Patrice Carter

Objective: In the UK, the incidence of paediatric-onset ulcerative colitis (UC) is rising. UC is incurable, thus paediatric patients will require transfer to adult healthcare services. Effective transition is critical for continuity of good care while optimising treatment outcomes; however, transitional care currently varies across the UK. We aimed to develop UK consensus recommendations to facilitate optimal management of children and young people with moderately to severely active UC transitioning from paediatric to adult care. Design/Method: A modified Delphi, following the ACcurate COnsensus Reporting Document for Delphi research was conducted. Current clinical guidelines, treatment and transition pathways, pathway implementation and limitations were evaluated. A panel, comprising paediatric and adult gastroenterologists, plus paediatric gastroenterology specialist nurses, most with over 15 years of individual experience managing UC, participated in two anonymous online surveys and an online consensus conference to develop recommendations. Results: The Delphi study identified key areas for improvement, including the need for early preparation, tailored implementation and the integration of digital health resources. Consensus (agreement ≥75%) was achieved on the importance of structured transition pathways, developmentally appropriate guidance, joint clinics and the various healthcare professionals who should be involved in the transition process. The study highlighted potential barriers to the use of advanced therapies and the need for updated management guidelines. Conclusion: The consensus recommendations developed provide a framework for optimising the transition pathway for children and young people with UC moving to adult care, to improve outcomes and ensure continuity of care during this critical period.

Advancements in antiretroviral therapy (ART) have improved prognoses among people with HIV (UNAIDS, 2018; Vitoria et al., 2019); however, people with HIV still experience discrimination and HIV-rel...

Uncontrolled hypertension (ucHTN) and treatment-resistant hypertension (trHTN) are associated with a substantial increase in the risk of cardiorenal events and mortality compared with well-controlled hypertension. Treatment strategies that can optimise blood pressure management are urgently needed to improve health outcomes in ucHTN and trHTN populations; health economic models play a key role in assessing the economic value of new and existing treatments and supporting resource allocation. This systematic literature review critically assesses the construct and quality of existing health economic modelling used in the evaluation of management approaches for ucHTN and trHTN, to inform the design and development of future health economic models. This review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. Searches were conducted on Medline, Embase, EconLit, the Cost-effectiveness Analysis and the International HTA database. Searches were run from inception to May 2024 and re-run in February 2026. Although no date limits were placed on the electronic searches, a limit of 2005 and onwards was applied during study selection. Economic model studies were included if they assessed pharmacological or renal denervation (RDN) interventions for treatment of either ucHTN or trHTN in adult populations. Study eligibility, data extraction and quality assessment using the Drummond checklist were conducted independently by two reviewers. After deduplication, a total of 2754 records were identified. Of these, 2556 did not meet the eligibility criteria after title and abstract screening; 198 full texts were reassessed for eligibility. A total of 21 modelling studies were included: 16 economic evaluations (14 cost-utility analyses, 1 cost-effectiveness analysis and 1 cost-minimization analysis), 4 burden-of-illness studies and 1 budget impact analysis. The majority of studies focused on people with ucHTN and employed a healthcare system perspective. Economic evaluations were based on treatment effects on systolic blood pressure estimated from clinical trials. Several models predicted long-term cardiorenal events and mortality on the basis of published, validated risk equations; however, these risk equations were not developed in populations with ucHTN or trHTN. Although models were generally assessed to be of good quality, models incorporated health-related quality of life and cost data from controlled hypertensive or non-hypertensive populations, rather than those with ucHTN and trHTN. A range of economic models were identified and considered structurally relevant. These models demonstrated that treatment related improvements in blood pressure were cost-effective and robust in scenario analysis. However, important model limitations include their lack of use of population-specific health-related quality-of-life data and risk equations which may result in underestimation of treatment cost effectiveness. To reduce uncertainty and support improved economic modelling that can accurately contextualize emerging therapies for ucHTN and trHTN, future economic model analyses in ucHTN and trHTN need appropriate population health and cost data for these underserved populations.

Aims: There is current apprehension among some clinicians and conflicting evidence regarding ocular complications in relation to Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs). We aimed to generate multi‐disciplinary, expert‐led consensus recommendations relating to ocular complications to facilitate optimum prescribing of GLP‐1RAs. Materials and Methods: A modified Delphi was conducted following the ACcurate COnsensus Reporting Document (ACCORD) for Delphi research. A structured literature review informed an anonymous online Delphi questionnaire, followed by a virtual consensus meeting. Eligible participants included ophthalmologists, diabetologists, and obesity specialists practising in Europe. Results: Responses from 58 participants across 17 countries were analysed. Respondents agreed that diabetic retinopathy (DR) worsening events are primarily linked to rapid blood glucose‐lowering, rather than a direct drug effect. The benefits of GLP‐1RAs were deemed to outweigh potential ocular risks and should not limit access to these medicines. Prescribers should ensure that people with diabetes are screened for diabetic retinopathy before commencing GLP‐1RAs, particularly in high‐risk populations (>10 years duration and/or poor glucose control, (haemoglobin A1c [HbA1c] >10% or 86 mmol/mol)). When prescribing GLP‐1RA to those with sight loss in one eye and/or prior history of non‐arteritic anterior ischaemic optic neuropathy (NAION), the risk of ocular complications should be discussed. The Delphi study highlighted current uncertainty in the evidence, with some topics on the relationship between GLP‐1RAs and ocular complications reaching limited consensus. Conclusions: Further research is needed into the direct effects of GLP‐1RAs on the retina and ocular complications. New evidence should be disseminated rapidly to optimise outcomes and safety.

Background: Direct oral anticoagulants for the treatment of venous thromboembolism are supported by robust clinical trial evidence. Despite published guidance, general practitioners are faced with increasingly complex decisions and implementation remains sub-optimal in certain real-world scenarios. Methods: A two stage formal consensus exercise was performed to formulate consensus statements and a summary guide, facilitating optimal management of direct oral anticoagulants in venous thromboembolism patients by generalist physicians across Europe. An online questionnaire distributed to a broad panel (Phase 1), followed by a virtual panel discussion by an expert group (Phase 2) were conducted. Phase 1 statements covered nine management domains, and were developed via a literature review and expert steering committee. Participants rated statements by their level of agreement. Phase 1 responses were collated and analysed prior to discussion and iterative refinement in Phase 2. Results: In total 56 participants from across Europe responded to Phase 1. The majority had experience working as general practitioners. Consensus indicated that direct oral anticoagulants are the treatment of choice for managing patients with venous thromboembolism, at initiation and for extended treatment, with a review at three to six months to re-assess treatment effect and risk profile. Direct oral anticoagulant choice should be based on individual patient factors and include shared treatment choice between clinicians and patients; the only sub-group of patients requiring specific guidance are those with cancer. Conclusion: Results demonstrate an appreciation of best practices, but highlight challenges in clinical practice. The patient pathway and consensus recommendations provided, aim to highlight key considerations for general practice decision making, and aid optimal venous thromboembolism treatment.

Background: This feasibility study has the primary aim of capturing and comparing participant expectations and experiences of using a formal consensus method (FCM) and to explore whether these views change following participation within a guideline committee where FCM are used. Methods: Twelve healthcare committee members and associated technical team members participated in semi-structured qualitative interviews before and after using FCM during guideline committee meetings. Interviews also focused on past experiences and expectations of informal consensus methods. Results: Participants said formal consensus included a greater range of evidence. They described positive reactions and found it a useful way to encourage involvement by balancing group power dynamics. Group discussion time was identified as important to clarify ideas, supported by good group chairing. However, participants reported that undertaking FCM required additional resources and suggested targeting its use for low quality evidence, limited committee expertise, or where the evidence is controversial. Conclusions: FCM is an acceptable alternative to informal consensus methods that has qualities specifically helpful to healthcare guidelines such as encouraging participation, inclusivity of a broad range of evidence, and managing group dynamics. More research is required to better understand when using formal consensus is most appropriate and effective.

During any emerging infectious disease outbreak, people with symptoms of the illness are asked to report to a health service immediately to facilitate contact tracing. Several factors may influence a person's willingness to report symptoms and their ability to access healthcare services. Understanding these factors has become urgent during the COVID-19 pandemic. To determine which factors influence symptom reporting during an emerging infectious disease outbreak, we conducted a rapid review of the evidence. Studies included in the review were based on primary research, published in a peer-reviewed journal, written in English, included factors associated with symptom reporting or accessing healthcare, and were related to a major public health incident involving an infectious disease outbreak. Five themes were identified as facilitators of symptom reporting or accessing healthcare: accurate and informative communication about the disease and the need to seek help, symptom severity, concern about disease exposure, ease of access to healthcare facilities, and relationship with the healthcare provider. Seven themes were identified as barriers to symptom reporting or accessing healthcare: lack of knowledge of the disease and its treatment, fear of the disease and fear of subsequent treatments or requirements, stigmatization attached to having a disease, invasion of privacy, low concern about symptoms, economic consequences of disease diagnosis, and challenges related to attending a healthcare facility. For contract tracing services to be effective, members of the public need to have the capability, opportunity, and motivation to use them. The themes identified should be used to evaluate information provided to the public to ensure as many people as possible with relevant symptoms report them to a healthcare provider.

Background: Recommendations within guidelines are developed by synthesising the best available evidence; when limited evidence is identified recommendations are generally based on informal consensus. However, there are potential biases in group decision making, and formal consensus methods may help reduce these. Methods: We conducted a case study using formal consensus, to develop one set of recommendations within the Neonatal Parenteral Nutrition guideline being produced for the National Institute for Health and Care Excellence. Statements were generated through identification of published guidelines on several topics relating to neonatal parenteral nutrition. Ten high quality guidelines were included, and 28 statements were generated; these statements were rated by the committee via two rounds of voting. The statements which resulted in agreement were then used to develop the recommendations. Results: The approach was systematic and provided transparency. Additionally, a number of lessons were learnt; including the value of selecting the appropriate topic, giving adequate time to the process, and ensuring methodologies are understood by the committee for their value and relevance. Conclusion: Formal consensus is a valuable option for use within guideline development when specific criteria are met. The approach provides transparent methodology, ensuring clarity on how recommendations are developed.

Introduction: During any emerging infectious disease outbreak, people with symptoms of the illness are often asked to report their symptoms to the health service in a timely manner, to facilitate contact tracing. Numerous factors may influence an individual’s willingness to report these symptoms. Understanding these factors has become urgent during the COVID-19 pandemic. Objective: To determine which factors influence symptom reporting during an emerging infectious disease outbreak. Methods: We conducted a rapid review of the evidence. We included papers based on primary research; published in a peer-reviewed journal; written in English; included factors associated with symptom reporting or accessing healthcare; and related to a major public health incident involving an infectious disease outbreak. Main results: Five themes were identified as facilitators of symptom reporting or accessing healthcare: accurate and informative communication; symptom severity; concern about exposure; ease of access; and relationship with the healthcare provider. Seven themes were identified as barriers of symptom reporting or accessing healthcare: lack of knowledge; fear; stigmatization; invasion of privacy; low concern about symptoms; economics; and practicalities of attending a healthcare facility. Discussion & Conclusion: If contract tracing services are to be effective, members of the public need to have the capability, opportunity and motivation to use them. The themes identified should be used to evaluate the information provided to the public about such a service, the routes of access, and the underlying policies relating to the service, in order to ensure that as many people as possible with relevant symptoms will make contact.