'Scan-negative' cauda equina syndrome: Evidence of functional disorder from a prospective case series.

In the first prospective comparison of 'scan-negative' (n=11) and 'scan-positive' (n=7) patients with cauda equina syndrome (CES) we found that Hoover's sign of functional leg weakness but not routine clinical features differentiated the two groups (p<0.02). This offers a new direction of study in this area, although magnetic resonance imaging is still required for all patients with possible CES.

Innovations in Practice: Empowering Parents, Empowering Communities: A pilot evaluation of a peer-led parenting programme.

BACKGROUND: Efficacious parenting interventions are under-utilised in mainstream services. Empowering Parents, Empowering Communities (EPEC) aims to increase community access to effective parenting support through a peer-led manualised intervention. METHOD: Training outcomes, clinical effectiveness and acceptability of EPEC were evaluated using a pre-post cohort design. Data were collected from trained peer facilitators (n=31) and parenting group participants (n=73). RESULTS: Peer facilitators demonstrated significantly increased knowledge of and confidence in delivering parenting groups. Parents attending groups reported improvements in child behaviour and parenting stress, and high satisfaction. CONCLUSIONS: Early evidence suggests that EPEC may be an effective and acceptable service model in socially disadvantaged communities.

FutureMS cohort profile: a Scottish multicentre inception cohort study of relapsing-remitting multiple sclerosis.

PURPOSE: Multiple sclerosis (MS) is an immune-mediated, neuroinflammatory disease of the central nervous system and in industrialised countries is the most common cause of progressive neurological disability in working age persons. While treatable, there is substantial interindividual heterogeneity in disease activity and response to treatment. Currently, the ability to predict at diagnosis who will have a benign, intermediate or aggressive disease course is very limited. There is, therefore, a need for integrated predictive tools to inform individualised treatment decision making. PARTICIPANTS: Established with the aim of addressing this need for individualised predictive tools, FutureMS is a nationally representative, prospective observational cohort study of 440 adults with a new diagnosis of relapsing-remitting MS living in Scotland at the time of diagnosis between May 2016 and March 2019. FINDINGS TO DATE: The study aims to explore the pathobiology and determinants of disease heterogeneity in MS and combines detailed clinical phenotyping with imaging, genetic and biomarker metrics of disease activity and progression. Recruitment, baseline assessment and follow-up at year 1 is complete. Here, we describe the cohort design and present a profile of the participants at baseline and 1 year of follow-up. FUTURE PLANS: A third follow-up wave for the cohort has recently begun at 5 years after first visit and a further wave of follow-up is funded for year 10. Longer-term follow-up is anticipated thereafter.

Evaluation of a peer led parenting intervention for disruptive behaviour problems in children: community based randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of a peer led parenting intervention delivered to socially disadvantaged families. DESIGN: Randomised controlled trial. SETTING: Schools and children's centres in a socially deprived borough of inner London. PARTICIPANTS: Parental caregivers seeking help with managing the problem behaviours of 116 index children, aged 2-11 years; 59 families were randomised to the intervention and 57 to a waitlist control condition. INTERVENTION: Empowering parents, empowering communities is an eight week (two hours each week), manualised programme delivered to groups of parents by trained peer facilitators from the local community. MAIN OUTCOME MEASURES: Child problems (number and severity), parental stress, and parenting competencies were assessed before and after the intervention using standardised parent reported measures. RESULTS: Significantly greater improvements in positive parenting practices and child problems were observed in the intervention group compared with the waitlist group, with no difference in parental stress between the groups. An intention to treat analysis for the primary outcome measure, the intensity subscale of the Eyberg child behaviour inventory, showed an intervention effect size of 0.38 (95% confidence interval 0.01 to 0.75, P=0.01). The intervention group had high rates of treatment retention (91.5%) and user satisfaction. CONCLUSION: The peer led parenting intervention significantly reduced child behaviour problems and improved parenting competencies. This is a promising method for providing effective and acceptable parenting support to families considered hard to reach by mainstream services. TRIAL REGISTRATION: Current Controlled Trials ISRCTN01962337.

A reminder of the classical biochemical sequelae of adult gastric outlet obstruction.

The commonest cause of gastric outlet obstruction (GOO) is pyloric stenosis secondary to peptic ulcer disease or gastric carcinoma. Patients with GOO have unique metabolic sequelae, namely hypochloraemic, hypokalaemic metabolic alkalosis with paradoxical aciduria and hypocalcaemia. A case of a patient presenting as GOO is discussed. The aim of this report is to highlight the metabolic abnormalities and management in patients with GOO.

Colonic injury following percutaneous endoscopic-guided gastrostomy insertion.

Percutaneous endoscopic gastrostomy (PEG) is a common practice usually offered to patients who are unable to tolerate or swallow oral feed and require long-term nutrition. We present a case of early pneumoperitoneum after a PEG placement due to colonic perforation. The patient was severely malnourished and had a medical history of brain injury, cerebrovascular accident cerebrovascular accident (CVA) and bilateral below knee amputations from a bomb blast 13 years ago. The PEG tube was placed under sedation. On the first postoperative day, the patient had a subtle pneumoperitoneum that was considered secondary to the procedure. On the third postoperative day, the patient became tachycardiac with abdominal distension. A CT scan showed the PEG tube traversing through the transverse colon. The patient underwent a laparotomy and repair of colonic injury and made an uneventful recovery.