Inspire Student Journal Autumn 2023

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to antibiotics but is also more cost-effective and should thereforebe considered as a gold-standard treatment moving forward. Theincreasing antibiotic non-susceptibility and resistance poses a hugeproblem for the NHS in treating infections, yet FMT is not currentlybeing utilised enough to stop rCDI due to failure of antibiotics. Thereare concerns with FMT’s safety due to the invasive nature of deliverybut with the development of the capsule delivery this could helpreduce the number of adverse effects and improve patient experience.There should also be further research conducted into understandingFMT and the relationship between donor and recipient to maximisesuccess rate and begin to standardise the therapy.Copyright This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 International License.To view a copy of the license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode. The copyright of all articles belongsto the author(s), and a citation should be made when any article isquoted, used or referred to in another work. All articles included inthe INSPIRE Student Health Sciences Research Journal are writtenand reviewed by students, and the Editorial Board is composed ofstudents. Thus, this journal has been created for educational purposesand all content is available for reuse by the authors in other formats,including peer-reviewed journals.20.21.22.23.Du C, Luo Y, Walsh S, Grinspan A. Oral fecal microbiota transplant capsulesare safe and effective for recurrent Clostridioides difficile infection. J ClinGastroenterol. 2021; 55:300–8.Bibbò S, Settanni CR, Porcari S, Bocchino E, Ianiro G, Cammarota G, et al.Fecal microbiota transplantation: screening and selection to choose theoptimal donor. J Clin Med. 2020; 9:1757.Wilson BC, Vatanen T, Cutfield WS, O'Sullivan JM. The super-donor phenomenonin fecal microbiota transplantation. Front Cell Infect Microbiol. 2019;9:00002.Li SS, Zhu A, Benes V, Costea PI, Hercog R, Hildebrand F, et al. Durable coexistenceof donor and recipient strains after fecal microbiota transplantation.Science. 2016; 352:586–9.Niamh PrattI’m Niamh and I study medicine at PeninsulaMedical School in Plymouth. I have a passionfor microbiome research and antimicrobialresistance so this research put two of myfavourite topics together. I look forward toone day being a part of delivering these newtreatments to patients contributing to the fightagainst antimicrobial resistance.References1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.16.17.18.19.Vedantam G, Clark A, Chu M, McQuade R, Mallozzi M, Viswanathan VK.Clostridium difficile infection. Gut Microbes. 2012; 3:121–34.Rineh A, Kelso MJ, Vatansever F, Tegos GP, Hamblin MR. Clostridium difficileinfection: molecular pathogenesis and novel therapeutics. Expert Rev AntiInfect Ther. 2014; 12:131–50.Schäffler H, Breitrück A. Clostridium difficile – from colonization to infection.Front Microbiol. 2018; 9:00646.Public Health England. Inclusion criteria for reporting C. difficile infectionto the surveillance system. 2014 https://www.gov.uk/government/publications/clostridium-difficile-infection-criteria-for-reporting.Accessed: 9February 2023Office for Health Improvement and Disparities. Public health profiles. 2023https://fingertips.phe.org.uk/search/c%20diff. Accessed: 9 February 2023Fu Y, Luo Y, Grinspan AM. Epidemiology of community-acquired and recurrentClostridioides difficile infection. Therap Adv in Gastroenterol. 2021;14:175628482110162.National Institute for Health and Care Excellence. Clostridioides difficileinfection: antimicrobial prescribing (NG199). 2021 https://www.nice.org.uk/guidance/ng199/chapter/recommendations#choice-of-antibiotic.Accessed: 9 February 2023Sholeh M, Krutova M, Forouzesh M, Mironov S et al. Antimicrobial resistancein Clostridioides (clostridium) difficile derived from humans: a systematicreview and meta-analysis. Antimicrob Resist Infect Control. 2020; 9:158.Dilnessa T, Getaneh A, Hailu W, Moges F, Gelaw B. Prevalence and antimicrobialresistance pattern of clostridium difficile among hospitalizeddiarrheal patients: a systematic review and meta-analysis. PLOS ONE. 2022;17:0262597.Nabal Díaz SG, Algara Robles O, García-Lechuz Moya JM. New definitions ofsusceptibility categories EUCAST 2019: Clinic application. Revista Españolade Quimioterapia. 2022; 35:84–8.Darkoh C, Keita K, Odo C, Oyaro M et al. Emergence of clinical Clostridioidesdifficile isolates with decreased susceptibility to vancomycin. Clin Infect Dis.2021; 74:120–6.Song JH, Kim YS. Recurrent Clostridium difficile infection: risk factors, treatment,and prevention. Gut Liver. 2019; 13:16–24.National Institute for Health and Care Excellence. Faecal microbiotatransplant for recurrent Clostridium difficile infection (IPG485). 2014 https://www.nice.org.uk/guidance/ipg485/chapter/1-Recommendations. Accessed:9 February 2023Gupta S, Allen-Vercoe E, Petrof EO. Fecal microbiota transplantation: inperspective. Therap Adv Gastorenterol. 2016; 9:229–39.van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM,et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. NEngl J Med. 2013; 368:407–15.Abdali ZI, Roberts TE, Barton P, Hawkey PM. Economic evaluation of faecalmicrobiota transplantation compared to antibiotics for the treatment of recurrentClostridioides difficile infection. eClinicalMedicine. 2020; 24:100420.Halaweish HF, Boatman S, Staley C. Encapsulated fecal microbiota transplantation:development, efficacy, and clinical application. Front Cell InfectMicrobiol. 2022; 12:826114.Ramai D, Zakhia K, Fields PJ, Ofosu A, Patel G, Shahnazarian V, et al. Fecal microbiotatransplantation (FMT) with colonoscopy is superior to enema andnasogastric tube while comparable to capsule for the treatment of recurrentClostridioides difficile infection: a systematic review and meta-analysis.Dig Dis Sci. 2020; 66:369–80.Wang S, Xu M, Wang W, Cao X, Piao M, Khan S, et al. Systematic review:adverse events of fecal microbiota transplantation. PLoS ONE. 2016;11:0161174.Inspire Student Health Sciences Research Journal | Autumn 202316
ReviewMEDICINEGuidance controversy may impactindividuals with chronic painLucy CounsellYear 2, Medicine, Plymouth University Peninsula Medical SchoolEmail: lucymay.counsell@googlemail.comAbstractChronic pain affects around 20% of UK adults, impacting individualssignificantly, leading to disability, depression and adverse socialconsequences, with many unable to work.This article looks at the recently published NICE guidelines,including the Chronic Primary and Secondary Pain (CPP and CSP)categorisation, and the evidence based used in their development.The guidelines are a step in the right direction, with the potentialto raise awareness of the condition, encourage consistency intreatment and shared decision-making and ultimately improve thequality of life of people who have often previously felt neglectedby the healthcare system. However, their publication has not beenwithout controversy. This includes the clear shift away from initiatingpainkillers, particularly opioids, with anti-depressants being theonly pharmacological treatment recommended, along with nonpharmacologicaltreatments such as acupuncture. Another concernis that the distinction between CPP and CSP has not been widelyimplemented into clinical practice which may limit the effectivenessof the guidelines. Creating such guidelines that attempt to generaliseacross a vast variety of conditions that can be highly individual wasalways going to be a challenge. However, drawing upon a broaderevidence base to mitigate the current lack of large-scale clinical trialscould have addressed some of the controversies.AbbreviationsCBT – cognitive behavioural therapyFOPM – Faculty of pain medicineGPs – General PractitionersNICE – National institute for health care excellenceTENs – Transcutaneous electrical nerve stimulationKey termsPain – unpleasant sensory and emotional experience associatedwith actual or potential tissue damage or described in terms of suchdamage. 1Chronic pain (CP) – pain characterised by significant emotionaldistress or functional disability 2 that persists or reoccurs for morethan three months. 3Chronic Primary Pain (CPP) – chronic pain with no underlyingcondition that adequately accounts for the pain or impact. 3Chronic Secondary Pain (CSP) – caused by an underlying conditionsuch as osteoarthritis, rheumatoid arthritis and endometriosis. 3The National Institute for Health and Care Excellence (NICE)released the first guidelines for the management of chronicprimary pain on 7 April 2021.This article describes CPP from a medical perspective in the contextof the recently published NICE guidelines. It draws upon freelyaccessible studies referenced in the guidance along with systematicreviews highlighted by commentators in their response to theguideline’s release.Around 20% of UK adults suffer from CP, 1, 4 which is likely to increasewith an ageing population. 5 The new guidelines categorise CP intoCSP and CPP3 both impacting individuals significantly, leading todisability, 2 depression, 4,6 adverse social consequences 6 and sleepdisturbances 4 with many unable to work. 1,6 Creating clinical guidelinescan improve not only the quality of life but the consistency of carefor people who often feel neglected by the healthcare system, 7 withindividuals referring to their CP as an invisible illness. 6The guideline’s key aim 3 was to focus on person-centred collaborativecare and shared decision making for those aged 16 and above. Thisincludes understanding the contributing patient-related factorsof the pain as well other aspects that may influence it, includingsubstance misuse, housing and employment. A consequence of theguidelines was a shift away from the routine use of opioids, 1 nonsteroidanti-inflammatory (NSAIDs), anti-epileptic drugs and a shifttowards anti-depressants. 3 The guidelines recommended other nonpharmacologicalapproaches such as exercise, CBT and acupuncturebut did not encourage other methods such as TENs machines. 3Shared-decision making has become a widely used practice in whichpatients and clinicians share information and opinions to reachInspire Student Health Sciences Research Journal | Autumn 202317
Page 2 and 3: Hi! Welcome to the Autumn 2023 issu
Page 4 and 5: ObituaryProfessor Jo TarrThe GW4 IN
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Page 44 and 45: InterviewDENTISTRYDr Wayne Nishio A
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