• • To collect a database of all patients with ADHD in the adult mental health community team.

• • Investigate current compliance with following NICE guidelines on physical health monitoring for patients with ADHD taking medication.

• • Ensure all patients on medications were under the care of the Physical Health Monitoring Team (PHMT) who undertake the monitoring.

• • Make recommendations for improvement in care where guidelines are not being adhered to.

A database was compiled with patients suffering from ADHD and those on medications were noted.

The following criteria from the NICE guidelines on ADHD management were included:

• • Baseline observations (heart rate (HR), blood pressure (BP), height, weight) – we reviewed this for those patients who had commenced ADHD medications less than one year ago.

• • 6 monthly weight

• • 6 monthly HR and BP

• • 6 monthly psychiatry review

• • Assessment for side effects at review – This includes cardiovascular issues, emerging tics / abnormal movements, sexual dysfunction, seizures, sleep, worsening behaviour

• • 21/31 patients with confirmed ADHD were being medicated for same.

• • 10/21 medicated patients were not under the care of the PHMT nor did they have a key worker.

• • Medications included forms of methylphenidate or lisdexamfetamine and/or both:9/21 (43%) Concerta XL, 5/21 (24%) Equasym XL, Lisdexamfetamine 6/21 (29%), methylphenidate 3/21 (14%).

• • 9/21 (43%) did not receive appropriate baseline observations.

• • 14/21 (67%) did not have a 6 monthly weight documented.

• • 15/21 (71%) did not have 6 monthly HR/BP checks

• • 8/21 (38%) did not have a 6-month psychiatry review.

• • Regarding assessment for side-effects, on reviewing clinical letters, 1/21 (5%) of letters did not document any discussion regarding side effects. Variation in side effects discussed was evident with 10/21 (48%) documenting general side effects such as sleep and 8/21 (38%) documenting more specific side effects such as tics or sexual dysfunction.

This audit highlighted that ADHD monitoring was being neglected in a large percentage of patients on our ADHD database and variation in documentation regarding side effects.

• • Review led to the following improvements being made:

• • We developed an identifiable case load of patients with ADHD which is helpful for future audit and monitoring.

• • Patients were referred to the PHMT for follow up of monitoring, helping to improve the likelihood that NICE guidelines will be adhered to.

• • A reflection on the need for more specific documentation regarding monitoring of side effects in clinical letters.

Ultra-high dose rate (UHDR) radiation, popularly known as FLASH, has been demonstrated to selectively kill tumor cells with minimal or negligible effects on normal cells but the biological effects induced by UHDR are not fully understood.

In this study, cytogenetic damage induced by UHDR radiation was compared with conventional dose rate (CDR) in human peripheral blood lymphocytes. Human blood samples were irradiated with 3 Gy and 8 Gy doses using 9 MeV electrons at 2 different dose rates: CDR 1 Gy/min and UHDR 600 Gy/Sec. Unstable and stable chromosomal aberrations were detected by fluorescence in situ hybridization (FISH).

Reduced yields of chromosomal aberrations were observed after UHDR radiation at both radiation doses and the extent of reduction was more in colcemid arrested metaphase chromosomes than in G2-PCCs.

The reduced yields of chromosomal aberrations detected after UHDR of electrons may be due to rapid delivery of radiation dose within seconds, resulting in a non-uniform exposure of lymphocytes with varying levels of DNA damage induction. Future studies using well defined human equivalent in vivo and in vitro model systems are required to determine the underlying mechanisms for the FLASH effects.

Newborn bloodspot screening (NBS) is used to identify rare, serious health conditions. The choice of conditions to screen for can be contentious, with no internationally agreed panel. Multicriteria decision analysis (MCDA), involving a priori identification and weighting of criteria, has been proposed as an approach to assess and rank conditions for inclusion in newborn screening panels or for further assessment.

The aim of this review was to summarize existing MCDA-like processes used internationally in the context of NBS conditions. Publications were identified using a scoping methodology including electronic database and gray literature searches. Information on the methodology used to derive criteria and weightings, the criteria used, the scoring systems, and the weightings were extracted. The results were synthesized narratively.

Five publications reporting on the use of MCDA or MCDA-like processes in the context of NBS were identified. In three publications, the aim of the MCDA processes was to select conditions for inclusion in an NBS panel. Two referred to the potential use of MCDA to inform prioritization of candidate conditions for future evaluation. While the criteria used were broadly consistent across studies, assigned weightings varied. Key challenges noted in the studies in relation to applying MCDA included the subjectivity associated with the choice and weighting of criteria, the absence of data to inform criteria, and its low discriminatory power.

Choosing criteria and weightings for MCDA processes regarding NBS can be a highly deliberative process that is intrinsically linked to the values and perspectives of those involved. Given the lack of international consensus on criteria and weightings, MCDA processes to aid decision-making would likely require a de novo tool or careful adaptation of an existing tool to reflect local contexts.

Herpes zoster and post-herpetic neuralgia (PHN) can cause significant pain and morbidity, impacting on the health-related quality of life of those affected. This research aimed to identify primary studies that elicited health state utility values (HSUVs) relating to both acute herpes zoster and PHN, and to assess their suitability for an economic model of herpes zoster vaccination.

Cost-effectiveness analyses of herpes zoster vaccination were identified from (i) a recently published systematic review of economic evaluations of herpes zoster vaccination and (ii) an independently conducted rapid review that sought to update the results of the identified systematic review. The evaluations were hand-searched to identify original studies that elicited HSUVs of interest. Narrative synthesis of the original study characteristics was conducted and possible sources of variation in the studies identified. Appraisal of the methodological quality of the studies was undertaken using a published open response tool that outlined key quality assessment criteria for HSUV studies.

Twenty-one studies that elicited HSUVs were identified. Values related either to changes in utility resulting from increased pain severity, or to changes with time since disease onset. Heterogeneity was observed, potentially caused by differences in population size and characteristics, methods of elicitation, and preference weights used to value utility. Methodological quality varied across studies, with concerns around low sample sizes for populations with PHN, and poor reporting of both missing data and uncertainty around the HSUVs obtained. Differences in study population, time of participant recruitment, and methods of measuring utility could limit the applicability of HSUV study data.

This study highlights both the heterogeneity in HSUVs obtained for herpes zoster and the challenges associated with selecting HSUV data suitable for an economic model. An evidence base from which to select values for an economic evaluation has been created, though poor methodological quality and reporting of the primary studies may compromise the validity of point estimates obtained.

Growing evidence suggests that air pollution exposure may adversely affect the brain and increase risk for psychiatric disorders such as schizophrenia and depression. However, little is known about the potential role of air pollution in severity and relapse following illness onset.

To examine the longitudinal association between residential air pollution exposure and mental health service use (an indicator of illness severity and relapse) among individuals with first presentations of psychotic and mood disorders.

We identified individuals aged ≥15 years who had first contact with the South London and Maudsley NHS Foundation Trust for psychotic and mood disorders in 2008–2012 (n = 13 887). High-resolution (20 × 20 m) estimates of nitrogen dioxide (NO2), nitrogen oxides (NOx) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. In-patient days and community mental health service (CMHS) events were recorded over 1-year and 7-year follow-up periods.

Following covariate adjustment, interquartile range increases in NO2, NOx and PM2.5 were associated with 18% (95% CI 5–34%), 18% (95% CI 5–34%) and 11% (95% CI 3–19%) increased risk for in-patient days after 1 year. Similarly, interquartile range increases in NO2, NOx, PM2.5 and PM10 were associated with 32% (95% CI 25–38%), 31% (95% CI 24–37%), 7% (95% CI 4–11%) and 9% (95% CI 5–14%) increased risk for CMHS events after 1 year. Associations persisted after 7 years.

Residential air pollution exposure is associated with increased mental health service use among people recently diagnosed with psychotic and mood disorders. Assuming causality, interventions to reduce air pollution exposure could improve mental health prognoses and reduce healthcare costs.

To compare the nutrient profile of packaged supermarket food products available in Australia and New Zealand. Eligibility to carry health claims and relationship between nutrient profile score and nutritional content were also evaluated.

Nutritional composition data were collected in six major Australian and New Zealand supermarkets in 2012. Mean Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC) scores were calculated and the proportion of products eligible to display health claims was estimated. Regression analyses quantified associations between NPSC scores and energy density, saturated fat, sugar and sodium contents.

NPSC scores were derived for 23 596 packaged food products (mean score 7·0, range −17 to 53). Scores were lower (better nutrient profile) for foods in Australia compared with New Zealand (mean 6·6 v. 7·8). Overall, 45 % of foods were eligible to carry health claims based on NPSC thresholds: 47 % in Australia and 41 % in New Zealand. However, less than one-third of dairy (32 %), meat and meat products (28 %) and bread and bakery products (27·5 %) were eligible to carry health claims. Conversely, >75 % of convenience food products were eligible to carry health claims (82·5 %). Each two-unit higher NPSC score was associated with higher energy density (78 kJ/100 g), saturated fat (0·95 g/100 g), total sugar (1·5 g/100 g) and sodium (66 mg/100 g; all P values<0·001).

Fewer than half of all packaged foods available in Australia and New Zealand in 2012 met nutritional criteria to carry health claims. The few healthy choices available in key staple food categories is a concern. Improvements in nutritional quality of foods through product reformulation have significant potential to improve population diets.