Birmingham Community Healthcare NHS Trust

ABSTRACTThe aim of this systematic review was to identify how psychotherapies have been adapted to suit the needs of people with intellectual disabilities. A comprehensive literature search garnered 39,777 studies, which were screened for eligibility. Systematic searches, following PRISMA guidelines, identified 122 studies that met eligibility criteria, and findings were synthesised using framework synthesis. Six overarching adaptation categories were identified: (1) multisensory methods, (2) activities, (3) communication, (4) delivery medium, (5) additional support and (6) structure. Adaptations were primarily used to increase engagement, promote retention of information and improve communication between clients and clinicians. While a group of adaptations that aimed to improve the acceptability and accessibility of psychotherapy for people with intellectual disabilities were identified, larger studies are required to understand their efficacy.

ObjectiveIn recent years, there has been an expansion in the literature on the effects of computerized alerts on prescribing and patient outcomes. The aim of our study was to examine the impact of these systems on clinician prescribing and patient outcomes.MethodsWe searched three databases (Medline, Embase, and PsychINFO) for studies that had been conducted since 2009 and included studies that examined the effects of alerts at the point of prescribing. We extracted data from 69 studies.ResultsMost studies reported a beneficial effect on prescribing of computerized alerts (n = 58, 84.1%), including all studies (n = 4) that used passive alerts. Seven of the 10 studies that reported on patient outcomes showed a beneficial effect. Both randomized controlled trials (RCTs) and non-RCTS showed beneficial effects on prescribing across a range of different types of alerts. In 43 studies, it was possible to ascertain the effects of different types of alerts; the interventions that were most frequently associated with improvements in prescribing were drug-laboratory alerts (9/11; 81.8%); dose range checking (6/7; 85.7%); formulary alerts (8/9; 88.9%), and drug-allergy alerts (4/4; 100%). However, most of the studies did not satisfy the quality criteria.ConclusionMost of the studies found a beneficial effect of computerized alerts on prescribing. We have also shown that these benefits are apparent for a range of different types of alerts. These findings support the continued development, implementation, and evaluation of computerized alerts for prescribing.

Aims: The primary aim of the re-audit was to identify specific areas where key components of the NCISH guidelines were not consistently applied in the care of patients who died by suicide. By addressing these gaps, the Trust seeks to ensure that NCISH-recommended standards are embedded into practice across all patient care pathways. Our objectives were to assess the level of compliance with NCISH standards across all localities where patients died by suicide, evaluate whether the care provided aligns with National Standards and extract key lessons from the cases audited to drive improvements in care delivery and patient safety.Methods: This was a PAN Trust re-audit. A retrospective collection of data was done, and a sample was provided by the trust’s Serious Incident & Inquest Manager. The criteria were any patient known to the trust who completed suicide between April 2022 and March 2023, in line with NCISH guidelines. This collection saw 33 cases, however only 32 cases were audited, as one was withdrawn. This was an increase from the previous 2 years. The cases were split between team members for data collection, and for each case the RiO patient notes and incident reports were used to fill out the audit tool on Microsoft Excel. Data was analysed by the quality improvement team.Results: The audit revealed that no patients died as psychiatric inpatients, but six suicides occurred within three months of discharge. Most were males in their 60s, single, unemployed, and living alone, with depressive illness as the primary diagnosis. Common methods included hanging and self-poisoning, with most suicides occurring at home. Many patients received treatment, though risk assessments and follow-up practices were inconsistent, with structured tools used in only three cases. Lessons learnt emphasize the need for timely, structured post-discharge care, better crisis intervention, enhanced staff training, improved communication between services, and increased access to dual-diagnosis and mental health resources.Conclusion: Post-Review Changes:Risk assessments now use formal tools, with improved documentation and training on difficult conversations. Collaboration between GPs and mental health services has improved.Recommendations:Strengthen post-discharge follow-ups within three months. Provide suicide prevention training for GPs and staff. Increase home monitoring for high-risk patients, especially in Dudley. Launch male-focused mental health campaigns addressing stigma. Enhance inter-service collaboration between GPs, community mental health services, and crisis teams for seamless care coordination. Address systemic resource gaps like staffing and waiting lists.

ObjectiveNicotine pouch use has been linked to oral health concerns, including oral lesions and gingival irritation. This pilot study examines self-reported oral health outcomes following the use of a novel nicotine pouch (Stingfree Strong Blue Mint), with an impermeable barrier on the interior side designed to reduce mucosal irritation.Materials and methodsA total of 23 Swedish dentists who were current snus or nicotine pouch users participated in a 5-week observational study. Baseline and follow-up assessments included self-reported oral health status and photographic documentation of mucosal conditions, reviewed by an independent blinded dental expert. Primary outcomes included changes in self-reported snus lesions, gingival recession, gingival irritation, and gingivitis.ResultsThe prevalence of self-reported snus lesions decreased from 95.7% (n = 22) to 69.6% (n = 16). Median Axell-scale lesion severity declined from 2 (interquartile range [IQR]: 1–3) to 1 (IQR: 0–2) (z = 3.756, p = 0.0002). Moderate-to-severe lesions (Axell score ≥ 3) dropped from 39.1% (n = 9) to 0% (n = 0). Self-reported gingivitis cases (n = 3) were eliminated, and gingival irritation decreased by 90.0%.ConclusionsPreliminary findings suggest that the use of the Stingfree Strong Blue Mint nicotine pouch may reduce mucosal irritation. While promising, these findings warrant validation through large randomised controlled trials to establish long-term effectiveness and safety.

ABSTRACTBackgroundThis Consensus Workshop dealt with diagnostic methodologies in the context of surveillance, screening, assessment of stage and grade, prognosis, monitoring and prediction of periodontal status. Several elements provided the impetus for the workshop, including the limited quality of available research on diagnostic tests, the rapid development of new technologies, the implementation of the 2018 classification and the declarations of the World Health Organisation on diagnosis and oral health.AimTo update and evaluate the evidence on diagnostic methods, considering recent advances in knowledge and the implementation of the 2018 classification.MethodsThe European Workshop Committee of the European Federation of Periodontology guided the development of a consensus report after commissioning eight systematic reviews within three working groups. The reviews were discussed during the in‐person consensus meeting involving 70 participants from 21 different countries.ResultsWorking Group 1 discussed innovations in traditional diagnostic approaches, justified manual probing as the reference standard and assessed the value of image‐based methods. Working Group 2 analysed diagnostic tests based on microbial and host biomarkers and genetic diagnostic tests. Working Group 3 covered emerging technologies to be used within dental and non‐dental clinical settings, focusing principally on the impact of questionnaire‐based assessments and artificial intelligence systems (AIS) in interpreting different data modalities.ConclusionAlthough manual periodontal probing is firmly established as the reference standard, additional approaches based on imaging, biomarkers, host genetics, questionnaires and the development of emerging applied data science methods (e.g., AIS) are increasingly integrated in periodontal diagnostics.

Introduction Medication-related osteonecrosis of the jaw (MRONJ) is a significant adverse drug reaction associated with anti-angiogenic and anti-resorptive medications. The aim of this survey was to highlight the importance of reporting adverse drug reactions, including MRONJ.Methodology An electronic survey was disseminated to dentists working in the oral surgery department Birmingham Community Healthcare Trust in November 2021. The survey consisted of 14 open and closed questions relating to the identification and reporting of MRONJ as an adverse drug reaction.Results Although 97% of participants had seen a patient with MRONJ, only 19% had reported an adverse drug reaction to any medication. Interestingly, 27% of respondents felt that MRONJ should be classified as a 'post-operative complication' rather than an 'adverse drug reaction'. In total, 22% of participants were unaware of how to report an adverse drug reaction.Conclusion This survey acts as an important reminder to encourage both patients and dental professionals to report adverse drug reactions, including suspected MRONJ, to the Medicines and Healthcare products Regulatory Agency. Reporting aids accurate national data collection, highlights risk and supports ongoing research in this area.

Junctional epidermolysis bullosa (JEB) is a rare autosomal recessive genodermatosis with a broad spectrum of phenotypes. Current genotype-phenotype paradigms are insufficient to accurately predict JEB subtype and characteristics from genotype, particularly for splice site mutations, which account for over a fifth of disease-causing mutations in JEB. This study evaluated genetic and clinical findings from a JEB cohort, investigating genotype-phenotype correlations through bioinformatic analyses and comparison with previously reported mutations.Eighteen unique mutations in LAMB3, LAMA3, LAMC2 or COL17A1 were identified from seventeen individuals. Seven had severe JEB, nine intermediate JEB and one laryngo-onycho-cutaneous syndrome. Seven mutations were previously unreported. Deep phenotyping was completed for all intermediate JEB cases and demonstrated substantial variation between individuals. Splice site mutations underwent analysis with SpliceAI, a state-of-the-art artificial intelligence tool, in order to predict resultant transcripts. Predicted functional effects included exon skipping and cryptic splice site activation, which provided potential explanations for disease severity and in most cases correlated with lamimin-332 immunofluorescence. RT-PCR was performed for one case to investigate resultant transcripts produced from the splice site mutation.This study expands the JEB genomic and phenotypic landscape. AI tools show potential for predicting functional effects of splice site mutations and may identify candidates for confirmatory laboratory investigation. Investigation of RNA transcripts will help to further elucidate genotype-phenotype correlations for novel mutations.