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This study explores the views of children, parents, school staff and intervention staff regarding interventions designed to promote healthy lifestyles and positive choices in primary schools in the North East of England, United Kingdom. The interventions consisted of six weekly sessions in which classroom learning was followed by physically active games. Focus groups and semi-structured interviews were conducted with a total of 45 participants and thematic analysis was performed on the resultant 26 transcripts to identify themes relating to the role of physical activity, facilitators and barriers to children’s engagement in the sessions and the perceived outcomes of intervention participation. Results indicated that participants across the four groups felt the inclusion of classroom learning and physical activity made the interventions suitable for a range of children, with the games reinforcing classroom messages and acting as a reward for their work. Central to children’s active engagement was their enjoyment, and they were felt to benefit in terms of psychosocial wellbeing and–especially when the topic of the intervention was fitness and nutrition–physical wellbeing. Overall, combined classroom- and games-based interventions were valued methods for communicating healthy lifestyle and positive choices messages to a primary school audience, though research into intervention outcomes is currently limited. [ABSTRACT FROM AUTHOR]

Objective: To compare isoflurane with midazolam for prolonged sedation in ventilated patients.Design: Randomised controlled study.Setting: General intensive care unit in university teaching hospital.Patients: Sixty patients aged 17-80 years who required mechanical ventilation for more than 24 h.Interventions: Sedation with either 0.1-0.6% isoflurane in an air-oxygen mixture (30 patients) or a continuous infusion of midazolam 0.02-0.20 mg/kg/h (30 patients). Sedation was assessed initially and hourly thereafter on a six point scale. The trial sedative was stopped when the patient was ready for weaning from ventilatory support.Measurements and Results: Measurements were made of haemodynamic, respiratory and biochemical variables regularly during the period of sedation and for a week after stopping the sedative agent. There was no difference in any of the physiological or biochemical variables recorded between the two groups. Patients sedated with isoflurane recovered more rapidly and were weaned from mechanical ventilation sooner than those sedated with midazolam.Conclusions: Isoflurane is a useful agent for prolonged sedation of ventilated patients and does not have any adverse effect on the cardiorespiratory system or on hepatic, renal or adrenal function. [ABSTRACT FROM AUTHOR]

Summary: This study considers the surface water concentrations of nitrate in areas designated as nitrate vulnerable zones (NVZs) for between 12 and 15years. The study proposes a range of tests of the effectiveness of nitrate management within the NVZs and in particular the results from within NVZs were compared to a range of controls. The tests show that: [(i)] Sixty-nine percent of NVZs showed no significant improvement in surface water concentrations even after 15years. [(ii)] In comparison to a control catchment 29% of NVZs showed a significant improvement but 31% showed a significant worsening. [(iii)] The average improvement relative to a control due to NVZ designation was 0.02±0.08mg N/l/yr. [(iv)] Differences between NVZs could not be significantly related to the size of the NVZ, uptake of the scheme, extent of uptake, land use change or geology of the local aquifer. [(v)] Land use data suggest that NVZ designation buffered the designated areas against wider changes in arable farming in England and helped maintain a higher proportion of arable within the areas than would be expected. The lack of objective success for NVZ designation suggests that nitrate pollution control strategies based on input management need to be rethought. [Copyright &y& Elsevier]

Objectives: To evaluate the feasibility and acceptability of a primary care-based intervention for improving post-diagnostic dementia care and support (PriDem), and implementation study procedures., Design: A non-randomised, mixed methods, feasibility study., Setting: Seven general practices from four primary care networks (PCNs) in the Northeast and Southeast of England., Participants: We aimed to recruit 80 people with dementia (PWD) and 66 carers INTERVENTION: Clinical Dementia Leads delivered a 12-month intervention in participating PCNs, to develop care systems, build staff capacity and capability, and deliver tailored care and support to PWD and carers., Outcomes: Recruitment and retention rates were measured. A mixed methods process evaluation evaluated feasibility and acceptability of the intervention and study procedures. Using electronic care records, researchers extracted service use data and undertook a dementia care plan audit, preintervention and postintervention, assessing feasibility of measuring the primary implementation outcome: adoption of personalised care planning by participating general practices. Participants completed quality of life, and service use measures at baseline, 4 and 9 months., Results: 60 PWD (75% of recruitment target) and 51 carers (77% of recruitment target) were recruited from seven general practices across four PCNs. Retention rate at 9 months was 70.0% of PWD and 76.5% of carers. The recruitment approach showed potential for including under-represented groups within dementia. Despite implementation challenges, the intervention was feasible and acceptable, and showed early signs of sustainability. Study procedures were feasible and accessible, although researcher capacity was crucial. Participants needed time and support to engage with the study. Care plan audit procedures were feasible and acceptable., Conclusions: The PriDem model is an acceptable and feasible intervention. A definitive study is warranted to fully inform dementia care policy and personalised dementia care planning guidance. Successful strategies to support inclusion of PWD and their carers in future research were developed., Trial Registration Number: ISRCTN11677384., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Provision of personalised care planning is a national priority for people with dementia. Research suggests a lack of quality and consistency of care plans and reviews. The PriDem model of care was developed to deliver feasible and acceptable primary care-based postdiagnostic dementia care. We aimed to increase the adoption of personalised care planning for people with dementia, exploring implementation facilitators and barriers., Design: Mixed-method feasibility and implementation study., Setting: Seven general practices from four primary care networks (PCNs) in the Northeast and Southeast of England., Participants: A medical records audit collected data on 179 community-dwelling people with dementia preintervention, and 215 during the intervention year. The qualitative study recruited 26 health and social care professionals, 14 people with dementia and 16 carers linked to participating practices., Intervention: Clinical dementia leads (CDL) delivered a 12-month, systems-level intervention in participating PCNs, to develop care systems, build staff capacity and capability, and deliver tailored care and support to people with dementia and their carers., Primary and Secondary Outcome Measures: Adoption of personalised care planning was assessed through a preintervention and postintervention audit of medical records. Implementation barriers and facilitators were explored through semistructured qualitative interviews and non-participant observation, analysed using codebook thematic analysis informed by Normalisation Process Theory., Results: The proportion of personalised care plans increased from 37.4% (95% CI 30.3% to 44.5%) preintervention to 64.7% (95% CI 58.3% to 71.0%) in the intervention year. Qualitative findings suggest that the flexible nature of the PriDem intervention enabled staff to overcome contextual barriers through harnessing the skills of the wider multidisciplinary team, delivering increasingly holistic care to patients., Conclusions: Meaningful personalised care planning can be achieved through a team-based approach. Although improved guidelines for care planning are required, commissioners should consider the benefits of a CDL-led approach., Trial Registration Number: ISRCTN11677384., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The Pediatric Quality of Life Inventory™ (PedsQL™) General Core Scales (GCS) were designed to provide a modular approach to measuring health-related quality of life in healthy children, as well as those with acute and chronic health conditions, across the broadest, empirically feasible, age groups (2-18 years). Currently, it is not possible to estimate health utilities based on the PedsQL™ GCS, either directly or indirectly. This paper assesses different mapping methods for estimating EQ-5D health utilities from PedsQL™ GCS responses., Methods: This study is based on data from a cross-sectional survey conducted in four secondary schools in England amongst children aged 11-15 years. We estimate models using both direct and response mapping approaches to predict EQ-5D health utilities and responses. The mean squared error (MSE) and mean absolute error (MAE) were used to assess the predictive accuracy of the models. The models were internally validated on an estimation dataset that included complete PedsQL™ GCS and EQ-5D scores for 559 respondents. Validation was also performed making use of separate data for 337 respondents., Results: Ordinary least squares (OLS) models that used the PedsQL™ GCS subscale scores, their squared terms and interactions (with and without age and gender) to predict EQ-5D health utilities had the best prediction accuracy. In the external validation sample, the OLS model with age and gender had a MSE (MAE) of 0.036 (0.115) compared with a MSE (MAE) of 0.036 (0.114) for the OLS model without age and gender. However, both models generated higher prediction errors for children in poorer health states (EQ-5D utility score <0.6). The response mapping models encountered some estimation problems because of insufficient data for some of the response levels., Conclusion: Our mapping algorithms provide an empirical basis for estimating health utilities in childhood when EQ-5D data are not available; they can be used to inform future economic evaluations of paediatric interventions. They are likely to be robust for populations comparable to our own (children aged 11-15 years in attendance at secondary school). The performance of these algorithms in childhood populations, which differ according to age or clinical characteristics to our own, remains to be evaluated.

Background: Obesity increases the risk of hospital admission for gallbladder disease but its impact on the length of hospital stay is largely unknown., Methods: Prospective population-based study of 1.3 million women aged 56 years on average, recruited from 1996 to 2001 in England and Scotland and followed-up through NHS hospital admission record databases for gallbladder disease (cholelithiasis, cholecystitis, cholecystectomy) over a total of 7.8 million person-years., Results: During follow-up, 24 953 women were admitted with gallbladder disease, 87% who had a cholecystectomy. After adjusting for age, socioeconomic status and other factors, women with higher BMI at recruitment to the study were more likely to be admitted and spend more days in hospital. For 1000 person-years of follow-up, women in BMI categories of 18.5-24.9, 25-29.9, 30-39.9, 40+ kg/m(2) spent, respectively, 16.5[16.0-17.0], 28.6[28.3-28.8], 44.0[43.4-44.5] and 49.4[45.7-53.0] days in hospital for gallbladder disease., Conclusion: On the basis of these estimates, over a quarter of all the days in hospital for gallbladder disease in middle-aged women can be attributed to obesity.