Chronic constipation in people with intellectual disabilities in the community: cross-sectional study.

BACKGROUND: One-third to half of people with intellectual disabilities suffer from chronic constipation (defined as two or fewer bowel movements weekly or taking regular laxatives three or more times weekly), a cause of significant morbidity and premature mortality. Research on risk factors associated with constipation is limited. AIMS: To enumerate risk factors associated with constipation in this population. METHOD: A questionnaire was developed on possible risk factors for constipation. The questionnaire was sent to carers of people with intellectual disabilities on the case-loads of four specialist intellectual disability services in England. Data analysis focused on descriptively summarising responses and comparing those reported with and without constipation. RESULTS: Of the 181 people with intellectual disabilities whose carers returned the questionnaire, 42% reported chronic constipation. Constipation was significantly associated with more severe intellectual disability, dysphagia, cerebral palsy, poor mobility, polypharmacy including antipsychotics and antiseizure medication, and the need for greater toileting support. There were no associations with age or gender. CONCLUSIONS: People with intellectual disabilities may be more vulnerable to chronic constipation if they are more severely intellectually disabled. The associations of constipation with dysphagia, cerebral palsy, poor mobility and the need for greater toileting support suggests people with intellectual disabilities with significant physical disabilities are more at risk. People with the above disabilities need closer monitoring of their bowel health. Reducing medication to the minimum necessary may reduce the risk of constipation and is a modifiable risk factor that it is important to monitor. By screening patients using the constipation questionnaire, individualised bowel care plans could be implemented.

The use of technology for social interaction by people with dementia: A scoping review.

People with dementia (PwD) are at risk of experiencing loneliness, which is associated with physical and mental health difficulties [1]. Technology is a possible tool to increase social connection and reduce loneliness. This scoping review aims to examine the current evidence regarding the use of technology to reduce loneliness in PwD. A scoping review was carried out. Medline, PsychINFO, Embase, CINAHL, Cochrane database, NHS Evidence, Trials register, Open Grey, ACM Digital Library and IEEE Xplore were searched in April 2021. A sensitive search strategy was constructed using combinations of free text and thesaurus terms to retrieve articles about dementia, technology and social-interaction. Pre-defined inclusion and exclusion criteria were used. Paper quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and results reported according to PRISMA guidelines [2,3]. 73 papers were identified publishing the results of 69 studies. Technological interventions included robots, tablets/computers and other forms of technology. Methodologies were varied and limited synthesis was possible. There is some evidence that technology is a beneficial intervention to reduce loneliness. Important considerations include personalisation and the context of the intervention. The current evidence is limited and variable; future research is warranted including studies with specific loneliness outcome measures, studies focusing on PwD living alone, and technology as part of intervention programmes.

A Review of Network and Computer Analysis of Epileptiform Discharge Free EEG to Characterize and Detect Epilepsy.

Objectives. There is emerging evidence that network/computer analysis of epileptiform discharge free electroencephalograms (EEGs) can be used to detect epilepsy, improve diagnosis and resource use. Such methods are automated and can be performed on shorter recordings of EEG. We assess the evidence and its strength in the area of seizure detection from network/computer analysis of epileptiform discharge free EEG. Methods. A scoping review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance was conducted with a literature search of Embase, Medline and PsychINFO. Predesigned inclusion/exclusion criteria were applied to selected articles. Results. The initial search found 3398 articles. After duplicate removal and screening, 591 abstracts were reviewed, 64 articles were selected and read leading to 20 articles meeting the requisite inclusion/exclusion criteria. These were 9 reports and 2 cross-sectional studies using network analysis to compare and/or classify EEG. One review of 17 reports and 10 cross-sectional studies only aimed to classify the EEGs. One cross-sectional study discussed EEG abnormalities associated with autism. Conclusions. Epileptiform discharge free EEG features derived from network/computer analysis differ significantly between people with and without epilepsy. Diagnostic algorithms report high accuracies and could be clinically useful. There is a lack of such research within the intellectual disability (ID) and/or autism populations, where epilepsy is more prevalent and there are additional diagnostic challenges.

An 8-year study of admissions and discharges to a specialist intellectual disability inpatient unit.

BACKGROUND: In the United Kingdom, policy change has led to specialist intellectual disability inpatient bed reduction. Little evidence exists assessing the results for patients admitted to such units. This study evaluates the outcomes of a specialist intellectual disability inpatient unit. METHOD: Gender/age/ethnicity/intellectual disability severity/co-morbid psychiatric/developmental disorders, treatment length and stay data were collected. The health of the nation outcome scales for people with learning disabilities (HoNOS-LD) scores at admission, treatment completion and discharge were recorded. Analysis of these multiple variables and correlations within different patient groups was investigated using various statistical tests. RESULTS: Of 169/176 patients (2010-2018), admission to discharge, HoNOS-LD global and all individual items score decreased significantly, for all patient categories. Treatment completion to discharge duration was significant for the whole cohort. CONCLUSIONS: This is the largest study of intellectual disability inpatient outcomes. Discharge from the hospital appears not associated with duration of treatment. Using HoNOS-LD to demonstrate treatment effectiveness is recommended.

EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review.

Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.

The evidence for switching dibenzazepines in people with epilepsy.

The dibenzazepines particularly carbamazepine are associated with known adverse effects (AEs) and drug to drug interactions. Eslicarbazepine acetate (ESL) is structurally distinct from other members of the dibenzazepine family and has the advantage of once daily dosing. Observational and trial data report successful switching from older dibenzazepines to ESL. The evidence base for doing so is unclear and not standardized. This is a literature review following the PRISMA scoping guidelines identifying the evidence of switching dibenzazepines. Transition methods, ratios, tolerance to change, adverse effects and retention post-change were evaluated. Study quality was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. Seven studies investigated the outcome of transition between carbamazepine and or oxcarbazepine to ESL, with specific data on the transition dose ratio and scheduling. The available data suggest that the overnight transition between oxcarbazepine and ESL in a 1:1 ratio (most common) is generally well tolerated with high retention rates. The transition showed improvement in adverse events associated with oxcarbazepine across a variety of domains. Almost 60% transitioned because of adverse events experienced no further symptoms at 12 months. There is less data on the transition from carbamazepine to ESL. The evidence available suggests an overnight transition in the ratio of 1:1.3-1.5. The retention rate following transition from carbamazepine to ESL was 69% (follow-up of 4 months) with almost half of those transitioned because of adverse events experiencing no further symptoms. There is Grade C evidence available to help guide clinicians in the transition.

Head first - Review of epilepsy head injury risk and protection.

INTRODUCTION: The causes of falls and resultant head injuries in people with epilepsy are complex and represent important clinical issues significantly impacting on safety, quality of life and long-term prognosis. A general solution for many years has been to provide helmets for head protection. There is poor understanding of the influencing risk factors and solutions to give person-centred clinical advice. METHODS: A focused narrative review was conducted to investigate the risk factors for seizure-related head injuries and evidence of current helmets to offer protection. Four databases were searched (Embase, Medline, PsycInfo and Cochrane Library) using combinations of text words and thesaurus terms for the retrieval of articles relating to seizure-related head injury. Articles for full analysis were selected by a ten item pre-defined inclusion criteria. RESULTS: Of 104 relevant studies longlisted 21 studies met four or more of the predefined criteria and included in this review. A further nine papers were included because they added additional relevant information. CONCLUSIONS: Seizure-related head injury, although rare, may have serious consequences. High doses of antiepileptic/antiseizure drugs (AEDs/ASDs) and a prescription for three or more AEDs/ASDs are significant, modifiable, risk factors for head injury. Differentiating confusion due to post-ictal changes or concussion can be challenging. Seizure-related cardiac causes leading to injury due to ictal bradycardia or asystole is under investigated. More research is required to validate the protective benefit of various helmet designs in seizure-related head injury. It is striking that there are no International Standards for protective helmets in seizures.

Neuromodulation of autism spectrum disorders using vagal nerve stimulation.

Influential theories propose an important role for the autonomic nervous system in social behaviour and emotion regulation. Difficulties with these capabilities occur in autism spectrum disorders (ASD). Vagus nerve stimulation (VNS) is a neuromodulation technique that stimulates autonomic pathways by means of an electrode implanted around the left vagus nerve in the neck. It is a licenced treatment for epilepsy and depression. This study searches the literature for evidence of VNS effects on behaviour in ASD. A literature search was conducted by two independent reviewers using Embase, Medline, PsycInfo and Cochrane using relevant search terms following the principals of the PRISMA guidance. The search strategy utilised a combination of text words and thesaurus terms to retrieve records relating to autism/pervasive developmental disorder and vagus nerve stimulation. No limits were applied. Supplementary searches were carried out on trials registers, and using backwards and forwards citation searching. A predesigned inclusion and exclusion criteria was administered to the identified results. From the 242 results identified search strategy 11 were found to satisfy the full search criteria and used to discuss the hypothesis. Eight studies were case series and three case reports. There is some evidence that VNS, when performed for epilepsy, may improve behaviour in people with ASD. There are indications that this occurs independently of its effects on seizure frequency and mood, although more rigorous studies are required.

Going down the tubes! Impact on seizure control of antiepileptic medication given via percutaneous feeding tubes.

BACKGROUND: Long-term feeding by percutaneous endoscopic gastrostomy tube (PEG) is uncommon but can present significant issues when both nutrition and medication have to be fed down the same tube. This is especially important in people with epilepsy where the dose and bioavailability of antiepileptic drugs are critical to maintain adequate seizure control. This group with long-term PEG tubes is particularly vulnerable and dependent on their carers to provide high standard of care. Indeed, approximately half of the people with long-term feeding tubes suffer from severe intellectual disability which requires careful coordination of all members of the multidisciplinary team. It is all the more important when consideration is given that around 50% of people with severe ID have seizures, mostly treatment resistant. METHOD: A detailed literature review was conducted with the focus on the numerous factors that can affect medication delivery and absorption with the potential to destabilize seizure control in people with PEG. Issues concerning the site of drug absorption, excipients and dilution, interaction between antiepileptic drugs and the nutritional feed, bioavailability, and problems with the PEG tube are considered. RESULTS: There is limited research in this area and the studies are often based on small numbers, healthy volunteers or in vitro findings. CONCLUSION: In the absence of sound research data, seizure control in each patient with a PEG needs to be considered on an individual basis. Establishing a baseline by measuring the serum levels prior to the tube insertion may be helpful, followed by checking the levels after PEG insertion.

Increasing the rural general practitioners' use of library and information services through publicity: a randomized controlled trial in Cornwall, UK.

OBJECTIVES: To provide evidence on the effectiveness of publicity with the aim of encouraging general practitioners (GPs) in Cornwall to make better use of the Cornwall Health Library Service (CHLS). In the light of the findings, a second objective was formulated to determine which resources they used to look for health information. METHODS: A cluster randomized controlled trial (RCT) measured the effect of two types of publicity, comparing emails with visiting GP practices. After the trial period, a questionnaire was sent to all 332 GPs to ascertain the resources they accessed for their information and any barriers to their use of the CHLS. RESULTS: The GP's use of the library services was lower than the level needed for a conclusive statistical analysis; however, visiting practices was associated with an apparent increase in library use and warrants further investigation. The questionnaire showed that GPs make good use of databases and colleagues. CONCLUSION: The RCT confirmed the low uptake of library services anticipated, but was inconclusive in demonstrating the most effective form of publicity. The questionnaire suggested that a substantial number of GPs are interested in the library services and has provided an insight into the way that GPs look for information in Cornwall.