bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analysis of algorithm-guided treatment and predefined duration treatment programmes for depression: exploring cost-effectiveness using routine care data
Authors: Li Fang , Visser Ellen , Brilman Maarten , Vries Sybolt O de , Goeree Bob , Feenstra Talitha , Jörg Frederike
Published: November 2023

Background

More knowledge on the cost-effectiveness of various depression treatment programmes can promote efficient treatment allocation and improve the quality of depression care.

Objective

This study aims to compare the real-world cost-effectiveness of an algorithm-guided programme focused on remission to a predefined duration, patient preference-centred treatment programme focused on response using routine care data.

Methods

A naturalistic study (n=6295 in the raw dataset) was used to compare the costs and outcomes of two programmes in terms of quality-adjusted life years (QALY) and depression-free days (DFD). Analyses were performed from a healthcare system perspective over a 2-year time horizon. Incremental cost-effectiveness ratios were calculated, and the uncertainty of results was assessed using bootstrapping and sensitivity analysis.

Findings

The algorithm-guided treatment programme per client yielded more DFDs (12) and more QALYs (0.013) at a higher cost (€3070) than the predefined duration treatment programme. The incremental cost-effectiveness ratios (ICERs) were around €256/DFD and €236 154/QALY for the algorithm guided compared with the predefined duration treatment programme. At a threshold value of €50 000/QALY gained, the programme had a probability of <10% of being considered cost-effective. Sensitivity analyses confirmed the robustness of these findings.

Conclusions

The algorithm-guided programme led to larger health gains than the predefined duration treatment programme, but it was considerably more expensive, and hence not cost-effective at current Dutch thresholds. Depending on the preferences and budgets available, each programme has its own benefits.

Clinical implication

This study provides valuable information to decision-makers for optimising treatment allocation and enhancing quality of care cost-effectively.
Effectiveness of lipid-lowering therapy on mortality and major adverse cardiovascular event outcomes in patients undergoing percutaneous coronary intervention: a network meta-analysis of randomised controlled trials
Authors: Deng Chang-Jiang , Yan Ju , Zheng Ying-Ying , Wu Ting-Ting , Pan Ying , Hou Xian-Geng , Wang Si-Fan , Sirajidin Subinur , Aimaitijiang Mikereyi , Xie Xiang
Published: November 2023

Background

Emergency percutaneous coronary intervention (PCI) can quickly restore myocardial perfusion after acute coronary syndrome. Whether and which lipid-lowering regimens are effective in reducing major adverse cardiovascular events (MACEs) and mortality risk after PCI remain unclear.

Objective

This study assessed the benefits of different lipid-lowering regimens on the risk of MACEs and mortality in the post-PCI population by network meta-analysis.

Methods

Public databases, including PubMed, Embase and the Cochrane Library, were searched from inception to August 2022. Randomised controlled trials (RCTs) on lipid-lowering regimens in post-PCI populations were included and analysed. The outcomes were the incidence of all-cause mortality and MACEs, whether reported as dichotomous variables or as HRs.

Results

Thirty-nine RCTs were included. For MACEs, alirocumab plus rosuvastatin (OR: 0.18; 95% CI: 0.07 to 0.44), evolocumab plus ezetimibe and statins (OR: 0.19; 95% CI: 0.06 to 0.59), eicosapentaenoic acid (EPA) plus pitavastatin (HR: 0.67; 95% CI: 0.49 to 0.96) and icosapent ethyl plus statins (HR: 0.73; 95% CI: 0.62 to 0.86) had significant advantages and relatively high rankings. For mortality, rosuvastatin (OR: 0.30; 95% CI: 0.11 to 0.84), ezetimibe plus statins (OR: 0.55; 95% CI: 0.43 to 0.89) and icosapent ethyl plus statins (OR: 0.66; 95% CI: 0.45 to 0.96) had significant advantages compared with the control.

Conclusion

EPA, especially icosapent ethyl, plus statins had a beneficial effect on reducing the risk of MACEs and mortality in post-PCI patients. Proprotein convertase subtilisin/kexin type-9 inhibitors plus statins were able to reduce the risk of MACEs, but the risk of mortality remained unclear.

PROSPERO registration number

CRD42018099600.
Prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in urban Selangor, Malaysia: a cross-sectional study
Authors: Samsudin Ely Zarina , Yaacob Siti Sara , Xin Wee Chen , Mat Ruzlin Aimi Nadira , Azzani Meram , Jamil Ahmad Taufik , Muzaini Kamarulzaman , Ibrahim Khalid , Suddin Leny Suzana , Selamat Mohamad Ikhsan , Ahmad Saman Mohd Shahril , Abdullah Nik Nairan , Ismail Nurhuda , Yasin Siti Munira , Azhar Zahir Izuan , Ismail Zaliha , Rodi Isa Mohamad , Mohamad Mariam
Published: November 2023

Background

Cyberbullying is a growing public health concern with clear, negative impacts on the mental, physical and social health of targeted victims. Previous research on cyberbullying has largely focused on examining its occurrence among children and adolescents. The present study aims to examine the prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in Selangor, Malaysia.

Methods

A cross-sectional study was conducted in a locality within Selangor, sampling a total of 1449 young adults. The Cyberbullying and Online Aggression Survey was used to measure cyberbullying victimisation. The Family APGAR scale, General Health Questionnaire, Pittsburgh Sleep Quality Index and single-item measures were used to assess family dysfunction, psychological distress and health behaviour, respectively.

Results

The 1-month prevalence of cyberbullying victimisation among young adults was 2.4%. The most common cyberbullying act experienced was mean or hurtful comments about participants online (51.7%), whereas the most common online environment for cyberbullying to occur was social media (45.8%). Male participants (adjusted OR (AOR)=3.60, 95% CI=1.58 to 8.23) had at least three times the odds of being cyberbullied compared with female participants. Meanwhile, participants with higher levels of psychological distress had increased probability of being cyberbullied compared with their peers (AOR=1.13, 95% CI=1.05 to 1.21).

Conclusions

As evident from this study, cyberbullying victimisation prevails among young adults and is significantly related to gender and psychological distress. Given its devastating effects on targeted victims, a multipronged and collaborative approach is warranted to reduce incidences of cyberbullying and safeguard the health and well-being of young adults.
A qualitative exploration of the facility-based trauma care for Road Traffic Crash patients in Bangladesh: When only numbers do not tell the whole story
Authors: Tune Samiun Nazrin Bente Kamal , Mehmood Amber , Naher Nahitun , Islam Bushra Zarin , Ahmed Syed Masud
Published: November 2023

Objective

Bangladesh is currently undergoing an epidemic of road traffic crashes (RTCs). In addition to morbidity and mortality, the economic loss from RTC as per cent of gross domestic product is comparatively higher than in countries with similar socioeconomic conditions. However, trauma care remained poorly developed as a specialty and service delivery mechanism. This study aimed to examine the current situation of in-hospital trauma care after RTCs to inform the design of a comprehensive service for Bangladesh.

Design, setting and participants

This qualitative study attempted to elicit stakeholders’ perceptions and experiences of managing RTCs through in-depth interviews and focus group discussions. Three districts and Dhaka city were selected based on the frequency of occurrence of RTCs. Fifteen in-depth interviews and 5 focus group discussions were conducted with 38 RTC patients, their relatives and community members in the catchment areas of 11 facilities managing trauma patients. Key informant interviews were conducted with 21 service providers and 17 key stakeholders/policy-makers.

Results

Hospital-based trauma care was generally poor in primary and secondary-level facilities. There was no triage area or triage protocol in the emergency rooms, no trained staff for trauma care, no dedicated RTC patient register and scarce life-saving equipment. Only in Dhaka-based tertiary hospitals was trauma care prioritised. These hospitals follow Advanced Trauma Life Support guidelines and maintain an RTC logbook. Emergency diagnostic services were not always available in the hospitals. Most RTC patients were males; the female participants were additionally vulnerable to physical and mental trauma. Affected people avoided taking legal action considering it a lengthy, complicated and ultimately ineffective process.

Conclusion

The trauma care services currently available in the studied health facilities are very rudimentary and without the necessary human and financial resources. This needs urgent attention from policymakers, programmers and practitioners to reduce morbidity and mortality from the current epidemic of RTCs in Bangladesh.
Effectiveness and cost-effectiveness of Assets-based feeding help Before and After birth (ABA-feed) for improving breastfeeding initiation and continuation: protocol for a multicentre randomised controlled trial (Version 3.0)
Authors: Clarke Joanne , Dombrowski Stephan U , Gkini Eleni , Hoddinott Pat , Ingram Jenny , MacArthur Christine , Moss Ngawai , Ocansey Laura , Roberts Tracy , Thomson Gillian , Sanders Julia , Sitch Alice J , Stubbs Clive , Taylor Beck , Tearne Sarah , Woolley Rebecca , Jolly Kate
Published: November 2023

Introduction

Breastfeeding has health benefits for infants and mothers, yet the UK has low rates with marked social inequalities. The Assets-based feeding help Before and After birth (ABA) feasibility study demonstrated the acceptability of a proactive, assets-based, woman-centred peer support intervention, inclusive of all feeding types, to mothers, peer supporters and maternity services. The ABA-feed study aims to assess the clinical and cost-effectiveness of the ABA-feed intervention compared with usual care in first-time mothers in a full trial.

Methods and analysis

A multicentre randomised controlled trial with economic evaluation to explore clinical and cost-effectiveness, and embedded process evaluation to explore differences in implementation between sites. We aim to recruit 2730 primiparous women, regardless of feeding intention. Women will be recruited at 17 sites from antenatal clinics and various remote methods including social media and invitations from midwives and health visitors. Women will be randomised at a ratio of 1.43:1 to receive either ABA-feed intervention or usual care. A train the trainer model will be used to train local Infant Feeding Coordinators to train existing peer supporters to become ‘infant feeding helpers’ in the ABA-feed intervention. Infant feeding outcomes will be collected at 3 days, and 8, 16 and 24 weeks postbirth. The primary outcome will be any breastfeeding at 8 weeks postbirth. Secondary outcomes will include breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support and healthcare utilisation. All analyses will be based on the intention-to-treat principle.

Ethics and dissemination

The study protocol has been approved by the East of Scotland Research Ethics Committee. Trial results will be available through open-access publication in a peer-reviewed journal and presented at relevant meetings and conferences.

Trial registration number

ISRCTN17395671.
Synthesising the evidence for effective hand hygiene in community settings: an integrated protocol for multiple related systematic reviews
Authors: Caruso Bethany A , Snyder Jedidiah S , Cumming Oliver , Esteves Mills Joanna , Gordon Bruce , Rogers Hannah , Freeman Matthew C , Wolfe Marlene
Published: November 2023

Introduction

Despite evidence for the efficacy and effectiveness of hand hygiene in reducing the transmission of infectious diseases, there are gaps in global normative guidance around hand hygiene in community settings. The goal of this review is to systematically retrieve and synthesise available evidence on hand hygiene in community settings across four areas: (1) effective hand hygiene; (2) minimum requirements; (3) behaviour change and (4) government measures.

Methods and analysis

This protocol entails a two-phased approach to identify relevant studies for multiple related systematic reviews. Phase 1 involves a broad search to capture all studies on hand hygiene in community settings. Databases, trial registries, expert consultations and hand searches of reference lists will be used to ensure an exhaustive search. A comprehensive, electronic search strategy will be used to identify studies indexed in PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary published in English from January 1980 to March 2023. The outcome of phase 1 will be a reduced sample of studies from which further screening, specific to research questions across the four key areas can be performed. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Quantitative and qualitative data will be extracted following best practices. We will assess all studies using the Mixed Method Appraisal Tool. All effect measures pertaining to review outcomes will be reported and a narrative synthesis of all studies will be presented including ‘data-driven’ descriptive themes and ‘theory-driven’ analytical themes as applicable.

Ethics and dissemination

This systematic review is exempt from ethics approval because the work is carried out on published documents. The findings of the reviews will be disseminated in related peer-reviewed journals.

PROSPERO registration number

CRD42023429145.
Improving surgical wound classification accuracy through education and audit processes
Authors: Fullington Hannah , Block Morgan , Jose Nisha , Peschka Stephanie , Brooks Jessica , Price Steven , Monroe David , Dirisala Karunakara , Street Austin
Published: November 2023

Precise wound classification is essential for surgical site infection risk stratification and appropriate hospital reimbursement. We instituted a multifaceted approach to improve institutional wound class identification including an education and awareness bundle, as well as a formal audit process. Overall, we saw significant improvements in wound class accuracy, interprofessional collaboration and provider compliance.
Candida utiliscandidaemia in premature infants: a retrospective single-centre study
Authors: Li Qiuping , Zhuang Lu , Zhang Sheng , Feng Zhichun
Published: November 2023

This retrospective study was conducted in a neonatal intensive care unit in Beijing. Patients whose blood culture yieldedCandida utilisduring hospitalisation from January 2009 to December 2017 were enrolled. Thirteen preterm infants of median gestational age 29.85 weeks were included. Laboratory tests on the day of onset showed thrombocytopaenia in 11 patients, granulocytopaenia in eight and elevated C-reactive protein in seven. No fungal endophthalmitis, renal infection, carditis or involvement of other end organs was observed in any of the cases. All 13 patients were cured after fluconazole therapy.
Aquatic high-intensity interval training (HIIT) may be similarly effective to land-based HIIT in improving exercise capacity in people with chronic conditions: a systematic review and meta-analysis
Authors: Bunæs-Næss Heidi , Kvæl Linda Aimée Hartford , Nilsson Birgitta Blakstad , Heywood Sophie , Heiberg Kristi Elisabeth
Published: November 2023

Objective

To investigate the effect of aquatic high-intensity interval training (AHIIT) on exercise capacity in people with chronic conditions.

Design

Systematic review and meta-analysis.

Participants

Adults (age ≥18 years) with any chronic conditions (long duration, continuing health problems).

Data sources

The databases Medline, EMBASE, CINAHL, SPORTSDiscus, PEDro and The Cochrane Library were searched from inception to 11 August 2023.

Eligibility criteria

Randomised or non-randomised controlled trials of adults reporting one or more chronic conditions were included, comparing the effect of AHIIT with a non-exercising control group, land-based high-intensity interval training (LBHIIT) or aquatic moderate-intensity continuous training (AMICT).

Results

Eighteen trials with 868 participants with chronic musculoskeletal, respiratory, cardiovascular, metabolic or neurological conditions were included. Adherence to AHIIT was high, ranging from 84% to 100%. There was moderate certainty in evidence according to the Grading of Recommendations Assessment, Development and Evaluation system for a moderate beneficial effect on exercise capacity standardised mean differences (SMD) 0.78 (95% CI 0.48 to 1.08), p<0.00001) of AHIIT compared with a non-exercising control group. There was moderate certainty in evidence for no difference of effects on exercise capacity (SMD 0.28 (95% CI −0.04 to 0.60), p=0.08) of AHIIT compared with LBHIIT. There was moderate certainty in evidence for small effect on exercise capacity (SMD 0.45 (95% CI 0.10 to 0.80), p=0.01) of AHIIT compared with AMICT.

Conclusion

There are beneficial effects of AHIIT on exercise capacity in people with a range of chronic conditions. AHIIT has similar effects on exercise capacity as LBHIIT and may represent an alternative for people unable to perform LBHIIT.

PROSPERO registration number

CRD42022289001.
Histological features of liver disease development in the Atp7b−/−mouse: a model of Wilson’s disease
Authors: Lavrut Pierre-Marie , Guillaud Olivier , Dumortier Jérôme , Mintz Elisabeth , Brun Virginie , Heissat Sophie , Couchonnal Bedoya Eduardo , Lachaux Alain , Bost Muriel , Hervieu Valerie
Published: November 2023

Aims

Wilson’s disease (WD) is caused by mutations in the ATP7B gene, resulting in copper accumulation and toxicity in liver and brain tissues. Due to the initial asymptomatic liver involvement, the progression of liver injuries in WD stays primarily unknown. Atp7b−/− knockout mice have been shown to be an appropriate model of WD for liver involvement.

Methods

A total of 138 Atp7b−/− mice were included and separated into five groups according to age as follows: 6, 20, 39 and 50 weeks without treatment, and 50 weeks with copper chelator treatment from 39 to 50 weeks of age and compared with 101 wild-type (WT) mice at the same stages. The evolution of histological liver lesions was analysed and compared between groups.

Results

Significant changes were observed in Atp7b−/− mice compared with WT. Copper deposits in hepatocytes appeared as early as 6 weeks but no significant increase over time was observed. Inflammation appeared as early as 6 weeks and progressed henceforth. Lobular and periportal acidophilic bodies appeared after 20 weeks. Significant atypia was also observed at 20 weeks and increased over time to reach a severe stage at 39 weeks. Fibrosis also became apparent at 20 weeks, progressing subsequently to precirrhotic stages at 50 weeks. Copper content, inflammation and fibrosis scores were significantly reduced in the treated group. No bile duct lesions or dysplastic changes were noted.

Conclusions

Copper accumulation leads to progressive changes in Atp7b−/− mice regarding inflammation, fibrosis and atypia. The severity of liver damage is lessened by chelation therapy.
Language as a biomarker in dementia
Authors: Garrard Peter
Published: November 2023

Professor Peter Garrard is an expert consultant neurologist and active clinician scientist in London, with a focus on linguistic profiles of disorders of the nervous system. He has more than 25 years of clinical experience, including 15 years as an accredited specialist in neurology. His specialist interests include neurological disorders, cognitive disorders, progressive language disorders, frontotemporal dementia, and early-onset dementia.

In 1990, Professor Garrard received his primary medical qualification from the University of Bristol and subsequently undertook his higher medical training in Edinburgh for surgery and Yeovil for medicine. Once in London, he completed his general medical training before taking on specialist training in neurology in 2000. During this time, Professor Garrard completed his PhD at Cambridge University on language abnormalities in Alzheimer’s and other dementias as a Medical Research Council clinical training fellow.

Professor Garrard has completed extensive neuroscience research, and currently holds the position of Professor of Neurology at St George’s University of London, where his primary research interest is in the early language changes associated with neurodegenerative dementians, such as Alzheimer’s. He is deputy director of the Molecular and Clinical Sciences Research Institute at St George’s, and also leads an active dementia research laboratory. Additionally, Professor Garrard has continuously taken on educational roles in his field since becoming a member of the General Medical Council.

In this talk I will briefly review the origins and development of the idea that the neurodegenerative dementias may have a presymptomatic signature detectable in spontaneous speech, and the implications of the diagnostic potential that this idea may hold. I will move on to discussing the special case of neurodegenerative syndromes that selectively impair language (the primary progressive aphasias), and describe the principles by which clinical information relevant to these conditions can be obtained using the newly developed mini linguistic state examination (MLSE). Finally, the diagnostic properties of the MLSE and its further development will be discussed.
Placebo, suggestion and FND – interactions and clues to pathophysiology
Authors: Terhune Devin , Edwards Mark
Published: November 2023

Devin Terhune. I joined the Department of Psychology at KCL in 2022 as a Reader in Experimental Psychology. I completed my BA in Philosophy and Psychology at Concordia University (Canada), my MSc in Psychology (with distinction) at the University of Liverpool, and my PhD in Psychology at Lund University (Sweden). After completing my PhD, I was a Postdoctoral Research Fellow in the Department of Experimental Psychology at the University of Oxford. More recently, before joining KCL, I lectured in statistics and coding in the Department of Psychology at Goldsmiths, University of London.

Mark Edwards is a Professor of Neurology and Interface Disorders at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London and works clinically at the Maudsley Hospital and Kings College Hospital. He has a specialist clinical and research interest in Movement Disorders and Functional Neurological Disorder (FND). He did his PhD with Professor John Rothwell and Professor Kailash Bhatia at the UCL Institute of Neurology, studying the pathophysiology of genetic dystonia. Following completion of neurology training he became a Senior Lecturer and Honorary Consultant Neurologist at UCL and the National Hospital for Neurology. Here he developed an NIHR funded research program and specialist diagnostic and treatment service for patients with FND. He is President of the Association of British Neurology Movement Disorders Group, International Executive Committee member of the International Parkinson’s and Movement Disorders Society, Board Member of the Functional Neurological Disorder Society, Associate Editor of the European Journal of Neurology, and medical advisor for FNDHope, the UK Dystonia Society and the British Association of Performing Arts Medicine.

Both abnormal beliefs (predictions) and attention are proposed as key pathophysiological processes in Functional Neurological Disorder. These processes are also central to our current understanding of the effects of suggestion (for example in the context of hypnosis) and placebo and nocebo phenomena and thereby suggest mechanistic overlap across these domains. In this talk we will discuss the mechanisms of suggestion, placebo/nocebo and FND. We will then consider ways in which these phenomena might overlap, including whether dissociation and predictive processing may be useful unifying themes here, the relevance of placebo and suggestion as methods for modelling FND and their potential therapeutic role.
Psychiatry in humanitarian emergencies
Authors: Hughes Peter
Published: November 2023

Dr Peter Hughes is a UK based Consultant Psychiatrist. He has been working globally for over 15 years in Humanitarian and development settings. He has worked with UN and non UN organisations. He founded the RCPsych Volunteering Special Interest group. He has written extensively on the topic and launches his book on Global Mental Health volunteering this year. He has been Chair of the London Division of RCPsych. He has most recently been working in Afghanistan. His main professional interest is in integrated mental health in Primary Care and Humanitarian emergencies.

This is an overview of humanitarian emergencies. There will be a description of background context of global mental health and in particular complex humanitarian emergencies. The basic principles of emergency response through the Global Interagency Standing Committee, ‘building back better’ and the mental health effects will be outlined. The message of hope comes through the building back better narrative. Effects on front line workers are discussed along with the importance of self care. There is a discussion around how high income countries need to have some accountability for emergencies in other parts of the world. There is guidance on how Psychiatrists can become involved in these emergencies worldwide.
01 Functional seizures and their misdiagnosis and mimics: a review of video-telemetry referrals and case outcomes in a tertiary epilepsy centre
Authors: Dudley Peter , Marquez Jan-Paul , O’Sullivan Suzanne , Walker Matthew , Farrell Fiona , Benson Jennifer , Yogarajah Mahinda
Published: November 2023

Objectives

To identify, describe, and characterize functional seizure mimics by analyzing patients referred with a putative functional seizure diagnosis that following video telemetry EEG (VT-EEG), received an alternate diagnosis. In addition, identify the proportion of patients who had habitual events captured that had this revision.

Background

Making a diagnosis of functional seizures from description alone can prove challenging as they share several features with epileptic seizures. The misdiagnosis of functional seizures as epileptic has previously been described in the literature.1However, little is known on the reverse.

Methods

The reports of VT-EEGs performed on patients admitted to the Chalfont Centre for Epilepsy between 2019 and 2022 were reviewed. Recordings that did not capture habitual events were excluded. The VT-EEG report, referral letters, and pre-admission clinic letters were reviewed to identify the pre-VT-EEG impression. These were categorised as epileptic, functional, unclear, or both. Subsequently, the VT-EEG reports were categorised based on the VT-EEG findings of the habitual event as epileptic, functional, or an alternative diagnosis. Those seizures that had a pre-VTEEG impression of functional and a post-VT-EEG diagnosis of epileptic, or other miscellaneous conditions, were analysed to identify clinically relevant features that favour an alternate diagnosis. In some cases, these features were used to localize seizure foci

Results

There were 444 VT-EEG reports where habitual events were recorded. Approximately 5% of these were of those with functional seizures who had their diagnosis revised. Several groups could be identified in those whose diagnoses were amended. The largest group were of frontal lobe seizures with bizarre semiology. In another group, no ictal abnormalities were present but stereotyped seizures arose during EEG defined sleep. Others included: patients with insular epilepsy and predominant autonomic features; patients with absence seizures; patients with brief epileptic seizures followed by functional overlay or elaboration; and patients with a dual diagnosis whose epileptic seizures were revealed on drug reduction.

Conclusion

In patients referred to a tertiary epilepsy unit, the majority of patients retained their diagnosis or changed from epileptic to functional. However, in a small minority of cases, seizures previously diagnosed as functional were reclassified as epileptic or an alternative diagnosis. It is clinically important to be aware of these mimics.

Reference

Lanzillotti AI, Sarudiansky M, Lombardi NR, Korman GP, D Alessio L. Updated review on the diagnosis and primary management of psychogenic nonepileptic seizure disorders.Neuropsychiatr Dis Treat. 2021;17:1825–1838. Published 2021 Jun 4. doi:10.2147/NDT.S286710
02 Predicting the cause of TLOC using an automated analysis of interactions with a virtual agent
Authors: Pevy Nathan , Christensen Heidi , Walker Traci , Reuber Markus
Published: November 2023

Objectives/Aims

A clinical decision tool for Transient Loss of Consciousness (TLOC) could reduce misdiagnosis rates and waiting times. Most clinical decision tools fail to stratify between the three most common causes of TLOC (epilepsy, functional (dissociative) seizures, and syncope) or are hindered by the challenging differentiation between epilepsy and FDS. Based on previous research describing differences in spoken accounts of epileptic and nonepileptic seizures, this study explored the feasibility of predicting the cause of TLOC by combining the automated analysis of patient-reported symptoms and spoken TLOC descriptions.

Method

Participants completed an online web application that consisted of a 34-item medical history and symptom questionnaire (iPEP) and interaction with a virtual agent (VA) that asked eight questions about the most recent experience of TLOC. Support Vector Machines (SVM) were trained using different combinations of features and nested leave-one-out cross validation. The iPEP provided a baseline performance. Three language-based feature sets were created: features designed to measure formulation effort, features that measured the proportion of words from different semantic categories, and features based on verb, adverb, and adjective usage. Two methods of integrating the iPEP and language features were compared. Method one involved training a single SVM model using all features and all diagnoses. Method two used a ‘model stacking’ approach whereby predictions of epilepsy or FDS from the iPEP model were passed into a second stage language analysis to improve this differential diagnosis.

Results

76 participants completed the application (Epilepsy = 24, FDS = 36, syncope = 16). Only 61 participants also completed the VA interaction (Epilepsy = 20, FDS = 29, syncope = 12). The iPEP model accurately predicted 65.8% of diagnoses. For the binary classification between epilepsy and FDS, the three language feature sets predicted the diagnosis with an accuracy between 75.5–85.7%. Combining the iPEP and language features resulted in an overall accuracy of 59% for the first integration method and 85.5% for method two (model stacking).

Conclusion

These findings suggest that an automated analysis of TLOC descriptions collected using an online web application and VA could improve the accuracy of current clinical decisions tools for TLOC and facilitate clinical stratification processes (such as the appropriate referral to cardiological versus neurological investigation and management pathways). Future research should aim to improve the baseline performance of the iPEP and explore methods for analysing TLOC descriptions from patients with syncope that can improve the identification of this diagnostic group.
03 Development of a screening checklist to diagnose functional memory symptoms: a Delphi study
Authors: Cabreira Verónica , McWhirter Laura , Frostholm Lisbeth , Stone Jon , Carson Alan
Published: November 2023

Introduction

Currently there is no standardized way to diagnose functional cognitive disorder (FCD) in clinical practice. We aimed to develop a bedside screening tool to differentiate between FCD and neurodegenerative causes of memory complaints.

Methods

A Delphi methodology was used to obtain consensus based on expert opinion through a series of three consecutive rounds. International experts with an interest and experience in cognitive disorders and functional neurological disorders were selected. The first and second rounds included both clinical vignettes and a list of diagnostic clinical signs favoring a FCD diagnosis (obtained from a systematic review of the literature), to be ranked using a 7-point Likert scale. Qualitative and quantitative analysis were undertaken. Finally, experts reviewed the component items for which consensus had been achieved and provided recommendations for modifications to better discriminate between FCD and dementia.

Results

45 experts, from 12 different countries, participated in the first round. A retention rate of at least 80% was obtained in subsequent rounds. 47% of the participants diagnosed between 10 and 50 patients with FCD over the last year. 69% reported that FCD comprises between 5 and 30% of the patients with memory complaints seen in the clinic. 91.4% would be interested in using a newly developed resource of this kind with the patients. A checklist was built and adapted into a scale, based on 11 statements for which strong (discrepancy between the level of symptoms reported and observed everyday functioning; patient’s ability to detail memory complaints with specific examples; and variable and/or fluctuating cognitive symptoms; 2 points each), moderate (ability to detail the list of drugs and/or previous interactions with other doctors; history of a non-cognitive functional neurological disorder or somatic symptoms; 1 point each) or low consensus (patient more aware of the cognitive changes than others; normal/incongruent cognitive performance; absence of symptom progression; dating symptom onset with precision; presence of psychological stressors; and ability to answer compound questions; 1 point each) was achieved. There was poor inter-rater agreement (Fleiss’ kappa=.035, p<.000). Regarding the vignettes, there was a major consensus gap in diagnosing FCD (<50% agreement) and neurodegenerative syndromes including Alzheimer’s disease (60–95% agreement).

Conclusions

This 11-item checklist is a simple complementary clinical tool aiming to improve diagnostic accuracy and direct patients to early post-diagnostic treatment. Further retrospective and prospective validation will be needed before it can be used clinically. This study is part of a wider project trying to improve the diagnosis of FCD.
07 Identifying ADHD in adult patients with dissociative seizures using the ASRS v1.1 questionnaire
Authors: Singhal Sumeet
Published: November 2023

Objectives and Aims

A service evaluation was performed in patients with dissociative seizures to check if a screening tool was proving useful in identifying adult ADHD in this highly specialised group. The idea of using such a tool came about after several dissociative seizure patients were coincidentally diagnosed with ADHD and appeared to show improvements in seizure control and fatigue with treatment.

Methods

All suitable dissociative seizure patients attending a seizure clinic between October 2019 and October 2022 underwent screening with the World Health Organisation (WHO) Adult ADHD ASRS v1.1 18-point questionnaire. Patients with co-existent epilepsy were excluded for the purposes of the service evaluation.

Results

Ninety-three new and follow up patients agreed to complete the ASRS. Of these, only one felt unable to complete the screen. Of the remainder, 11/92 failed to meet the eligibility criteria for formal ADHD testing based on the 6 point ASRS mini-screen. The remaining 81 scored a mean of 80.7/90 on the ASRS, which compares with a mean score of 41/90 in the normal population and 63/90 in the adult ADHD population. Of these 81, only 13 (16%) have so far had a formal assessment for ADHD, of which 12 (92%) were confirmed to have adult ADHD. Of the remainder, two were referred for formal assessment but were refused, one because of a negative assessment in 2015, the other for unclear reasons. Another sixteen were referred over 2 years before the study ended and are either still awaiting an assessment or DNA’ed the assessment or the results are pending. The remainder (62) had been referred in the last two years and given current waiting times are not expected to have yet had a formal assessment.

Conclusions

It was possible to apply the ASRS v1.1 to almost everyone in this cohort, a few face to face or over the telephone in clinic, but most self-completed in their own time and returned by post or email. The vast majority who completed the ASRS scored well within the adult ADHD range. For those who did go on to have a formal assessment, almost all ended up with a confirmed diagnosis of ADHD. This service evaluation therefore also suggests that the prevalence of ADHD in adult patients with dissociative seizures is worthy of formal study, and there are theoretical and anecdotal reasons to believe this could benefit control of the seizures themselves.
08 The economic cost of functional neurological disorders: a systematic review introduction
Authors: O’Mahony Brian
Published: November 2023

Functional Neurological Disorders (FND) represent genuine involuntary neurological symptoms and signs including seizures, weakness and sensory disturbance which have characteristic clinical features, and represent a problem of voluntary control and perception despite normal basic structure of the nervous system. The historical view of FND as a diagnosis of exclusion can lead to unnecessary healthcare resource utilisation, and high direct and indirect economic costs. A systematic review was performed using PRISMA guidelines in order to assess these economic costs, and to assess for any cost- effective treatments.

Methods

We searched electronic databases (Pubmed, PsycInfo, Medline, EMBASE, and the National Health Service Economic Evaluations Database of the University of York) for original, primary research publications between inception of the databases and 8thApril 2022. Key search terms included ‘functional neurological disorder’, ‘conversion disorder’ and ‘functional seizures’. Reviews, case reports, case series and qualitative studies were excluded. We performed a descriptive and qualitative thematic analysis of the resulting studies.

Results

The search resulted in a total of 3,244 studies. A hand-search of conference abstracts was also conducted. 16 studies were included after screening, and exclusion of duplicates. These included: cost-of-illness (COI) studies which were conducted alongside cohort studies without intervention, which included a comparator group, e.g. another neurological disorder (n=4); COI studies which were conducted alongside cohort studies without intervention, which did not include a comparator group (n=4); economic Evaluations (EE) of interventions which were either pre-post cohort studies (n=6) or randomized controlled trials (n=2). Of these, five studies assessed active interventions, and three studies assessed costs before and after a definitive diagnosis of FND.

Studies showed an excess cost associated with FND, which consisted of both direct, but also large indirect costs. Studies showed promise that interventions, including provision of a definitive diagnosis, could reduce this cost. No cost-effective treatments were identified. Study comparison was limited by study design and location heterogeneity.

Conclusion

FND is associated with significant use of healthcare resources, resulting in economic costs to both the patient and the tax-payer, as well as intangible losses. Interventions, including accurate diagnosis, appear to offer an avenue towards reducing these costs.
15 The clinical relevance of serum versus CSF NMDAR autoantibodies associated exclusively with psychiatric features: a systematic review and meta-analysis of individual patient data
Authors: Lim Mao Fong , Blackman Graham , Pollak Thomas , Al-Diwani Adam , Symmonds Mkael , Mazumder Asif , Carter Ben , Irani Sarosh , David Anthony
Published: November 2023

Objectives/Aims

A variety of psychiatric syndromes are associated with NMDAR autoantibodies; however, their clinical relevance when only present in the serum is unclear. We explored whether patients with CSF NMDAR autoantibodies could be distinguished from patients with serum-only NMDAR autoantibodies.

Methods

The electronic databases MEDLINE, EMBASE, PubMed, and PsycINFO were searched. Articles reporting adult patients with isolated psychiatric features and positive for NMDAR autoantibodies with relevant investigations were included. Patient level meta-analysis compared patients positive for CSF NMDAR autoantibodies with patients positive for serum NMDAR autoantibodies, but negative for CSF NMDAR autoantibodies. Dichotomous data were analysed using crude odds ratios (OR), whilst continuous data were analysed using Mann-Whitney Test (U). The protocol was prospectively registered (CRD42018082210).

Results

Of 4413 publications, 42 were included, reporting 79 patients. Median age was 34 years (IQR 19 years); 56% (45/79) were female and 24% (16/68) had a tumour. In total, 41 patients were positive for CSF autoantibodies and 20 were positive for serum- only autoantibodies. Patients with CSF autoantibodies were significantly more likely to be female (p< 0.001) and have a rapid (< 3 month) onset of symptoms (p= 0.02) than patients with serum-only autoantibodies. They were also more likely to present with psychosis (p< 0.001), exhibit EEG (p= 0.006), MRI (p= 0.002), and CSF (p= 0.001) abnormalities, but less likely to present with insomnia (p= 0.04).

Conclusions

Patients with an isolated psychiatric syndrome with CSF NMDAR autoantibodies can potentially be distinguished from those with serum-only NMDAR autoantibodies based on clinicodemographic and investigation findings.
16 Comparing communication in face-to-face and telephone epilepsy consultations
Authors: Reuber Markus
Published: November 2023

Objectives/Aims

Research suggests that patients and neurologists are generally satisfied with the use of teleconsultations in the treatment of seizure disorders. However, to gain a full picture of the relative merits of face-to-face and teleconsultations, we need to compare them empirically using recordings of real-life neurologist-patient interactions. Studies from other areas of medicine suggest that consultations can be compared on three levels of increasing detail:

Abstract level: comparing the duration of consultations.

Structural level: comparing how talking time is distributed between the doctor and patient/companion.

Detailed level: comparing what is said and how it is said.

The aim of this research is to compare face-to-face and teleconsultations in the seizure clinic based on their duration, distribution of talk, and the number of questions asked by patients.

Methods

Statistical comparison between and transcripts of 34 telephone consultations (recorded in 2021) and 56 face-to-face consultations (recorded in 2013).

Results

There was no significant difference in duration between face-to-face and telephone consultations (median of 16.5 versus 16.2 minutes). Likewise, there was no significant difference in the ratio of neurologist versus patient/companion talk between modalities (55% vs. 45% and 54% vs. 46% respectively). However, patients/companions asked more questions in face-to-face than telephone consultations (median 3 vs. 1, p < 0.05).

Conclusions

From a broad perspective, face-to-face and teleconsultations in the seizure clinic are similar, lasting for roughly the same amount of time with a similar distribution of talk between parties. However, more detailed analysis reveals potentially consequential differences, suggesting that patients may find it more difficult to ask questions in telephone encounters. Future research should explore other such differences.
17 The national hospital for neurology and neurosurgeryand functional seizures: a historical perspective using a collective case analysis of archived records from 1863 to 1945
Authors: Pop Mihai-Ioan , Linden Stefanie , Stone Jon , Sander Ley , Yogarajah Mahinda
Published: November 2023

Introduction and Aims

Functional seizures (also known historically as hysterical, dissociative or psychogenic non-epileptic seizures) are seizures that look like epileptic seizures but are not associated with epileptogenic brain discharges. They are the most common form of functional neurological disorder and have been written about since Babylonian times. For the latter part of the 20th century, study into the diagnosis, mechanisms and treatment of these seizures was neglected. However, in the last 20 years, there has been a resurgence in research into functional seizures.

The National Hospital for Neurology and Neurosurgery (NHNN) which opened in 1859 was the first hospital to be established in England dedicated exclusively to treating the diseases of the nervous system. The early pioneers of British and European neurology were based at the NHNN and cared for patients with functional seizures. While many of these historical figures published articles about patients with functional seizures and functional neurological disorders, the raw case files of their patients have never been systematically analysed.

This project aims to conduct a qualitative analysis of the archived records of patients with functional seizures from the NHNN from 1863 to 1945. We aim to assess the approaches of these individual clinicians to patients with functional seizures, and how they evolved over time.

Methods

Cases of functional seizures have been identified from the Queen Square archive database using relevant search terms. The notes pertaining to these identified cases have then been retrieved and transcribed into digital records. The qualitative data within these digital records have been analysed thematically using a coding matrix, combined with additional themes that emerge from the data. Delve analytics software has been used to analyse transcribed records.

Results

Initial screening of the Queen Square archived database has revealed that over 350 cases of functional seizures were looked after as in-patients in the years 1863 to 1945. Using a coded qualitative analysis we have identified several themes that emerge from this review of archived cases. These themes include variability in the clinical approach and management of patients, dependent on both the neurologist in charge and contemporary knowledge of and attitudes to functional seizures (eg world- war I compared to pre-world- war I).

Conclusion

Analyses of the previously unseen individual case records in the Queen Square archives provide a deeper and more holistic understanding of the historical approach to patients with functional seizures.