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Background : A serious game called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), originally developed in New Zealand and incorporating cognitive behavioural therapy (CBT) principles, has been shown to help reduce symptoms of depression and anxiety in adolescents with mild to moderate depression in studies undertaken in Australasia. However, SPARX has never been trialled in the United Kingdom (UK), and there have been issues relating to low engagement when it has been used in a real-world context. Aims: To conduct the first pilot and feasibility randomised controlled trial (RCT) in England to explore the use of SPARX in different settings. The trial will explore whether SPARX supported by an e-coach (assistant psychologists) improves adherence and engagement compared with self-directed (i.e. self-help) use. The trial results will be used to inform the optimal mode of delivery (SPARX supported vs. SPARX self-directed), to calculate an appropriate sample size for a full RCT, and to decide which setting is most suitable. Methods: Following consultation with young people to ensure study suitability/appropriateness, a total of 120 adolescents (11–19 years) will be recruited for this three-arm study. Adolescents recruited for the study across England will be randomised to receive either SPARX with human support (from an e-coach), self-directed SPARX, or a waitlist control group. Assessments will be conducted online at baseline, week 4, and 8–10-week post-randomisation. The assessments will include measures which capture demographic, depression (Patient Health Questionnaire modified for adolescents [PHQ-A]) and anxiety (Revised Child Anxiety and Depression Scale [RCADS]) symptomatology, and health-related quality-of-life data (EQ-5D-Y and proxy version). Analyses will be primarily descriptive. Qualitative interviews will be undertaken with a proportion of the participants and clinical staff as part of a process evaluation, and the qualitative data gathered will be thematically analysed. Finally, feasibility data will be collected on recruitment details, overall study uptake and engagement with SPARX, participant retention, and youth-reported acceptability of the intervention. Discussion: The findings will inform the design of a future definitive RCT of SPARX in the UK. If the subsequent definitive RCT demonstrates that SPARX is effective, then an online serious game utilising CBT principles ultimately has the potential to improve the provision of care within the UK's health services if delivered en masse. Trial registration: ISRCTN: ISRCTN15124804. Registered on 16 January 2023, https://www.isrctn.com/ISRCTN15124804. [ABSTRACT FROM AUTHOR]

Objective: We sought to determine the economic costs associated with moderate and late preterm birth.Design: An economic study was nested within a prospective cohort study.Sample: Infants born between 32(+0) and 36(+6)  weeks of gestation in the East Midlands of England. A sample of infants born at ≥37 weeks of gestation acted as controls.Methods: Data on resource use, estimated from a National Health Service (NHS) and personal social services perspective, and separately from a societal perspective, were collected between birth and 24 months corrected age (or death), and valued in pounds sterling, at 2010-11 prices. Descriptive statistics and multivariable analyses were used to estimate the relationship between gestational age at birth and economic costs.Main Outcome Measures: Cumulative resource use and economic costs over the first two years of life.Results: Of all eligible births, 1146 (83%) preterm and 1258 (79%) term infants were recruited. Mean (standard error) total societal costs from birth to 24 months were £12 037 (£1114) and £5823 (£1232) for children born moderately preterm (32(+0) -33(+6)  weeks of gestation) and late preterm (34(+0) -36(+6)  weeks of gestation), respectively, compared with £2056 (£132) for children born at term. The mean societal cost difference between moderate and late preterm and term infants was £4657 (bootstrap 95% confidence interval, 95% CI £2513-6803; P < 0.001). Multivariable regressions revealed that, after controlling for clinical and sociodemographic characteristics, moderate and late preterm birth increased societal costs by £7583 (£874) and £1963 (£337), respectively, compared with birth at full term.Conclusions: Moderate and late preterm birth is associated with significantly increased economic costs over the first 2 years of life. Our economic estimates can be used to inform budgetary and service planning by clinical decision-makers, and economic evaluations of interventions aimed at preventing moderate and late preterm birth or alleviating its adverse consequences.Tweetable Abstract: Moderate and late preterm birth is associated with increased economic costs over the first 2 years of life. [ABSTRACT FROM AUTHOR]

We evaluated the effect of literature appraisal workshops on participants views, attitudes and knowledge about evidence based medicine in the West Midlands region in 1998. The performance of 55 practitioners was evaluated, before and after attending the workshop. After attending the workshop, participants paid more attention to the study design (81% vs. 98%, P=0·02), they did not find research evidence confusing (35% vs. 52%, P=0·05), and they felt more confident in assessing research evidence (26% vs. 59%, P=0·0001). Their mean knowledge scores improved from 47·3 (SD12·2) to 57·9 (SD 9·0) (P=0·0001). Our critical appraisal skills workshops improved attitudes and knowledge needed for the provision of evidence-supported healthcare. Such workshops should be incorporated in postgraduate obstetrics and gynaecology training programmes. [ABSTRACT FROM AUTHOR]

Whilst a considerable amount of social prescribing activity is taking place across the North West of England, little is known about how different models are being implemented, how data is being collected to support evidence of impact and outcomes, and how these models could be positively or negatively influencing health inequalities. Our study aims to investigate the reach and impact of two social prescribing services by using a mixed-methods approach which will include analysing secondary data from social prescribing management databases held by participating organisations, workshops, focus groups and interviews. Participants will include professionals involved in commissioning, delivery and monitoring and evaluation roles related to social prescribing link workers and members of the public who have accessed social prescribing services. Observational data will also be collected during meetings and informal conversations with those involved in the project. The findings will be reviewed with participants to support the development of a larger research project to explore the effects of social prescribing on health inequalities in ways that are meaningful to stakeholders. In this presentation the findings will be presented and discussed loosely around the following questions: 1. What routinely collected outcome data is currently available to social prescribing researchers (locally, nationally and internationally)?; 2.What is missing from that data regarding meaningful outcomes in relation to health inequalities?; 3. How might social prescribing reduce or exacerbate health inequalities? [ABSTRACT FROM AUTHOR]

Background: Great Western Hospital is a busy district general hospital with a catchment population of 340,000. Target population of this study was elderly patients aged >70 undergoing Emergency Laparotomy (EL). Introduction: Approximately 8% of the population is aged over 75 years and operations in this patient group account for 23% of all surgical procedures. The 2010 National Confidential Enquiry into Patient Outcome and Death report “An Age Old Problem”, suggested routine daily input from Geriatrics should be available to elderly patients undergoing surgery. This study focuses at the impact of Geriatrician input for EL patients with primary outcome of reduction in Length of Stay (LoS). Methods: The service was designed with allocation of 4 hours per week of Consultant Geriatrician and 2.5 days per week of a Clinical Innovation Fellow (CIF) time. The existing team of surgical junior doctors, nursing and allied health professionals carried out plans suggested by the geriatrician. Retrospective data (Prior to service initiation) for the emergency laparotomy patients >70 years, was collected from December 2015-May 2016. Prospective data collected from February 2018 – July 2018 for EL patients aged > 70, patients with inpatient stay > 7 days, patients with delirium/inpatient falls. Length of stay and Inpatient mortality were compared between the two cohorts. Intervention: Prior to the establishment of this service the medical support was provided on ad-hoc basis. Funding was obtained from local postgraduate medical education for CIF and twice weekly consultant led ward rounds were carried out. Patients were recruited from hospital database and from a referrals book kept at surgical ward. Results: 45 patients were included in prospective study and Mean LoS was 17.8 days, which was reduced from 22.5 days prior to Geriatrician involvement (N=56). Average 4.7 days per patient were saved. IP mortality was 8.8% (2/4 deaths were palliative resections) after geriatrician input compared to 8.9% previously. 6.6% of patients had a new medical diagnosis, 24.4% patients were followed up in prospective cohort. Conclusions: This study suggests the regular geriatrician input reduces the inpatient LoS. A day stay at surgical ward costs roughly £250, for 45 patients in last six months it saved approximately £52,875. [ABSTRACT FROM AUTHOR]