Service user perspectives on social prescribing services for mental health in the UK: a systematic review

AIM

To thematically synthesise adult service users' perspectives on how UK-based social prescribing services support them with their mental health management.

METHODS

Nine databases were systematically searched up to March 2022. Eligible studies were qualitative or mixed methods studies involving participants aged ⩾ 18 years accessing social prescribing services primarily for mental health reasons. Thematic synthesis was applied to qualitative data to create descriptive and analytical themes.

RESULTS

51,965 articles were identified from electronic searches. Six studies were included in the review (n = 220 participants) with good methodological quality. Five studies utilised a link worker referral model, and one study a direct referral model. Modal reasons for referral were social isolation and/or loneliness (n = 4 studies). Two analytical themes were formulated from seven descriptive themes: (1) person-centred care was key to delivery and (2) creating an environment for personal change and development.

CONCLUSIONS

This review provides a synthesis of the qualitative evidence on service users' experiences of accessing and using social prescribing services to support their mental health management. Adherence to principles of person-centred care and addressing the holistic needs of service users (including devoting attention to the quality of the therapeutic environment) are important for design and delivery of social prescribing services. This will optimise service user satisfaction and other outcomes that matter to them.

Integrating EM and Patch-seq data: Synaptic connectivity and target specificity of predicted Sst transcriptomic types

Neural circuit function is shaped both by the cell types that comprise the circuit and the connections between those cell types ¹ . Neural cell types have previously been defined by morphology ^{2, 3} , electrophysiology ^{4, 5} , transcriptomic expression ^6-8 , connectivity ^9-13 , or even a combination of such modalities ^14-16 . More recently, the Patch-seq technique has enabled the characterization of morphology (M), electrophysiology (E), and transcriptomic (T) properties from individual cells ^17-20 . Using this technique, these properties were integrated to define 28, inhibitory multimodal, MET-types in mouse primary visual cortex ²¹ . It is unknown how these MET-types connect within the broader cortical circuitry however. Here we show that we can predict the MET-type identity of inhibitory cells within a large-scale electron microscopy (EM) dataset and these MET-types have distinct ultrastructural features and synapse connectivity patterns. We found that EM Martinotti cells, a well defined morphological cell type ^{22, 23} known to be Somatostatin positive (Sst+) ^{24, 25} , were successfully predicted to belong to Sst+ MET-types. Each identified MET-type had distinct axon myelination patterns and synapsed onto specific excitatory targets. Our results demonstrate that morphological features can be used to link cell type identities across imaging modalities, which enables further comparison of connectivity in relation to transcriptomic or electrophysiological properties. Furthermore, our results show that MET-types have distinct connectivity patterns, supporting the use of MET-types and connectivity to meaningfully define cell types.

215 Examining the Benefits of One-To-One African Caribbean Mentoring for Prospective Medical Students

Aim

African Caribbean people are underrepresented in UK medical schools. African Caribbean Medical Mentors (ACMM) is a UK registered charity that provides one-to-one mentoring to prospective African Caribbean medical students. Mentors consist of current African Caribbean medical students and doctors. This study aimed to investigate the specific benefits provided by ACMM and the attributes of successful mentoring relationships.

Method

Participants were identified using ACMM's database of mentees and mentors enrolled within the last 3 years and an online questionnaire was distributed via Qualtrics. Questions were scored on a scale between 1 and 10 and participants were asked to explain their rankings.

Results

11 mentees and 7 mentors responded to the surveys. 63.6% and 72.7% of mentees gave a score between 8 – 10 regarding the importance of having a mentor and having a mentor that was African Caribbean respectively. All mentees reported satisfaction with their mentor, with 45.5% citing individualised interview practice and 63.6% reporting mentor support and availability as positive aspects of their mentoring relationship.

All mentors reported being satisfied with the program, with 57.1% and 71.4% giving a score between 8 – 10 regarding the importance of having a mentor and having a mentor that was African Caribbean respectively. 42.9% of mentors reported that improved methods and proactivity with communication could have improved their mentoring relationship.

Conclusion

This study suggests that one-to-one mentoring between African Caribbean mentors and mentees was helpful during medical school applications. Interview practice proved particularly useful, whilst methods and timescales of communication represent areas for improvement.

217 Can Virtual Reality Enhance the Patient Experience During Awake Invasive Procedures? a Systematic Review and Meta-Analysis of Randomised Controlled Trials

Aim

Procedural anxiety and pain negatively impacts surgical outcomes and contributes towards patient non-attendance for awake, invasive procedures (AIPs). Providing patients with virtual reality (VR) headsets may optimise their intraprocedural experience. This meta-analysis assesses the effect of VR on subjective pain, anxiety and satisfaction scores, and patient requirements for sedative and analgesic medication during AIPs.

Method

This review was performed according to PRISMA guidelines. PubMed, EMBASE, CENTRAL, and medrxiv databases were systematically searched for randomised controlled trials investigating the use of VR to enhance the patient experience in adults during AIPs. Meta-analyses were conducted for patient-reported anxiety (n=7), pain (n=7) and satisfaction (n=3) scores, and for total doses of sedative (n=3) and analgesic (n=3) medication administered to patients.

Results

9 studies were included. Patients underwent endoscopic diagnostic procedures (n=5), minimally invasive surgery (n=2) or orthoplastic operations (n=2), under local (n=4) or regional anaesthesia (n=2), conscious sedation (n=2) or simple analgesia alone (n=1). Meta-analysis revealed a significant effect in favour of using VR to alleviate procedural anxiety (SMD: -0.51, 95%CI: -0.85 to -0.16, p=0.004), when one study was omitted. Sub-group analysis of studies where AIPs was performed without anaesthesia, showed a significant reduction in pain scores for VR cohorts (MD: -1.33, 95%CI: -2.57 to -0.09, p=0.04). No significant differences between groups were found for patient satisfaction or requirements for sedative and analgesic medication.

Conclusions

This review supports using VR to reduce procedural anxiety and attenuate pain during AIPs performed without anaesthesia. The effect of VR on patient satisfaction and requirements for sedative and analgesic medications remains unclear.

473 A Review of The Risk Stratification Models Used in The Management of Oncological Hepato-Pancreato-Biliary Surgical Patients

Introduction

Oncological scoring systems in surgery are used as evidence-based decision aids to best support management through assessing prognosis, effectiveness and recurrence. Currently, the use of scoring systems in the hepato-pancreato-biliary (HPB) subspecialty is limited as concerns over precision and applicability prevent widespread clinical implementation. The aim of the review is to discuss clinically useful oncological scoring systems for the surgical management of HPB patients.

Method

Primary articles of validated novel and established scoring systems were searched over a 25-year period using PubMed, Cochrane and Ovid Medline.

Results

This review discusses 9 clinically useful scoring systems in cancers of the liver (CLIP, BCLC, ALBI Grade, RETREAT, Fong et al.), pancreas (Genc et al., mGPS) and biliary tract (TMHSS, MEGNA). CLIP and BCLC are extensively validated prognostic tools, with BCLC clinically endorsed by guidelines. Conversely, patient and treatment stratification is limited in CLIP and BCLC respectively - ALBI works to improve patient stratification. RETREAT, Fong et al. and Genc et al. scores predict recurrence following surgery, however these scores require further validation in heterogenous patient groups. mGPS and MEGNA are simple prognostic scores, but also require further validation in varied patient cohorts. TMHSS is user-friendly, however is limited at discriminating treatment for the middle patient group.

Conclusion

A diverse range of HPB surgical scoring systems may facilitate evidenced-based treatment decisions and improve management. Future scoring systems need to be developed on heterogenous patient cohorts with improved stratification, with current trends towards implementing machine learning and genetics to improve outcome prediction.

Yersinia massiliensis (Enterobacteriales: Enterobacteriaceae) in the host Anaphes nitens (Hymenoptera: Mymaridae): first report of association with insects

Endosymbiont bacteria can affect biological parameters and reduce the effectiveness of natural enemies in controlling the target insect. The objective of this work was to identify endosymbiont bacteria in Anaphes nitens (Girault, 1928) (Hymenoptera: Mymaridae), the main natural enemy used to manage Gonipterus platensis (Marelli, 1926) (Coleoptera: Curculionidae). Genomic DNA from six A. nitens populations was extracted and polymerase chain reactions (PCR) were performed with the primers to detect endosymbiont bacteria in this insect. The PCR products were amplified, sequenced, and compared with sequences deposited in the GenBank for the bacteria identification. All A. nitens populations had the bacterium Yersinia massiliensis (Enterobacteriales: Enterobacteriaceae). This bacterium was originally described as free-living, and it is associated with and composes part of the A. nitens microbiota. This is the first report of Y. massiliensis in an insect host.

Real-life use of remdesivir in hospitalized patients with COVID-19

Objective

Controversial results on remdesivir efficacy have been reported. We aimed to report our real-life experience with the use of remdesivir from its availability in Spain.

Methods

We performed a descriptive study of all patients admitted for ≥48 hours with confirmed COVID-19 who received remdesivir between the 1st of July and the 30th of September 2020.

Results

A total of 123 patients out of 242 admitted with COVID-19 at our hospital (50.8%) received remdesivir. Median age was 58 years, 61% were males and 56.9 % received at least one anti-inflammatory treatment. No adverse events requiring remdesivir discontinuation were reported. The need of intensive care unit admission, mechanical ventilation and 30-days mortality were 19.5%, 7.3% and 4.1%, respectively.

Conclusion

In our real-life experience, the use of remdesivir in hospitalized patients with COVID-19 was associated with a low mortality rate and good safety profile.

Microfluidic nutrient gradient-based three-dimensional chondrocyte culture-on-a-chip as an in vitro equine arthritis model

In this work, we describe a microfluidic three-dimensional (3D) chondrocyte culture mimicking in vivo articular chondrocyte morphology, cell distribution, metabolism, and gene expression. This has been accomplished by establishing a physiologic nutrient diffusion gradient across the simulated matrix, while geometric design constraints of the microchambers drive native-like cellular behavior. Primary equine chondrocytes remained viable for the extended culture time of 3 weeks and maintained the low metabolic activity and high Sox9, aggrecan, and Col2 expression typical of articular chondrocytes. Our microfluidic 3D chondrocyte microtissues were further exposed to inflammatory cytokines to establish an animal-free, in vitro osteoarthritis model. Results of our study indicate that our microtissue model emulates the basic characteristics of native cartilage and responds to biochemical injury, thus providing a new foundation for exploration of osteoarthritis pathophysiology in both human and veterinary patients.

Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility

STUDY QUESTION

What is the recommended assessment and management of infertile women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertize and consumer preference?

SUMMARY ANSWER

International evidence-based guidelines, including 44 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of infertile women with PCOS.

WHAT IS KNOWN ALREADY

Previous guidelines on PCOS lacked rigorous evidence-based processes, failed to engage consumer and multidisciplinary perspectives or were outdated. The assessment and management of infertile women with PCOS are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Governance included a six continent international advisory and a project board, a multidisciplinary international guideline development group (GDG), consumer and translation committees. Extensive health professional and consumer engagement informed the guideline scope and priorities. The engaged international society-nominated panel included endocrinology, gynaecology, reproductive endocrinology, obstetrics, public health and other experts, alongside consumers, project management, evidence synthesis and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Extensive online communication and two face-to-face meetings over 15 months addressed 19 prioritized clinical questions involving nine evidence-based reviews and 10 narrative reviews. Evidence-based recommendations (EBRs) were formulated prior to consensus voting within the guideline panel.

STUDY DESIGN, SIZE, DURATION

International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. A (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation and ultimately recommendation strength. The guideline was peer-reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREE II criteria and underwent methodological review. This guideline was approved by all members of the GDG and has been approved by the NHMRC.

MAIN RESULTS AND THE ROLE OF CHANCE

The quality of evidence (QOE) for the EBRs in the assessment and management of infertility in PCOS included very low (n = 1), low (n = 9) and moderate (n = 4) quality with no EBRs based on high-quality evidence. The guideline provides 14 EBRs, 10 clinical consensus recommendations (CCRs) and 20 clinical practice points on the assessment and management of infertility in PCOS. Key changes in this guideline include emphasizing evidence-based fertility therapy, including cheaper and safer fertility management.

LIMITATIONS, REASONS FOR CAUTION

Overall evidence is generally of low to moderate quality, requiring significantly greater research in this neglected, yet common condition. Regional health systems vary and a process for adaptation of this guideline is provided.

WIDER IMPLICATIONS OF THE FINDINGS

The international guideline for the assessment and management of infertility in PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program.

STUDY FUNDING/COMPETING INTEREST(S)

The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine (ASRM). GDG members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Norman has declared a minor shareholder interest in the IVF unit Fertility SA, travel support from Merck and grants from Ferring. Prof. Norman also has scientific advisory board duties for Ferring. The remaining authors have no conflicts of interest to declare.

This article was not externally peer-reviewed by Human Reproduction Open.

Prediction of medication non-adherence and associated outcomes in pediatric kidney transplant recipients

Studies have continued to evaluate risk factors associated with post-transplant non-adherence in pediatric patients. However, many of these studies fail to evaluate how risk factors can be utilized to predict MNA. The aims of this study were to (i) determine salient risk factors associated with MNA to develop an adequate predictive risk model and (ii) assess transplant outcomes based on the presence of MNA in a large, diverse cohort of pediatric KTX recipients. One hundred and seventy-five solitary pediatric KTX recipients transplanted from 1999 to 2013 were included. AA, males, older patients, those who lived in urban environments, had legal issues, and lived shorter distances from the transplant center were more likely to have MNA. Using logistic regression, a parsimonious model applying nine risk factors together was developed for predicting MNA, demonstrating a PPV of 69% and a NPV of 81%. Patients with MNA had more than twice the risk of biopsy proven acute rejection, 1.6 times the risk of hospitalization, and 1.8 times the risk of graft loss. Utilization of a predictive model to determine risk of MNA after pediatric KTX may offer clinicians the ability to efficiently and effectively monitor MNA following transplant.