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The Centre for Evidence-Based Medicine (CEBM) at Oxford University develops, promotes and disseminates better evidence for health care.
"In Their Own Words": A Qualitative Exploration of Lived Experience and Healthcare Professional Perspectives on Evaluating a Digital Intervention for Binge Eating.
OBJECTIVE: Eating disorders characterized by binge eating are prevalent yet under-recognized, limiting access to effective care. The digital, programme-led (self-help) version of Enhanced Cognitive Behavior Therapy (CBT-E) offers a potentially scalable treatment. This study gathered insights from individuals with lived experience of binge eating (LE) and healthcare professionals (HCPs) to inform the design of a randomized controlled trial evaluating the intervention's effectiveness and to support early-stage implementation planning. METHOD: Four focus groups were conducted with 20 participants (8 with LE, 12 HCPs). Discussions explored recruitment strategies, participant engagement, meaningful outcome measures, and barriers to implementation. Data were analyzed using thematic analysis. RESULTS: Two overarching themes were identified: (1) Reach People in Accessible and Supportive Ways, and (2) Be Open to Different Experiences of Progress. Participants emphasized inclusive recruitment and compassionate, hopeful messaging. Stigma and limited recognition of binge eating were cited as recruitment barriers in healthcare settings. Both groups recommended community and online platforms to enhance reach. Participants stressed the importance of outcomes beyond symptom reduction (e.g., emotional well-being) and qualitative methods to capture recovery narratives. Findings also highlighted implementation-relevant factors, including how interventions are framed and delivered, and how engagement can be optimized. DISCUSSION: Perspectives from individuals with LE and HCPs support a person-centred trial aligned with the needs of those experiencing binge eating and those providing care, while considering both evaluative and implementation priorities. Findings inform strategies to enhance reach and understanding of digital intervention outcomes, contributing to trial designs that are consistent with real-world care and meaningful to participants.
Title: Designing Religiously Informed and Culturally Acceptable Tobacco Cessation Interventions for UK-Based Muslims
Abstract Introduction Globally, tobacco use rates in Muslim communities, particularly among men, are significantly higher than in non-Muslim communities. In the UK, there are also low rates of help seeking among British Muslims who use tobacco. Ramadan could be a “window of opportunity” to support tobacco use behavior change but we lack the voice of British Muslim communities on culturally tailored cessation support. We undertook a public and patient involvement and engagement (PPIE) project to gain views from representatives of these communities. Methods Discussions with fifteen PPIE representatives from, or who worked with, a variety of British Muslim communities identified through gatekeepers, social media and snowballing approaches. Key points and views from PPIE discussions were summarized into broad themes. Results Opportunities and challenges with culturally adapting tobacco cessation support to Ramadan were raised. “Light touch” positive religious messaging connected to tobacco cessation was recommended, and over-emphasizing religion in messaging content to be avoided. Quitting during Ramadan was felt challenging due to fasting, precluding the use of nicotine replacement products or medication, and reinforcing tobacco use as part of fast-breaking routines. Instead, PPIE representatives suggested quitting in advance of Ramadan or promoting cessation afterwards by capitalizing on tobacco reduction achieved during Ramadan. There was support for digital cessation approaches, but it was felt many in their communities would prefer traditional approaches, including interpersonal support and messaging through influential community members. Conclusions “Light touch” culturally tailored tobacco cessation support before or after Ramadan was felt more promising than supporting cessation initiation during Ramadan. Implications Members of British Muslim communities identified challenges with using Ramadan as a “window of opportunity” for tobacco behavior change and favored quitting ahead of time for Ramadan or capitalizing on tobacco behavior change achieved during Ramadan to promote a quit attempt afterwards. Taking a “light touch” approach with religiously tailored messaging could help engage Muslim people who smoke in cessation support. However, avoiding any strong or negatively framed tobacco-related messages linked to religious phrases or imagery is important. This work reinforces the importance of engaging with communities when considering culturally adapting interventions to prevent misdirected adaptions.
Real-world waitlist randomised controlled trial of gameChange VR to treat severe agoraphobic avoidance in patients with psychosis: A study protocol
Introduction Many people with psychosis find the world very frightening. It can be difficult for them to do everyday things - for example, walking down a busy street, travelling on a bus or going to the shops. Sometimes, the fears are so great that individuals rarely leave their homes. gameChange virtual reality therapy is designed to reduce this agoraphobic avoidance. In gameChange, users practise going into computerised immersive versions of ordinary situations. A virtual therapist guides users through the programme. A mental health worker also supports people. People normally do six sessions of gameChange, but now they can do more as headsets can be left with many people. We originally tested gameChange with 346 patients with psychosis. People saw a significant reduction in their fears. People with the most severe problems made the biggest improvements. This led to gameChange receiving National Institute for Health and Care Excellence (NICE) Early Value Assessment (EVA) approval for its use with patients with psychosis who have severe agoraphobic avoidance. NICE EVA approval is conditional on further evidence generation. We aim to carry out a real-world trial of gameChange used in the NHS. The overall aim is to gather evidence on the four essential areas (clinical benefits on agoraphobia, level of engagement and adherence, healthcare resource use, adverse effects) and the two further supporting areas (health-related quality of life, generalisability) identified in the NICE evidence generation plan for gameChange. Methods and analysis 200 patients with psychosis and severe agoraphobic avoidance will be randomised (1:1) to receive gameChange in addition to treatment as usual (TAU) or to a waitlist control group receiving TAU. Assessments will be conducted blind to group allocation at baseline, 8 weeks (end of treatment) and 26 weeks (follow-up). The trial will be embedded in services in at least seven National Health Service (NHS) trusts across England. The primary outcome is agoraphobic avoidance at 26 weeks assessed with the Oxford Agoraphobic Avoidance Scale. The secondary clinical outcomes are agoraphobic distress, paranoia and social contacts. There will be tests of moderation of the main clinical outcome. Treatment acceptability, adverse effects and cost-effectiveness will also be assessed. The target estimand is the treatment policy estimand and all primary and secondary analyses will be carried out incorporating data from all participants including those who do not complete treatment. Ethics and dissemination The trial has received ethical approval from the NHS Health Research Authority and Health and Care Research Wales (25/WA/0081). A key output will be the evidence needed for a NICE guidance update on gameChange and a clear recommendation concerning future routine use in the NHS. Trial registration number ISRCTN79060696.
Removal notice to “Ivermectin and COVID-19” Journal of Infection 91 (2025) 106530 (Journal of Infection (2025) 91(2), (S0163445325001240), (10.1016/j.jinf.2025.106530))
This article has been removed at the request of the editor and publisher. The publisher regrets that an error occurred which led to the premature publication of this paper. This error bears no reflection on the article or its authors. The publisher apologizes to the authors and the readers for this unfortunate error. The full Elsevier Policy on Article Withdrawal can be found at (https://www.elsevier.com/about/policies/article-withdrawal).
Introduction of point-of-care blood testing in early intervention in psychosis services: effects on physical health screening
Background There is a significant mortality gap between the general population and people with psychosis. Completion rates of regular physical health assessments for cardiovascular risk in this group are suboptimal. Point-of-care testing (POCT) for diabetes and hyperlipidaemia - providing an immediate result from a finger-prick - could improve these rates. Aims To evaluate the impact on patient-clinician encounters and on physical health check completion rates of implementing POCT for cardiovascular risk markers in early intervention in psychosis (EIP) services in South East England. Method A mixed-methods, real-world evaluation study was performed, with 40 POCT machines introduced across EIP teams in all eight mental health trusts in South East England from March to May 2021. Clinician training and support was provided. Numbers of completed physical health checks, HbA1c and lipid panel blood tests completed 6 and 12 months before and 6 months after introduction of POCT were collected for individual patients. Data were compared with those from the South West region, which acted as a control. Clinician questionnaires were administered at 2 and 8 months, capturing device usability and impacts on patient interactions. Results Post-POCT, South East England saw significant increases in HbA1c testing (odds ratio 2.02, 95% CI 1.17-3.49), lipid testing (odds ratio 2.38, 95% CI 1.43-3.97) and total completed health checks (odds ratio 3.61, 95% CI 1.94-7.94). These increases were not seen in the South West. Questionnaires revealed improved patient engagement, clinician empowerment and patients' preference for POCT over traditional blood tests. Conclusions POCT is associated with improvements in the completion and quality of physical health checks, and thus could be a tool to enhance holistic care for individuals with psychosis.
A realist review of acute pain management in children and young people attended by ambulance
Acute pain management in children and young people (CYP) attended by ambulance services is a significant challenge due to the complex nature of pain, the variation of approach needed across the age range, and the unpredictability of the environment. We aimed to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP. A realist review was conducted and reported in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. We developed an initial programme theory (PT) using key stakeholder input, searched the major bibliographic databases MEDLINE, CINAHL Complete and PsycINFO, and other sources from January 2000 to February 2024, screened and assessed relevance and rigour in duplicate, and performed synthesis and programme theory refinement. We developed an initial PT that focussed on the preparedness of staff and the expectations of CYP and parents/carers, along with key outcomes such as pain score severity, fear and anxiety. The subsequent search strategy yielded 1503 documents, of which 95 were included, representing empirical research articles, reviews, theses, book chapters and clinical guidelines. The initial PT was tested and refined throughout the synthesis to produce a PT underpinned by 34 context-mechanism-outcome configurations. The PT portrayed positive (e.g. presence of parents, focussed education and training, building trust) and negative (e.g. misinformation, fear and anxiety, long-term consequences) effects on prehospital acute pain management for CYP. This PT was mapped to the Behaviour Change Wheel to provide a clinically relevant behaviour change model for improvement. This realist review has provided a clinically focussed model to guide the improvement of prehospital acute pain management in children and young people attended by ambulance. The programme theory lays a foundation on which future empirical testing can be conducted to effect behaviour change in practice. Registration: CRD42024505978.
Implementation of link workers in primary care: Synopsis of findings from a realist evaluation
Background: Social prescribing link workers formed part of the Additional Roles Reimbursement Scheme introduced into primary care in England from 2019. Link workers assist patients experiencing issues affecting their health and well-being that are 'non-medical' (e.g. lack of social connections, financial difficulties and housing problems). They give patients space to consider these non-medical issues and, when relevant, connect them to support, often within the voluntary-community-social-enterprise sector. We conducted an earlier realist review on the link worker role in primary care. We then carried out a realist evaluation, described in this report, to address the question: When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances? Aim: To develop evidence-based recommendations to optimise the implementation of link workers in primary care and to enable patients to receive the best support possible. Design: A realist evaluation, involving two work packages. Setting: Data were collected around seven link workers in different parts of England. Methods: For work package 1, researchers spent 3 weeks with each link worker - going to meetings with them, watching them interact with patients, with healthcare professionals and with voluntary-community-social-enterprise staff. During this time, researchers had a daily debrief with the link worker, inviting them to reflect on their working day, and they collected relevant documents (e.g. job descriptions and information on social prescribing given to patients). They also conducted interviews with 93 primary care/voluntary-community-social-enterprise staff and 61 patients. As part of this work package, data on patient contact with a general practitioner before and after being referred to a link worker were collected. Work package 2 consisted of follow-up interviews (9-12 months later) with patients; 41 were reinterviewed. In addition, link workers were reinterviewed. A realist logic of analysis was used to test (confirm, refute or refine) the programme theory we developed from our realist review. Analysis explored connections between contexts, mechanisms and outcomes to explain how, why and in what circumstances the implementation of link workers might be beneficial (or not) to patients and/or healthcare delivery. Results: We produced three papers from the research - one on link workers 'holding' patients, one on the role of discretion in their job, and another exploring patient-focused data and readiness to engage in social prescribing. Data from these papers were considered in relation to Normalisation Process Theory - a framework for conceptualising the implementation of new interventions into practice (e.g. link workers into primary care). By doing so, we identified infrastructural factors required to help link workers to: (1) offer person-centred care; (2) develop patients' self-confidence, sense of hope and social capital; (3) facilitate appropriate general practitioner use; (4) foster job satisfaction among those delivering social prescribing. Discussion: Our research highlighted the importance of a supportive infrastructure (including supervision, training, leadership/management, clarity about the role, link workers' ability to use existing skills and knowledge and having capacity to connect with providers in the voluntary-community-social-enterprise sector) in order to produce person-centred care, to nurture hope, self-confidence and social capital among patients, to ensure they receive the right support (medical or non-medical), and to promote link workers' job satisfaction. Data showed how link workers can contribute to the offer of holistic care beyond a purely medical lens of health and illness. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.
Adopting and embedding home sensors in social care: findings from a mixed methods, rapid evaluation
Background The growing pressure faced by adult social care in England has fuelled interest in technology-enabled care (TEC). This includes the use of sensor-based technology to monitor activity patterns for ‘proactive’ interventions and care. However, evidence on its effectiveness and use is limited to feasibility pilots, as opposed to business-as-usual. Working with three local authorities using home sensors, we sought to define good practices and draw transferable lessons on implementing and embedding this technology in routine care practice. Methods Across all sites, we interviewed 51 staff and system stakeholders, 19 service users, and family/informal caregivers. We also used secondary data to determine the feasibility of a full economic study. The analysis was guided by the NASSS (non-adoption, abandonment, and challenges to scale-up, spread and sustainability) framework to explore factors influencing implementation and sustained adoption of the technology in use. Results Home sensors were used across multiple care contexts (assessment, reablement, and long-term care monitoring). Perceived value and impact included an increase in service user independence and safety, family/informal caregiver reassurance, identifying healthcare needs, providing more holistic and objective assessments, and supporting dialogue regarding care needs. However, evidence of the impact across these areas was limited, and we were unable to obtain the data required to undertake an economic analysis. Key issues to consider for sustained adoption include the materiality and dependability of the technology, compatibility with service users and their care networks, workforce knowledge and confidence, inter-organizational routines and coordination work, and strategic alignment. Conclusion Our findings indicate the need to acknowledge the labor-intensive process of embedding and adapting the use of home sensors for proactive care. Decision makers need to focus on how to support and resource incremental and system wide-changes, with particular attention paid to ensuring technology dependability, ‘wrap around’ support, workforce knowledge and skills, co-adaptation of inter-organization routines, cross-stakeholder collaboration, and evaluation capabilities.
Diagnostic accuracy evaluation of a point-of-care antigen test for SARS-CoV-2 and influenza in UK primary care (RAPTOR-C19)
Objectives To evaluate the diagnostic accuracy of the Roche SARS-CoV-2 & Flu A/B Rapid Antigen Test at the point of care. Design Prospective diagnostic accuracy study. Setting 17 primary care practices in England. Participants 500 individuals with symptoms consistent with possible SARS-CoV-2 or influenza infection identified upon presentation to primary care or via medical note review. Primary and secondary outcome measures Sensitivity, specificity and predictive values, compared to a laboratory reference standard of real-time reverse transcription PCR, using samples collected using a combined nasal and oropharyngeal swab. Of 481 participants with available index and reference test results, 5.6% (27/481) were reference standard-positive for SARS-CoV-2, 11.4% (55/481) for Influenza A and 1.9% (9/481) for Influenza B. The sensitivity of the antigen test to detect SARSCoV-2 was 70.4% (19/27, 95% CI 49.6–86.2%) and specificity was 99.3% (451/454, 95%CI 98.1–99.9%). For Influenza A, sensitivity was 29.1% (16/55, 95% CI 17.6–42.9%) and specificity 98.6% (420/426, 97.0–99.5%), and for Influenza B, sensitivity was 22.2% (2/9, 2.8–60.0%) and specificity 98.1% (463/472, 96.4–99.1%). Conclusions In a primary care population of symptomatic individuals, the assay was highly specific and had moderate sensitivity to detect SARS-CoV-2, but did not detect the majority of influenza infections.
Routes to social prescribing outside National Health Service (NHS) structures: a systematic map.
OBJECTIVES: Social prescribing, linking to community-based interventions to support individuals' health and well-being, has become established across social medicine in the UK. Currently, most of the evidence and knowledge about how social prescribing pathways' function focuses on primary care, and we know less about how social prescribing operates outside of these structures. This review explored the evidence concerning non-health service delivered social prescribing with a view to developing guidance that would support social prescribing pathways that function outside of the health service framework. DESIGN: This paper reports a systematic mapping review of evidence concerning how community-based social prescribing pathways were delivered, exploring what these looked like, what needed to be in place for these to function, what outcomes were measured and how could non-health service pathways be supported to deliver these outcomes. The review searched database and grey sources and synthesised findings relating to how social prescribing pathways' function. SETTING: Community settings, outside of formal National Health Service (NHS) structures without statutory service input. PARTICIPANTS: All participants that experienced pathways were included; no limits were applied. INTERVENTIONS: Non-NHS social prescribing pathways that included the core components of social prescribing. MAIN OUTCOME MEASURES: Rich descriptions of functions of pathways. RESULTS: This mapping review included 17 studies. The synthesis indicated that NHS and non-NHS social prescribing pathways are intertwined and mutually reliant, such that it was neither sensible nor valuable to view them as separate. CONCLUSIONS: Our review provides further evidence for social prescribing as a concept, variable across all components, rather than a single, coherent model. While there exists a 'core' health service pathway, we suggest that further work should be done with those delivering services to understand the roles and functions that contribute but may not presently be funded.