Bristol Clinical Commissioning Group

Abstract Stroboscopic light stimulation (SLS) on closed eyes reliably evokes vivid geometric visual phenomena, and in some contexts, altered-state experiences, leading to its increasing use across research, public installations, recreational use, and exploratory clinical contexts. The main clinical risk for SLS is a photosensitive epileptic response. In contrast, non-epileptic sensitivities (e.g., migraine/photophobia, anxiety, autism/ADHD, psychosis) typically induce discomfort or distress rather than convulsive events. Here, we integrate a multi-laboratory safety survey of 1,070 participants, operational data from two commercial SLS providers, and a focused review of SLS and sensory-intolerance evidence. This synthesis was used to refine safety screening and to characterise adverse events. Across laboratory studies, 20 minor side effects (e.g., early withdrawal due to discomfort; ∼18.7 per 1,000) were reported, with no severe incidents requiring medical attention. From two commercial datasets (∼4.2 million closed-eye SLS sessions), 14 major adverse events requiring medical attention were documented (∼3.3 per million); minor reactions were not systematically captured. Synthesising these strands, we developed the evidence-based Sussex Strobe Safety Screening Questionnaire (4SQ), which uses non-specialist language to identify known sensitivities to SLS, alongside practical recommendations for risk mitigation across research, clinical, commercial, and public contexts. Together, these findings suggest that the absolute risk under SLS is low but non-zero. Screening tools can help exclude pre-existing conditions, while graded exposure (e.g., a short ’taster’ session, after which participants may opt out) and trained staff can mitigate the risk of first-episode events. Nonetheless, such events should be anticipated and minimised through clear screening pathways and managed through rehearsed on-site response plans.

IntroductionPaediatric polypharmacy is defined as two or more medicines, which is lower than the definition in adults (>5 medicines). A recent scoping review of paediatric polypharmacy found a mean prevalence of 39.7% with a large range from 0.9% to 98.4%.MethodsPrescribing data from 85 active practices across Liverpool Clinical Commissioning Group (CCG), was extracted on the 6th January 2021 to include all patients below 18 years of age. Prescribing data was also obtained for Alder Hey Children’s Hospital from the electronic prescribing system, Meditech on the 12th January 2021. Descriptive analysis was performed.ResultsOf the 110,097 CYP registered in primary care, 17,271 (16%) were prescribed >2 medications, 3,507 (3·2%) >5, 715 (0·7%) ≥10, and 202 (0·2%) ≥15. The median number of CYP prescribed ≥10 and ≥15 medications per primary care practice was 7 (range 0–34) and 2 (range 0–11), respectively.Within Alder Hey Children’s Hospital, 139 inpatients were identified, with 126 patients (91%) prescribed two or more medicines. The most frequently prescribed medicine was paracetamol. When ‘as required’ and ‘one off’ medicines were removed, omeprazole was the most frequently prescribed medicine.ConclusionsMany children within Liverpool CCG meet the definition for paediatric polypharmacy. Further research is required to assess the consequences of paediatric polypharmacy and address its management which is under recognised and underrepresented in the literature to date.

Abstract Type 2 diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk‐reduction strategies beyond glycaemic control. Cardiovascular and metabolic derangements individually and interdependently lead to a substantial increase in cardiovascular disease morbidity and mortality. Chronic kidney disease is also associated with increased risks of cardiovascular morbidity, premature mortality and decreased quality of life. Established and evolving treatment strategies including moderate physical activity, weight reduction, rigorous blood pressure control, correction of dyslipidaemia, and glycaemic control have proven beneficial in reversing these abnormal responses and decreasing the cardiovascular risk. Most patients with type 2 diabetes are treated by their primary health care team who need guidance in choosing the best treatment regimens for their patients since the number of glucose‐lowering agents is rapidly increasing, as is the amount of clinical data regarding these drugs. Early intervention models of care improve glycaemic, cardiovascular and patient outcomes. Copyright © 2023 John Wiley & Sons.

IntroductionMaking a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient‐facing mode, could change how information is shared between patients and healthcare professionals and improve the diagnostic process.MethodsParticipants diagnosed with asthma within the last 5 years were recruited from general practices across four UK regions. In‐depth interviews were used to explore patient experiences relating to their asthma diagnosis and to understand how a CDSS could be used to improve the diagnostic process for patients. Interviews were audio recorded, transcribed verbatim and analysed using a thematic approach.ResultsSeventeen participants (12 female) undertook interviews, including 14 individuals and 3 parents of children with asthma. Being diagnosed with asthma was generally considered an uncertain process. Participants felt a lack of consultation time and poor communication affected their understanding of asthma and what to expect. Had the nature of asthma and the steps required to make a diagnosis been explained more clearly, patients felt their understanding and engagement in asthma self‐management could have been improved. Participants considered that a CDSS could provide resources to support the diagnostic process, prompt dialogue, aid understanding and support shared decision‐making.ConclusionUndergoing an asthma diagnosis was uncertain for patients if their ideas and concerns were not addressed by clinicians and were influenced by a lack of consultation time and limitations in communication. An asthma diagnosis CDSS could provide structure and an interface to prompt dialogue, provide visuals about asthma to aid understanding and encourage patient involvement.Patient and Public ContributionPrespecified semistructured interview topic guides (young person and adult versions) were developed by the research team and piloted with members of the Asthma UK Centre for Applied Research Patient and Public Involvement (PPI) group. Findings were regularly discussed within the research group and with PPI colleagues to aid the interpretation of data.

BackgroundADHD in adults is a common and debilitating neurodevelopmental mental health condition. Yet, diagnosis, clinical management and monitoring are frequently constrained by scarce resources, low capacity in specialist services and limited awareness or training in both primary and secondary care. As a result, many people with ADHD experience serious barriers in accessing the care they need.MethodsProfessionals across primary, secondary, and tertiary care met to discuss adult ADHD clinical care in the United Kingdom. Discussions identified constraints in service provision, and service delivery models with potential to improve healthcare access and delivery. The group aimed to provide a roadmap for improving access to ADHD treatment, identifying avenues for improving provision under current constraints, and innovating provision in the longer-term. National Institute for Health and Care Excellence (NICE) guidelines were used as a benchmark in discussions.ResultsThe group identified three interrelated constraints. First, inconsistent interpretation of what constitutes a ‘specialist’ in the context of delivering ADHD care. Second, restriction of service delivery to limited capacity secondary or tertiary care services. Third, financial limitations or conflicts which reduce capacity and render transfer of care between healthcare sectors difficult. The group recommended the development of ADHD specialism within primary care, along with the transfer of routine and straightforward treatment monitoring to primary care services. Longer term, ADHD care pathways should be brought into line with those for other common mental health disorders, including treatment initiation by appropriately qualified clinicians in primary care, and referral to secondary mental health or tertiary services for more complex cases. Long-term plans in the NHS for more joined up and flexible provision, using a primary care network approach, could invest in developing shared ADHD specialist resources.ConclusionsThe relegation of adult ADHD diagnosis, treatment and monitoring to specialist tertiary and secondary services is at odds with its high prevalence and chronic course. To enable the cost-effective and at-scale access to ADHD treatment that is needed, general adult mental health and primary care must be empowered to play a key role in the delivery of quality services for adults with ADHD.

Patients with head and neck cancer may be required to travel significant distances for treatment, follow up and rehabilitation. This article presents findings from an evaluation of a pilot head and neck cancer service redesign in Thames Valley Cancer Alliance to enable patients from Swindon and Wiltshire to receive follow up and rehabilitation closer to home. The evaluation identified a decrease in overall outpatient visit time for these patients, resulting in reduced travel costs and improved quality of life. Other positive findings included improved outpatient clinic attendance and reduced emergency admissions. However, two aims of the service redesign – increased uptake of holistic needs assessments and delivery of patient education – were not achieved. The evaluation provided evidence for moving the pilot service to a recurrently commissioned model.

Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a life-threatening birth defect that often occurs with other major birth defects (EA/TEF+). Despite advances in genetic testing, a molecular diagnosis can only be made in a minority of EA/TEF+ cases. Here, we analyzed clinical exome sequencing data and data from the DECIPHER database to determine the efficacy of exome sequencing in cases of EA/TEF+ and to identify phenotypic expansions involving EA/TEF. Among 67 individuals with EA/TEF+ referred for clinical exome sequencing, a definitive or probable diagnosis was made in 11 cases for an efficacy rate of 16% (11/67). This efficacy rate is significantly lower than that reported for other major birth defects, suggesting that polygenic, multifactorial, epigenetic, and/or environmental factors may play a particularly important role in EA/TEF pathogenesis. Our cohort included individuals with pathogenic or likely pathogenic variants that affect TCF4 and its downstream target NRXN1, and FANCA, FANCB, and FANCC, which are associated with Fanconi anemia. These cases, previously published case reports, and comparisons to other EA/TEF genes made using a machine learning algorithm, provide evidence in support of a potential pathogenic role for these genes in the development of EA/TEF.