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Petrie J, Loban A, Turton E, Derebecka J, North S, Herbert E, Hind D. "Reality is frequently inaccurate" A case study examining the whens and whys of post-live database changes in a UK clinical trials unit *Douglas Adams. Contemp Clin Trials 2024; 142:107573. [PMID: 38759865 DOI: 10.1016/j.cct.2024.107573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/16/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Accurately estimating the costs of clinical trials is challenging. There is currently no reference class data to allow researchers to understand the potential costs associated with database change management in clinical trials. METHODS We used a case-based approach, summarising post-live changes in eleven clinical trial databases managed by Sheffield Clinical Trials Research Unit. We reviewed the database specifications for each trial and summarised the number of changes, change type, change category, and timing of changes. We pooled our experiences and made observations in relation to key themes. RESULTS Median total number of changes across the eleven trials was 71 (range 40-155) and median number of changes per study week was 0.48 (range 0.32-1.34). The most common change type was modification (median 39, range 20-90), followed by additions (median 32, range 18-55), then deletions (median 7, range 1-12). In our sample, changes were more common in the first half of the trial's lifespan, regardless of its overall duration. Trials which saw continuous changes seemed more likely to be external pilots or trials in areas where the trial team was either less experienced overall or within the particular therapeutic area. CONCLUSIONS Researchers should plan trials with the expectation that clinical trial databases will require changes within the life of the trial, particularly in the early stages or with a less experienced trial team. More research is required to understand potential differences between clinical trial units and database types.
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Affiliation(s)
- Jennifer Petrie
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, S1 4DA, UK.
| | - Amanda Loban
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Emily Turton
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Julia Derebecka
- Department of Computer Science, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Siobhán North
- Department of Computer Science, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Esther Herbert
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Daniel Hind
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, S1 4DA, UK
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Davis TE, Brennan J. Specific Phobia, Fear, and the Autism Spectrum in Children and Adolescents: Adapting OST for ASD. Clin Child Fam Psychol Rev 2024; 27:509-522. [PMID: 38632150 DOI: 10.1007/s10567-024-00475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/19/2024]
Abstract
Fears and phobias are a common mental health concern for youth, and particularly for autistic youth. The following review briefly summarizes the extant literature on specific phobias and specific phobias in autistic youth. The evidence base is briefly highlighted pointing to the strong base behind behavioral and cognitive-behavioral treatments and techniques. A broad discussion of key evidence-based treatment findings is presented, leading up to the impactful work of Thomas H. Ollendick in researching Öst's One-Session Treatment (OST) with children and adolescents. OST for child specific phobias is discussed, and particular emphasis is given to this treatment's ongoing adaptation for use with youth on the autism spectrum.
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Affiliation(s)
- Thompson E Davis
- Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall, Box 870348, Tuscaloosa, AL, 35487, USA.
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA.
| | - Justine Brennan
- Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall, Box 870348, Tuscaloosa, AL, 35487, USA
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Geng W, Cao J, Jin L, Wei J. Case report: specific phobia of vaginal penetration in a pregnant patient. Front Psychiatry 2023; 14:1218900. [PMID: 37593448 PMCID: PMC10427344 DOI: 10.3389/fpsyt.2023.1218900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Specific phobia is frequently unrecognized or untreated unless it causes significant impairment. In this report, we documented a rare case of a pregnant patient who had a specific fear related to vaginal penetration. Due to abnormal fetal cardiac development in the second trimester, the patient was admitted for termination of pregnancy. The patient's persistent request for surgical termination via cesarean delivery prompted the obstetrician to seek psychiatric consultation for tokophobia, a labor- and childbirth-related phobia. The consulting psychiatrist discovered that the patient had developed a significant fear of vaginal penetration during adolescence. Throughout the extended period of this specific phobia, the patient established a range of avoidance strategies. Had it not been for the unforeseen need for abortion, her phobia may not have been identified. Psychoeducation on specific phobias, exposure therapy, muscle relaxation techniques, and the administration of anxiolytics were implemented. The pregnancy was terminated through a vaginal labor induction procedure 2 days later. Collaboration across disciplines is necessary to support a thorough assessment of obstetric patients who express hesitancy toward vaginal delivery.
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Affiliation(s)
- Wenqi Geng
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Jin
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cheng X, Bao B, Cui W, Liu S, Zhong J, Cai L, Yang H. Classification and Analysis of Human Body Movement Characteristics Associated with Acrophobia Induced by Virtual Reality Scenes of Heights. SENSORS (BASEL, SWITZERLAND) 2023; 23:5482. [PMID: 37420652 DOI: 10.3390/s23125482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 07/09/2023]
Abstract
Acrophobia (fear of heights), a prevalent psychological disorder, elicits profound fear and evokes a range of adverse physiological responses in individuals when exposed to heights, which will lead to a very dangerous state for people in actual heights. In this paper, we explore the behavioral influences in terms of movements in people confronted with virtual reality scenes of extreme heights and develop an acrophobia classification model based on human movement characteristics. To this end, we used wireless miniaturized inertial navigation sensors (WMINS) network to obtain the information of limb movements in the virtual environment. Based on these data, we constructed a series of data feature processing processes, proposed a system model for the classification of acrophobia and non-acrophobia based on human motion feature analysis, and realized the classification recognition of acrophobia and non-acrophobia through the designed integrated learning model. The final accuracy of acrophobia dichotomous classification based on limb motion information reached 94.64%, which has higher accuracy and efficiency compared with other existing research models. Overall, our study demonstrates a strong correlation between people's mental state during fear of heights and their limb movements at that time.
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Affiliation(s)
- Xiankai Cheng
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Benkun Bao
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Weidong Cui
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Shuai Liu
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Jun Zhong
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Liming Cai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Hongbo Yang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
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Odgers K, Kershaw KA, Li SH, Graham BM. The relative efficacy and efficiency of single- and multi-session exposure therapies for specific phobia: A meta-analysis. Behav Res Ther 2022; 159:104203. [PMID: 36323055 DOI: 10.1016/j.brat.2022.104203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Exposure therapy is the preferred treatment for specific phobia (SP), with evidence supporting its efficacy whether delivered over multiple sessions or as a single session, such as One-Session Treatment. In this meta-analysis, we compared the efficiency and effectiveness of single- and multi-session exposure for SP. PsycINFO, Embase, MEDLINE, and Cochrane were systematically searched for peer-reviewed articles reporting the effects of multi-session (k = 30) and/or single-session (k = 55) in vivo exposure on SP symptoms in clinical populations (n = 1758 participants). A random-effects model was used to synthesise and compare the pre-post treatment effects (Hedges' g) on approach behaviour and self-reported SP symptoms. Mean total treatment time was significantly longer for multi-session exposure than for single-session. There were no significant differences in the pooled effect sizes of single-session and multi-session exposure at post-treatment and follow-up assessments; effect sizes were large for all outcomes. Phobia subtype significantly moderated the effect size for both treatment approaches, although the direction of association differed according to the outcome measures. Results suggest no evidence for differences in the effectiveness of single- and multi-session exposure, but single-session is more time efficient. These outcomes suggest that policies to facilitate access to single-session exposure would be beneficial.
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Affiliation(s)
- Katarzyna Odgers
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Kelly A Kershaw
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Sophie H Li
- Black Dog Institute, University Of New South Wales, Sydney, Australia
| | - Bronwyn M Graham
- School of Psychology, University Of New South Wales, Sydney, Australia.
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Wright B, Tindall L, Scott AJ, Lee E, Biggs K, Cooper C, Bee P, Wang HI, Gega L, Hayward E, Solaiman K, Teare MD, Davis T, Lovell K, Wilson J, McMillan D, Barr A, Edwards H, Lomas J, Turtle C, Parrott S, Teige C, Chater T, Hargate R, Ali S, Parkinson S, Gilbody S, Marshall D. One-session treatment compared with multisession CBT in children aged 7–16 years with specific phobias: the ASPECT non-inferiority RCT. Health Technol Assess 2022; 26:1-174. [DOI: 10.3310/ibct0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background
Up to 10% of children and young people have a specific phobia that can significantly affect their mental health, development and daily functioning. Cognitive–behavioural therapy-based interventions remain the dominant treatment, but limitations to their provision warrant investigation into low-intensity alternatives. One-session treatment is one such alternative that shares cognitive–behavioural therapy principles but has a shorter treatment period.
Objective
This research investigated the non-inferiority of one-session treatment to cognitive–behavioural therapy for treating specific phobias in children and young people. The acceptability and cost-effectiveness of one-session treatment were examined.
Design
A pragmatic, multicentre, non-inferiority randomised controlled trial, with embedded economic and qualitative evaluations.
Settings
There were 26 sites, including 12 NHS trusts.
Participants
Participants were aged 7–16 years and had a specific phobia defined in accordance with established international clinical criteria.
Interventions
Participants were randomised 1 : 1 to receive one-session treatment or usual-care cognitive–behavioural therapy, and were stratified according to age and phobia severity. Outcome assessors remained blind to treatment allocation.
Main outcome measures
The primary outcome measure was the Behavioural Avoidance Task at 6 months’ follow-up. Secondary outcomes included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children’s Anxiety and Depression Scale, a goal-based outcome measure, Child Health Utility 9D, EuroQol-5 Dimensions Youth version and resource usage. Treatment fidelity was assessed using the Cognitive Behaviour Therapy Scale for Children and Young People and the One-Session Treatment Rating Scale.
Results
A total of 274 participants were recruited, with 268 participants randomised to one-session treatment (n = 134) or cognitive–behavioural therapy (n = 134). A total of 197 participants contributed some data, with 149 participants in the intention-to-treat analysis and 113 in the per-protocol analysis. Mean Behavioural Avoidance Task scores at 6 months were similar across treatment groups when both intention-to-treat and per-protocol analyses were applied [cognitive–behavioural therapy: 7.1 (intention to treat), 7.4 (per protocol); one-session treatment: 7.4 (intention to treat), 7.6 (per protocol); on the standardised scale adjusted mean difference for cognitive–behavioural therapy compared with one-session treatment –0.123, 95% confidence interval –0.449 to 0.202 (intention to treat), mean difference –0.204, 95% confidence interval –0.579 to 0.171 (per protocol)]. These findings were wholly below the standardised non-inferiority limit of 0.4, which suggests that one-session treatment is non-inferior to cognitive–behavioural therapy. No between-group differences in secondary outcome measures were found. The health economics evaluation suggested that, compared with cognitive–behavioural therapy, one-session treatment marginally decreased the mean service use costs and maintained similar mean quality-adjusted life-year improvement. Nested qualitative evaluation found one-session treatment to be considered acceptable by those who received it, their parents/guardians and clinicians. No adverse events occurred as a result of phobia treatment.
Limitations
The COVID-19 pandemic meant that 48 children and young people could not complete the primary outcome measure. Service waiting times resulted in some participants not starting therapy before follow-up.
Conclusions
One-session treatment for specific phobia in UK-based child mental health treatment centres is as clinically effective as multisession cognitive–behavioural therapy and highly likely to be cost-saving. Future work could involve improving the implementation of one-session treatment through training and commissioning of improved care pathways.
Trial registration
This trial is registered as ISRCTN19883421.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Lucy Tindall
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | | | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katie Biggs
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Penny Bee
- School of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Han-I Wang
- Centre for Health Economics, University of York, York, UK
| | - Lina Gega
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Emily Hayward
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Kiera Solaiman
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Thompson Davis
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Karina Lovell
- School of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Jon Wilson
- Central Norfolk Youth Service, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Dean McMillan
- Centre for Health Economics, University of York, York, UK
| | - Amy Barr
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hannah Edwards
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Jennifer Lomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Chris Turtle
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Steve Parrott
- Centre for Health Economics, University of York, York, UK
| | - Catarina Teige
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rebecca Hargate
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Shehzad Ali
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Sarah Parkinson
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
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Wang HI, Wright B, Tindall L, Cooper C, Biggs K, Lee E, Teare MD, Gega L, Scott AJ, Hayward E, Solaiman K, Davis T, McMillan D, Gilbody S, Parrott S. Cost and effectiveness of one session treatment (OST) for children and young people with specific phobias compared to multi-session cognitive behavioural therapy (CBT): results from a randomised controlled trial. BMC Psychiatry 2022; 22:547. [PMID: 35962334 PMCID: PMC9372970 DOI: 10.1186/s12888-022-04192-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 07/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the UK, around 93,000 (0.8%) children and young people (CYP) are experiencing specific phobias that have a substantial impact on daily life. The current gold-standard treatment-multi-session cognitive behavioural therapy (CBT) - is effective at reducing specific phobia severity; however, CBT is time consuming, requires specialist CBT therapists, and is often at great cost and limited availability. A briefer variant of CBT called one session treatment (OST) has been found to offer similar clinical effectiveness for specific phobia as multi-session CBT. The aim of this study was to assess the cost-effectiveness of OST compared to multi-session CBT for CYP with specific phobias through the Alleviating Specific Phobias Experienced by Children Trial (ASPECT), a two-arm, pragmatic, multi-centre, non-inferiority randomised controlled trial. METHODS CYP aged seven to 16 years with specific phobias were recruited nationally via Health and Social Care pathways, remotely randomised to the intervention group (OST) or the control group (CBT-based therapies) and analysed (n = 267). Resource use based on NHS and personal social services perspective and quality adjusted life years (QALYs) measured by EQ-5D-Y were collected at baseline and at six-month follow-up. Incremental cost-effectiveness ratio (ICER) was calculated, and non-parametric bootstrapping was conducted to capture the uncertainty around the ICER estimates. The results were presented on a cost-effectiveness acceptability curve (CEAC). A set of sensitivity analyses (including taking a societal perspective) were conducted to assess the robustness of the primary findings. RESULTS After adjustment and bootstrapping, on average CYP in the OST group incurred less costs (incremental cost was -£302.96 (95% CI -£598.86 to -£28.61)) and maintained similar improvement in QALYs (QALYs gained 0.002 (95% CI - 0.004 to 0.008)). The CEAC shows that the probability of OST being cost-effective was over 95% across all the WTP thresholds. Results of a set of sensitivity analyses were consistent with the primary outcomes. CONCLUSION Compared to CBT, OST produced a reduction in costs and maintained similar improvement in QALYs. Results from both primary and sensitivity analyses suggested that OST was highly likely to be cost saving. TRIAL REGISTRATION ISRCTN19883421 (30/11/2016).
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Affiliation(s)
- Han-I. Wang
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK
| | - Barry Wright
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK ,grid.450937.c0000 0001 1410 7560Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Lucy Tindall
- grid.450937.c0000 0001 1410 7560Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Cindy Cooper
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
| | - Katie Biggs
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
| | - Ellen Lee
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
| | - M. Dawn Teare
- grid.1006.70000 0001 0462 7212Newcastle University, Newcastle upon Tyne, UK
| | - Lina Gega
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK ,grid.413631.20000 0000 9468 0801Hull York Medical School, York, UK
| | | | - Emily Hayward
- grid.450937.c0000 0001 1410 7560Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Kiera Solaiman
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
| | - Thompson Davis
- grid.64337.350000 0001 0662 7451Louisiana State University, Baton Rouge, USA ,grid.411015.00000 0001 0727 7545The University of Alabama, Tuscaloosa, USA
| | - Dean McMillan
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK ,grid.413631.20000 0000 9468 0801Hull York Medical School, York, UK
| | - Simon Gilbody
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK ,grid.413631.20000 0000 9468 0801Hull York Medical School, York, UK
| | - Steve Parrott
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK
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