Derbyshire Community Health Services NHS Foundation Trust

In the United Kingdom and Sweden, men aged 65 are offered screening for Abdominal Aortic Aneurysm (AAA). Men with small AAA enter a surveillance programme to monitor growth until the AAA is large enough for referral for treatment. Some men develop anxiety related to having an AAA or being in surveillance. The original aim was to develop and assess the acceptability of a new intervention to help men in surveillance manage anxiety. As the study progressed, the aim changed to developing an information booklet to address men's uncertainties about AAA and surveillance because uncertainties might lead to anxiety. An intervention development study was undertaken, following guidance in three phases: 1. Identifying need using surveys of screening staff and men, and qualitative interviews with men and family members; 2. Co-design of an intervention using a literature review, programme theory development, and two workshops with men, family members, and a patient representative; 3. Assessing the acceptability of the intervention using a telephone survey of 23 men in AAA surveillance. Although the original aim was to develop an intervention to help men manage anxiety, men and screening staff identified the need for an information-based intervention to address men's uncertainties about AAA. Published evidence identified that uncertainty about health conditions or treatment can lead to anxiety, so the intervention taken forward was an information booklet to address men's uncertainties about AAA. A 16-page A5 booklet was developed with men and their family members, addressing why men had to wait for AAA to become large before referral for treatment, the risk of rupture for different sizes of AAA, and how to reduce the risk of rupture. In the telephone survey, 20/23 men in the AAA surveillance who read the draft booklet found it helpful because it addressed their uncertainties. They suggested minor refinements. A refined version of the prototype booklet was produced based on this feedback. A co-designed information booklet is available that addresses the uncertainties of men with AAA in surveillance. Future research should measure the impact of the information booklet on AAA-related anxiety. We set up a patient panel specifically for this study. We identified five men from different sources including asking the vascular clinicians on the team to invite patients to consider joining the panel and approaching existing health research studies patient panels to identify men who had AAA. One member of our team was the patient representative on the research committee for the NHS AAA Screening Programme in England. He attended all our patient panel meetings. The panel reviewed all the documents we used to invite men to different parts of the study, offered advice about recruitment, and gave feedback about the findings. They offered advice about the prototypes of the information booklet.

Purpose This paper aims to provide an overview of forensic-compassion-focused therapy (f-CFT), highlighting key components and the fusion of CFT and forensic practice to form an overarching trauma-sensitive approach to rehabilitative work with people who have caused harm to others. Design/methodology/approach The paper provides an overview of published research describing CFT interventions in forensic settings. Findings Descriptions of various ways that CFT has been used in forensic settings are provided along with a fusion of the application of CFT in such contexts. Practical implications This paper offers guidance on the implementation of CFT interventions based on previously published research. Originality/value To the best of the author’s knowledge, there have been no previously published summaries of the applications of CFT in forensic settings. This paper provides the first overarching review of such work.

Person-centred care planning is essential in mental health inpatient services, ensuring that patient goals align with clinical recovery plans. Despite its recognised importance, occupational therapists (OTs) in acute inpatient settings often face challenges in implementing structured, person-centred care plans within 10 days of admission based on the OT process within the acute inpatient services. The Goal-Directed Care Planning (GDCP) framework, previously successful in forensic and rehabilitation settings, was introduced to improve OT input into care plans in acute inpatient services. This study aimed to enhance the person-centredness of occupational therapy care plans by implementing the GDCP framework, with a target of improving OT contributions from 27.44% to 70% by October 2024. A quality improvement approach using multiple plan-do-study-act cycles was employed to embed the GDCP framework into three inpatient wards. Key interventions included standardising OT care-plan input, providing in-house training on care-plan audits, and ensuring timely documentation of patient goals and interventions. Monthly audits were conducted to assess progress and identify areas for further improvement. Across the board, OT input into care plans significantly improved from 27.44% (June-October 2023) to 53.25% (November 2023-October 2024). Ward-specific improvements were observed, with Ward T increasing from 24.42% to 43.32%, Ward M from 37% to 67.03% and Ward P from 21.09% to 44.34%. Key areas of improvement included clearer goal-action links and increased involvement of patients in care planning. Implementing the GDCP framework enhanced the quality and consistency of OT contributions to care plans, fostering a more structured and outcome-driven approach. However, ongoing challenges such as workforce shortages and OTs being allocated to non-specialist roles in safer staffing need to be addressed to sustain improvements in person-centred care planning.

Testicular torsion is a time-sensitive urological emergency in which delays in diagnosis and treatment can lead to testicular loss. Despite advances in healthcare delivery, delayed presentation and management remain common worldwide and contribute to significant morbidity. This scoping review aimed to explore trends in presentation, diagnosis, and surgical management of testicular torsion across healthcare settings; identify and categorise the causes of delays; assess the impact of these delays on outcomes; highlight predictive factors influencing salvage; and map gaps in the literature to inform future research and interventions. The review was conducted in accordance with the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed, Scopus, and Google Scholar were searched for studies published between 2010 and 2025. Eligible studies were original peer-reviewed research articles reporting on delays, predictive factors, or outcomes of testicular torsion. Data were charted on study characteristics, delays, predictive factors, and surgical outcomes. Ten studies were included, representing 1,910 patients with acute scrotal pain, of whom 1,529 had confirmed torsion. Delays in presentation and diagnosis were multifactorial, arising from patient-related, diagnostic, and system-level barriers. Salvage rates varied from 12% to 82%, with an overall salvage rate of 41.5% and orchidectomy rate of 58.5%. Outcomes were closely linked to timing of surgery, with salvage highest within six hours of symptom onset and declining sharply thereafter. Predictive factors included symptom duration, degree of torsion, age, and imaging findings. None of the studies reported long-term functional outcomes. Delays remain the most important determinant of outcome in testicular torsion. Findings are consistent with international guidelines emphasising urgent exploration within six hours. Improved patient education, streamlined referral pathways, and institutional preparedness are essential to reduce preventable testicular loss. Future research should prioritise long-term outcomes and the evaluation of system-level interventions.

People living with conditions such as motor neurone disease (MND) have complex health needs and require input from a multidisciplinary team (MDT) perspective. The nursing associate role has been embedded within the MDT in support of registered professionals since 2016. Case studies giving a personal account of caring for patients with complex health needs can illustrate the challenges faced by those providing such care. This article gives a personal account of caring for a patient with MND and some of the challenges faced. It highlights the importance of understanding complexities of health conditions for nursing associates within current health services, both during training and as a registrant.

Aims: Cherry Tree Close, a mental health rehabilitation and recovery unit based in Derby, England was assessed in October 2023 to compare current standards against the quality standards outlined in the Standards for Inpatient Mental Health Rehabilitation Services 4th Edition though did not fulfil the required criteria to achieve accreditation. Since then, the service has made further developments. This is a service evaluation study to compare the current service delivery of Cherry Tree Close, against the quality standards set out in the Standards for Inpatient Mental Health Rehabilitation Services 4th Edition document to identify progress towards achieving accredited status.Methods: The electronic patient records of service users admitted to the ward were reviewed between November and December 2024. Service users and members of the multidisciplinary team were interviewed. A visual inspection of the unit was carried out. Relevant standard operating procedures were reviewed.To achieve accreditation, services are required to meet 100% of type 1, 80% of type 2 and 60% of type 3 standards.Results: For type 1 standards, 95/109 standards (87.1%) were achieved in 2024 when compared with 93/109 (85.3%) in 2023.For type 2 standards, 39/50 standards (78.0%) were achieved in 2024 when compared with 38/50 (76.0%) in 2023.For type 3 standards, 8/14 standards (57.1%) were achieved in 2024 when compared with 5/14 (35.7%) in 2023.The improvement relates to development of a local community enhanced rehabilitation service and expansion of the multidisciplinary professionals including recruitment of team psychologists, assistant psychologists, and resident doctor in training.The remaining unmet standards relate to the infrastructure of the unit, care pathways, staff training, supervision, wellbeing, and service management.Conclusion: Currently, Cherry Tree Close has not fulfilled the criteria to achieve accreditation status. Further meetings have been arranged with the transformation team to work on further developing the service towards achieving accreditation.

SummaryGlucagon‐like peptide‐1 receptor agonists (GLP1RAs) are used for the management of type 2 diabetes (T2DM) and obesity. GLP1RAs induce significant weight loss but concerns have been raised regarding the associated effects on muscle mass (MM). We therefore conducted a systematic review and meta‐analysis assessing the effects of GLP1RAs on various measures of MM in individuals living with overweight or obesity, with and without T2DM. Comprehensive search of Medline, Pubmed, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar was performed. Studies involving cohorts with a mean age over 40 years and a mean body mass index over 25 kg.m‐2 were included. The primary outcome was any measure used to estimate MM, whilst fat mass (FM) and total body weight were included as secondary outcomes. Thirty‐eight publications, involving 1735 participants, were included in the review. Separate meta‐analyses were performed for studies involving participants with T2DM and individuals without T2DM (non‐DM). In individuals with T2DM, GLP1RAs induced a non‐significant mean reduction in MM measures (‐0.74 kg, 95% CI: ‐1.61, 0.14, p = 0.10), despite significantly reducing FM (‐3.18 kg, 95% CI: ‐4.09, ‐2.28, p < 0.0001). In the non‐DM analysis, a significant mean reduction in MM measures was observed (‐1.41 kg, 95% CI: ‐2.12, ‐0.71, p = 0.0001), however, this was significantly less than the reduction in FM (‐6.02 kg, 95% CI: ‐7.53, ‐4.50, p < 0.0001). In both populations, the reduction in measures of MM accounted for less than 20% of the total weight reduction. These findings provide some clarity to clinicians that use GLP1RAs to manage individuals with T2DM and/or obesity, however, further more detailed analysis of the impact of these medications on functional skeletal muscle is required.

Abstract Background: Almost two thirds of the adult UK population is either overweight or obese, a condition associated with physical and psychological comorbidities. Evidence shows that engaging with specialist weight management services can lead to significant reductions in weight. However, little is known about how legally protected characteristics impact on access to services and on outcomes. The purpose of this evaluation was to explore any barriers and health inequalities related to patients’ age, gender, disability, ethnicity, and socio-economic background in access or outcomes within a Tier 3 specialist Weight Management service in the UK. Methods: The evaluation was conducted in a pragmatic paradigm. Mixed methods were used in an iterative design where findings informed action. The evaluation included a narrative literature review, a quantitative demographic analysis on equity of access to the service (n=1896), a quantitative analysis on patient pathways and outcomes (n=2148), a patient focus group and interview (n=3), staff interviews (n=7) and a survey amongst referring General Practitioners (n=9). Results: Both weight stigma and male gender are perceived as barriers to accessing and engaging with weight management. Fewer men than women are referred to and access the service. However, after 52 weeks, both genders have similar outcomes in terms of BMI reduction. Older adults are under-represented in the service due to a lower referral rate, but they achieve higher than average BMI reduction. People from areas with the highest levels of deprivation are over-represented at referral and as starters in the service, and whilst they have lower-than-average BMI reduction after six months, longer engagement (12 months) achieves above average outcomes. Mistrust and disempowerment can be barriers to access but support from staff can help build trust and empowerment, facilitating positive outcomes. Staff’s existing skills facilitate working with people with protected characteristics, yet skills gaps still exist that act as barriers. Conclusions: Individual, societal and structural factors intertwine to generate inequalities. Relationship-building and empathy skills from health professionals, combined with improved communication, practical information, and support may alleviate these inequalities. However, some sample sizes were small and generalisations may only be made with caution.