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BACKGROUND Individuals with severe mental illness living in supported accommodation are often socially excluded. Enabling social inclusion is an important aspect of recovery-based practice, and improves quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people who have mental health problems. Previous research has suggested that the SInQUE could also help to support care planning focused on enabling social inclusion in routine mental health practice. OBJECTIVE To develop an online version of the SInQUE for use in mental health supported accommodation services, and examine its acceptability and perceived usefulness as a tool to support care planning with service users. METHODS i) A lab-testing stage to assess the acceptability of the SInQUE tool through ‘think-aloud’ testing with six supported accommodation staff; ii) A field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was employed in one London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff who used the tool were conducted and analysed using thematic analysis. Use of the SInQUE was compared with two other local authority areas, one urban and one rural, where the tool was made available for use but no implementation strategy was employed. RESULTS In total, 17 staff used the SInQUE with 28 different service users during the implementation period (about 10% of all service users living in supported accommodation in the study area). Staff and service users we interviewed felt that the SInQUE was collaborative, comprehensive, and user-friendly. Staff deemed the tool relevant to their role. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help to identify individuals’ priorities regarding different aspects of social inclusion through prompting in-depth conversations and tailoring specific support to address areas where service users would like to be more included. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable need across the borough, that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. CONCLUSIONS The online SInQUE is an acceptable and potentially useful tool, that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, take-up rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.

BackgroundIndividuals with severe mental illness living in supported accommodation are often socially excluded. Enabling social inclusion is an important aspect of recovery-based practice, and improves quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people who have mental health problems. Previous research has suggested that the SInQUE could also help to support care planning focused on enabling social inclusion in routine mental health practice.ObjectivesTo develop an online version of the SInQUE for use in mental health supported accommodation services, and examine its acceptability and perceived usefulness as a tool to support care planning with service users.Methodsi) A lab-testing stage to assess the acceptability of the SInQUE tool through ‘think-aloud’ testing with six supported accommodation staff; ii) A field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was employed in one London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff who used the tool were conducted and analysed using thematic analysis. Use of the SInQUE was compared with two other local authority areas, one urban and one rural, where the tool was made available for use but no implementation strategy was employed.ResultsIn total, 17 staff used the SInQUE with 28 different service users during the implementation period (about 10% of all service users living in supported accommodation in the study area). Staff and service users we interviewed felt that the SInQUE was collaborative, comprehensive, and user-friendly. Staff deemed the tool relevant to their role. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help to identify individuals’ priorities regarding different aspects of social inclusion through prompting in-depth conversations and tailoring specific support to address areas where service users would like to be more included. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable need across the borough, that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy.ConclusionsThe online SInQUE is an acceptable and potentially useful tool, that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, take-up rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.

Background Cow's milk protein allergy (CMPA) is an immune-mediated allergic response to proteins in milk that is common in infants. Broad CMPA symptoms make diagnosis a challenge, particularly in primary care. Symptom scores may improve a clinician's awareness of symptoms, indicating a need for further testing. This systematic review examined the development and evaluation of such symptom scores for use in infants. Methods CENTRAL, MEDLINE, Embase, and CINAHL databases were searched from inception to 3 December 2019 (Updated 14 November 2020) for diagnostic accuracy studies, randomised controlled trials, observational studies, economic evaluations, qualitative studies, and studies reporting development of the tools. Data were not suitable for meta-analysis due to clinical and methodological heterogeneity, so were narratively synthesised. Results We found two symptom scores evaluated in one and fourteen studies, respectively. Estimated sensitivity and specificity ranged from 37-98% and 38-93%. The evaluations of each tool were at high risk of bias or failed to address issues such as clinical and cost-effectiveness. Conclusions Estimates of accuracy of symptom scores for CMPA offered so far should be interpreted cautiously. Rigorous, conflict-free research based on well-defined roles for the tools is urgently required.

OBJECTIVE Pregnancy and type 1 diabetes are each associated with increased anxiety and depression, but the combined impact on well-being is unresolved. We compared the mental health of women with and without type 1 diabetes during pregnancy and postpartum and examined the relationship between mental health and glycemic control. RESEARCH DESIGN AND METHODS Participants were women enrolled from 2016 to 2020 in the Environmental Determinants of Islet Autoimmunity (ENDIA) study, a pregnancy to birth prospective cohort following children with a first-degree relative with type 1 diabetes. Edinburgh Postnatal Depression Scale (EPDS) and Perceived Stress Scale (PSS) were completed during the third trimester (T3) (median [interquartile range] 34 [32, 36] weeks) and postpartum (14 [13, 16] weeks) by 737 women (800 pregnancies) with (n = 518) and without (n = 282) type 1 diabetes. RESULTS EPDS and PSS scores did not differ between women with and without type 1 diabetes during T3 and postpartum. EPDS scores were marginally higher in T3: predicted mean (95% CI) 5.7 (5.4, 6.1) than postpartum: 5.3 (5.0, 5.6), independent of type 1 diabetes status (P = 0.01). HbA1c levels in type 1 diabetes were 6.3% [5.8, 6.9%] in T3 and did not correlate with EPDS or PSS scores. Reported use of psychotropic medications was similar in women with (n = 44 of 518 [8%]) and without type 1 diabetes (n = 17 of 282 [6%]), as was their amount of physical activity. CONCLUSIONS Overall, mental health in late pregnancy and postpartum did not differ between women with and without type 1 diabetes, and mental health scores were not correlated with glycemic control.

To quantify use of shorthand description of research design in the titles and abstracts of diagnostic test accuracy studies, comparing 2012 and 2019.Joint examination, using pre-specified criteria, by two investigators of 320 randomly sampled articles indexed as "diagnostic (test) accuracy studies" in EMBASE in 2012 and 2019.The percentage of abstracts with shorthand descriptions of study design was 11% in 2012 and 15% in 2019, a difference of 4% (95% CI -3, 12). Although use of the term accuracy in the abstract did increase (58% in 2012 to 74% in 2019, difference 16% (95% CI 5, 26)), accuracy was only used to convey purpose or design in 49% (95% CI 43, 56) of abstracts where accuracy appeared (2012+2019).It is difficult to identify the study design of test evaluations from information in the title and abstract. This is important because bias is associated with different study designs. Developing a limited number of standardised, widely understood study design descriptions could greatly improve clarity of the only freely available information on many pieces of medical research. It may be helpful that the fact that a study addresses test accuracy be part of shorthand descriptions.

Background: Cow’s milk protein allergy (CMPA) is an immune-mediated allergic response to proteins in milk, a common infant food allergy. The wide range and frequency of CMPA symptoms make diagnosis a challenge, particularly in primary care. Symptom scores may improve a clinician’s awareness of symptoms, thus indicating a need for further testing. This systematic review examined the development and evaluation of such symptom scores for use in infants. Methods: Four databases were searched from inception to 3 December 2019, for diagnostic accuracy studies, randomised controlled trials, observational studies, economic evaluations, qualitative studies, and studies reporting on the development of the tools. Experts were consulted for additional studies. Data were not suitable for meta-analysis due to heterogeneity, so were narratively synthesised. Results: We found two symptom scores evaluated in one and fourteen studies, respectively. Estimated sensitivity and specificity ranged from 37-98% and 38-93%. The evaluations of each tool were at high risk of bias or failed to address issues such as clinical and cost-effectiveness. Conclusions: Estimates of accuracy of symptom scores for CMPA offered so far should be interpreted cautiously. Rigorous research based on well-defined roles for the tools and free of potential conflicts of interest is urgently required.

ObjectivesThere have been few clinical trials (CTs) on antibiotics that inform neonatal and paediatric drug labelling. The rate of unlicensed and off-label prescribing in paediatrics remains high. It is unclear whether the current neonatal and paediatric antibiotic research pipeline is adequate to inform optimal drug dosing. Using the ClinicalTrials.gov registry, this review aims to establish the current global status of antibiotic CTs in children up to 18 years of age.MethodsStudies were identified using key word searches of the ClinicalTrials.gov registry and were manually filtered using prespecified inclusion/exclusion criteria.Results76 registered open CTs of antibiotics in children were identified globally; 23 (30%) were recruiting newborns (only 8 (11%) included preterm neonates), 52 (68%) infants and toddlers, 58 (76%) children and 54 (71%) adolescents. The majority of registered trials were late phase (10 (15%) phase 3 and 23 (35%) phase 4/pharmacovigilance). Two-thirds were sponsored by non-profit organisations, compared with pharmaceutical companies (50 (66%) vs 26 (34%), respectively). A greater proportion of non-profit funded trials were efficacy-based strategic trials (n=34, 68%), in comparison with industry-led trials, which were most often focused on safety or pharmacokinetic data (n=17, 65%). Only 2 of the 37 antibiotics listed on the May 2016 Pew Charitable Trusts antibiotic development pipeline, currently being studied in adults, appear to be currently recruiting in open paediatric CTs.ConclusionsThis review highlights that very few paediatric antibiotic CTs are being conducted globally, especially in neonates. There is a striking disparity noted between antibiotic drug development programmes in adults and children.

John Warburton Thompson loved medicine. Born in Guy’s Hospital, London, he attended the City of London School as choral scholar at the Temple Choir. He attended the London Hospital in 1943 as a Price scholar and did national service in the Royal Air Force Medical Corps in Sri Lanka. His pharmacology career started as a research assistant in the department of applied pharmacology at the medical unit of University College Hospital and the department of pharmacology at UCL. He set up the department of pharmacology with Professor Sir William Paton at the Royal College of Surgeons, where …

Five patients with juvenile neuronal ceroid-lipofuscinosis, who were shown to have absent or reduced serum prebetalipoprotein and a deficiency of polyunsaturated fatty acids in erythrocyte membrane lipids, were treated for a period of one year with supplements of fish oil extract (rich in omega-3 fatty acids) and encouraged to increase dietary intake of corn oil lipid (rich in omega-6 fatty acids) in an attempt to promote incorporation of these fatty acids into membranes. After one year there was a significant increase in omega-3 fatty acids (P less than 0.05) and in the total polyunsaturated fatty acids (P less than 0.02) in erythrocyte membranes but no change in the incorporation of omega-6 fatty acids. The patients were assessed clinically, psychometrically and neurophysiologically before and after the supplementation. No significant changes were noted after one year of treatment.