Brooklands Hospital

Abstract The paper focuses on the emerging area of wearable assistive exoskeletons which has been receiving considerable attention over the past 30 years or so. Exoskeleton technology has been widely assessed as having great potential to meet several societal challenges and major investments have been made to advance research and development (R&D), and to open new commercialisation opportunities via investment to develop exoskeleton products. However, to date, little impact has been made despite the technological developments and large number of startups that have been created globally only to disappear very quickly. We review the sector holistically and present evidence-based rationale why meaningful progress is not being made to progress the sector so that it is able to meet the expectations of stakeholders. This under-performance stems from a basic misunderstanding of the demanding requirements for success coupled with the non-availability of high-quality exoskeleton parts at an appropriate cost; in fact, most are at low technology readiness level (TRL). The paper presents details of the challenging requirements for the main exoskeleton sectors and the TRLs of available exoskeleton components by reviewing the literature and using personal expertise and experience of the authors. After understanding the technology and commercial landscapes for exoskeletons, a commercially viable strategy is proposed to focus on how the emerging and growing global healthy-aging applications can be successfully addressed via creation of consumer exoskeleton products able to meet the high quality/affordable cost challenges based on recent ISO robot modularity guidelines.

<bold>Introduction:</bold> Remission is now an aspiration for asthma patients on biologics, although there is no agreed definition. Predicting the likelihood of remission at an early stage on treatment would improve precision therapy. <bold>Aims:</bold> To identify the characteristics at 4 and 16 weeks on treatment associated with remission at 1 year in a real-world asthma cohort on benralizumab. <bold>Methods:</bold> BenRex is a multicentre study of exacerbations on benralizumab for severe eosinophilic asthma. We defined remission at 1 year as meeting all of: no OCS for asthma (for maintenance/exacerbation); ACQ <1.5 and FEV1 ≥ 80% predicted and/or ≥ 10% higher than baseline FEV1% predicted. Forest plots of associations between early changes at 4 and 16 weeks and remission at 1 year were derived from logistic regression models. <bold>Results:</bold> 36 of 136 subjects (26.5%) met remission criteria. Subjects achieving remission were older (p=0.04). Male and female participants achieved remission at similar rates (p=0.84). Fig 1 shows predictors of remission using changes from baseline at 4 and 16 weeks. FEV1 and SGRQ improvement are strongly associated with subsequent remission. <bold>Conclusion:</bold> An improvement in FEV1 of ≥100 ml and SGRQ change of double the MCID at 4 and 16 weeks on benralizumab are strongly associated with clinical remission at one year. <fig><object-id>erj;66/suppl_69/PA4619/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

Purpose This paper aims to showcase the work of the Learning Disability Professional Senate (LDPS) to update their guidance on effective community learning disabilities health teams (CTLDs). Design/methodology/approach A working group from the LDPS was established and the document from 2015 was reviewed and updated to provide up-to-date guidance. The guidance was reviewed by all members of the LDPS and confirmed to be acceptable to all four nations of the UK. Findings A summary version of the updated guidance is included in this paper together with a link to the full guidance. Research limitations/implications The vision for community learning disability teams (CLDTs)/services relevant to the wider NHS agenda is to ensure they enable access to high-quality effective mainstream and specialist services that are equally accessible to all and designed to meet the needs and aspirations of people with learning disabilities, thereby reducing health inequalities and restrictive practices. Practical implications This guidance has been made available via the LDPS to commissioners and services across the UK. It is intended as a contemporary guide to best practice. Social implications The model promotes an integrated approach to health care. Originality/value To the best of the authors’ knowledge, this is the the first paper to summarise the revised LDPS guidance.

Obsessive-compulsive disorder (OCD) is a severe and disabling psychiatric disorder that impacts people all around the world. OCD has several different phenotypes, with intrusive visual images being a presentation of the disease. In this paper, a case is presented of a patient who suffers from intrusive visual images of a large spider and octopus with visualization of the tentacle on her body. These visual images were identified as a symptom of OCD; therefore, this paper aims to present this unique presentation of the disease.

The lives of adolescents and young people living with HIV (LHIV) are dominated by complex psychological and social stressors. These may be more pronounced among those perinatally infected. This longitudinal mixed-methods study describes the clinical and psychosocial challenges faced by HIV perinatally infected young mothers in Harare, Zimbabwe to inform tailored support. HIV perinatally infected young mothers were recruited in 2013 and followed up in 2019. In 2013, they completed a structured interview, clinical examination, psychological screening and had viral load and drug resistance testing. A subset completed in-depth interviews (n = 10). In 2019, they were re-interviewed and had viral load testing. Data were analyzed using STATA 15.0. and thematic analysis. Nineteen mothers aged 17-24 years were recruited in 2013. Eleven (57.9%) were successfully recontacted in 2019; 3 had died, 2 had relocated and 3 were untraceable. In 2013, all 19 mothers were taking antiretroviral therapy (median duration 8 years, range 2-11 years) and median CD4 count was 524 (IQR 272). In 2013, eight mothers (42.1%) had virological failure (≥1000 copies/ml) (3 of whom subsequently died) and 7 (36.8%) had evidence of drug resistance. In 2019, the proportion with virological failure was 2/11 (18.1%). Six of 11 (54.5%) had switched to second line therapy. In 2013, 64.3% were at risk of common mental disorder and this risk was higher at follow-up (72.7%). Qualitative data highlighted three pertinent themes: HIV status disclosure, adherence experiences and, social and emotional support. Findings from this study underscore the significant clinical, social and psychological challenges faced by perinatally infected young mothers. The high rates of virological failure, drug resistant mutations, mental health issues and mortality observed in this population indicate the need for tailored and comprehensive health and support services to assist these young mothers.

<bold>Background:</bold> The COVID-19 pandemic escalated the need for remote study procedures in clinical trials. Adaptations to the BenRex Study (Benralizumab Exacerbation Study) allowed for validation of video supported home spirometry against on site face-to-face sessions in severe asthma patients. <bold>Methods:</bold> At screening, participants received a Micro spirometer [Vitalograph, Buckingham, UK] and education on its use. A spirometry session was performed on site with face-to-face coaching from study staff, followed by a remote spirometry session within 24 hours, with coaching over video link at 3 visits. All Spirometry sessions had an over-read for quality assessment, by Respiratory Physiologists at Vitalograph, using the grading system per the ATS-ERS 2019 Standardisation of Spirometry Guidelines. Statistical summaries were produced to compare the acceptability grade of FEV₁ and FVC at each session. McNemar tests were used to compare acceptability. <bold>Results:</bold> There were 166 sessions in total with clinic and off site spirometry readings, from 82 subjects. An FEV1 grade of A or B (as per ATS/ERS 2019 guidelines) was achieved in 161 sessions (97%) conducted on site and 156 (94%) conducted at home (p=0.32). An FVC grade of A or B was achieved in 152 sessions (91.5%) on site and 148 (89.1%) conducted at home (p=0.68). <bold>Discussion:</bold> The results from the BenRex cohort suggest that there is a high level of reproducibility of technical quality for remote spirometry [FEV₁ and FVC] conducted via video coaching. This has implications for study design and may support remote decentralised asthma trials in broader populations limited by geographical or time constraints.

BackgroundPeriods of droughts can lead to decreased food security, and altered behaviours, potentially affecting outcomes on antiretroviral therapy (ART) among persons with HIV (PWH). We investigated whether decreased rainfall is associated with adverse outcomes among PWH on ART in Southern Africa.MethodsData were combined from 11 clinical cohorts of PWH in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, participating in the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration. Adult PWH who had started ART prior to 01/06/2016 and were in follow-up in the year prior to 01/06/2016 were included. Two-year rainfall from June 2014 to May 2016 at the location of each HIV centre was summed and ranked against historical 2-year rainfall amounts (1981–2016) to give an empirical relative percentile rainfall estimate. The IeDEA-SA and rainfall data were combined using each HIV centre’s latitude/longitude. In individual-level analyses, multivariable Cox or generalized estimating equation regression models (GEEs) assessed associations between decreased rainfall versus historical levels and four separate outcomes (mortality, CD4 counts < 200 cells/mm3, viral loads > 400 copies/mL, and > 12-month gaps in follow-up) in the two years following the rainfall period. GEEs were used to investigate the association between relative rainfall and monthly numbers of unique visitors per HIV centre.ResultsAmong 270,708 PWH across 386 HIV centres (67% female, median age 39 [IQR: 32–46]), lower rainfall than usual was associated with higher mortality (adjusted Hazard Ratio: 1.18 [95%CI: 1.07–1.32] per 10 percentile rainfall rank decrease) and unsuppressed viral loads (adjusted Odds Ratio: 1.05 [1.01–1.09]). Levels of rainfall were not strongly associated with CD4 counts < 200 cell/mm3 or > 12-month gaps in care. HIV centres in areas with less rainfall than usual had lower numbers of PWH visiting them (adjusted Rate Ratio: 0.80 [0.66–0.98] per 10 percentile rainfall rank decrease).ConclusionsDecreased rainfall could negatively impact on HIV treatment behaviours and outcomes. Further research is needed to explore the reasons for these effects. Interventions to mitigate the health impact of severe weather events are required.

BackgroundWe examined whether a series of variables were related to the number of psychiatric inpatients using publicly available data about English psychiatric bed utilisation and NHS workforce.MethodUsing linear regression, with auto‐regressive errors, we examined relationships between variables over time using data from December 2013 to March 2021.ResultsOver time, the number of inpatients reduced by either 6.58 or 8.07 per month depending upon the dataset utilised, and the number of community nurses and community nursing support staff reduced by 7.43 and 2.14 nurses per month, respectively. Increasing numbers of consultant psychiatrists were associated with fewer inpatients over time. More care and treatment reviews (CTRs) were associated with more admissions over time, while more post‐admission CTRs were associated with increased discharges over time.ConclusionsFuture studies should examine whether psychiatric bed utilisation elsewhere within the NHS by people with intellectual disabilities has increased.

Unrecognised psychiatric and medical conditions can lead poorer health outcomes, lower health-related quality of life and increased mortality in people with autism, compared with the general population. A reasonable adjustment required in mainstream services is patient prioritisation by clinicians with knowledge and understanding of autism. Developed as part of the revised autism strategy, the recently developed autism competency framework lists the range of capabilities that psychiatrists who treat people with autism should have. Psychiatrists could lead the workforce transformation required to make the reasonable adjustments to mainstream mental health services needed to improve outcomes for people with autism.