Ben Carter

King's College London | KCL · Biostatistics and Health Informatics

Background The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed to establish the prevalence of frailty in patients...

Background Older people are the largest group admitted to hospital with serious injuries. Many older people are living with frailty, a risk factor for poor recovery. We aimed to examine the effect of preinjury frailty on outcomes. Methods In this multicentre observational study (FiTR 1), we extracted prospectively collected data from all 23 adult...

Aim To assess the association between problematic smartphone usage and anxiety and depression in adolescents. Methods A cross‐sectional study in five schools in the UK were included. The primary outcome was moderate anxiety (GAD‐7 ≥10) symptoms and secondary outcomes were moderate depression symptoms (PHQ‐9 ≥10) and insomnia. Problematic smartphon...

Background Despite the availability of evidence-based treatments for anorexia nervosa (AN), remission rates are moderate, and mortality is high. Olanzapine is used as adjunct therapy for AN in case of insufficient response to first-line treatments, even though the evidence is limited. Its effect on eating disorder (ED) psychopathology, its efficacy...

Importance Toddler screen time has been associated with poorer sleep and differences in attention. Understanding the causal impact of screen time on early development is of the highest importance. Objective To test (1) the feasibility of the 7-week parent-administered screen time intervention (PASTI) in toddlers (aged 16-30 months) who have screen...

Background Depression and anxiety are increasingly prevalent in adolescents. The Brief Educational Workshops in Secondary Schools Trial investigated the effectiveness of a brief self-referral stress workshop programme for sixth-form students aged 16–18 years old. Objective This study conducted a secondary analysis on the outcomes of participants w...

Introduction Over 3000 infants suffer a brain injury around the time of birth every year in England. Although these injuries can have important implications for children and their families, our understanding of how these injuries affect children’s lives is limited. Methods and analysis The aim of the CHERuB study (Childhood Health and Educational...

Background Depression and anxiety are common in adolescents and have increased over the last decade. During that period, smartphone usage has become ubiquitous. Objectives The study aim was to assess the association between problematic smartphone usage (PSU) and anxiety. Methods Using a prospective mixed methods cohort study design, students aged...

We will develop a novel approach to drug repurposing, utilising Natural Language Processing (NLP) and Literature Based Discovery (LBD) techniques. This will present a simplified, accessible drug repurposing pipeline using Word2Vec embeddings trained on PubMed abstracts to identify potential new medications to be repurposed. We present this approach...

Men are less likely to seek help for their mental health than women, but less is known about the specific patterns of help-seeking in adolescent boys and young men. This is concerning as adolescent boys and young men have high suicide rates but a low take-up of services. It is therefore of particular importance that the access needs of this group a...

Background Despite the availability of evidence-based treatments for anorexia nervosa (AN), remission rates are moderate, and mortality is high. Olanzapine is used for treatment-resistant AN even though the evidence is limited. Its effect on eating disorder (ED) psychopathology, its efficacy and tolerability, and its acceptability and adherence rat...

Background Frailty is a clinical state that increases susceptibility to minor stressor events. The risk of frailty is higher in chronic conditions, such as Chronic Obstructive Pulmonary Disease (COPD). Recent studies on COPD have shown that patients living with frailty have an increased risk of mortality. The presence of cardiovascular diseases or...

Objectives The Social media, Smartphone use and Self-Harm (3S-YP) study is a prospective observational cohort study to investigate the mechanisms underpinning associations between social media and smartphone use and self-harm in a clinical youth sample. We present here a comprehensive description of the cohort from baseline data and an overview of...

Hypoalbuminemia associates with poor acute ischemic stroke (AIS) outcomes. We hypothesised a non-linear relationship and aimed to systematically assess this association using prospective stroke data from the Norfolk and Norwich Stroke and TIA Register. Consecutive AIS patients aged ≥40 years admitted December 2003–December 2016 were included. Outco...

Background The prevalence of frailty is increasing as the global population ages. The relationship between frailty and poor outcomes and the utility of frailty indices to assess frailty is well documented. Although secondary spontaneous pneumothorax (SSP) is common, there are no data evaluating the relationship between frailty and outcomes in this...

Objective To evaluate the effectiveness of a system based psychological first aid (PFA) training programme for emergency medical first responders in China. Design Parallel-group, assessor-blinded, cluster randomised controlled trial. Setting 42 clusters of health workers from various health facilities in China. Participants 1399 health workers w...

Background The Brief Educational Workshops in Secondary Schools Trial (BESST) is an England-wide school-based cluster randomised controlled trial assessing the clinical and cost-effectiveness of an open-access psychological workshop programme (DISCOVER) for 16–18-year-olds. This baseline paper describes the self-referral and other recruitment proce...

Background Attention Deficit/Hyperactivity Disorder (ADHD), if severe, is usually treated with stimulant or non-stimulant medication. However, users prefer non-drug treatments due to side effects. Alternative non-medication treatments have so far only shown modest effects. External trigeminal nerve stimulation (eTNS) is a minimal risk, non-invasive...

Purpose Screening for frailty in people admitted with emergency surgical pathology can initiate timely referrals to enhanced perioperative services such as intensive care and geriatric medicine. However, there has been little research exploring surgical healthcare professionals' opinions to frailty assessment, or accuracy in identification. This st...

Background There are currently no data on the relationship between frailty and mortality in pleural disease. Understanding the relationship between frailty and outcomes is increasingly important for clinicians to guide decisions regarding investigation and management. This study aims to explore the relationship between all-cause mortality and frail...

Background Liver disease is within the top five causes of premature death in adults. Deaths caused by complications of cirrhosis continue to rise, whilst deaths related to other non-liver disease areas are declining. Portal hypertension is the primary sequelae of cirrhosis and is associated with the development of variceal haemorrhage, ascites, hep...

Around 25% of patients with inflammatory bowel disease (IBD) have depressive symptoms, yet antidepressants have been poorly studied in IBD. We systematically searched IBD studies testing antidepressants in four databases. Outcomes were depressive symptoms, anxiety, IBD disease activity, quality of life (QoL) and adverse events. For randomized contr...

Background Frailty is a clinical state that increases susceptibility to minor stressor events. The risk of frailty is higher in chronic conditions, such as Chronic Obstructive Pulmonary Disease (COPD). Recent studies on COPD have shown that patients living with frailty have an increased risk of mortality. The presence of cardiovascular diseases or...

Introduction Age is the greatest risk factor for Alzheimer's disease (AD). A limitation of randomized control trials in AD is a lack of specificity in the age ranges of participants who are enrolled in studies of disease‐modifying therapies. We aimed to apply Emax (i.e., maximum effect) modeling as a novel approach to identity ideal treatment windo...

Offenders with personality disorder cause disproportionate harm to society and pose significant challenges for those responsible for their care and rehabilitation. Personality disorders are heterogeneous in terms of symptoms, as well as their pathways to offending behaviour. Thus, there is limited evidence regarding effective interventions. One sol...

Background The burden of psychiatric symptoms in Parkinson's disease includes depression, anxiety, apathy, psychosis, and impulse control disorders. However, the relationship between psychiatric comorbidities and subsequent prognosis and neurological outcomes is not yet well understood. In this systematic review and meta-analysis, in individuals wi...

Chronic obstructive pulmonary disease (COPD), the sixth leading cause of death in the United States in 2022 and the third leading cause of death in England and Wales in 2022, is associated with high symptom burden, particularly dyspnoea. Frailty is a complex clinical syndrome associated with an increased vulnerability to adverse health outcomes. Th...

Introduction Antipsychotics are routinely prescribed off‐label for anorexia nervosa (AN) despite limited evidence. This article presents a protocol of a study aiming to assess the feasibility of a future definitive trial on olanzapine in young people with AN. Methods and analysis In an open‐label, one‐armed feasibility study, 55 patients with AN o...

Introduction COVID-19 restrictions created barriers to “business as usual” in healthcare but also opened the door to innovation driven by necessity. This manuscript (1) describes how ADVANCE, an in-person group perpetrator program to reduce intimate partner violence (IPV) against female (ex)partners by men in substance use treatment, was adapted fo...

Background Adolescence represents a distinctive phase of development, and variables linked to this developmental period could affect the efficiency of prevention and treatment for depression and anxiety, as well as the long-term prognosis. The objectives of this study were to investigate the long-term effectiveness of psychosocial interventions for...

Background Many clinical trials of disease‐modifying therapies which seek to delay or prevent Alzheimer’s disease (AD) currently exist. However, a limitation of these trials is the absence of considering the earliest age groups at which decline in cognition can be detected to guide optimal participant recruitment. Previous work has shown that in pe...

Background Liver disease is within the top five causes of premature death in adults. Deaths caused by complications of cirrhosis continue to rise, while deaths related to other non-liver disease areas are declining. Portal hypertension, the primary sequalae of cirrhosis and is associated with the development of variceal haemorrhage, ascites, hepati...

Objectives/Aims A variety of psychiatric syndromes are associated with NMDAR autoantibodies; however, their clinical relevance when only present in the serum is unclear. We explored whether patients with CSF NMDAR autoantibodies could be distinguished from patients with serum-only NMDAR autoantibodies. Methods The electronic databases MEDLINE, EMB...

Introduction: Low serum albumin levels have been associated with poor acute ischemic stroke (AIS) outcomes. We hypothesised this relationship may be non-linear and aimed to assess it in a large cohort of unselected AIS patients with long term follow-up. Method: This retrospective cohort study included patients from the Norfolk and Norwich Stroke an...

Background Approximately 15% of pregnant women experience anxiety disorders. Effective treatments exist but their acceptability during pregnancy, particularly exposure therapy, is not known. Aims To understand patient and therapist experiences of time-intensive and weekly exposure-based therapy for anxiety disorders delivered during pregnancy. Tri...

Untreated mental health problems continue from childhood and adolescence into adulthood, meaning accessible early intervention is essential to reduce long-term negative outcomes. However, there is often a reluctance to engage in mental health treatment, with considerable evidence that young men are less likely to seek help than young women. This or...

Introduction In psychedelic therapy, mystical as well as challenging experience may influence therapeutic outcome. However, predictors of such experience have not been sufficiently established. Determining predictors of their intensity is, therefore, potentially beneficial in targeting psilocybin therapy for depression. Methods In a post hoc data...

Frailty increases vulnerability to adverse outcomes. Long-term conditions increase the risk of frailty. We searched PubMed, Web of Science, The Cochrane Library, EMBASE from inception to March 2022. Quality assessment was conducted using the NOS. Data was analysed in a pooled a random-effects meta-analysis. Our primary outcome was the impact of fra...

Background Worldwide, opioid use causes more than 100,000 overdose deaths annually. Naloxone has proven efficacy in reversing opioid overdoses and is approved as an emergency antidote to opioid overdose. Take home naloxone (THN) programmes have been introduced to provide ‘community members’, who are likely to observe opioid overdoses, with naloxone...

Background: Frailty is a syndrome characterised by increased vulnerability to negative outcomes. Interstitial lung disease (ILD), asthma, and pleural disease are leading causes of morbidity and mortality. We aimed to investigate the prevalence and impact of frailty in adult patients with these diseases. Methods: We conducted a systematic review...

Introduction: Frailty is common in patients with atherosclerotic disease and is associated with substantially increased morbidity, mortality and significant economic and resource implications. Major limb amputation (MLA) secondary to critical limb threatening ischaemia (CLTI) is also associated with high mortality rates. This study aims to examine...

The existing ‘gold standard’ assessments of depression suffer various issues, which include the evaluation of constructs extraneous to the core symptoms of the illness, and low sensitivity to change over time. Members of our team developed a new, simple visual analogue scale that aims to address these issues (M3VAS). Initial validation of the scale...

Background : People living with dementia often experience a myriad of behavioural and psychological symptoms of dementia (BPSD). Agitation is highly common within BPSD, negatively impacting their health, accelerating dementia progression, and is distressing both to patients and those caring for them. It also costs society a great deal, with increas...

Introduction The role of orthostatic hypertension (OHT) in cardiovascular disease (CVD) and mortality is unclear. We aimed to determine if this association exists through a systematic review and meta-analysis. Methods Study inclusion criteria included: (i) any observational/interventional studies of participants aged ≥18 years (ii) which assessed...

Background: Quality of life (QoL) assessment forms an integral part of modern cancer care and research. The aim of this study is to determine patients' preferences and willingness to complete commonly used head-and-neck cancer (HNC) QoL questionnaires (QLQs) in routine follow-up clinics. Methods: This is a randomised control trial of 583 subject...

Background Around 10% of school-aged children experience mental health difficulties. Many more are ‘vulnerable’: experiencing emotional and/or behavioural problems reaching clinical levels, and thus at greatest risk of future mental illness. The trial aim is to evaluate the effectiveness of the CUES for schools programme in reducing emotional and b...

Background: Half of those undergoing major lower limb amputation for peripheral arterial disease die within 1 year. Advance care planning reduces days in hospital and increases the chance of dying in a preferred place. Aim: To investigate the prevalence and content of advance care planning for people having a lower limb amputation due to acute o...

Background Peer support is effective in improving psychological well-being of family caregivers of people with conditions such as dementia, cancer, and brain injury. However, there are limited data on effective psychological interventions for family caregivers of people living with motor neurone disease. Our objective is to evaluate the efficacy of...

Introduction: As the population ages, frailty is becoming more common and understanding how frailty impacts on patient outcomes has become an integral part of clinical care. To date, there is no evidence available on the relationship between frailty and patient outcomes in pleural disease. In this study we explore the relationship between frailty a...

Background: Catatonia is a psychomotor syndrome that has a wide range of aetiologies. Determining whether catatonia is due to a medical or psychiatric cause is important for directing treatment but is clinically challenging. We aimed to ascertain the performance of the electroencephalogram (EEG) in determining whether catatonia has a medical or psy...

Introduction Young people are the most frequent users of social media and smartphones and there has been an increasing speculation about the potential negative impacts of their use on mental health. This has coincided with a sharp increase in the levels of self-harm in young people. To date, studies researching this potential association are predom...

Background Depression symptoms are thought to be associated with lower educational attainment, but patterns of change in attainment among those who receive a clinical diagnosis of depression at any point during childhood and adolescence remain unclear. Methods We conducted a secondary analysis of an existing data linkage between a national educati...

Social media usage impacts upon the mental health and wellbeing of young people, yet there is not enough evidence to determine who is affected, how and to what extent. While it has widened and strengthened communication networks for many, the dangers posed to at-risk youth are serious. Social media data offers unique insights into the minute detail...

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder associated with increased stroke risk. Its association with stroke outcomes remains poorly understood. In this study, we aimed to compare the sex-specific SLE-associated acute stroke outcomes. Methods: Stroke hospitalisations between 2015 and 2018 from the National Inpatient S...

Introduction There is insufficient evidence on the effectiveness and cost-effectiveness of psychological interventions to enhance frontline responders’ mental health proficiency and competence in emergency settings. This paper describes the methods for the evaluation of the effectiveness and cost-effectiveness of Psychological First Aid training, t...

This systematic review is to evaluate the effectiveness and cost-effectiveness of mental health interventions delivered by frontline health care workers in disasters and public health emergencies. Six databases and trial registries were searched, and manual searches were conducted. Of the 221 studies identified, 21 were included. Meta-analyses asse...

• Background Peer support is effective in improving psychological well-being of family caregivers of people with conditions such as dementia, cancer, and brain injury. However, there are limited data on effective psychological interventions for family caregivers of people living with motor neurone disease. Our objective is to evaluate the efficacy...

Caloric restriction and vegan diets have demonstrated protective effects for diabetes, however their role in improving clinically relevant outcomes has not been summarized. Our aim was to evaluate the evidence for low-calorie diets (VLCD) and vegan diets on weight and glycemic control in the management of patients with Type 2 Diabetes. Database sea...

Anxiety and depression are increasingly prevalent in adolescents, often causing daily distress and negative long-term outcomes. Despite the significant and growing burden, less than 25% of those with probable diagnosis of anxiety and depression are receiving help in England. Significant barriers to help-seeking exist in this population, with a scar...