Royal Edinburgh Hospital

Clarity and consistency of required knowledge and skills is crucial in supporting the development of members of cystic fibrosis (CF) multidisciplinary teams. Syllabi are effective frameworks for delivering a more uniform and evidence-based approach to high quality holistic care and research. Expert group representatives of the European Cystic Fibrosis Society (ECFS) Education Committee developed multiple speciality focused syllabi to define relevant core knowledge and skills. Contributors from a range of CF disciplines and countries reviewed each syllabus, which were further edited by members of the relevant ECFS speciality / working groups. Nine syllabus frameworks were developed and ratified for medicine, physiotherapy, nursing, pharmacy, psychosocial, exercise, nutrition, clinical trials and fundamental and translational science. Multiple challenges exist when developing and applying international syllabi. Examples include disparities in economics, health care infrastructure, available resources, and differing roles and responsibilities. By tapping into a broad international knowledge base, we were able to develop a clear framework for both comprehensive training and ongoing continuous professional development. These syllabi will support the further harmonisation of training and enhance education for both clinical and academic CF health care professionals across Europe.

Transplantations of cryopreserved immature testicular tissue (ITT) or spermatogonial stem cells (SSCs) represent promising approaches to restore fertility in patients with testicular tissue or cell suspension cryopreserved for fertility preservation. With over 3000 testicular samples cryopreserved globally, clinically viable and standardized protocols restoring fertility using cryopreserved testicular tissue/cells are urgently needed. Decades of research demonstrate the feasibility of immature testicular tissue transplantation (ITTT) or spermatogonial stem cell transplantation (SSCT) in animal models, including non-human primates. However, significant challenges remain in translating these options to human clinical practice. Critical factors include rigorous patient selection, robust pre-transplant evaluations to mitigate risks of malignant cell reintroduction, and the optimization of transplantation timing to support spermatogenesis. Developing comprehensive follow-up protocols and international data-sharing frameworks is essential to optimize outcomes. While offering the potential for genetic parenthood and enhanced quality of life for cancer survivors, these techniques require further refinement to ensure safety, efficacy, and realistic expectations. This paper outlines the framework for advancing the clinical translation of autotransplantation of testicular tissue/cells through collaboration and innovation.

BackgroundThe SCHEMA trial evaluates whether interpersonal art psychotherapy reduces the frequency/severity of aggressive incidents or patient distress associated with psychiatric symptoms, compared to usual care.ObjectiveTo describe the statistical and health economic analysis plan.MethodsA multicentre, two-arm, parallel-group, single blind individually randomised controlled trial with 150 adults within NHS secure care who have borderline to mild/moderate intellectual disability. The primary outcome is the frequency/severity of aggressive behaviour, measured on the Modified Overt Aggression Scale (MOAS) 19 weeks post-randomisation, analysed using a linear mixed-effect model, adjusted for baseline MOAS and stratification by gender and psychosis diagnosis. Changes in aggressive behaviour will be evaluated using weekly MOAS scores between 19 and 38 weeks. Patient distress relating to psychiatric symptoms will be assessed using the Brief Symptom Inventory Positive Symptom Distress Index across baseline, 19, and 38 weeks. Health-related quality-of-life will be assessed using self- and proxy-reported EQ-5D three-level (EQ-5D-3L) and Recovering Quality of Life 10-item measures, the latter to estimate the ReQoL Utility Index, across baseline, 19, and 38 weeks. The self-reported EQ-5D-3L is collected using an adapted version for people with intellectual disabilities. Resource-use is collected based on secure care records, to estimate intervention and healthcare costs over 19 and 38 weeks. HRQoL and cost data will inform cost-effectiveness based on the incremental cost per quality-adjusted life year over 38 weeks.DiscussionThis paper details the planned analyses and discusses recruitment challenges, sample size implications, and effect size assumptions. The plan was developed prior to database lock and unblinding to minimise analytical bias.Trial registrationISRCTN, ISRCTN57406593. Registered on 18/01/2023.

Abstract Feline cognitive dysfunction syndrome (CDS) is an age-related neurodegenerative disorder, comparable to dementia in people, characterised by behavioural changes such as increased vocalisation, altered social interactions, sleep-wake cycle, disorientation and house-soiling. Although the underlying mechanisms remain poorly understood, pathologies similar to those observed in Alzheimer’s disease (AD), have been identified in the brains of aged or CDS-affected cats, including brain atrophy, neuronal loss, amyloid-beta plaques, tau pathology, and cerebral amyloid angiopathy. Neuroinflammation and synapse loss, other important hallmarks of AD, may also play important roles in feline ageing and CDS, but these are yet to be explored. Several mechanisms of synapse loss have been described in human AD and mouse models of amyloidopathy, including synaptic accumulation of amyloid-beta, and the aberrant induction of synaptic engulfment by microglia and astrocytes. In this study, immunohistochemistry and confocal microscopy were used to examine the parietal cortex of young (n=7), aged (n=10), and CDS-affected (n=8) cats. Linear mixed effect modelling revealed that amyloid-beta accumulates within synapses in the aged and CDS-affected brain. Additionally, in the aged and CDS groups there was microgliosis, astrogliosis and increased synaptic engulfment by microglia and astrocytes in regions with Aβ plaques. Further, microglia and astrocytes show increased internalisation of amyloid-beta-containing synapses near plaques. These findings suggest that amyloid-beta exerts a pathogenic effect in the feline brain, with mechanisms mirroring those seen in human AD.

ABSTRACT Peer support is where individuals with the same shared experience provide mutual support. Using a non-controlled repeated measure design, this study evaluates initial efficacy of one-to-one email peer support. Young people with an eating disorder were matched with a recovered volunteer befriender, for up to one year, providing 1–3 email contacts a week. All participants completed measures (self-esteem, self-efficacy, wellbeing) at start of service, two and four-month intervals for recipients (n = 92) and peer befrienders (n = 86) respectively, and at end of service. Recipients also completed measures of social connectedness, impact of eating disorder, and goal-based outcomes. Multilevel mixed-effects linear regression models indicated significant improvements across all outcomes for recipients by 4 months, apart from self-esteem, and improvements self-efficacy, eating disorder impact and goal-based outcomes maintained at end of service. Peer befrienders did not show changes in self-esteem or self-efficacy, but there was a small significant reduction in wellbeing. The study provides evidence for email peer support for young people with eating disorders and highlights the need for robust support for befriending roles.

ObjectivesMandatory nutrition labels for out-of-home food consumption have been introduced in several countries to curb rising obesity levels. However, concerns have been raised about the potential negative impacts of such policies on individuals with eating disorders. This review aimed to summarise the literature on the impact of out-of-home nutrition labels on individuals with eating disorders or disordered eating.DesignA systematic search across eight databases was conducted on 11 October 2023.Data sourcesMEDLINE, EMBASE, APA PsycINFO, Web of Science, ProQuest Dissertations and Theses Global, Scopus and CINAHL. Unpublished studies were searched for on Google Scholar and PsyArXiv.Eligibility criteriaStudies were included if they assessed the impact of out-of-home nutrition labelling policies on individuals with eating disorders or disordered eating.Data extraction and synthesis538 studies were screened, of which 16 studies met inclusion criteria.ResultsThe reviewed studies included five experimental/quasi-experimental studies, five cross-sectional studies and six qualitative/mixed-methods studies. Across studies, eating disorder pathology was associated with noticing labels more frequently, paying more attention to caloric intake and more frequent behaviour changes due to caloric values. The metasynthesis identified five themes based on the qualitative findings, being drawn to calories, facilitating the eating disorder, reassurance, social eating and frustration.ConclusionsThe current review summarised the existing literature on the impact of out-of-home nutrition label policies on individuals with eating disorders. The evidence suggests that there is cause for concern regarding negative impacts, particularly for those with restrictive eating disorders, which should be explored further by research and considered by policymakers when making decisions on public health policies.

Common neuroanatomical regions are associated with both states of anorexia nervosa (AN) and autistic characteristics, but restoration of body mass index (BMI) has been associated with decreased presentation of autistic characteristics in some individuals with AN. This study aims to examine neuroanatomical correlates associated with autistic characteristics in those with acute anorexia nervosa (ac-AN) and those previously diagnosed with AN but whose weight has been restored (WR). In total, 183 individuals (healthy controls [HCs] = 67; n[ac-AN] = 68; n[WR] = 48) from the Brain imaging of Emotion And Cognition of adolescents with Anorexia Nervosa (BEACON) study were included, with autistic characteristics determined in both ac-AN and WR individuals (n = 116). To further examine BMI, ac-AN and WR group associations were compared. Random forest regression (RFR) models examined whether autistic characteristics and morphology of the anterior cingulate cortex (ACC), middle frontal gyrus (MFG), and orbitofrontal cortex (OFC) were able to predict future levels of social anhedonia and alexithymia. Group-wise differences were identified within the volume and surface area of the MFG and OFC, which were unrelated to BMI. Autistic characteristics were inversely associated with MFG and ACC volume, with differences in associations between ac-AN and WR groups seen in the surface area of the MFG. RFR models identified moderate-to-weak performance and found that autistic characteristics were not important predictive features in a priori and exploratory models. Findings suggest that the presence of autistic characteristics in those with ac-AN are associated with the volume of the MFG and are unrelated to BMI restoration.