that compared acute electrocardiogram (ECG) changes during episodes of hypoglycaemia and euglycaemia. RESULTS: Our search resulted in 4625 citations, among which 20 studies met the predefined inclusion criteria. Finally, 12 studies were included in the descriptive analysis and 15 in the meta-analysis. Overall hypoglycaemia was associated with a reduction in heart rate variability and an increase in arrhythmia occurrence. QTc interval length was more significantly prolonged during hypoglycaemia compared to euglycaemia (pooled mean difference [95% confidence intervals] [0.64 (0.27-1.01], P = ·001). Subgroup analysis based on diabetes type showed that QTc prolongation occurred in individuals with Type 1 and Type 2 diabetes; however, the change between euglycaemia reached statistical significance only among individuals with Type 1 diabetes. CONCLUSION: Our findings suggest that hypoglycaemia results in ECG alterations that are associated with increased risk of cardiac arrhythmia, which is associated with increased cardiovascular events and mortality. More clinical studies are needed to determine the cardiac risks of hypoglycaemia in individuals with diabetes, especially in Type 2 diabetes