Leicestershire Partnership NHS Trust

Chronic pain affects up to 60% of people with chronic kidney disease (CKD), yet remains under-recognised and under-treated. Pain management in this population is complicated by altered drug pharmacokinetics, polypharmacy, and the potential nephrotoxicity of conventional analgesics. Despite the high prevalence and significant impact on quality of life, evidence-based guidance specific to pain management in CKD remains limited. This systematic review aims to evaluate the effectiveness and safety of both pharmacological and non-pharmacological interventions in reducing chronic pain intensity among people with CKD on dialysis, not on dialysis, and kidney transplant recipients, across all stages of CKD. The primary outcome is the effectiveness of interventions in reducing chronic pain intensity as assessed by pain assessment tools. We will conduct a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and ClinicalTrials.gov from their inception to the present date to identify studies for chronic pain management in people living with CKD. Study screening will be conducted independently by two reviewers. One reviewer will extract data from each study, with a second reviewer cross-checking for accuracy and completeness. Data will be extracted on study characteristics, participant demographics, intervention components, pain outcomes, and adverse events. The certainty of evidence will be evaluated independently by two reviewers using the GRADE approach. Where applicable, data will be combined in meta-analyses using random-effects models. Additionally, a network meta-analysis will be performed if enough studies are available. This review will synthesise the current evidence for pain management strategies in CKD, by evaluating effectiveness of interventions among people receiving different renal replacement therapy modalities with varying pain and disease phenotypes. Findings will highlight the comparative effectiveness of various interventions while considering their safety profiles specific to the CKD context. The review will identify gaps in the literature and provide recommendations for clinical practice and future research. This review seeks to deliver a thorough evaluation of pain management strategies for people living with CKD. This systematic review is supported by the UK Kidney Association (UKKA), and findings will inform the upcoming UKKA guideline on symptoms management in people with CKD, alongside the other symptoms including itch, fatigue, and gastrointestinal symptoms. This review will aid clinicians in making well-informed decisions regarding pain management strategies, ensuring a balance between effectiveness and the specific risks associated with CKD.

IntroductionParental mental illness is a major public health issue across the globe with well-known intergenerational impacts on children. There is a wide body of evidence supporting the effectiveness of a range of interventions supporting families, however, their implementation has rarely been sustained across public health systems. Systemic change is an important part of workforce development and known to be crucial to embed and sustain practice, policy and structural initiatives in services for families. While much is known about the barriers to implementing family focused approaches within organizations and systems, less is known about how systems change occurs and what supports systems change to improve outcomes for families.MethodsThis study uses a Delphi method, with 103 experts from 17 countries participating to identify systems change factors from their own experience and to build consensus about key strategies required across the globe to support systems change in health, education, social welfare and mental health services.ResultsThe findings identify that systems change can be defined as any workforce, policy, legislation or other mental health promotion strategy that collectively contributes to improving outcomes for parents with mental illness, their children and their families. A systems approach to improve outcomes for families where a parent has a mental illness requires partnerships and collaboration between services and sectors affecting families (mental health, welfare, primary health, education, social care, public health), social and health policy development, and families themselves. Success in system change requires a focus on change at all levels of the system for momentum building, leadership support, the use of relevant data and reporting mechanisms, establishing practice competency and collaborative care, and being able to reflect and adapt to changing conditions and structural barriers.DiscussionA focus on system change for supporting families where a parent has a mental illness appears to require the combination of many strategies and factors, with international approaches to knowledge sharing imperative to support implementing, resourcing and sustaining change.

Adult community intellectual disability services in the United Kingdom (UK) are required to deliver specialist, evidence-based care for a variety of conditions while minimising restrictive practices and reliance on inpatient provision. Care pathway models have emerged as a potential mechanism to reconcile these aims yet remain under-used in care philosophies in intellectual disabilities. We propose a generalisable pathways model for community intellectual disability services and examine its implications for policy, clinical practice, and research. The model integrates care navigation, proportionate specialist input, and defined clinical condition care including behaviours that challenge, mental and physical health, forensics, neurodevelopmental conditions, epilepsy, and dementia within a community-based service architecture. It considers recent focus on digitalsation, prevention, workforce and practice innovation. The model aligns with contemporary policy priorities. We argue that pathway-based care delivery provides a pragmatic and ethically grounded framework for organising services. It supports consistency, integration, and preventative care while reducing reliance on reactive risk-based responses. By synthesising service design principles, core pathway functions, and system interfaces, this paper offers a coherent model for contemporary community intellectual disability services. Further empirical evaluation is required to assess the impact of care pathways on outcomes, patient experience, and cost-effectiveness.

To identify and map the existing literature on the conduct of patient and public involvement and engagement (PPIE) for statistical methodology. PPIE refers to the consideration of patient and public perspectives into research development, conduct and dissemination and, while commonly integrated in applied healthcare research, it currently remains underutilised in statistical methodology research. Many statistical methodologists lack confidence in conducting PPIE citing barriers such as insufficient training, unclear tasks, and concerns about impact. This review will examine literature on PPIE in the context of statistical methodology aiming to inform the design or analysis of healthcare research studies and related methodological research domains such as trials methodology and health data science. A three-step search strategy, developed with an information specialist and based on JBI guidelines, will identify published and unpublished PPIE literature. This will include database searches, hand-searching key journals, and grey literature searches via search engines. The authors will contact their professional networks to identify additional material. The literature will be screened, selected and extracted by two independent researchers. Results will be presented in an evidence map and using a qualitative, thematic analysis.

We captured the perspectives of 23 pregnant and parenting adolescents aged 14–18 years, five peer support workers and ten professionals in Kenya, through focus groups, on how their psychosocial needs could be addressed. A thematic codebook framework established three themes on social exclusion, being parented to parent, and relational psychosocial support. These were intersected by negative attitudes toward pregnancy and motherhood across the adolescents’ socioecology. The findings indicate the importance of community awareness, multi-modal interventions, integrated informal and service systems, and active involvement of young mothers with lived experience as peer educators or support workers.

<bold>Introduction:</bold> Recent ERS and UK guidelines outline a stepwise approach to diagnosing asthma in children, but real-world data on its application are limited. <bold>Methods:</bold> Data were collected from children (5−18 years) referred from primary care for asthma diagnostic testing in Leicester, UK, from 12/2022 to 12/2024. The pathway began with spirometry and bronchodilator reversibility(BDR), followed by an indirect bronchial challenge(exercise), and direct methacholine bronchial challenge if results were normal at the preceding step. <bold>Results:</bold> 582 children were referred; mean age 9.4(±3.3) years, 54% boys, 59% White. Of 533 who managed spirometry + BDR, 94(18%) had asthma confirmed with BDR≥12% (figure). Median FEV1/FVC was 87%, 40(7%) children had abnormal FEV1(mean 70%predicted; range 35−80%), 14(3%) PRISm (Preserved Ratio Impaired Spirometry) and 54(10%) dysanapsis. 324 children with negative first-line testing proceeded to bronchial challenge; 80 were diagnosed with exercise challenge and 51 after methacholine bronchial challenge. Overall, 225(39%) were objectively diagnosed with asthma, 126(21%) had it ruled out, and 231(40%) did not complete the pathway. <bold>Conclusion:</bold> A robust routine asthma diagnostic service can confirm or exclude a diagnosis in over half of children referred. However, barriers to compliance with the pathway must be addressed. In case of negative BDR, indirect and direct challenge testing are key investigations in the asthma diagnostic pathway. <fig><object-id>erj;66/suppl_69/PA3814/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

ObjectiveTo explore the challenges experienced by people with intellectual disability, their carers and health and social care professionals when using and managing medication.DesignA synthesis of qualitative research using meta-ethnography.Data sourceWe searched seven databases: MEDLINE, Embase, CINAHL, Science, Social Science and Conference Proceedings Citation Indices (Web of Science), Cochrane Library, PsycINFO and Proquest Dissertations and Theses from inception to September 2022 (updated in July 2023).Eligibility criteria for selecting studiesWe included studies exploring the challenges and perceptions of people with intellectual disability, their carers and health and social care professionals regarding medication management and use.ResultsWe reviewed 7593 abstracts and 475 full texts, resulting in 45 included papers. Four major themes were identified: (1) Medication-related issues, (2) navigating autonomy and relationships, (3) knowledge and training needs and (4) inequalities in the healthcare system. We formulated a conceptual framework centred around people with intellectual disability and described the interconnectedness between them, their carers and health and social care professionals in the process of managing and using medication. We identified challenges that could be associated with the person, the medication and/or the context, along with a lack of understanding of these challenges and a lack of capability or resources to tackle them. We developed an overarching concept of ‘collective collaboration’ as a potential solution to prevent or mitigate problems related to medication use in people with intellectual disability.ConclusionsThe effective management of medication for people with intellectual disability requires a collaborative and holistic approach. By fostering person-centred care and shared decision-making, providing educational and practical support, and nurturing strong relationships between all partners involved to form a collective collaboration surrounding people with intellectual disability, improved medication adherence and optimised therapeutic outcomes can be achieved.PROSPERO registration numberCRD42022362903.

Fire and rescue services in England routinely carry out Home Fire Safety Visits which aim to reduce risk of fire, support independent living and improve quality of life. The visits include a person-centred assessment and providing general advice on health-related topics such as preventing falls. To assess the effectiveness and cost-effectiveness of Home Fire Safety Visits (also known as Safe and Well Visits) to reduce falls and improve quality of life in older adults living in the community. We designed a multicentre, randomised controlled trial with economic and qualitative evaluations, involving two fire and rescue services in England, to recruit 1156 community-dwelling adults aged 65 years and over. All participants could continue to access routine care from healthcare professionals and were provided with a falls prevention leaflet as part of the trial. The intervention group were additionally offered a Home Fire Safety Visit. The usual care group were offered a visit after they had completed the trial. Blinding was not possible. Participants were randomised 1 : 1 using a secure web-based system. The primary outcomes were (1) the number of falls per participant and (2) health-related quality of life (EuroQol-5 Dimensions, five-level version) over 12 months from randomisation. Secondary outcomes included fire risk-taking behaviours, loneliness, fear of falling and time to first fall. The planned economic evaluation comprised cost-utility and cost-effectiveness analyses. The qualitative study was designed to examine intervention fidelity and acceptability. It proved impossible to conduct the trial as planned in the current research landscape. We faced significant delays in setting up and starting recruitment, in large part due to this coinciding with the start of the COVID-19 pandemic. Obtaining regulatory approval took longer than anticipated. Additionally, we were unable to access general practitioner registration data to identify participants as planned and so we had to use Consumer Classification Platform data to identify potential households to send study invitations to. This resulted in a less targeted and non-personalised mail-out as this is not patient-level data so the householder names were unavailable. Ultimately, recruitment was much lower than expected. In total, 237 participants were assessed for eligibility and 63 randomised (intervention, n = 32; usual care, n = 31). The Home Fire Safety Visits were delivered as planned to both groups; however, the planned statistical and health economic analyses could not be conducted due to the limited data. Data from the qualitative evaluation indicated the intervention was largely acceptable to staff and service users. Conducting trials in this setting is currently extremely challenging. To facilitate future research, we recommend an urgent review of research governance issues related to the types of personal data that can be accessed and used for research. This review should aim to provide support and avoid creating additional obstacles to research in this area. The evidence for the effectiveness and cost-effectiveness of Home Fire Safety Visits remains inconclusive. Research governance in local authorities needs urgent review. This trial is registered as Current Controlled Trials NCT04717258. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128341) and is published in full in Public Health Research; Vol. 13, No. 7. See the NIHR Funding and Awards website for further award information.

SUMMARY Machine learning, an artificial intelligence (AI) approach, provides scope for developing predictive modelling in mental health. The ability of machine learning algorithms to analyse vast amounts of data and make predictions about the onset or course of mental health problems makes this approach a valuable tool in mental health research of the future. The right use of this approach could improve personalisation and precision of medical and non-medical treatment approaches. However, ensuring the availability of large, good-quality data-sets that represent the diversity of the population, along with the need for openness and transparency of the AI approaches, are some of the challenges that need to be overcome. This article provides an overview of current machine learning applications in mental health research, synthesising literature identified through targeted searches of key databases and expert knowledge to examine research developments and emerging applications of AI-enabled predictive modelling in psychiatry. The article appraises both the potential applications and current challenges of AI-based predictive modelling in psychiatric practice and research.

BackgroundConstipation is a significant problem for people with intellectual disabilities, with a prevalence of 33–50%, causing at least five deaths annually in England. Individualised bowel care plans (IBCP) are recommended in England and Wales.AimsWe evaluated the feasibility and impact of IBCPs for people with intellectual disabilities who are in in-patient psychiatric units, and the effect on clinical outcomes.MethodPeople with intellectual disabilities who were at risk of constipation were recruited from four specialist in-patient psychiatric units in England and Wales. A constipation questionnaire was used to capture relevant data to devise IBCPs. Baseline, 3- and 6-monthly Health of the Nation Scales – Learning Disability (HoNOS-LD) were completed after the intervention. Descriptive statistics, Wilcoxon signed-rank, Mann-Whitney U, repeated-measures analyses of variance, with Bonferroni adjustment and Mauchly’s tests were conducted. Significance was taken at P < 0.05.ResultsOf 24 people with intellectual disabilities recruited from four units, all three data points were available for 18 patients. Constipation rates showed no statistically significant decline. The total HoNOS-LD score (18 items) did not decline. HoNOS-LD item 12 for physical functioning showed significant improvement for PwID with constipation compared with those without, between baseline and 6 months.ConclusionsThis quality improvement project suggests that a bigger study of IBCPs is feasible. Most outcomes examined via the HoNOS-LD, particularly those linked with mental illness, challenging behaviour and quality of life, did not show significant change, possibly because of the small sample size. However, people with intellectual disabilities and constipation showed positive changes in their physical functioning outcomes compared with those without constipation. Further in-depth evaluation of this intervention is needed.