Effectiveness of the internet-based Unified Protocol transdiagnostic intervention for the treatment of depression, anxiety and related disorders in a primary care setting: a randomized controlled trial

Background Research has shown that internet-based cognitive behavioural therapy (iCBT) can be a very promising solution to increase access to and the dissemination of evidence-based treatments to all of the population in need. However, iCBT is still underutilized in clinical contexts, such as primary care. In order to achieve the effective implementation of these protocols, more studies in ecological settings are needed. The Unified Protocol (UP) is a transdiagnostic CBT protocol for the treatment of emotional disorders, which includes depression, anxiety and related disorders, that has shown its efficacy across different contexts and populations. An internet-based UP (iUP) programme has recently been developed as an emerging internet-based treatment for emotional disorders. However, the internet-delivered version of the UP (iUP) has not yet been examined empirically. The current project seeks to analyse the effectiveness of the iUP as a treatment for depression, anxiety and related emotional disorders in a primary care public health setting. Methods The current study will employ a parallel-group, randomized controlled trial design. Participants will be randomly assigned to (a) the internet-based Unified Protocol (iUP), or (b) enhanced waiting list control (eWLC). Randomization will follow a 2:1 allocation ratio, with sample size calculations suggesting a required sample of 120 (iUP=80; eWLC=40). The Mini-International Neuropsychiatric Interview (M.I.N.I.) will be used for assessing potential participants. The Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS) as well as other standardized questionnaires will be used for assessments at baseline, 4 weeks, 8 weeks and 12 weeks from baseline and for the iUP condition during the follow-up. Discussion Combining the advantages of a transdiagnostic treatment with an online delivery format may have the potential to significantly lower the burden of emotional disorders in public health primary care setting. Anxiety and depression, often comorbid, are the most prevalent psychological disorders in primary care. Because the iUP allows for the treatment of different disorders and comorbidity, this treatment could represent an adequate choice for patients that demand mental health care in a primary care setting

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

The influence of cytomegalovirus and Epstein-Barr virus serostatus on haemoglobin levels and erythropoietin-stimulating agent responsiveness in patients on the transplant list with stage 5 chronic kidney disease

Cytomegalovirus (CMV) seropositivity has been reported to be a major determinant of erythropoietin-stimulating agent (ESA) resistance in patients with chronic kidney disease (CKD). It is hypothesised that prior CMV infection induces significant changes in T-cell subtypes that promote bone marrow resistance to ESA. We examined whether CMV or Epstein-Barr virus (EBV) serostatus influenced haemoglobin (Hb) levels and/or ESA resistance in our population of CKD stage 5 patients. Data on CMV and EBV serology, age, sex and Hb was collected on 1,417 patients presenting for a renal transplant from 2000 to 2009 in Ireland. Patients were split into four groups (CMVneg/EBVneg, CMVpos/EBVneg, CMVneg/EBVpos, and CMVpos/EBVpos) and analysis of variance was performed to examine whether CMV and EBV serostatus influenced Hb levels pre transplantation. Data was then collected on 117 patients currently on the transplant pool from Beaumont and Tallaght Hospitals. CMV and EBV serostatus, Hb, ESA dose and other parameters associated with ESA responsiveness (iron studies, B12/folate, albumin, PTH, diabetes, vascular access, dialysis adequacy) were collected. Multivariate analysis was performed to determine factors associated with increased ESA dosage. CMV positivity was found to have no effect on Hb levels or ESA dosage. Likewise, EBV serostatus had no effect on these parameters. First, analysis of 1,417 patients showed no difference in mean Hb between the various CMV/EBV serostatus groups. Second, analysis of patients currently on the transplant pool also showed that there was no difference in mean Hb between CMV and EBV groups. Analysis of a subpopulation of haemodialysis patients alone showed that CMV positivity was associated with a higher mean Hb and a lower mean ESA dose. Our results contrast with those of a recent report by Betjes et al. linking ESA resistance to CMV seropositivity. No association was found between CMV or EBV serostatus and Hb levels or ESA dosage. CMV seropositivity is not associated with increased ESA requirements in our population. These conflicting results may be due to differences in patient demographics and a lower target Hb level in our study.</p

The influence of socioeconomic status on allograft and patient survival following kidney transplantation: Socioeconomic status and transplant outcome

Aim: Whether socioeconomic status confers worse outcomes after kidney transplantation is unknown. Its influence on allograft and patient survival following kidney transplantation in Ireland was examined. Methods: A retrospective, observational cohort study of adult deceased-donor first kidney transplant recipients from 1990 to 2009 was performed. Those with a valid Irish postal address were assigned a socioeconomic status score based on the Pobal Hasse-Pratschke deprivation index and compared in quartiles. Cox proportional hazards models and Kaplan–Meier survival analysis were used to investigate any significant association of socioeconomic status with patient and allograft outcomes. Results: A total of 1944 eligible kidney transplant recipients were identified. The median follow-up time was 8.2 years (interquartile range 4.4–13.3 years). Socioeconomic status was not associated with uncensored or death-censored allograft survival (hazard ratio (HR) 1.0, 95% confidence interval (CI) 0.99–1.00, P = 0.33 and HR 1.0, 95% CI 0.99–1.00, P = 0.37, respectively). Patient survival was not associated with socioeconomic status quartile (HR 1.0, 95% CI 0.93–1.08, P = 0.88). There was no significant difference among quartiles for uncensored or death-censored allograft survival at 5 and 10 years. Conclusion: There was no socioeconomic disparity in allograft or patient outcomes following kidney transplantation, which may be partly attribut- able to the Irish healthcare model. This may give further impetus to calls in other jurisdictions for universal healthcare and medication coverage for kidney transplant recipients

Outcomes of kidney transplantation in alport syndrome compared with other forms of renal disease

Introduction: Alport syndrome is an inherited renal disease characterized by hematuria, renal failure, hearing loss and a lamellated glomerular basement membrane. Patients with Alport syndrome who undergo renal transplantation have been shown to have patient and graft survival rates similar to or better than those of patients with other renal diseases. Methods: In this national case series, based in Beaumont Hospital Dublin, we studied the cohort of patients who underwent renal transplantation over the past 33 years, recorded prospectively in the Irish Renal Transplant Registry, and categorized them according to the presence or absence of Alport syndrome. The main outcomes assessed were patient and renal allograft survival. Results: Fifty-one patients diagnosed with Alport syndrome in Beaumont Hospital received 62 transplants between 1982 and 2014. The comparison group of non-Alport patients comprised 3430 patients for 3865 transplants. Twenty-year Alport patient survival rate was 70.2%, compared to 44.8% for patients with other renal diseases (p = 0.01). Factors associated with patient survival included younger age at transplantation as well as differences in recipient sex, donor age, cold ischemia time, and episodes of acute rejection. Twenty-year graft survival was 46.8% for patients with Alport syndrome compared to 30.2% for those with non-Alport disease (p = 0.11). Conclusions: Adjusting for baseline differences between the groups, patients with end-stage kidney disease (ESKD) due to Alport syndrome have similar patient and graft survival to those with other causes of ESKD. This indicates that early diagnosis and management can lead to favorable outcomes for this patient cohort