Tag: Healthcare provider

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Validation of a criterion-based screening and triage pathway for adult ADHD: a prospective observational study of safety and operational efficiency

BackgroundThe increasing demand for adult attention-deficit hyperactivity disorder (ADHD) assessments has required the development of efficient triage pathways. This study provides a formal assessment of a criterion-based screening model designed to prioritise patient safety and operational efficiency within a National Health Service (NHS) specialist secondary care setting.MethodsA prospective observational validation design was employed, involving 49 consecutive adults referred for ADHD assessment none of whom had a previous ADHD diagnosis. The Comprehensive ADHD Screening Questionnaire (CASQ), a clinician-administered instrument based on DSM-5 criteria, was utilised by four trained Physician Assistants. To ensure an assessment of triage safety, a universal assessment model was adopted: all participants received a blinded, gold-standard diagnostic assessment (NICE-compliant) regardless of the initial triage recommendation thereby eliminating verification bias. The primary outcome measure was the Number Needed to Harm (NNH), defined as the number of people screened before a single false-negative result occurs.ResultsOf the 48 participants who completed the diagnostic process, six (12.5%) received an ADHD diagnosis. The triage pathway correctly identified all six cases, resulting in a sensitivity of 100.0% (95% CI: 61.0%–100.0%) and an infinite NNH. Specificity was 45.2% (95% CI: 31.2%–59.9%), with a positive predictive value of 20.7%. The pathway permitted 39.6% (n = 19) of referrals to be triaged to alternative pathways rather than full ADHD assessment, potentially saving significant specialist clinician time. Exploratory analyses indicated that score magnitude did not reliably distinguish between true and false positives within the group triaged as appropriate for further assessment.ConclusionsThese preliminary findings suggest that criterion-based screening conducted by appropriately trained non-specialist clinicians can achieve high levels of safety whilst improving service efficiency. The findings support the feasibility of task-shifting models in adult ADHD services, provided that triage thresholds are calibrated to prioritise sensitivity. These results require replication in adequately powered multi-site studies before firm conclusions regarding pathway safety can be drawn. Further research is required to establish inter-rater reliability and cost-effectiveness across diverse clinical settings.
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Protracted encephalopathy and subacute combined degeneration associated with chronic nitrous oxide use: a case report

Nitrous oxide is a dissociative hallucinogen that is increasingly used recreationally, in part due to its widespread availability. Its use is known to cause subacute combined degeneration via inactivation of vitamin B12; it may also result in acute delirium and chronic progressive encephalopathy. Though current practice guidelines call for treatment of neurological sequelae of nitrous oxide use with vitamin B12 supplementation, a paucity of long-term outcome data limits our ability to guide extended courses of treatment. In this report, we discuss a case of protracted encephalopathy associated with nitrous oxide use. We track the response to vitamin B12 supplementation in the hospital setting using the Mini-Mental Status Exam to assess the severity and improvement of cognitive impairment. We also review the patient’s comorbid medical and psychiatric conditions, which complicate diagnosis and treatment planning in this patient population.
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Adoption of Digital Mental Health Interventions in National Health Service England, Scotland, and Wales: Freedom of Information Questionnaire Study

<strong>Background:</strong> Digital mental health interventions (DMHIs) have been widely promoted to improve access to mental health care within the UK National Health Service (NHS), particularly following the COVID-19 pandemic. In 2015, a total of 48 technologies were reportedly used in NHS services in England, but over the past decade, substantial changes to regulatory requirements, evidence standards, and procurement processes have reshaped the digital mental health landscape. There is limited clarity regarding which DMHIs are currently being formally procured and funded by NHS mental health services across the United Kingdom. <strong>Objective:</strong> This study aimed to identify and describe the DMHIs currently procured, contracted, or paid for by NHS mental health service providers in England, Scotland, and Wales for adult common mental health problems and to compare current procurement practices with findings reported in 2015. <strong>Methods:</strong> Freedom of Information requests were submitted to all NHS mental health trusts in England and all health boards in Scotland and Wales. Responses were collated and screened to provide an updated and extended record of which technologies are reportedly procured or paid for by services. <strong>Results:</strong> In total, 19 different DMHIs were identified as being procured across mental health service providers for adult common mental health problems at the time of data collection. This demonstrates a substantial reduction in the number of technologies being adopted into practice compared to the 48 reported in England in 2015. The findings reveal several key insights, including that only 2 technologies have remained in use for a decade, and they shed light on the types of technologies being selected and the variations in procurement practices among the 3 national health services. <strong>Conclusions:</strong> Despite the expansion of the digital mental health marketplace, the number of DMHIs formally procured by NHS mental health services has markedly decreased over the past decade. This consolidation may reflect increased selectivity and the adoption of higher-quality products, driven by strengthened regulatory oversight, evidence standards, and national guidance. Although these developments may enhance safety and quality assurance, they also raise important questions about innovation, market sustainability, and equitable access to digital mental health care. Ongoing monitoring of procurement practices is needed to inform policy, service design, and the future development of DMHIs.
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Generative AI–Assisted Microlearning for Erectile Dysfunction Myth Reduction: Single-Center Pre–Post Quasi-Experimental Study

Background: Erectile dysfunction (ED) is strongly influenced by persistent misconceptions that delay help-seeking and limit engagement with effective care. Patient-centered digital strategies, including generative artificial intelligence (AI) microlearning, may improve sexual-health knowledge; however, real-world evidence in urological practice remains sparse. Objective: This study aimed to evaluate whether a clinician-supervised generative AI microlearning video improves ED-related knowledge in adult men attending routine outpatient care. Methods: This single-center pre–post quasi-experimental study included 200 adult men in a university urology clinic. Participants completed an 8-item ED myth questionnaire immediately before and after watching a 3-minute educational video. The narration script was drafted using a large language model (ChatGPT) and iteratively reviewed by urologists for accuracy and cultural appropriateness. The primary outcome was the within-participant change in total correct responses (0‐8). Subgroup analyses assessed effects across age (<40 years vs ≥40 years), education level, and self-reported ED. Paired analyses and multivariable logistic regression were used (α=.05). Results: All participants completed the intervention (mean age 44.0, SD 11.6 years). Total mean correct responses increased from 3.77 to 6.56 (mean difference 2.79; <.001), indicating a large effect (Cohen =1.52). Knowledge gains were consistent across subgroups, with greater improvements among those with lower education. Self-reported ED was independently associated with lower odds of achieving ≥2-point improvement (odds ratio 0.46, 95% CI 0.26‐0.81; =.01). No adverse events or technical difficulties occurred. Conclusions: A brief clinician-supervised generative AI microlearning video was associated with substantial short-term improvements in ED myth–related knowledge in routine outpatient care. AI-assisted microlearning may represent a scalable adjunct to patient education during urological consultations. Future studies should evaluate long-term retention and behavioral outcomes.