Hallucinations are common and distressing symptoms in Parkinson’s disease (PD). Treatment response in clinical trials is measured using validated questionnaires, including the Scale for Assessment of Positive Symptoms-Hallucinations (SAPS-H) and University of Miami PD Hallucinations Questionnaire (UM-PDHQ). The minimum clinically important difference (MCID) has not been determined for either scale. This study aimed to estimate a range of MCIDs for SAPS-H and UM-PDHQ using both consensus-based and statistical approaches.

A Delphi survey was used to seek opinions of researchers, clinicians, and people with lived experience. We defined consensus as agreement ≥75%. Statistical approaches used blinded data from the first 100 PD participants in the Trial for Ondansetron as Parkinson’s Hallucinations Treatment (TOP HAT, NCT04167813). The distribution-based approach defined the MCID as 0.5 of the standard deviation of change in scores from baseline at 12 weeks. The anchor-based approach defined the MCID as the average change in scores corresponding to a 1-point improvement in clinical global impression-severity scale (CGI-S).

Fifty-one researchers and clinicians contributed to three rounds of the Delphi survey and reached consensus that the MCID was 2 points on both scales. Sixteen experts with lived experience reached the same consensus. Distribution-defined MCIDs were 2.6 points for SAPS-H and 1.3 points for UM-PDHQ, whereas anchor-based MCIDs were 2.1 and 1.3 points, respectively.

We used triangulation from multiple methodologies to derive the range of MCID estimates for the two rating scales, which was between 2 and 2.7 points for SAPS-H and 1.3 and 2 points for UM-PDHQ.

Technical and trade-off issues to incorporating environmental data in health technology assessment (HTA) decision processes are known. Multiple-criteria decision analysis (MCDA) has been successfully used across disciplines, supporting multifaceted technology decision-making. Challenges in prioritizing environmental criteria, resource constraints, and other criteria to assess technologies can be overcome through the application of MCDA, also used in conjunction with other techniques in HTA.

A systematic review of methods to evaluate environmental sustainability in HTA was conducted following the PRISMA guidelines. Using a comprehensive search strategy, Ovid Embase, Web of Science (all databases), PubMed, EBSCOhost GreenFILE, IEEE Xplore, international HTA database, Cochrane Library, and grey literature were searched. The review analyzed the following broad themes: methods to overcome barriers, including how methods can handle “trade-off” issues between financial and environmental considerations; resource and expertise constraints; and data quality issues. This review determined how comprehensive the methods are for assessing sustainability in HTA. Frameworks were also ranked based on their overall transparency and feasibility.

This review (SR) identified 10 key studies. Half of these studies outline MCDA models within the frameworks. All MCDA studies have been combined with other techniques to support sustainable technology decision-making HTA. Analytical MCDA models with roots in mathematics are highlighted as reproducible techniques to support multifaceted decision-making, particularly where there are conflicting criteria. Analytical hierarchy process (AHP) used in conjunction with a circular economy framework for health technology supports global health system net zero and wider sustainability goals. A performance matrix model elicits outcome trade-off by assigning weights to costs, technical performance, and environmental outcomes.

The multidisciplinary findings of this research provide valuable insight in an area where there is currently limited research, confirming and expanding on previous scoping reviews. The results highlight several comprehensive MCDA models supporting HTA sustainability framework development. Further research is warranted into the feasibility of the frameworks. Study selection and data extraction were undertaken independently due to project time constraints.

Research widely reports healthcare technologies contribute substantial environmental impacts. Timely health technology assessment (HTA) environmental sustainability (ES) framework development is critical. A lack of multisectoral expertise, resource constraints, and consensus to assess environmental impact is delaying methodological progression. The study objective was to identify and critically evaluate methods supporting ES in HTA and formulate recommendations to underpin the development of an ES framework in HTA.

This multisectoral systematic review followed PRISMA guidelines. Maximizing the opportunity to evaluate applied environmental assessment methods, the databases Web of Science, Embase, PubMed, IEEE Xplore, EBSCOhost GreenFILE, Cochrane Library, and International Network of Agencies for Health Technology Assessment (INAHTA) were searched between 2008 and 2023. Full-text published studies applying both qualitative and quantitative methods to evaluate technology ES were included. Frameworks were critiqued for their comprehensiveness based on sustainability scope and in challenging barriers to decision-making. Studies were ranked according to how transparent and feasible frameworks were in their ability to assess technology ES and alignment with HTA principles.

A total of 10 studies were identified and ranked in order of suitability in assessing technology ES in HTA. All studies applied a combination of methods to overcome issues such as data and resource constraints, expert knowledge, consensus in decision-making, and multiple criteria trade-off. Ranked highest, the One Health “extended” life cycle assessment (LCA) framework that utilized SimaPro LCA advanced software addressed the greatest methodological needs for HTA. Ranked second, the circular economy (CE) framework used in conjunction with an analytical hierarchy process (AHP) makes use of weighting and expert consultation to support multiple-criteria decision-making (MCDM).

This is the first systematic review to identify multidisciplinary frameworks, supporting evaluation of ES and decision-making in HTA. Providing valuable insight into potential methodological solutions where there is limited research, this study facilitates ES policy development in HTA. This study challenges limitations to methodological development highlighted by previous research. Further research should apply these recommendations in an HTA setting.

We aimed to explore participant perspectives on social prescribing (SP) for mental health and well-being and the acceptability of community pharmacists (CP) as members of SP pathways that support people with mild to moderate depression and anxiety.

SP aims to support people with poor health related to socio-demographic determinants. Positive effects of SP on self-belief, mood, well-being, and health are well documented, including a return to work for long-term unemployed.

The study was set in a city in southwest England with diverse cultural and socio-demographics. We recruited SP stakeholders, including CP, to either one of 17 interviews or a focus group with nine members of the public.

An inductive iterative approach to thematic analysis produced four superordinate themes: (1) offering choice a non-pharmacological option, (2) supporting pharmacy communities – ‘it is an extension of what we do’, (3) stakeholder perspectives – pharmacists are very busy and their expertise unknown by some, and (4) potential for pharmacy in primary care.

Stakeholders viewed CP as local to and accessible by their community. Pharmacists perceived referral to SP services as part of their current role. General practitioner participants considered pharmacy involvement could reduce their workload and expand the primary healthcare team. Importantly, general practitioners and CP viewed SP as a non-pharmacological alternative to prescribing unnecessary antidepressants and reduce associated adverse effects. All participants voiced concerns about pharmacy dispensing busyness as a potential barrier to involvement and pharmacists requesting mental health training updates.

Key findings suggest CP offer a potential alternative to the general practitioner for people with mild to moderate depression and anxiety seeking access to support and health information. However, CP need appropriately commissioned and funded involvement in SP, including backfill for ongoing dispensing, medicines optimization, and mental health first aid training.

England's primary care service for psychological therapy (Improving Access to Psychological Therapies [IAPT]) treats anxiety and depression, with a target recovery rate of 50%. Identifying the characteristics of patients who achieve recovery may assist in optimizing future treatment. This naturalistic cohort study investigated pre-therapy characteristics as predictors of recovery and improvement after IAPT therapy.

In a cohort of patients attending an IAPT service in South London, we recruited 263 participants and conducted a baseline interview to gather extensive pre-therapy characteristics. Bayesian prediction models and variable selection were used to identify baseline variables prognostic of good clinical outcomes. Recovery (primary outcome) was defined using (IAPT) service-defined score thresholds for both depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Depression and anxiety outcomes were also evaluated as standalone (PHQ-9/GAD-7) scores after therapy. Prediction model performance metrics were estimated using cross-validation.

Predictor variables explained 26% (recovery), 37% (depression), and 31% (anxiety) of the variance in outcomes, respectively. Variables prognostic of recovery were lower pre-treatment depression severity and not meeting criteria for obsessive compulsive disorder. Post-therapy depression and anxiety severity scores were predicted by lower symptom severity and higher ratings of health-related quality of life (EuroQol questionnaire [EQ5D]) at baseline.

Almost a third of the variance in clinical outcomes was explained by pre-treatment symptom severity scores. These constructs benefit from being rapidly accessible in healthcare services. If replicated in external samples, the early identification of patients who are less likely to recover may facilitate earlier triage to alternative interventions.

Operative cancellations adversely affect patient health and impose resource strain on the healthcare system. Here, our objective was to describe neurosurgical cancellations at five Canadian academic institutions.

The Canadian Neurosurgery Research Collaborative performed a retrospective cohort study capturing neurosurgical procedure cancellation data at five Canadian academic centres, during the period between January 1, 2014 and December 31, 2018. Demographics, procedure type, reason for cancellation, admission status and case acuity were collected. Cancellation rates were compared on the basis of demographic data, procedural data and between centres.

Overall, 7,734 cancellations were captured across five sites. Mean age of the aggregate cohort was 57.1 ± 17.2 years. The overall procedure cancellation rate was 18.2%. The five-year neurosurgical operative cancellation rate differed between Centre 1 and 2 (Centre 1: 25.9%; Centre 2: 13.0%, p = 0.008). Female patients less frequently experienced procedural cancellation. Elective, outpatient and spine procedures were more often cancelled. Reasons for cancellation included surgeon-related factors (28.2%), cancellation for a higher acuity case (23.9%), patient condition (17.2%), other factors (17.0%), resource availability (7.0%), operating room running late (6.4%) and anaesthesia-related (0.3%). When clustered, the reason for cancellation was patient-related in 17.2%, staffing-related in 28.5% and operational or resource-related in 54.3% of cases.

Neurosurgical operative cancellations were common and most often related to operational or resource-related factors. Elective, outpatient and spine procedures were more often cancelled. These findings highlight areas for optimizing efficiency and targeted quality improvement initiatives.

Multimorbidity, the presence of two or more health conditions, has been identified as a possible risk factor for clinical dementia. It is unclear whether this is due to worsening brain health and underlying neuropathology, or other factors. In some cases, conditions may reflect the same disease process as dementia (e.g. Parkinson's disease, vascular disease), in others, conditions may reflect a prodromal stage of dementia (e.g. depression, anxiety and psychosis).

To assess whether multimorbidity in later life was associated with more severe dementia-related neuropathology at autopsy.

We examined ante-mortem and autopsy data from 767 brain tissue donors from the UK, identifying physical multimorbidity in later life and specific brain-related conditions. We assessed associations between these purported risk factors and dementia-related neuropathological changes at autopsy (Alzheimer's-disease related neuropathology, Lewy body pathology, cerebrovascular disease and limbic-predominant age-related TDP-43 encephalopathy) with logistic models.

Physical multimorbidity was not associated with greater dementia-related neuropathological changes. In the presence of physical multimorbidity, clinical dementia was less likely to be associated with Alzheimer's disease pathology. Conversely, conditions which may be clinical or prodromal manifestations of dementia-related neuropathology (Parkinson's disease, cerebrovascular disease, depression and other psychiatric conditions) were associated with dementia and neuropathological changes.

Physical multimorbidity alone is not associated with greater dementia-related neuropathological change; inappropriate inclusion of brain-related conditions in multimorbidity measures and misdiagnosis of neurodegenerative dementia may better explain increased rates of clinical dementia in multimorbidity

This comprehensive literature scoping review outlines available infection prevention and control (IPC) methods for viral-mediated gene therapies and provides one IPC strategy for the healthcare setting based on a single-center recommendation.

A team of experts in pharmacy, healthcare epidemiology, and biosafety with experience in viral-mediated gene therapy was assembled within a pediatric hospital to conduct a comprehensive literature scoping review. The comprehensive review included abstracts and full-text articles published since 2009 and utilized prespecified search terms of the five viral vectors of interest: adenovirus (AV), retrovirus (RV), adeno-associated virus (AAV), lentivirus (LV), and herpes simplex virus (HSV). Case reports, randomized controlled trials, and bench research studies were all included, while systematic reviews were excluded.

A total of 4473 case reports, randomized control trials, and benchtop research studies were identified using the defined search criteria. Chlorine compounds were found to inactivate AAV and AV, while alcohol-based disinfectants were ineffective. There was a relative paucity of studies investigating surface-based disinfection for HSV, however, alcohol-based disinfectants were effective in one study. Ultraviolent irradiation was also found to inactivate HSV in numerous studies. No studies investigated disinfection for LV and RV vectors.

The need to define IPC methods is high due to the rapid emergence of viral-mediated gene therapies to treat rare diseases, but published clinical guidance remains scarce. In the absence of these data, our center recommends a 1:10 sodium hypochlorite solution in clinical and academic environments to ensure complete germicidal activity of viral-mediated gene therapies.

Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated M. abscessus (HA-Mab) put in place following a prior institutional outbreak of M. abscessus alerted investigators to a cluster of 3 extrapulmonary M. abscessus infections among patients who had undergone cardiothoracic surgery.

Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of M. abscessus in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental M. abscessus isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.

Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. M. abscessus was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of M. abscessus from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.

Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted M. abscessus to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.

Dementia worry (DW) is anxious rumination about personal risk for dementia. Personal experience with dementia may affect DW, such that individuals with personal experience with dementia may have higher worry about developing dementia themselves. Further, dementia knowledge (DK), including what may increase one’s dementia risk as well as treatment options for dementias, may be influenced by one’s dementia experience. Prior studies have suggested that personal experience alters the relationship of age to DW; no prior studies have examined this for DK. In the present study, we examined whether DW and/or DK were differentially related to age in older adults.

Adults (≥ 50 years old; N=252) in Ohio and Louisiana completed an online survey. 94 participants reported no personal dementia experiences, and 158 participants endorsed having a biological relative with dementia. The sample ranged in age from 23 to 92 (M=65, SD=9.3), with 96% identifying as White and 76% holding advanced degrees. DW was measured with the Dementia Worry Scale. Dementia knowledge was measured with true or false questions about causes and treatments for dementia.

Groups did not differ in age (p=.73), education (p=.50), or perceived SES (p=.28), but did differ in gender (p=.06). The experience group had higher dementia knowledge (p=.02). In those with biological dementia experience, lower age was related to higher dementia worry (r=-.24, p=.003) and greater dementia knowledge (r=-.18, p=.03). However, in those with no experience, age was not related to either dementia worry (r=.04) or to dementia knowledge (r=.16). Dementia worry did not relate to dementia knowledge in either group (no experience r=.03, experience r=.13).

Findings suggest that younger individuals who have personal experience with dementia are highly worried about personal risk for dementia, despite having higher knowledge of dementia. Further, these results demonstrate that dementia knowledge is not related to dementia worry in older individuals with or without biological dementia experience. Findings may be important for informing dementia prevention education efforts.