Antidepressant and antipsychotic prescribing in patients with type 2 diabetes in Scotland: A time-trend analysis from 2004 to 2021.

AIMS: Prescribing of antidepressant and antipsychotic drugs in general populations has increased in the United Kingdom, but prescribing trends in people with type 2 diabetes (T2D) have not previously been investigated. The aim of this study was to describe time trends in annual prevalence of antidepressant and antipsychotic drug prescribing in adult patients with T2D. METHODS: We conducted repeated annual cross-sectional analysesof a population-based diabetes registry with 99% coverage, derived from primary and secondary care data in Scotland, from 2004 to 2021. For each cross-sectional calendar year time period, we calculated the prevalence of antidepressant and antipsychotic drug prescribing, overall and by sociodemographic characteristics and drug subtype. RESULTS: The number of patients with a T2D diagnosis in Scotland increased from 161 915 in 2004 to 309 288 in 2021. Prevalence of antidepressant and antipsychotic prescribing in patients with T2D increased markedly between 2004 and 2021 (from 20.0 per 100 person-years to 33.3 per 100 person-years and from 2.8 per 100 person-years to 4.7 per 100 person-years, respectively). We observed this pattern for all drug subtypes except for first-generation antipsychotics, prescribing of which remained largely stable. The degree of increase, as well as the overall prevalence of prescribing, differed by age, sex, socioeconomic status and subtype of drug class. CONCLUSIONS: There has been a marked increase in the prevalence of antidepressant and antipsychotic prescribing in patients with T2D in Scotland. Further research should identify the reasons for this increase, including indication for use and the extent to which this reflects increases in incident prescribing rather than increased duration.

Bereaved pupil support in schools: teacher training.

OBJECTIVES: Approximately, 1600 pupils are bereaved by a parent or sibling each year in Northern Ireland, equating to at least one child in every school class. Despite this, many children who are bereaved do not receive support from their school or college. Unsupported childhood bereavement is a risk factor for a number of social, psychological and educational difficulties. We aimed to carry out a service evaluation to explore the impact of a bereavement training course delivered to teaching staff in Northern Ireland. METHODS: A mixed methods, participant-oriented evaluation was carried out. Data were collected via a survey distributed at baseline (prior to training) and 4-month follow-up, and semistructured interviews. All participants were staff within the school community who had participated in the training. Quantitative survey data were analysed via statistical analysis, and open-text survey responses and interview data were analysed via thematic analysis. RESULTS: Quantitative survey responses indicated statistically significant improvements in teachers' confidence and knowledge on supporting bereaved children after the training. Six key themes were developed from interview data: the impact of the training on teaching staff's confidence, knowledge, on the schools' policy and practice, the impact on pupils, and whole school training. CONCLUSIONS: Given the significant role that teachers have in a child's formative years, it is essential that teaching staff are adequately trained and equipped to recognise and support both prebereavement and grief in pupils. A whole school bereavement training programme can be effective, as part of a wider culture and practice which values bereavement support in school.

Antidepressant and antipsychotic drug prescribing and diabetes outcomes: A systematic review of observational studies.

AIMS: Psychotropic medication may be associated with adverse effects, including among people with diabetes. We conducted a systematic review of observational studies investigating the association between antidepressant or antipsychotic drug prescribing and type 2 diabetes outcomes. METHODS: We systematically searched PubMed, EMBASE, and PsycINFO to 15th August 2022 to identify eligible studies. We used the Newcastle-Ottawa scale to assess study quality and performed a narrative synthesis. RESULTS: We included 18 studies, 14 reporting on antidepressants and four on antipsychotics. There were 11 cohort studies, one self-controlled before and after study, two case-control studies, and four cross-sectional studies, of variable quality with highly heterogeneous study populations, exposure definitions, and outcomes analysed. Antidepressant prescribing may be associated with increased risk of macrovascular disease, whilst evidence on antidepressant and antipsychotic prescribing and glycaemic control was mixed. Few studies reported microvascular outcomes and risk factors other than glycaemic control. CONCLUSIONS: Studies of antidepressant and antipsychotic drug prescribing in relation to diabetes outcomes are scarce, with shortcomings and mixed findings. Until further evidence is available, people with diabetes prescribed antidepressants and antipsychotics should receive monitoring and appropriate treatment of risk factors and screening for complications as recommended in general diabetes guidelines.

The impact of COVID-19 on the assessment and management of ectopic pregnancies.

Lay Summary: During the COVID-19 pandemic, the public delayed seeking medical help, which may have affected the impact of having an ectopic pregnancy. An ectopic pregnancy is when pregnancy tissue grows outside its normal position in the womb, and it can be life-threatening. It can be treated by non-surgical or surgical options, and any delay in seeking help can reduce the options for treatment and increase the need for more urgent management. We wanted to assess whether there were differences in the presentation and management of ectopic pregnancies in a major teaching hospital between 2019 (pre-COVID-19) and 2021 (COVID-19 period). We found that the pandemic did not cause a delay in seeking medical help or cause worse outcomes. In fact, immediate surgical treatment and time in the hospital were less during COVID-19, perhaps because of a desire to avoid admission to hospital. One outcome of COVID-19 is reassurance that we can safely use more non-surgical treatments for ectopic pregnancies.

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice.

BACKGROUND: Opioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018. AIM: An audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines. METHOD: A search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine's best-practice guidelines were used. RESULTS: Demographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. INDICATIONS: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. REVIEW: 56% 4-week, 70% past year. CONCLUSION: Opioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

In the Long Run: Physical Activity in Early Life and Cognitive Aging.

A certain degree of age-related cognitive decline is normal; however, some people retain more cognitive function than others. Cognitive impairment is associated with an increased risk of dementia. Thus, understanding the factors that contribute to cognitive reserve is crucial, so effective strategies for the prevention of dementia can be developed. Engaging in physical activity can delay cognitive decline and reduce the risk of dementia and a number of early life conditions have been shown to have long-lasting effects on cognition. This mini-review combines these two observations to evaluate the evidence from both animal models and epidemiological studies for physical activity in early life (≤30 years) delaying cognitive decline in later life (cognition tested ≥60 years). Three epidemiological studies were found; two showed a positive association and one found none. The latter was deemed to have an unreliable method. A review of animal studies found none that analyzed the effect of physical activity in early life on cognition in later life. However, in rodent models that analyzed mid-life cognition, runners showed improved cognition and enhanced adult hippocampal neurogenesis, changes which were preserved across the life span. Currently, there is insufficient evidence to conclude whether physical activity in early life may delay cognitive decline in later life, but these results indicate that further studies are warranted. Future human research should be in the form of longitudinal studies that begin below ≤15 years and assess sex differences. Crucially, the physical activity data must define type, quantity and intensity of exercise.

GOD'S HEALING LEAVES: THE COLONIAL QUEST FOR MEDICINAL PLANTS IN THE TORRID ZONE.

The colonial era witnessed a fevered quest for exotic medicinal plants by European physicians and scientists. This essay explores the geographical principles that oriented the search towards the lands and peoples of the humid tropics. Believing that God had planted botanical cures for diseases in their places of origin, medicinal plant collectors concentrated their efforts in the pestilential equatorial latitudes. Although many subscribed to the ancient Doctrine of Signatures, colonial bioprospectors discovered early that indigenous and diasporic peoples represented storehouses of plant knowledge. Assuming that native knowhow constituted more instinct than intelligence, Europeans employed coercion, bribes, torture, and promises of freedom to extract their ethnomedical secrets. In the case of especially lucrative healing plants, imperial and colonial entities conspired to pilfer and naturalize endemic species in their distant colonies. In response to this legacy of inappropriate exploitation of native peoples and tropical plants during the colonial era, most present day bioprospectors follow established codes of ethnobotanical ethics.

Brief compression-only cardiopulmonary resuscitation training video and simulation with homemade mannequin improves CPR skills.

BACKGROUND: Cardiopulmonary resuscitation (CPR) training has traditionally involved classroom-based courses or, more recently, home-based video self-instruction. These methods typically require preparation and purchase fee; which can dissuade many potential bystanders from receiving training. This study aimed to evaluate the effectiveness of teaching compression-only CPR to previously untrained individuals using our 6-min online CPR training video and skills practice on a homemade mannequin, reproduced by viewers with commonly available items (towel, toilet paper roll, t-shirt). METHODS: Participants viewed the training video and practiced with the homemade mannequin. This was a parallel-design study with pre and post training evaluations of CPR skills (compression rate, depth, hand position, release), and hands-off time (time without compressions). CPR skills were evaluated using a sensor-equipped mannequin and two blinded CPR experts observed testing of participants. RESULTS: Twenty-four participants were included: 12 never-trained and 12 currently certified in CPR. Comparing pre and post training, the never-trained group had improvements in average compression rate per minute (64.3 to 103.9, p = 0.006), compressions with correct hand position in 1 min (8.3 to 54.3, p = 0.002), and correct compression release in 1 min (21.2 to 76.3, p < 0.001). The CPR-certified group had adequate pre and post-test compression rates (>100/min), but an improved number of compressions with correct release (53.5 to 94.7, p < 0.001). Both groups had significantly reduced hands-off time after training. Achieving adequate compression depths (>50 mm) remained problematic in both groups. Comparisons made between groups indicated significant improvements in compression depth, hand position, and hands-off time in never-trained compared to CPR-certified participants. Inter-rater agreement values were also calculated between the CPR experts and sensor-equipped mannequin. CONCLUSIONS: A brief internet-based video coupled with skill practice on a homemade mannequin improved compression-only CPR skills, especially in the previously untrained participants. This training method allows for widespread compression-only CPR training with a tactile learning component, without fees or advance preparation.

Regeneration of uterine horn using porcine small intestinal submucosa grafts in rabbits.

Tubal factor infertility may be reversed using porcine small-intestinal submucosa (SIS). The method uses as a model the New Zealand White rabbit uerine horn. In surgery, SIS grafts were prepared from porcine jejunum; the uterine horn segment was resected and a graft was placed; then the contralateral adnexa was resected. Fecundability was tested with natural mating. Three out of six rabbits became pregnant. Gross and microscopic examination confirmed regeneration of all tissue layers. Thus, this study determined that SIS facilitates successful regeneration of uterine horn morphology in a manner similar to that observed in other tissues and species.

Role of small intestine submucosa (SIS) as a nerve conduit: preliminary report.

The goal of peripheral nerve repair is to successfully direct the regenerating fibers into the environment of the distal terminus with minimal loss of fibers at the suture line. Successful nerve repair is dependent on sensory, motor, and autonomic axons making appropriate connection with their distal terminus. The subsequent results are dependent on parameters such as the location and extent of the injury, appropriateness of realignment of the injured nerve, and the surgical technique. Peripheral nerve repair using autograft material has several shortcomings, including donor site morbidity, inadequate return of function, and aberrant regeneration. Recent peripheral nerve research has focused on the generation of synthetic conduits for nerve guidance. Small intestine submucosa (SIS) is a biological material that might better address those outcomes and improve regeneration. Its unique properties appear to offer several advantages. The SIS graft acts as a natural conduit between the proximal and distal nerves, provides a favorable growth environment, and appears to lack antigenicity. This preliminary study to evaluate the integrity of sciatic nerve repair was conducted over a period of 90 d. Distally directed growth of the proximal nerve was demonstrated histologically. Further investigations to demonstrate the extent and integrity of this regeneration are underway.