Feasibility randomised controlled trial of online group Acceptance and Commitment Therapy for Functional Cognitive Disorder (ACT4FCD)

INTRODUCTION

Functional cognitive disorder (FCD) is seen increasingly in clinics commissioned to assess cognitive disorders. Patients report frequent cognitive, especially memory, failures. The diagnosis can be made clinically, and unnecessary investigations avoided. While there is some evidence that psychological treatments can be helpful, they are not routinely available. Therefore, we have developed a brief psychological intervention using the principles of acceptance and commitment therapy (ACT) that can be delivered in groups and online. We are conducting a feasibility study to assess whether the intervention can be delivered within a randomised controlled trial. We aim to study the feasibility of recruitment, willingness to be randomised to intervention or control condition, adherence to the intervention, completion of outcome measures and acceptability of treatment.

METHODS AND ANALYSIS

We aim to recruit 48 participants randomised 50:50 to either the ACT intervention and treatment as usual (TAU), or TAU alone. ACT will be provided to participants in the treatment arm following completion of baseline outcome measures. Completion of these outcome measures will be repeated at 8, 16 and 26 weeks. The measures will assess several domains including psychological flexibility, subjective cognitive symptoms, mood and anxiety, health-related quality of life and functioning, healthcare utilisation, and satisfaction with care and participant-rated improvement. Fifteen participants will be selected for in-depth qualitative interviews about their experiences of living with FCD and of the ACT intervention.

ETHICS AND DISSEMINATION

The study received a favourable opinion from the South East Scotland Research Ethics Committee 02 on 30 September 2022 (REC reference: 22/SS/0059). HRA approval was received on 1 November 2022 (IRAS 313730). The results will be published in full in an open-access journal.

TRIAL REGISTRATION NUMBER

ISRCTN12939037.

Antidepressant Advisor (ADeSS): a decision support system for antidepressant treatment for depression in UK primary care - a feasibility study

OBJECTIVES

To develop and probe the first computerised decision-support tool to provide antidepressant treatment guidance to general practitioners (GPs) in UK primary care.

DESIGN

A parallel group, cluster-randomised controlled feasibility trial, where individual participants were blind to treatment allocation.

SETTING

South London NHS GP practices.

PARTICIPANTS

Ten practices and eighteen patients with treatment-resistant current major depressive disorder.

INTERVENTIONS

Practices were randomised to two treatment arms: (a) treatment-as-usual, (b) computerised decision support tool.

RESULTS

Ten GP practices participated in the trial, which was within our target range (8-20). However, practice and patient recruitment were slower than anticipated and only 18 of 86 intended patients were recruited. This was due to fewer than expected patients being eligible for the study, as well as disruption resulting from the COVID-19 pandemic. Only one patient was lost to follow-up. There were no serious or medically important adverse events during the trial. GPs in the decision tool arm indicated moderate support for the tool. A minority of patients fully engaged with the mobile app-based tracking of symptoms, medication adherence and side effects.

CONCLUSIONS

Overall, feasibility was not shown in the current study and the following modifications would be needed to attempt to overcome the limitations found: (a) inclusion of patients who have only tried one Selective Serotonin Reuptake Inhibitor, rather than two, to improve recruitment and pragmatic relevance of the study; (b) approaching community pharmacists to implement tool recommendations rather than GPs; (c) further funding to directly interface between the decision support tool and self-reported symptom app; (d) increasing the geographic reach by not requiring detailed diagnostic assessments and replacing this with supported remote self-report.

TRIAL REGISTRATION NUMBER

NCT03628027.

Task-sharing with lay counsellors to deliver a stepped care intervention to improve depression, antiretroviral therapy adherence and viral suppression in people living with HIV: a study protocol for the TENDAI randomised controlled trial

INTRODUCTION

Non-adherence to antiretroviral therapy (ART) is the main cause of viral non-suppression and its risk is increased by depression. In countries with high burden of HIV, there is a lack of trained professionals to deliver depression treatments. This paper describes the protocol for a 2-arm parallel group superiority 1:1 randomised controlled trial, to test the effectiveness and cost effectiveness of the TENDAI stepped care task-shifted intervention for depression, ART non-adherence and HIV viral suppression delivered by lay interventionists.

METHODS AND ANALYSIS

Two hundred and ninety people living with HIV aged ≥18 years with probable depression (Patient Health Questionnaire=>10) and viral non-suppression (≥ 1000 HIV copies/mL) are being recruited from HIV clinics in towns in Zimbabwe. The intervention group will receive a culturally adapted 6-session psychological treatment, Problem-Solving Therapy for Adherence and Depression (PST-AD), including problem-solving therapy, positive activity scheduling, skills to cope with stress and poor sleep and content to target barriers to non-adherence to ART. Participants whose score on the Patient Health Questionnaire-9 remains ≥10, and/or falls by less than 5 points, step up to a nurse evaluation for possible antidepressant medication. The control group receives usual care for viral non-suppression, consisting of three sessions of adherence counselling from existing clinic staff, and enhanced usual care for depression in line with the WHO Mental Health Gap intervention guide. The primary outcome is viral suppression (<1000 HIV copies/mL) at 12 months post-randomisation.

ETHICS AND DISSEMINATION

The study and its tools were approved by MRCZ/A/2390 in Zimbabwe and RESCM-18/19-5580 in the UK. Study findings will be shared through the community advisory group, conferences and open access publications.

TRIAL REGISTRATION NUMBER

NCT04018391.

Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study

OBJECTIVES

This study aimed to estimate the incidence of DSM5 anorexia nervosa in young people in contact with child and adolescent mental health services in the UK and Ireland.

DESIGN

Observational, surveillance study, using the Child and Adolescent Psychiatry Surveillance System, involving monthly reporting by child and adolescent psychiatrists between 1st February 2015 and 30th September 2015.

SETTING

The study was based in the UK and Ireland.

PARTICIPANTS

Clinician-reported data on young people aged 8-17 in contact with child and adolescent mental health services for a first episode of anorexia nervosa.

MAIN OUTCOME MEASURES

Annual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk.

RESULTS

305 incident cases of anorexia nervosa were reported over the 8-month surveillance period and assessed as eligible for inclusion. The majority were young women (91%), from England (70%) and of white ethnicity (92%). Mean age was 14.6 years (±1.66) and mean percentage of median expected body mass index for age and sex was 83.23% (±10.99%). The overall IR, adjusted for missing data, was estimated to be 13.68 per 100 000 population (95% CI 12.88 to 14.52), with rates of 25.66 (95% CI 24.09 to 27.30) for young women and 2.28 (95% CI 1.84 to 2.79) for young men. Incidence increased steadily with age, peaking at 15 (57.77, 95% CI 50.41 to 65.90) for young women and 16 (5.14, 95% CI 3.20 to 7.83) for young men. Comparison with earlier estimates suggests IRs for children aged 12 and under have increased over the last 10 years.

CONCLUSION

These results provide new estimates of the incidence of anorexia nervosa in young people. Service providers and commissioners should consider evidence to suggest an increase in incidence in younger children.

TRIAL REGISTRATION NUMBER

ISRCTN12676087.

High-performance infrared narrow-bandpass filters for the Indian National Satellite System meteorological instrument (INSAT-3D)

This paper describes the design and manufacture of a set of precision cooled (210 K) narrow-bandpass filters for the infrared imager and sounder on the Indian Space Research Organisation (ISRO) INSAT-3D meteorological satellite. We discuss the basis for the choice of multilayer coating designs and materials for 21 differing filter channels, together with their temperature-dependence, thin film deposition technologies, substrate metrology, and environmental durability performance.

Infrared filters and coatings for the High Resolution Dynamics Limb Sounder (6-18 microm)

We describe the spectral design and manufacture of the narrow-bandpass filters and 6-18-microm broadband antireflection coatings for the 21-channel High Resolution Dynamics Limb Sounder. A method of combining the measured spectral characteristics of each filter and antireflection coating, together with the spectral response of the other optical elements in the instrument, to obtain a predicted system throughput response is presented. The design methods that are used to define the filter and coating spectral requirements, choice of filter materials, multilayer designs, and deposition techniques are discussed.

Partial sequence analysis of 130 randomly selected maize cDNA clones

As part of a project to identify novel maize (Zea mays L. cv B73) genes functionally, we have partially sequenced 130 randomly selected clones from a maize leaf cDNA library. Data base comparisons revealed seven previously sequenced maize cDNAs and 18 cDNAs with sequence similarity to related maize genes or to genes from other organisms. One hundred five cDNAs show little or no similarity to previously sequenced genes. Our results also establish the suitability of this library for large-scale sequencing in terms of its large insert size, proper insert orientation, and low duplication rate.

Aesthetic cervicofacial surgery for head and neck tumor patients

Carefully selected head and neck tumor patients can safely undergo a wide variety of aesthetic surgical procedures. The malignancy must first be adequately treated and clinically controlled before elective surgery. Each tumor patient's general health and life expectancy must be honestly assessed prior to aesthetic surgery, because operating on an individual who cannot survive to enjoy the benefits is injudicious. Through the combined efforts of sophisticated oncology and plastic surgery, the patient survival rate can be improved as quality of life is enriched in appropriately selected and carefully managed individuals.

Selection and care of cardiac patients for plastic surgery

A major operation after successful coronary artery bypass surgery has been proved as safe as an operation for a patient free from coronary artery disease. Most patients with angina who demonstrate an operable coronary lesion should usually be scheduled for coronary artery bypass before undergoing nonemergency surgery. It is advisable to postpone elective plastic surgery for 6 weeks to 3 months after coronary bypass and 6 months after myocardial infarction. The life expectancy of cardiac patients must be carefully considered before elective plastic surgery, because performing an operation on a patient who cannot live to enjoy the benefits is unwise. Working together, cardiac surgeons, cardiologists, and plastic surgeons can now prolong the quantity of life and enrich its quality in properly selected and carefully managed patients.

Combined abdominoplasty and augmentation mammaplasty through a transverse suprapubic incision

Simultaneous breast augmentation and abdominoplasty through a transverse suprapubic incision offers women the opportunity to undergo body restoration with one operation, one anestheitc, one incision, and no scars on or near the breasts. Prompted by the earlier work of Planas [5] and others, we have performed this combined procedure on 8 women since February, 1977, and have compared the results with those in 4 additional patients who underwent separate abdominoplasty and breast augmentation operations.

Groin flap coverage for an infant's exposed cardiac pacemaker in complete heart block

A laterally based groin flap was used to provide soft tissue coverage for an exposed cardiac pacemaker power source in the abdomen of an 11-week-old child born with complete heart block. We have found no previous report of usage of this flap in this manner.

Segmental gastric antral resection in experimental peptic ulceration

In using the technique of histamine in beeswax peptic ulceration in dogs, these experimental preparations were studied as to their efficacy to protect against ulceration: laparotomy controls; bilateral truncal vagotomy and pyloroplasty; a 50 per cent gastrectomy and vagotomy plus a Billroth II gastrojejeunostomy; a 50 per cent segmental resection of the gastric antrum and corplus plus bilateral truncal vagotomy and pyloroplasty; a 75 per cent gastrectomy and Billroth II gastrojejeunostomy, and a 75 per cent segmental resection of the gastric antrum and corpus and bilateral truncal vagotomy and pyloroplasty. Only a 75 per cent gastrectomy Billroth II and a 75 per cent segmental resection of the antrum and corpus plus vagotomy and pyloroplasty consistently protected against histamine in beeswax induced ulceration.

Treatment of full-thickness abdominal and chest wall losses with split-thickness skin grafting

A 22-year-old man developed a large abdominal wall and sternal defect resulting from wound dehiscence. This was a sequel to two operations for gunshot wounds of the abdomen, the second one being for intraperitoneal abscess. The infected dehiscence was treated by the open method using povidoneiodine (Betadine) packs. As soon as the patient's condition permitted, split-thickness grafts were applied to the defect. One hundred percent success resulted, and convalescence of this critically ill patient was thereafter uninterrupted until discharge 31 days later. It is the authors' opinion that this method has a wider application than it is usually accredited.