National Health Service Research Articles

Safety, resource use and nutritional content of home-blended diets in children who are gastrostomy fed: findings from ‘YourTube’ – a prospective cohort study

ObjectiveTo assess the risks, benefits and resource implications of using home-blended food in children with gastrostomy tubes compared with currently recommended formula feeds.DesignThis is a cohort study. Data were collected...

The role of psychological formulation in inpatient settings in supporting staff empathy and therapeutic optimism for adults diagnosed with borderline personality disorder: A pre- and post-vignette study.

OBJECTIVES: National Health Service (NHS) values, such as empathy and therapeutic optimism, are integral when supporting service users with complex mental health presentations. There is some evidence to suggest that psychological formulation can increase empathy and optimism in healthcare professionals. This study, therefore, aimed to investigate whether a psychological formulation of a hypothetical service user with a complex presentation, typically labelled with a diagnosis of borderline personality disorder (BPD), increased empathy and therapeutic optimism in professionals working in mental health inpatient services. Sixty-six mental health professionals working in NHS inpatient services took part in a pre- and post-vignette study. Participants were asked to read a case vignette about a hypothetical service user, with a diagnostic label of BPD, and complete questionnaires capturing levels of empathy and therapeutic optimism. Participants were then randomized into two conditions and either asked to read the same information again (control condition) or read a psychological formulation based on the same hypothetical service user (intervention condition). The findings were analysed using a series of ANCOVAs/ANCOHETs. Two constructs of empathy (i.e. perspective taking and empathic concern), and therapeutic optimism significantly increased following exposure to the psychological formulation when compared to the control group condition. This study warrants further replication. These initial findings; however, indicate that psychological formulation can significantly increase the ability to perspective take, display empathic concern, and hold therapeutic optimism towards service users with a presentation associated with a diagnosis of BPD.

Online peer support groups for individuals who hear voices: protocol for a nonrandomised feasibility study

ABSTRACT Background Hearing Voices Groups (HVGs) have proliferated internationally. They are premised on the notion that connections between peers facilitate personal recovery. Little systematic research exists into if, and how, HVGs may be effective, especially when convened online. This paper aims to harmonise standardised research methodology with the liberatory, survivor-led ethos of many HVGs to outline a protocol for the first longitudinal, nonrandomised trial of an online HVG to take place within UK mental health services. Methods Six to ten adults who hear voices will be recruited from both community and UK National Health Service (NHS) settings to participate in a six-month peer-support group that is delivered via videoconference. Participants will complete questionnaires assessing social support, voice-hearing and feelings of personal recovery and qualitative interviews at baseline and at the end of the group. Participants will also complete measures of group cohesion at weeks 4 and 12. Results Data will be analysed for feasibility, acceptability and safety. Discussion This is the first longitudinal study evaluating the feasibility and acceptability of an online HVG held within the NHS. The findings may provide insights into the impact of such interventions and inform the design of a future, definitive study.

Tailored leadership training in emergency medicine: qualitative exploration of the impact of the EMLeaders programme on consultants and trainees in England

BackgroundEmergency medicine (EM) consultants are expected to provide leadership to facilitate optimal clinical results, effective teamwork and learning. To foster leadership skills, the Emergency Medicine Leadership Programme (EMLeaders) was launched...

Socio-demographic disparities in HER2+ breast cancer trastuzumab receipt: An English population-based study.

Socio-demographic disparities in traditional breast cancer treatment receipt in non-publicly funded healthcare systems are well documented. This study investigated trastuzumab receipt by socio-demographic factors within a female, HER2+ breast cancer population in England's publicly funded National Health Service. The English national population-based cancer registry and linked Systemic Anti-Cancer Therapy (SACT) database identified 36,985 women with HER2+ invasive breast cancer diagnosed 01/01/2012-31/12/2017. Multivariable logistic regression determined likelihood of trastuzumab receipt in (i) early and (ii) metastatic disease by deprivation category of area of residence and other socio-demographic characteristics. Early-stage trastuzumab receipt followed a socio-economic gradient. Women residing in the most deprived areas were 10% less likely to receive trastuzumab (multivariable OR 0.90, (95% CI) 0.83, 0.98) compared to women residing in the least deprived areas. In both early and metastatic disease, trastuzumab receipt was less likely in older women with more comorbidities, ER positive disease, and who were not discussed at a multidisciplinary team meeting. Despite provision of free at the point of delivery care in England, socio-demographic disparities in early-stage HER2+ trastuzumab receipt occur. Further research determining how inequities contribute to disparities in outcomes is warranted to ensure optimized trastuzumab use for all. Fair access to novel cancer treatments regardless of place of residence, socio-demographic characteristics, and/or cancer stage requires prioritization in future cancer improvement policies.

Characteristics and outcomes of patients with COVID-19 at high risk of disease progression receiving sotrovimab, oral antivirals or no treatment in England: a retrospective cohort study

Objective To describe characteristics and acute clinical outcomes for patients with COVID-19 treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated patients at highest risk per National Health Service (NHS) criteria. Methods Retrospective study of non-hospitalized patients between 1 December 2021 and 31 May 2022, using data from the Discover-NOW dataset (North-West London). Included patients were aged ≥12 years and treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated but expected to be eligible for early treatment per NHS highest-risk criteria. COVID-19-related and all-cause hospitalizations were reported for 28 days from COVID-19 diagnosis (index). Subgroup analyses were conducted in patients with advanced renal disease, those aged 18–64 and ≥65 years, and by period of Omicron BA.1, BA.2 and BA.5 (post-hoc exploratory) predominance. Results Overall, 1503 treated and 4044 eligible high-risk untreated patients were included. A high proportion of patients on sotrovimab had advanced renal disease (29.3%), ≥3 high-risk comorbidities (47.6%) and were aged ≥65 years (36.9%). Five of 696 (0.7%) patients on sotrovimab, <5/337 (0.3–1.2%) on nirmatrelvir/ritonavir, 10/470 (2.1%) on molnupiravir and 114/4044 (2.8%) untreated patients were hospitalized with COVID-19. Similar results were observed across all subgroups. The proportion of patients dying within 28 days of the index period was similarly low across all cohorts (<2%). Conclusion Patients receiving sotrovimab appeared to show evidence of multiple high-risk comorbidities. Low hospitalization rates were observed for all treated cohorts across subgroups and periods of predominant variants of concern. These results require confirmation with comparative effectiveness analyses adjusting for differences in underlying patient characteristics.

Characteristics and outcomes of patients with COVID-19 at high risk of disease progression receiving sotrovimab, oral antivirals or no treatment in England: a retrospective cohort study

Objective To describe characteristics and acute clinical outcomes for patients with COVID-19 treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated patients at highest risk per National Health Service (NHS) criteria. Methods Retrospective study of non-hospitalized patients between 1 December 2021 and 31 May 2022, using data from the Discover-NOW dataset (North-West London). Included patients were aged ≥12 years and treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated but expected to be eligible for early treatment per NHS highest-risk criteria. COVID-19-related and all-cause hospitalizations were reported for 28 days from COVID-19 diagnosis (index). Subgroup analyses were conducted in patients with advanced renal disease, those aged 18–64 and ≥65 years, and by period of Omicron BA.1, BA.2 and BA.5 (post-hoc exploratory) predominance. Results Overall, 1503 treated and 4044 eligible high-risk untreated patients were included. A high proportion of patients on sotrovimab had advanced renal disease (29.3%), ≥3 high-risk comorbidities (47.6%) and were aged ≥65 years (36.9%). Five of 696 (0.7%) patients on sotrovimab, <5/337 (0.3–1.2%) on nirmatrelvir/ritonavir, 10/470 (2.1%) on molnupiravir and 114/4044 (2.8%) untreated patients were hospitalized with COVID-19. Similar results were observed across all subgroups. The proportion of patients dying within 28 days of the index period was similarly low across all cohorts (<2%). Conclusion Patients receiving sotrovimab appeared to show evidence of multiple high-risk comorbidities. Low hospitalization rates were observed for all treated cohorts across subgroups and periods of predominant variants of concern. These results require confirmation with comparative effectiveness analyses adjusting for differences in underlying patient characteristics.

Attitudes, knowledge and understanding towards mind-body practices as an asset for social prescribing in higher education

ABSTRACT Evidence is growing to support mind-body practices (e.g. yoga) as a therapeutic intervention for many health conditions. In the UK, yoga is promoted as a social prescription asset by the National Health Service (NHS), yet the factors influencing its implementation are poorly understood. This study explored the attitudes, knowledge and understanding of mind-body practices as a social prescribing asset amongst health science populations within higher education. Twenty-six health science staff and students completed an online questionnaire. Data analysis used a mixed-methods approach, employing thematic analysis for qualitative data and calculating the net promoter score (NPS) to assess participants’ inclination to recommend mind-body practices as a social prescribing asset. Nineteen participants (73%) were aware of the term ‘social prescription’ and understood it to be a non-clinical, community-based alternative to medication. Whilst participants were aware of the physical benefits of mind-body practices, particularly yoga, they lacked awareness of the social, emotional, and spiritual benefits. Although 42% of participants would recommend mind-body practices as a social prescribing asset (NPS of 15), the opposite was true for yoga (NPS of −15), potentially due to poor knowledge or personal engagement with yoga. This study underlines the importance of increasing understanding and promoting yoga as an adjuvant mind-body practice to achieve social, emotional, and spiritual benefits. Implementing educational strategies to increase knowledge of mind-body practices and yoga, with a focus on social prescribing practice, may help to improve future referral pathways in practice in line with the NHS long term plan.

Clinicians' perspectives on remote patient management: A qualitative exploration of physiotherapists using the DiAL (Direct Access Line) programme

BackgroundIn response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme. ObjectivesTo explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development. DesignQualitative focus groups. MethodsTwo virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted. ResultsTen clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes. ConclusionsClinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services’ goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics.

Characteristics and outcomes of patients with COVID-19 at high risk of disease progression receiving sotrovimab, oral antivirals, or no treatment: a retrospective cohort study

BackgroundThe clinical benefit of coronavirus disease 2019 (COVID-19) treatments against new circulating variants remains unclear. We sought to describe characteristics and clinical outcomes of highest risk patients with COVID-19 receiving early COVID-19 treatments in Scotland.MethodsRetrospective cohort study of non-hospitalized patients diagnosed with COVID-19 from December 1, 2021–October 25, 2022, using Scottish administrative health data. We included adult patients who met ≥ 1 of the National Health Service highest risk criteria for early COVID-19 treatment and received outpatient treatment with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or no early COVID-19 treatment. Index date was defined as the earliest of COVID-19 diagnosis or early COVID-19 treatment. Baseline characteristics and acute clinical outcomes in the 28 days following index were reported. Values of ≤ 5 were suppressed.ResultsIn total, 2548 patients were included (492: sotrovimab, 276: nirmatrelvir/ritonavir, 71: molnupiravir, and 1709: eligible highest risk untreated). Patients aged ≥ 75 years accounted for 6.9% (n = 34/492), 21.0% (n = 58/276), 16.9% (n = 12/71) and 13.2% (n = 225/1709) of the cohorts, respectively. Advanced renal disease was reported in 6.7% (n = 33/492) of sotrovimab-treated and 4.7% (n = 81/1709) of untreated patients, and ≤ 5 nirmatrelvir/ritonavir-treated and molnupiravir-treated patients. All-cause hospitalizations were experienced by 5.3% (n = 25/476) of sotrovimab-treated patients, 6.9% (n = 12/175) of nirmatrelvir/ritonavir-treated patients, ≤ 5 (suppressed number) molnupiravir-treated patients and 13.3% (n = 216/1622) of untreated patients. There were no deaths in the treated cohorts; mortality was 4.3% (n = 70/1622) among untreated patients.ConclusionsSotrovimab was often used by patients who were aged < 75 years. Among patients receiving early COVID-19 treatment, proportions of 28-day all-cause hospitalization and death were low.

Investigating the effectiveness of water fluoridation.

This retrospective cohort study used treatment claims data submitted over a 10-year period to explore the effect of water fluoridation on specified National Health Service (NHS) dental treatments, number of Decayed Missing and Filled Teeth (DMFT) and its cost-effectiveness. Ethical approval was granted and data was collected from NHS primary care settings via claims submitted to the NHS Business Services Authority (NHS BSA). To be included, participants must have attended dental services twicein the study period, been 12 years or over and had a valid English postcode. Those with claims related solely to orthodontic care were excluded, as were those who had requested NHS National Data Opt-out. Costs relating to water fluoridation were supplied by Public Health England. NHS BSA data was used to calculate NHS costs at 2020 prices. A personalised water fluoride exposure for the 2010-2020 period was assigned to all individuals, who were then split into two groups, above 0.7 mg F/L (optimally fluoridated group) or lower (non-optimally fluoridated group). Individuals in each group were matched for analysis using propensity scores, estimated via logistic regression. Values of absolute standardised mean differences were used to determine covariate balance between the two groups, alongside a generalised linear model with matching weights and cluster robust standard errors and a patient deprivation decile as an interaction term. An Incremental Cost-Effectiveness Ratio(ICER) was calculated and differences in the overall costs to the public sector were illustrated by the return on investment estimate. The cohort contained data on 6,370,280 individuals. Negative binomial regression models were used to analyse health outcomes. In the optimally fluoridated group, the rate of invasive dental treatments was 3% less than in the non-optimally fluoridated group, and the mean DMFT in the optimally fluoridated group was 2% lower. There was no evidence of a difference in the predicted mean number of missing teeth between groups. There was a small reduction in the predicted number of invasive treatments in the optimally fluoridated group but the largest predicted reduction was in the most deprived decile. DMFT did not exhibit the expected social inequalities gradient, and for the mean number of missing teeth there were small differences in each decile of deprivation between groups but the direct effect was inconsistent. Water fluoridation expenditure between 2010 and 2019 was estimated to be £10.30 for those receiving optimally fluoridated water. The marginal effects estimate illustrated savings of £22.26 per person (95% CI - £21.43, -£23.09), which is a relative reduction in costs to the NHS of 5.5% per patient. A subsequent estimation of cost effectiveness calculated the cost of water fluoridation to avoid one invasive dental treatment(the ICER) as £94.55. The estimated return on investment using a variety of NHS dental attendance estimates all lead to a positive return. These results suggest that water fluoridation appears to be producing less impactful effects on oral health, with water fluoridation resulting in 'exceedingly small' health effects and very small reductions in use of NHS dental services. A positive return for the public sector was identified as the costs of NHS dentistry are high and costs of water fluoridation are low, though this study did not include the original set up costs of fluoridation programmes.

O-179 From secrecy to transparency: The journey of donor identity in reproductive medicine in Portugal

Abstract Thanks to significant medical advancements in reproductive medicine, people have more opportunities to achieve their parenthood goals. Third-party reproduction allows individuals and couples who might not otherwise be able to conceive to have the chance to build their family, thanks to the availability of donor gametes and gestational surrogacy. Gamete donation policy in Europe varies by country, raising ethical and legal concerns. In recent years, shifts from anonymity towards openness in donor legislation have occurred in several countries. Globally, in the last decade, there has been an increase in the number of families created using egg, sperm or embryo donation. The number of IVF/ICSI cycles using donor eggs or sperm in Portugal totalled 1890 in 2019 and 54 in 2020 (an unusual year due to the Covid-19 pandemic). In Portugal, the first medically assisted reproduction (MAR) law was approved in 2006, and gamete donations were anonymous. Ten years later, in 2016, Portugal’s MAR legal framework changed, and access to MAR was broadened to all women, independent of their marital status and sexual orientation. Therefore, treatment with donor sperm, oocytes, and embryos became available to recipients, including heterosexual couples, lesbian couples, and single women. In 2018, there was another change in the law and gamete donations became non-anonymous. In Portugal, identity-release donation allows the donor to remain anonymous to the intended parents during treatment (although they may have access to some non-identifying information about the donor). Nevertheless, the child can request the National Council for Medically Assisted Reproduction access to the donor’s personal information (full name) once they turn 18. Considering this legal framework, the number of previous donors who were contacted and asked whether they would maintain their donation despite the non-anonymity was residual. The identity-release framework did not seem to have affected the number of donations either. Donations are more frequent in private clinics than in the Portuguese public gamete bank, and this leads to waiting lists that can reach two years for a treatment involving oocytes or sperm donation. In this context, efforts to increase gamete donation, particularly in the National Health Service, are crucial. A study is currently being conducted in Portugal to pinpoint the main reasons why people do not consider being gamete donors. Preliminary results in a sample comprising 297 participants (82.2% females), with a mean age of 25.43 (SD = 7.88) years old and a mean of 14.09 (SD = 2.06) years of education, revealed that 73 (24.6%) stated that they would not consider being a donor because of the non-anonymity and 39 (13.2%) indicated that they would not consider becoming a donor due to concerns about being contacted in the future and requested responsibilities. These results may contribute to informing future initiatives aiming at promoting awareness on the topic of gamete donation. Another relevant topic is secrecy, which refers to parents not disclosing information to their offspring or their social group about donated gametes’ conception. Disclosing is recommended as an ongoing process, preferably when the child is young. This disclosure process may benefit from counselling or other support resources (e.g., children’s books, patients’ associations).

P-720 Ethnic diversity in fertility treatment in 2017-2021 using national register data, United Kingdom

Abstract Study question Are there any differences in fertility treatment use and outcomes across ethnic groups in the UK? Summary answer There are clear ethnic disparities – Black patients had lower IVF birth rates and started treatment later than White patients. What is known already Previous studies in US and UK have shown disparities in IVF outcomes, differences in perceptions around fertility treatment usage and prevalence of infertility across ethnicities. The mechanism in differences recorded in IVF outcomes by ethnicity is not fully understood due to the complexity influenced by existing social and economic inequalities, pre-existing diseases and other societal factors. Study design, size, duration The study used data from the UK national register held by the Human Fertilisation and Embryology Authority (HFEA), where all licensed clinics in the UK are required to submit treatment data. Participants/materials, setting, methods All treatment cycles recorded on the HFEA Register with a focus on cycles undertaken in 2017-2021 were analysed. This includes over 232,000 patients who had treatment between 2017 and 2021 and their partners. Five aggregated ethnic categories were used in most of the analyses (Asian, Black, Mixed, White and Other). Main results and the role of chance IVF pregnancy and birth rates have increased in all major ethnic groups since ethnicity data started being collected in 2008. However, Black and Asian patients consistently had lower pregnancy and birth rates compared with White patients. For Black patients aged 18-37, the average IVF birth rate per embryo transferred using fresh embryo transfers was on average 23%, compared to 32% for White patients in 2020-21. Among heterosexual couples, IVF cycles funded by the National Health Service (NHS) declined most among Black patients, decreasing from 60% in 2019 to 41% in 2021, compared to a decrease from 66% to 53% among White patients. Average age at starting treatment was higher among Black patients in heterosexual couples at 36.0 years of age, compared to the national average of 35.0 in 2021. Partner type varied by ethnicity and Black patients were more commonly single compared to other ethnic groups, with 6% of Black IVF patients and 62% of Black DI patients being single in 2017-21. Multiple birth rates have decreased across all ethnic groups, with disparities narrowing in recent years. Limitations, reasons for caution Due to the COVID-19 pandemic and large-scale work to upgrade the HFEA data submission system and migrate data to a new database, data on treatments and pregnancies from 2020-21 and outcomes from 2019-21 have not yet been validated. Around 13% of patients excluded due to unreported ethnicity data. Wider implications of the findings The HFEA and key stakeholders in UK have agreed a call to action to reduce the ethnic disparities through improving in development of clinical policy, information and awareness, NHS commissioning, and research to tackle the ethnic disparities in fertility treatment. Trial registration number NA

The ‘uncomfortable aunt’: Acts of resistance against NHS practices that contradict our values

AbstractThis study explores the experience of family therapists performing ‘everyday’ acts of resistance against practices within the National Health Service (NHS) that contradict their values. Interpretative phenomenological analysis (IPA) was used to analyse semi‐structured interviews with five family therapists working in the NHS. Themes explored include the influence of the self of the therapist on their motivation to resist, and the necessity of resisting to survive in the job and ensure families' marginalised voices are heard in the wider system. The tension in balancing competing needs in the system and the energy that resisting both gives and takes are described, as well as how others in the system influence the therapists' ability to resist. Resisting emerges as a critical role of the family therapist, as well as crucial for practitioners to work in a way coherent with their sense of self.

Changes in sick notes associated with COVID-19 from 2020 to 2022: a cohort study in 24 million primary care patients in OpenSAFELY-TPP

ObjectivesLong-term sickness absence from employment has negative consequences for the economy and can lead to widened health inequalities. Sick notes (also called ‘fit notes’) are issued by general practitioners when...

Population Health in Northern Mozambique. The Civil Society Opinion: A Qualitative Study

Context: The Government of Mozambique, responding to Islamic insurgency since 2017, aiming to design a resilience strategy in Northern Mozambique (Cabo Delgado, Nampula and Niassa provinces), asked Lúrio University in 2021 to perform a consultation with grassroots communities in civil society and internally displaced people, to assess their health situation, needs and proposals.Materials and Methods: Qualitative descriptive study with focus groups discussions in urban, rural, inland, and coastal communities and internally displaced people, respecting ethical, safety, confidentiality, and preventive measures of the SARS-CoV-2 pandemic. Convenience sampling was determined in each community and participants were selected with the support of local leaders, focusing on "resource people", stratified by adults’ gender and youth. Demographic and social data were analysed with SPSS software and answers to health questions were collected in writing and dealt with discourse analysis by category and subcategory. Informed consent was obtained from all subjects involved in the study.Findings: A total of 54 focus group discussions were held with 320 participants, 47.5% female, 65.6% adult and 34.4% adolescent and youth, 23.8% internally displaced persons. Most families recognise the importance of the national health service but feel cheated by the widespread corruption in public services, COVID-19 pandemic, and insurgency.Conclusion: The grassroots communities of the three provinces of northern Mozambique face daily challenges to their livelihoods and consider that public services and external support are insufficient. Valuing the availability of a free national health service, they point out serious limitations in these services, but also some proposals for solutions.

Menopause Symptom Prevalence in three Post COVID-19 Syndrome clinics in England: a Cross-Sectional Analysis

BackgroundThere is overlap between symptoms of perimenopause/menopause and Post-COVID syndrome and there is concern that some female patients referred to Post-COVID syndrome clinics may have undiagnosed perimenopause/menopause. However, the prevalence of such symptoms in this population is unknown. MethodsCross-sectional analysis of 122 women's health questionnaires as part of a service improvement project in 3 National Health Service (NHS) Post-COVID syndrome clinics in England. The primary outcomes were prevalence of menopause symptoms and association between total MSQ score and key predictors. ResultsAge group 40-54 showed the highest prevalence of most individual symptoms and the highest mean total MSQ score (36.4; CIs 32.3-40.6) correlating clinically with the onset of perimenopause/menopause. Regression modelling shows a significant positive parabolic relationship between age and total MSQ score. Age group 40-54 is associated with 6.60 points higher (CIs 1.31 to 11.9) total MSQ score than age group 55-79; an increase of 1 IMD quintile is associated with 2.85 points lower (CIs -1.24 to -4.45) total MSQ score; presence of a gynaecological diagnosis is associated with 6.31 points higher (CIs 1.32 to 11.3) total MSQ score. Fifty-one percent of patients who menstruate report menstrual disturbance with COVID-19 infection, and 21% with COVID-19 vaccination. ConclusionsSymptoms possibly attributable to perimenopause and menopause are highly prevalent amongst female patients attending Post-COVID syndrome clinics in Greater Manchester, England. Our findings provide key prevalence estimates and significant predictors of MSQ scores – vital for future research, clinical practice, and policy.

Comparison between Palonosetron and Ondansetron in Prevention of Chemotherapy Induced Nausea Vomiting

Background: Chemotherapy induced nausea and vomiting (CINV) is the commonest and the most incapacitating experience of thepatient undergoing cancer chemotherapy. Poorly controlled CINV sometimes make patients to refuse further treatment. This study aimed to compare the efficacy and safety of Palonosetron and Ondansetron in preventing CINV during cancer chemotherapy. Methods:This randomized controlled trial was conducted in the Department of Pharmacology and Therapeutics of Sylhet MAG Osmani Medical College from January 2021 to December 2021. There were 190patients enrolled initially; 14 patients from both groups withdraw themselves. Finally, 91 patients of Palonosetron and 85 patients of Ondansetron treated were recruited. The Palonosetron group were treated with Palonosetron at 0.25 mg and the Ondansetron group were treated with Ondansetron 8.0 mg intravenously, 30min before chemotherapy. After that Palonosetron 0.5 mg single time and Ondansetron 8.0 mg orally three times a day were given and total follow-up period was seven days. Episode of nausea and vomiting graded according to the guideline “Common Terminology Criteria for Adverse Events (CTCAE)”, version 4.0, which was published by the US Department of Health and Human Services (National Institute of Health and National Cancer Institute). Result: The groups were matched for the age (p = 0.263), gender (p = 0.630), body weight (p = 0.846),site of malignancy (p = 0.375), and drugsused for chemotherapeutic (p = 0.301) in both study groups. Palonosetron treated patients experienced significant lower episode of nausea in day-1 (p = &lt;0.001) and day-2 (p = 0.025), and in case vomiting in day-1 (p = 0.026) compared to Ondansetron. Significantly higher number of patients of Palonosetron compared to Ondansetron treated group showed complete response in both acute phase (p = 0.026), delayed phase (p = 0.036) and finally in overall phase (p = 0.014). Only four patients experienced with treatment failure in Ondansetron treated group. Observed adverse effects were in low intensity and not caused to stop the treatment procedure. Conclusion: Palonosetron was found to be more efficacious and well tolerated in preventing acute, delayed and overall phase of chemotherapy induced nausea and vomiting in this study.

PD12 Roadmap on how to set up home handheld phototherapy in the National Health Service: implementation of evidence-based treatment in the ‘real world’

PD12 Roadmap on how to set up home handheld phototherapy in the National Health Service: implementation of evidence-based treatment in the ‘real world’

Chronic Kidney Disease Eligible for SGLT2 Inhibitors Through the Integration of Italian Administrative and Primary Care Data.

Background. Patients with chronic kidney disease (CKD) can be successfully treated with sodium-glucose cotransporter-2 inhibitors (SGLT2-Is), regardless of diabetes. Fondazione Ricerca e Salute's (ReSD) administrative and Health Search's (HSD) primary care databases were combined in the Database Consortium ReS-HS to quantify and describe patients with CKD potentially eligible for SGLT2-Is and assess costs charged to the Italian National Health Service (SSN). Methods. Patients aged ≥18 with CKD and estimated glomerular filtration rate (eGFR) <60 ml/min in 2018, without dialysis and/or renal transplantation, were included. HSD was used to develop and validate algorithms for estimating eGFR, based on covariates, within the ReSD. Comorbidities, dispensed drugs, and direct healthcare costs were assessed. Results. In 2018, 66,297 (5.0% of HSD population) and 211,494 (4.4% of ReSD population) patients with CKD potentially eligible for SGLT2-Is were identified (females ≥58%). Prevalence increased with age with a peak at 75-84 years. Within HSD and ReSD cohorts, respectively: 31.0% and 41.5% had diabetes; in the observation periods, >82% and >96% received ≥1 pharmacological treatment, of which ≥50% and ≥25% received cardiovascular/blood agents and antidiabetics, respectively. From ReSD, mean per capita direct SSN cost was € 3,825 (CI 95%, € 3,655-€ 4,000): 50.1% due to hospitalizations, and 40.2% to pharmaceuticals (31.6% to cardiovascular drugs and 10.1% to antidiabetics). Conclusion. The Database Consortium ReS-HS methodology found 5% of adult SSN beneficiaries with CKD potentially eligible for SGLT2-Is bringing with them a high cardio-metabolic burden which increases the risk of CKD progression.