Objectives Children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience a higher prevalence of depression and anxiety compared with age-matched controls. Our previous systematic reviews in 2015/16 found little evidence for effective treatment for children with CFS/ME with comorbid depression and/or anxiety. This review updates these findings. Design A systematic review. We searched Cochrane library, Medline, Embase and PsycINFO databases from 2015 to 2020. We combined the updated results with our previous reviews in a narrative synthesis. Participants Inclusion criteria: <18 years old; diagnosed with CFS/ME (using Centers for Disease Control and Prevention, National Institute for Health and Care Excellence or Oxford criteria); validated measures of depression and/or anxiety. Interventions Observational studies or randomised controlled trials. Comparison Any or none. Outcomes Studies with outcome measures of anxiety, depression or fatigue. Results The updated review identified two studies. This brings the total number of paediatric CFS/ME studies with a measure of anxiety and/or depression since 1991 to 16. None of the studies specifically targeted depression, nor anxiety. One new study showed the Lightning Process (in addition to specialist care) was more effective at reducing depressive and anxiety symptoms compared with specialist care alone. Previous studies evaluated cognitive–behavioural therapy (CBT); pharmacological interventions and behavioural approaches. CBT-type interventions had most evidence for improving comorbid anxiety and/or depressive symptoms but varied in delivery and modality. Other interventions showed promise but studies were small and have not been replicated. Conclusion Very few paediatric CFS/ME intervention studies have been conducted. This review update does not significantly add to what is known from previous reviews. The evidence is of poor quality and insufficient to conclude which interventions are effective at treating comorbid anxiety and/or depression in paediatric CFS/ME. PROSPERO registration numbers CRD42016043488 and CRD42015016813.

Medical EducationVolume 55, Issue 2 p. 276-276 LETTER TO THE EDITOR Cognitive overload—A medical student's perspective Jasmine Bailey, Corresponding Author jb15812@bristol.ac.uk orcid.org/0000-0003-1657-8926 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK Correspondence Jasmine Bailey, Bristol Medical School, The University of Bristol, First Floor, 5 Tyndall Avenue, Bristol BS8 1UD, UL. Email: jb15812@bristol.ac.ukSearch for more papers by this authorKatie Driver, orcid.org/0000-0002-5622-1238 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UKSearch for more papers by this authorElizabeth J. Wasson, orcid.org/0000-0002-8484-0175 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UKSearch for more papers by this authorMegan Hughes, orcid.org/0000-0002-2260-5233 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UKSearch for more papers by this author Jasmine Bailey, Corresponding Author jb15812@bristol.ac.uk orcid.org/0000-0003-1657-8926 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK Correspondence Jasmine Bailey, Bristol Medical School, The University of Bristol, First Floor, 5 Tyndall Avenue, Bristol BS8 1UD, UL. Email: jb15812@bristol.ac.ukSearch for more papers by this authorKatie Driver, orcid.org/0000-0002-5622-1238 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UKSearch for more papers by this authorElizabeth J. Wasson, orcid.org/0000-0002-8484-0175 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UKSearch for more papers by this authorMegan Hughes, orcid.org/0000-0002-2260-5233 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UKSearch for more papers by this author First published: 19 August 2020 https://doi.org/10.1111/medu.14359Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume55, Issue2February 2021Pages 276-276 RelatedInformation

Medical EducationVolume 54, Issue 8 p. 769-770 LETTERS TO THE EDITOR Stress levels in medical students: Can we accurately measure them? Jasmine Bailey, Corresponding Author Jasmine Bailey jb15812@bristol.ac.uk orcid.org/0000-0003-1657-8926 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK Correspondence Jasmine Bailey, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK. Email: jb15812@bristol.ac.ukSearch for more papers by this authorAyah Mekhaimar, Ayah Mekhaimar GKT School of Medical Education, King’s College London, London, UKSearch for more papers by this authorCora Griffin, Cora Griffin GKT School of Medical Education, King’s College London, London, UKSearch for more papers by this authorEmily Good, Emily Good orcid.org/0000-0003-4454-0546 Hull York Medical School, University of Hull, Hull, UKSearch for more papers by this authorMary Goble, Mary Goble The Medical School, University of Sheffield, Sheffield, UKSearch for more papers by this author Jasmine Bailey, Corresponding Author Jasmine Bailey jb15812@bristol.ac.uk orcid.org/0000-0003-1657-8926 Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK Correspondence Jasmine Bailey, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK. Email: jb15812@bristol.ac.ukSearch for more papers by this authorAyah Mekhaimar, Ayah Mekhaimar GKT School of Medical Education, King’s College London, London, UKSearch for more papers by this authorCora Griffin, Cora Griffin GKT School of Medical Education, King’s College London, London, UKSearch for more papers by this authorEmily Good, Emily Good orcid.org/0000-0003-4454-0546 Hull York Medical School, University of Hull, Hull, UKSearch for more papers by this authorMary Goble, Mary Goble The Medical School, University of Sheffield, Sheffield, UKSearch for more papers by this author First published: 02 March 2020 https://doi.org/10.1111/medu.14144Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume54, Issue8August 2020Pages 769-770 RelatedInformation

We found the concepts discussed by Nadarzynski et al on the acceptability of artificial intelligence (AI)-embedded chatbots, video consultations and live webchats in sexual and reproductive health (SRH) interesting.1 However, we think the broad conclusion made that among patients there is currently little support for SRH chatbots ignores potentially important uses of this technology. A recent systematic review on AI in primary care published in BMJ Health and Care Informatics highlighted the importance of testing AI in a similar scenario to that in which it would be used.2 In Nadarzynski et al …

It is through the grotesque that Flannery O'Conner's characters achieve grace, and often the only hope for self-actualization rests in death and malformation. This is perhaps her greatest irony. The protagonists of The Finer Things, however, never self-actualize: they simply act without understanding or questioning why. This is because they are rarely confronted with the grotesque; instead they actively seek it for themselves. The grotesque isn't revelatory, but rather, it satisfies romantic ideals and desires, or is pursued in effort to escape aggressive bureaucracies that typify Kafka's short stories. This characterizes the ironic aesthetic of The Finer Things. Working in tandem with the romantic and the grotesque is the overarching motif: there is little to distinguish the white walls of the city art galleries from the white walls of the asylum. People are created, manipulated, controlled, put on display against their will, judged, and in some cases destroyed, which further speaks to the universal longing for the macabre.