BACKGROUND:As community-based healthcare providers, NHS ambulance services may be able to offer easily accessible National Health Service Health Checks (NHSHCs). There is no previous evidence to indicate if this is feasible or if this approach can identify cases of cardiovascular disease (CVD) risk factors. We report a service evaluation of an ambulance service delivered NHSHC in North East England. METHODS:Mixed methods including data from an NHSHC delivered by paramedics and short telephone interviews with participants failing to follow referral advice. RESULTS:There were 462 NHSHCs delivered. Most participants were female, 42.2% were in the top two deciles regarding absolute deprivation and 388 had at least one CVD risk factor. There were 29 new prescriptions issued for cardiovascular medications and 13 patients required medicines optimization. Of the 62 tobacco smokers, 21 accepted a smoking cessation referral and 4 achieved a 28-day quit. Reasons preventing participants seeking further support were poor health literacy, the complexities of life and difficulties obtaining a GP appointment. CONCLUSION:A place-based NHSHC delivered by the ambulance service is feasible, appears acceptable to patients, and can identify new cases of CVD risk, but some individuals require additional help to engage in effective CVD risk management.

Background: There is a growing focus on a positive autistic identity; however, we know very little about self-defined autistic self-concept beyond what it means to be “autistic.” Methods: We conducted semistructured interviews (written or spoken) with 103 people; 51 were autistic, 10 were neurodivergent but not autistic, and 42 were neurotypical. We asked them questions about their identity and self-concept. We also invited them to submit an artifact (e.g., a photograph or a drawing) that they felt represented who they were. We analyzed the data using inductive reflexive thematic analysis, based on semantic and latent content. Results: We developed three themes. In theme 1, “The idea of the self might be one of those neurotypical things,” autistic participants suggested that the self was hard to define and might be a neurotypical construct. However, the non-autistic participants also found the self difficult to define. Overall, participants across groups believed the self was multifaceted and context dependent. Theme 2, It made me who I am, highlighted factors at different levels of a person’s social ecology (e.g., their development, their wider family and friends, and society) that impact the development of self-concept. Autistic and neurodivergent people experienced increased social stigma that impacted their ability to know and express themselves. Theme 3, Unapologetically me, showed that autistic people developing comfort was prevented by perceived social power dynamics and consequences of not following social norms. Autistic people highlighted the importance of embodied experience in their own authentic expression; being able to stim freely was a core part of who they were. Conclusion: Our findings suggest that rather than seeing the autistic self as impaired compared with non-autistic peers, we might recognize that it can be difficult to describe due to the influence of external neuronormative expectations and external power structures that prevent self-knowledge.

Background Atherosclerotic cardiovascular disease remains a leading cause of morbidity and mortality, with outcomes disproportionately worse in socioeconomically deprived populations. Despite clear guideline recommendations, therapeutic inertia frequently prevents high-risk patients from achieving optimal lipid targets following acute coronary syndrome. This service evaluation assessed the impact of a pharmacist-led lipid optimisation clinic on lipid control and health inequalities in a high-risk post-acute coronary syndrome population. Methods This service evaluation was conducted at a tertiary cardiothoracic centre in the North East of England. A cohort of 816 post-acute coronary syndrome patients who had not achieved lipid targets were reviewed in a pharmacist-led clinic delivered by an independent prescriber. Lipid-lowering therapy was intensified in accordance with national guidance through face-to-face or telephone consultations. Primary outcomes were changes in non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol across three time points: baseline, following cardiology-led optimisation, and following pharmacist-led intervention. Planned comparisons using analysis of variance assessed changes over time. A secondary factorial analysis of variance examined differential effects by socioeconomic deprivation status, defined using the CORE20 metric. Results Of the 816 patients included, 698 (85%) were classified within the most deprived CORE20 group. Following pharmacist-led optimisation, mean non-high-density lipoprotein cholesterol decreased from 3.91 mmol/L to 2.32 mmol/L and mean low-density lipoprotein cholesterol decreased from 3.02 mmol/L to 1.60 mmol/L. Overall, 70% of patients achieved guideline-directed lipid targets, corresponding to a number needed to treat of four. Factorial analysis demonstrated a significant interaction between intervention stage and deprivation status, with patients in the CORE20 group experiencing greater absolute lipid reductions than non-CORE20 patients (mean low-density lipoprotein cholesterol reduction 1.55 mmol/L vs 1.29 mmol/L). Conclusions A pharmacist-led lipid optimisation clinic significantly improved lipid target attainment and disproportionately benefited patients from the most socioeconomically deprived backgrounds. This model represents a scalable strategy to reduce therapeutic inertia and mitigate health inequalities in secondary cardiovascular prevention. Trial Registration ​Clinical trial number: not applicable. This study was conducted as a service evaluation and quality improvement initiative and was not prospectively registered.

Post-COVID-19 syndrome (PCS) is a common outcome of severe COVID-19 infection; however, less is known about PCS following mild COVID-19. Healthcare workers (HCWs) are more susceptible to acquiring COVID-19 and potentially suffering physical and psychological morbidity secondary to their role. We surveyed HCWs at four hospitals in northeast England at two timepoints during the pandemic, assessing physical and psychophysiological symptoms of PCS, alongside associated factors, whilst also testing for COVID-19 status by SARS-CoV-2 serology and reviewing evidence of infection from previous PCR nasopharyngeal swabs. Of the 379 participants at baseline and 250 HCWs recruited 18 months later, 46% and 64% (respectively) had evidence of previous COVID-19, with no significant associations between COVID-19 status or demographics and symptom scores or self-described PCS. Depression and fatigue were more common later in the pandemic. Furthermore, 20% self-described having PCS, 34% of whom had no evidence of previous COVID-19. Scores for fatigue, pain, mobility, anxiety, and depression were significantly worse in the PCS group compared to those without ongoing symptoms. Significant proportions of HCWs continued to suffer debilitating symptoms during the later pandemic period, although a significant minority had no evidence of previous COVID-19 infection, suggesting that other factors may be involved in their symptomatology.

RATIONALE: Respiratory disease is one of the leading causes of emergency hospital admissions and mortality in the UK. However, diagnostic pathways in respiratory care remain suboptimal. Currently, fewer than 6% of practice nurses in the UK are registered on the National Spirometry Register, with workforce limitations representing a major barrier to delivering effective spirometry services in primary care. Literature indicates that only 13.4% of spirometry performed in primary care settings meets international quality standards. ArtiQ.Spiro is an AI-based software solution designed to support primary care practitioners in conducting and interpreting spirometry. This study evaluates whether healthcare assistants using ArtiQ.Spiro can produce high-quality spirometry data, potentially expanding capacity for respiratory diagnostics in primary care. METHODS: A healthcare assistant (HCA) unregistered on the National Spirometry Register was provided with local training and competency assessment. The HCA conducted spirometry sessions using ArtiQ.Spiro as an enabler for high quality spirometry for a period of four months. For each session, the Forced Expiratory Volume in 1 second (FEV1) and Forced Vital Capacity (FVC) quality grades provided by ArtiQ.Spiro were recorded, along with the average number of trials required to achieve optimal quality. RESULTS: Spirometry was conducted on 19 patients, with bronchodilator response testing completed for 12 of them, totaling 31 sessions evaluated. The majority of sessions achieved high-quality ratings: FEV1 was rated as grade A in 29 sessions (94%), and FVC was rated as grade A in 22 sessions (71%) and grade B in 6 sessions (19%). A median of 3 trials per session was required to reach these quality standards. CONCLUSIONS: Our findings demonstrate that healthcare assistants, even without National Spirometry Register accreditation, can produce high-quality spirometry data when supported by AI tools like ArtiQ.Spiro. By enabling lower-band personnel to perform quality spirometry, AI-driven upskilling can expand workforce capacity and reduce access barriers to respiratory diagnostics in primary care.

Objectives: Neurodivergent (ND) individuals (e.g., autistic people) are more likely to experience health problems that are characterised by ‘Central Sensitisation’ (CS). Recent research suggests that a so-called ‘Long-COVID’ syndrome might also be explained by a heightened response to internal physiological stimuli, much like in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The primary objective of this study was to establish whether individuals who scored highly on a measure of CS would be more likely to experience long-term symptoms of COVID-19. A secondary aim considered if having a Type D personality was also linked to ongoing COVID-19 symptoms. Method: Using a standardised assessment tool, we examined whether traits associated with autism would predict long-term COVID-19 symptoms in 267 Healthcare Workers (HCWs). We also used a measure of Type D personality to establish if negative affect and social inhibition were related to Long-COVID. Results: A higher number of autistic traits predicted COVID-19 symptoms that lasted more than 12 weeks regardless of formal autism diagnosis. A personality measure also showed that negative affect was associated with experiencing COVID-19 symptoms for 4–12 weeks, though the direction of causality in this case is uncertain. Conclusions: Our main findings were (i) more HCWs scored above threshold for neurodivergence than those who were self-declared as having been diagnosed as neurodivergent; (ii) while there was no association between long-term COVID-19 and self-declared neurodivergent status, scores for the ‘sensory reactivity’ item of a standardised autism scale was predictive of COVID-19 symptoms lasting beyond 12 weeks post-infection; and (iii) HCWs with Type D Personality were not more likely to experience long-term COVID-19.

BACKGROUND AND AIMS: Patients attending vascular or diabetic foot clinics commonly have atherosclerotic disease, are at increased risk of cardiovascular disease (CVD), merit high-intensity lipid-modifying therapy to maintain secondary prevention targets and are often sub optimally treated in primary care. We set out to assess the impact of a pharmacist led lipid optimisation clinic in these patients in an area with high levels of social deprivation. METHODS: We performed a clinical cohort study to assess the effectiveness of a pharmacist led clinic to optimise lipid lowering therapy by optimising of statin therapy and commencing additional lipid lowering therapy if applicable with monitoring of blood lipid profiles. Results: Of the 216 patients (166 [77%] on statins) triaged by the pharmacist, 175 (81%) had nonhigh-density lipoprotein (non-HDL) cholesterol levels above the target value of 97 mg/dL (2.5 mmol/L) with a mean non-HDL cholesterol level of 135.73 mg/dL (3.51 mmol/L). Pre optimisation by the prescribing clinical pharmacist 41/216 (19%) patients were at target with a mean non-HDL cholesterol of 135.5 mg/dL improving to 92/137 (67%) patients achieving the target non-HDL cholesterol level with a mean post optimisation non-HDL cholesterol of 94.35 mg/dL (2.44 mmol/L), odds ratio (OR) for being at target 8.67 (95% CI 5.30-14.20). The calculated low-density lipoprotein cholesterol levels (Friedewald) demonstrated a mean reduction of 35.19 (95% CI 29.23-41.38) mg/dL (0.91 [95% CI 0.76-1.07] mmol/L). Proportion on high intensity statin increased from 65 out of 166 (39%) to 129 of 170 (76%) at follow up (OR 4.89 [3.06-7.82]), equivalent to an number needed to treat = 3. CONCLUSIONS: A pharmacist led service in undertreated and clinically challenging vascular and diabetic foot patients in an area of high social deprivation produced significant improvements in utilization of high intensity statin and other lipid lowering therapies and attainment of lipid goals.

The recent pandemic improved awareness amongst the public of the need for rapid blood tests for community and home settings. In this work, we evaluated the performance of a digital, lipid panel test in microfluidic assay format which can be read using a smartphone camera. The PocDoc Lipid test is embedded within a cardiovascular screening application that utilizes the QRISK3 risk prediction algorithm to determine an individual's risk of having a cardiovascular event in the next 10 years and their healthy heart age. The test can be used to screen for individuals at risk of hyperlipidemia (e.g. high total cholesterol or triglycerides) and for individuals at high risk of cardiovascular disease at home or in community or surgery settings. The device was evaluated in a performance evaluation study, using 125 whole blood samples, following CLSI guidelines. Performance evaluation of the PocDoc device demonstrated accuracy that meets international NCEP guidelines and that is on par with other point-of-care tests. Sensitivity and specificity analysis supports the use of PocDoc to identify patients with hyperlipidemia or at high risk of cardiovascular disease. Bland-Altman analysis suggests that this point-of-care device can be used as an alternative to venous blood collection. This single-step model for cardiovascular disease risk measurement which can be done at home or in community settings may improve cardiovascular disease prevention.

Background Individuals with low socio-economic status (SES) have disproportionate rates of cardio- vascular disease (CVD) but poorer engagement with preventative health. This study aimed to compare characteristics of individuals with and without hyperlipidaemia and describe their health behaviours.Methods A mixed-methods study between January and December 2022. Patients aged >= 40 years using the ambulance service with blood pressure of >= 140/90 had their total cholesterol measured using a point of care device. Data including blood pressure, smoking status, National Early Warning Score 2 and clinical frailty scale (CFS) were analysed.Results Of 203 patients (59% female, mean age 65.7 years), 115 (56.7%) had total cholesterol >= 5.1 mmol/L. Thirty patients (14.8%) sought treatment and received either statins (n = 9; 4.4%), dietary modification (n = 7; 3.4%) or no further intervention (n = 14; 6.9%), whilst 85 patients (41.9%) took no further action. Lower CFS (OR 0.53 [0.31-0.93]) and higher total cholesterol (OR 2.07 [1.03-2.76]) predicted seeking further management. SES was not associated with hyperlipidaemia or likelihood of seeking further management, rather this was dictated by competing co-morbidity, poor health literacy and digital divide.Conclusions Undiagnosed hyperlipidaemia exists in patients using the ambulance service, irrespective of SES. Individual and healthcare system factors prevent engagement in cholesterol lowering behaviours.

Introduction Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate identification of target populations for colonoscopy; then to use CDR to assess the impact of implementing an FIT-based referral pathway locally. Methods NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames. Results 1, 123, 624 NED diagnostic colonoscopies were analysed. Locally, there was a significant increase in CDR between 2019 and 2021, from 3.01% (2.45%–3.47%) to 4.32% (3.69%–4.95%), p=0.003. The CDR increase was due to both a 10% increase in the number of CRCs detected and a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a smaller, but significant, increase in CDR from 2.02% (1.99%–2.07%) to 2.33% (2.29%–2.37%), p<0.001. The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared with nationally. Conclusion Our study indicates that the introduction of a robustly vetted FIT-based algorithm to determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically calculated through NED, enabling monitoring of the quality of referral and vetting pathways.

Research suggests that there is a high prevalence of interpersonal violence and victimisation within the autistic population, and that this accounts for poor mental health outcomes. This study aimed to examine the impact of interpersonal violence and victimisation on autistic adults from their own perspective and explore what helps or hinders their recovery. In total, 102 autistic adults completed either an online survey or a spoken interview about their experiences of interpersonal violence and victimisation. We analysed the data using a thematic analysis, and found four themes: (1) The usual for autism (expectations of victimisation, experiences of othering), (2) Personhood revoked: The cost of living (being part of a neurominority, trauma, masking and burnout), (3) Unpacking the baggage (impact of hermeneutical injustice) and (4) ‘If you want to make an apple pie from scratch, you have to invent the universe first’ (structural inequality/power dynamics, support and community). Findings highlight the importance of considering the relationship between stigma and victimisation, and the relationship between trauma, masking, and burnout in autistic people. Reducing barriers to support and recovery are contingent on reducing structural inequality and providing better training about autistic people to frontline professionals. Lay abstract Research suggests that autistic people are more likely to be hurt by someone they know (e.g. a friend or a family member) compared to non-autistic people. In this study, we wanted to know how being hurt by someone you know affects autistic people, and what might help them recover. In total, 102 autistic people took part in an interview, where we asked questions like how being hurt by people they know had made them feel and whether anyone they had asked for help had done a good job of supporting them. We analysed what they had said using thematic analysis, which involved reading what everyone said and looking for common themes. Our findings showed that a lot of autistic people think it is normal to be hurt by people you know because it has happened to them so much. This makes many autistic people feel like they need to mask parts of themselves to stay safe, but this also makes them really exhausted. It took some people a long time to realise what had happened to them was wrong, and it was hard to ask for help. People who did ask for help often had bad experiences with professionals (e.g. police) who did not know much about autistic people. They said better support would come from creating more autistic-run support groups and educating people about autism. These findings are important for working out how to help people who have been hurt by people they know.

Prior studies suggest that adverse events (AEs) following doses one and two of BNT162b2/Pfizer vaccine are worse in those with a prior history of COVID-19. To establish whether this outcome applies to a third/booster dose, we conducted a survey with 534 healthcare workers (HCW) in Northeast England, who reported AEs following all three doses of BNT162b2/Pfizer vaccine. We also explored AEs associated with concurrent seasonal influenza immunisation, in a subset of 492 HCWs. For all doses of BNT162b2/Pfizer vaccine there was a cluster of systemic AEs that were consistently worse in HCWs with a prior history of COVID-19. AEs were no worse in HCWs who received their third/booster dose within 7 days of the influenza jab, rather than further apart. Gender and the presence of ongoing COVID-19 symptoms (OCS) had no effect on AEs associated with COVID-19 or influenza vaccination, though younger HCWs experienced more AEs overall. Our findings have implications for vaccine hesitancy and immunisation protocols.

Introduction and hypothesis Pelvic organ prolapse is a common problem affecting women, but there is currently a lack of research focusing on patient experience of pessary changes. This study was aimed at capturing the patient perspective of pessary changes and formally assessing pain during pessary removal and insertion. Methods A service evaluation request was granted by South Tees Hospitals NHS Trust. Patients undergoing pessary change (ring, shelf, or Gellhorn) in gynaecology outpatient clinics over a 6-month period were asked to rate their pain scores on a ten-point numerical pain-rating scale. Other associated data were collected. Results Out of 213 women, 58.2% reported that pessary removal was more painful than insertion, 30.5% reported equal pain, and 10.8% reported that insertion was more painful than removal. Pain scores were significantly higher for removal (mean 4.37, median 4, IQR 4-7) than for insertion (mean 2.66, median 2, IQR 2-4, p <0.001). Ring pessaries were significantly less painful to both remove and insert than shelf and Gellhorn pessaries. Smaller pessaries were more painful to both remove and insert. There was no significant difference in pain scores reported by those with or without diagnosed vulval conditions. Conclusions Pessary removal causes most women moderate pain, which should be communicated to patients beforehand. Ring pessaries are significantly less painful to change than other pessary types. Clinicians should consider pain as a factor in their decision-making surrounding pessary choice and when counselling patients. Future research should focus on ways to reduce pain during pessary removal.

Background:The victimization of autistic people by familiar others (interpersonal victimization) is an understudied phenomenon despite suggestions that prevalence rates may be disproportionately high. We know very little about the way autistic people perceive these experiences, and how to support them. The aim of the current study was to explore experiences of interpersonal victimization among autistic adults from their own perspective. Methods:We recruited 43 autistic adults to take part in a qualitative online study, and asked about their experiences of being victimized or taken advantage of by people they know in the past. We analyzed their comments at the semantic level using inductive thematic analysis, from a critical realist perspective. Results:We identified two key themes in the data. The first theme, "cycles of victimization" highlighted the occurrence of polyvictimization in the sample. The second ("perceptions of victimization") focused on how these experiences were related to difficulties with trust (of both self and others), the recognition of victimization, and heightened compliance. The participants expressed difficulty with saying no to people, and found it difficult to identify when someone had negative or manipulative intentions. Conclusions:Our findings suggest that autistic adults experience victimization from a range of close others, and may find it difficult to recognize when someone is acting in an abusive manner. Many participants had experienced heightened compliance in response to unreasonable requests from others, however, reasons for this were varied (e.g., fear and desire to avoid confrontation) and require further investigation. These findings have implications for developing supports that enable autistic adults to recognize their own boundaries and advocate for themselves, in addition to helping them to recognize what a healthy relationship looks like.

Interpersonal violence and victimisation (IPV) is violence and abuse that occurs within personal relationships (e.g. from a friend, or family member).Figures suggest that between 50-89% of autistic people have been victimised by someone they know1,2, and that this high prevalence is related to poor mental health outcomes for autistic people3. We conducted a qualitative exploration of autistic adult’s experiences of IPV, focussing on how it impacts their identity, and their experiences of seeking help and support.

Abstract Background Face transplantation is a surgical innovation to manage people with severely interrupted facial function and form. How the public perceive face transplantation and its potential implications for the recipient, donor, and society is unclear. The aim of this study was to understand the public perception of face transplantation, including when it is appropriate, what information is required to feel adequately informed, and which factors influence a person’s willingness to donate their face. Methods This was a nationwide survey of participants representative of the GB public. A quantitative analysis was performed. Free-text qualitative responses were coded with thematic content analysis and a narrative analysis was constructed. Results The survey included 2122 participants. Face transplantation was considered worth the potential risks if it improved an individual’s quality of life, gave them a ‘normal life’, and/or increased their confidence and social interaction. Respondents were worried about the impact face transplantation might have on donor families, especially recipient families adapting to the identity of the donor. Respondents most concerned about the concept of face transplantation were aged at least 55 years (χ2(4) = 38.9, P < 0.001), women (χ2(1) = 19.8, P < 0.001) , and Indian/Asian (χ2(4) = 11.9, P = 0.016). Conclusion The public perceive emotional and psychological outcomes as equally as important as, or more important than, surgical outcomes when determining the appropriateness of face transplantation. Future research should focus on measuring and describing emotional and psychological outcomes after face transplantation.