Orpington Hospital

BACKGROUND: Informal care givers support disabled stroke patients at home but receive little training for the caregiving role. OBJECTIVE: To evaluate the effectiveness of training care givers in reducing burden of stroke in patients and their care givers. DESIGN: A single, blind, randomised controlled trial. SETTING: Stroke rehabilitation unit. SUBJECTS: 300 stroke patients and their care givers. INTERVENTIONS: Training care givers in basic nursing and facilitation of personal care techniques. MAIN OUTCOME MEASURES: Cost to health and social services, caregiving burden, patients' and care givers' functional status (Barthel index, Frenchay activities index), psychological state (hospital anxiety and depression score), quality of life (EuroQol visual analogue scale) and patients' institutionalisation or mortality at one year. RESULTS: Patients were comparable for age (median 76 years; interquartile range 70-82 years), sex (53% men), and severity of stroke (median Barthel index 8; interquartile range 4-12). The costs of care over one year for patients whose care givers had received training were significantly lower (10,133 pounds sterling v 13,794 pounds sterling (18,087 dollars v 24,619 dollars; 15,204 euros v 20,697 euros); P = 0.001). Trained care givers experienced less caregiving burden (care giver burden score 32 v 41; P = 0.0001), anxiety (anxiety score 3 v 4; P = 0.0001) or depression (depression score 2 v 3; P = 0.0001) and had a higher quality of life (EuroQol score 80 v 70; P = 0.001). Patients' mortality, institutionalisation, and disability were not influenced by caregiver training. However, patients reported less anxiety (3 v 4.5; P < 0.0001) and depression (3 v 4; P < 0.0001) and better quality of life (65 v 60; P = 0.009) in the caregiver training group. CONCLUSION: Training care givers during patients' rehabilitation reduced costs and caregiver burden while improving psychosocial outcomes in care givers and patients at one year.

BACKGROUND AND PURPOSE: Assessment of stroke rehabilitation is complicated by the heterogeneity of patients and settings and by difficulties in disentangling effects of organization from effects of types and amounts of treatment input. METHODS: A prospective controlled study was undertaken in 245 stroke patients stratified into three groups according to prognosis and managed on a stroke rehabilitation unit (n = 124) or general medical wards (n = 121). Patients were randomly allocated to either setting 2 weeks after stroke and were comparable for baseline characteristics. RESULTS: Patients on general medical wards received more physiotherapy on average (16.2 +/- 7.2 versus 14.3 +/- 3.2 hours; P < .05) but similar amounts of occupational therapy (9.3 +/- 2.8 versus 9.5 +/- 3.2 hours) compared with stroke unit patients. More time was spent on individual rehabilitation on the stroke unit compared with general wards (P < .001). Functional abilities at discharge, destination of discharge, and length of hospital stay in patients with good prognosis were comparable in both settings. Patients with poor prognosis managed on general wards showed higher mortality (P < .05) and longer hospital stay (123.2 +/- 48.2 versus 52.3 +/- 19.8 days; P < .001), but functional abilities at discharge in survivors were comparable with those of stroke unit patients. Patients with intermediate prognosis had significantly better outcome on the stroke unit, with more patients being discharged home (75% versus 52%; P < .001), shorter average length of hospital stay (48.7 +/- 17.2 versus 104.6 +/- 28.6 days; P < .001), and better functional abilities at discharge (P < .05). CONCLUSIONS: Stroke units improve outcome and reduce hospital stay without increasing therapy time. Their effectiveness may be enhanced by patient selection.

OBJECTIVES: To evaluate the effectiveness of an enhanced balance training program in improving mobility and well-being of elderly people with balance problems. DESIGN: Prospective, single-blind, randomized, controlled trial. SETTING: District general hospital. PARTICIPANTS: One hundred ninety-nine patients aged 60 and older with a Berg Balance Scale (BBS) score of less than 45. INTERVENTIONS: Six weeks enhanced balance training consisting of a series of repetitive tasks of increasing difficulty specific to functional balance. The control group received physiotherapy conforming to existing practice in elderly patients with mobility problems. MEASUREMENTS: Ten-meter timed walk test (TWT), BBS, Frenchay Activities Index (FAI), Falls Handicap Inventory (FHI), and European Quality of Life questionnaire (Euroqol) measured at 6, 12, and 24 weeks after intervention. RESULTS: The mean age +/- standard deviation of subjects was 82.7 +/- 5.6, and baseline characteristics were comparable between the groups. Both groups showed improvements in TWT (intervention: 22.5-16.5 seconds, P =.001; control: 20.5-15.8 seconds, P =.054), BBS (intervention: 33.3-42.7, P =.001; control: 33.4-42.0, P <.0001), FAI (18-21, P =.02 in both groups), FHI score (intervention: 31-17, P =.0001; control: 33-17, P =.0001) and Euroqol score (intervention: 58-65, P =.04; control: 60-65, P =.07). There were no intergroup differences at any time. More patients reported increased confidence in walking indoors (36% vs 28%; P =.04) and outdoors (27% vs 18%; P =.02) in the enhanced balance-training group. CONCLUSION: Exercise programs significantly improve balance and mobility in patients with balance problems, independent of strategy. Enhanced balance training may, in addition, improve confidence and quality of life but needs further investigation.

BACKGROUND AND PURPOSE: Patients with any type of stroke managed in organized inpatient (stroke unit) care are more likely to survive, return home, and regain independence. However, it is uncertain whether these benefits apply equally to patients with intracerebral hemorrhage and ischemic stroke. METHODS: We conducted a secondary analysis of a systematic review of controlled clinical trials comparing stroke unit care with general ward care, including only trials published after 1990 that could separately report outcomes for patients with intracerebral hemorrhage and ischemic stroke. We performed random-effects meta-analyses and tested for subgroup interactions by stroke type. RESULTS: We identified 13 trials (3570 patients) of modern stroke unit care that recruited patients with intracerebral hemorrhage and ischemic stroke, of which 8 trials provided data on 2657 patients. Stroke unit care reduced death or dependency (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.471-0.92; P=0.0009; I2=60%) with no difference in benefits for patients with intracerebral hemorrhage (RR, 0.79; 95% CI, 0.61-1.00) than patients with ischemic stroke (RR, 0.82; 95% CI, 0.70-0.97; Pinteraction=0.77). Stroke unit care reduced death (RR, 0.79; 95% CI, 0.64-0.97; P=0.02; I2=49%) to a greater extent for patients with intracerebral hemorrhage (RR, 0.73; 95% CI, 0.54-0.97) than patients with ischemic stroke (RR, 0.82; 95%, CI 0.61-1.09), but this difference was not statistically significant (Pinteraction=0.58). CONCLUSIONS: Patients with intracerebral hemorrhage seem to benefit at least as much as patients with ischemic stroke from organized inpatient (stroke unit) care.

BACKGROUND: among elderly patients, readmission in the month following hospital discharge is a frequent occurrence which involves a risk of functional decline, particularly among frail subjects. While previous studies have identified risk factors of early readmission, geriatric syndromes, as markers of frailty have not been assessed as potential predictors. OBJECTIVE: to evaluate the risk of early unplanned readmission, and to identify predictors in inpatients aged 75 and over, admitted to medical wards through emergency departments. DESIGN: prospective multi-centre study. SETTING: nine French hospitals. SUBJECTS: one thousand three hundred and six medical inpatients, aged 75 and older admitted through emergency departments (SAFES cohort). METHODS: using logistic regressions, factors associated with early unplanned re-hospitalisation (defined as first unplanned readmission in the thirty days after discharge) were identified using data from the first week of hospital index stay obtained by comprehensive geriatric assessment. RESULTS: data from a thousand out of 1,306 inpatients were analysed. Early unplanned readmission occurred in 14.2% of inpatients and was not related with sociodemographic characteristics, comorbidity burden or cognitive impairment. Pressure sores (OR = 2.05, 95% CI = 1.0-3.9), poor overall condition (OR = 2.01, 95% CI = 1.3-3.0), recent loss of ability for self-feeding (OR = 1.9, 95% CI = 1.2-2.9), prior hospitalisation during the last 3 months (OR = 1.6, 95% CI = 1.1-2.5) were found to be risk factors, while sight disorders appeared as negatively associated (OR = 0.5, 95% CI = 0.3--0.8). CONCLUSIONS: markers of frailty (poor overall condition, pressure sores, prior hospitalisation) or severe disability (for self-feeding) were the most important predictors of early readmission among elderly medical inpatients. Early identification could facilitate preventive strategies in risk group.

BACKGROUND AND PURPOSE: Shorter lengths of hospital stay in stroke units could be due to quicker functional recovery or mechanisms of expediting hospital discharge. METHODS: Stroke survivors with an intermediate prognosis at 2 weeks after stroke (n = 146) were randomized for management in a stroke rehabilitation unit or in general wards. Barthel scores were monitored at weekly intervals until hospital discharge. The duration and type of physiotherapy and occupational therapy received by patients in either setting were also recorded. The rate of change of Barthel scores, therapy input, and the duration of hospital stay were compared between the two settings. RESULTS: Neurological deficits and median initial Barthel scores were comparable between patients in the stroke unit (n = 73) and general wards (n = 68). Median discharge Barthel score of patients managed in the stroke unit was significantly higher than that of patients managed in general wards (15 versus 12). Median Barthel scores in the stroke unit group rose rapidly after 2 weeks, reaching a plateau at 6 weeks. The change in median Barthel score in patients in general wards was significantly slower, reaching a plateau at 12 weeks despite similar therapy input. There was a significant delay in discharging stroke patients in general wards (20 weeks) compared with those in the stroke unit (6 weeks). CONCLUSIONS: Functional recovery is significantly greater and more rapid in a stroke rehabilitation unit compared with general wards despite similar therapy input. These units also shorten hospital lengths of stay by expediting appropriate discharges.

BACKGROUND AND PURPOSE: We sought to evaluate the effect of setting on the rate of medical complications during stroke rehabilitation. METHODS: A study of the frequency and nature of medical complications in stroke rehabilitation was undertaken in 245 patients managed either on a stroke rehabilitation unit (n = 124) or on general medical wards (n = 121). The stroke unit setting was characterized by established protocols for prevention, early diagnosis, and management of complications (eg, aspiration, infections, thromboembolism, pressure sores, depression, stroke progression). Similar protocols did not exist on general medical wards except for thromboembolism, pressure sores, and secondary stroke prevention. RESULTS: Medical complications were documented in 147 patients (60%) and were more common in patients with severe strokes (97%). The frequency of reported complications was similar in both settings. Aspiration (33% versus 20%; P < .01) and musculoskeletal pain (38% versus 23%; P < .05) were more commonly documented on the stroke unit, whereas urinary problems (18% versus 7%; P < .01) and infections (49% versus 25%; P < .01) were more commonly seen on general medical wards. The reported frequency of deep vein thrombi, pressure sores, and stroke progression was similar in both settings. Although depression was reported equally in both settings (34% on the stroke unit versus 27% on general wards), patients on the stroke unit were more likely to be treated compared with general wards (67% versus 36%; P < .05). CONCLUSIONS: The study shows that inpatient stroke rehabilitation is a medically active service. Management on specialist units is associated with earlier detection and management of stroke-related problems and prevention of potentially life-threatening complications.

OBJECTIVE: To determine the safety and clinical effectiveness of Nd-YAG laser ablation of the endometrium in the treatment of menorrhagia. DESIGN: A prospective 3-year observational multi-centre study. SETTING: Gynaecological units in the UK and USA with special interest in endoscopic laser surgery. SUBJECTS: 859 women with menorrhagia resistant to medical therapy. MAIN OUTCOME MEASURE: Duration of laser ablation, intra- and post-operative complications, amenorrhoea rate, oligomenorrhoea rate, and woman's subjective assessment of treatment. RESULTS: No major complications occurred in 859 treatments. Four (0.4%) cases of transient fluid overload, 4 (0.4%) of infection, and 3 (0.3%) of uterine perforation occurred. Each of the perforations occurred during insertion of the rigid instruments and none was produced by the laser. There were no major haemorrhages, no blood transfusions were needed, and no woman required a laparotomy. The mean duration of the laser ablation was 24 min, and the average stay in hospital was less than 24 h. Of the 479 women followed up for at least 6 months after treatment 288 (60%) developed complete amenorrhoea and 152 (32%) reported continuing but satisfactorily reduced menstruation; 39 (8%) failed to improve with the first treatment, but 26 of them responded to a second laser ablation. Overall 466 (97%) had a satisfactory response to laser ablation and only 13 (3%) required subsequent hysterectomy. CONCLUSION: Endometrial laser ablation would appear to be a popular, safe, effective and economical alternative to hysterectomy for the treatment of menorrhagia.

Multiple classes of environmental contaminants have been found in aquatic environments, globally. Understanding internalised concentrations in the organism could further improve the risk assessment process. The present study is concerned with the determination of several contaminant classes (107 compounds) in Gammarus pulex collected from 15 sites covering 5 river catchments across Suffolk, UK. Quantitative method performance was acceptable for 67 compounds including pharmaceuticals, pesticides, illicit drugs and drugs of abuse. A total of 56 compounds were detectable and ranged from <LOQ to 45.3 ng g−1, with cocaine and lidocaine being the most frequently detected compounds present in all biota samples (n = 66). For surface water, 50 compounds were detectable and ranged from <LOQ to 382.2 ng L−1. Additionally, some pesticides currently not approved for use were detected, including fenuron that reached a maximum of 16.1 ng g−1. The internal concentrations of pesticides were used to estimate toxic pressure which showed that for the measured pesticides toxic pressure was low ranging from logTU ≤−7 to ≤−2. This methodology was extended to pharmaceuticals and drugs of abuse in a novel approach that proposed the use of pharmacological data (human therapeutic plasma concentrations) to estimate the likelihood of an effect (or effect pressure) to occur based on the internal exposure of the organism. The quantified effect pressure ranged from logEU ≤−9 to ≤1 with haloperidol showing the largest likelihood for an effect. The approach showed that several pharmaceuticals have the potential to elicit effects but further investigation surrounding thresholds for effects would be required. This new approach presented showed potential to be used to improve risk assessment for pharmaceuticals in the environment.

The aim of this work is to examine the effects that certain plasticisers have on the properties of aqueous based hydroxypropylmethylcellulose (HPMC) films of a type used for film coating tablets, and to investigate whether or not the inclusion of these additives is in fact beneficial in all cases.The film former HPMC is being used increasingly as a coating for pharmaceutical tablets because of its suitable properties, not least of which is the ability to coat using a fully aqueous system. This greatly improves the method and safety of application.

Natural products (NPs) have long been an important source of, and inspiration for, developing novel compounds to control weeds, pathogens and insect pests. In this review, we use a dataset of 800 historic, current and emerging crop protection compounds to explore the influence of NPs on the introduction of new crop protection compounds (fungicides, herbicides, insecticides) as a function of time. NPs, their semisynthetic derivatives (NPDs) and compounds inspired by NPs (NP mimics, NPMs) account for 17% of all crop protection compounds. NPs, NPDs, and NPMs have been a fairly constant source of new agrochemicals over the past 70 years. NP synthetic equivalents (NPSEs) is a fourth group of NP-related crop protection compounds composed of synthetic compounds which by chance also happen to have an NP model (but are not involved in the discovery). If NPSE compounds are also included, then 50% of all crop protection compounds hypothetically could have had a NP origin. Similar trends also hold true for the impact of NPs on the discovery of new modes of action (MoA) or innovation in crop protection compounds as measured by the number of first-in-class compounds. NPs have had the largest impact on the numbers and global sales (2018 USD) of insecticides compared to fungicides and herbicides. The present analysis highlights NPs as a long-standing and continuing source of new chemistry, new MoAs and innovation in crop protection compound discovery. © 2021 Society of Chemical Industry.

Fatigue is reported to be a significant and distressing problem for people receiving chemotherapy, but the phenomenon is poorly understood and little is known about the factors influencing it. Nurses need to understand the dimensions of fatigue in order to provide effective help for individuals with cancer who experience it. This article describes a study that employed a daily diary with the aim of prospectively charting the onset, pattern, duration, intensity, and distress associated with fatigue in 109 patients receiving chemotherapy. The diary comprised four visual analogue scales measuring selected dimensions of fatigue: extent of fatigue, distress caused by fatigue, the influence of fatigue on the ability to engage in social activities, and the impact of fatigue on work-related activities. The patients' diaries produced detailed time series of data that captured the dynamics of their fatigue. Analyses of these data revealed the patterns of fatigue after the administration of chemotherapy, which appear strongly related to both the timing of treatment and the manner in which cytotoxic agents are administered. Furthermore, Kruskal-Wallis tests performed to compare fatigue among subgroups of patients revealed that it is statistically associated with particular types of cancer, specific chemotherapy regimens, and certain methods of drug administration. Fatigue varied throughout the day, more frequently occurring in the afternoon and early evening. These insights, gained during this study about the likely pattern of fatigue in the period after the administration of chemotherapy, and the potential benefits of maintaining a fatigue diary could be utilized by nurses engaged in the care of chemotherapy patients.

Many people with well defined borderline and schizotypal personality disorders may benefit considerably from small doses of neuroleptics. Depression that occurs with personality disorders, which is frequent, responds poorly to tricyclics but may respond better to neuroleptics, while the response to ECT is usually short lived. Selected borderline subjects may respond to MAOIs, particularly where there is a history of childhood hyperactivity. Carbamazepine and lithium may help some individuals with episodic behavioural dyscontrol and aggression, even in the absence of epileptic, affective or organic features. Drug treatments can be combined with psychotherapy, but further placebo-controlled trials are needed to clarify which drugs are most useful, and whether there are any useful clinical predictors of drug responsiveness.

BACKGROUND AND PURPOSE: The influence of age on benefits of stroke unit rehabilitation is largely unknown. METHODS: A prospective controlled study was undertaken in 245 stroke survivors randomized to a stroke unit or to general wards 2 weeks after stroke. Patients were divided into older (75 years and over) and younger (under 75 years) age groups, and their characteristics, prognosis, duration, and type of therapy input and outcome were compared in different settings. RESULTS: Younger (n = 101) and older (n = 144) stroke patients were comparable for neurological and functional deficits and were distributed equally between the stroke unit and general wards. The duration of therapy input was similar in younger patients in either setting. Older patients received more occupational therapy in both settings (10.7 +/- 2.4 versus 7.9 +/- 04.1) and more physiotherapy (18.4 +/- 9.6 versus 15.2 +/- 7.8) on general wards. Younger patients on the stroke unit showed better outcome compared with those on general wards (discharge home, 83% versus 60%; median Barthel score, 17 versus 13; median length of hospital stay, 27 versus 56 days) and with older patients on the stroke unit (discharge home, 83% versus 65%; median Barthel score, 17 versus 14). Outcome in older stroke patients was similar in both settings except for a shorter median length of hospital stay on the stroke unit (36 versus 84 days). Outcome in younger patients managed on general wards was worse than that in older patients with similar prognostic expectations (discharge home, 41% versus 61%; median Barthel score, 11 versus 13). CONCLUSIONS: Younger stroke patients benefited more by stroke unit rehabilitation compared with older patients, not only because of their age but also because of differences in the multidisciplinary input available for elderly patients outside the stroke unit.

BACKGROUND: Concurrent use of lithium and ECT is suspected to increase neurotoxicity. METHOD: A retrospective case-control study over an eight-year period was conducted to investigate the adverse effects of a combined lithium/ECT treatment. Thirty-one subjects with combined lithium/ECT treatment were compared with a control group (ECT only) of 135 cases matched for age and sex. RESULTS: Most cases in both groups had no adverse effects. Three (10%) study group subjects and 15 (11%) controls experienced brief delirium. Three controls and none of the subjects developed a prolonged confusion. There were no significant differences in the profile of other adverse effects between the two groups. CONCLUSION: Prescription of lithium together with ECT was not associated with higher frequency of adverse effects.

The Industry responsible for the discovery and development of crop protection compounds has undergone dramatic changes and increasing consolidation since the initial innovations in synthetic organic fungicides, herbicides and insecticides in the late 1940s and early 1950s. Likewise, there have been striking changes in the rate of introduction of new crop protection compounds over the past 70 years. While numerous studies over the past five decades have signaled the ongoing decline in the numbers of new active ingredients (AIs), a detailed analysis of the trends in the rate of introduction of crop protection compounds shows a more complex pattern in the overall output of new AIs. The recent (post-2000) decline in the numbers of new herbicides is the primary source of the perceived decline in overall numbers. When herbicides are excluded, the output of new fungicides and insecticides has been relatively constant, especially for the past 20 years. A notable observation is that innovation, as measured by the number of compounds representing a new chemical class (First-in-Class) has been relatively constant for the past 70 years, and most recently has been driven by the appearance of new fungicides and insecticides. Thus, the discovery and development of new AIs for crop protection and public health continues, in spite of the many challenges and changes to the Industry. © 2021 Society of Chemical Industry.

Abstract Important vertebrate faunas occur in fissure deposits of Late Triassic–Jurassic age in SW Britain. Although the faunas are well described, their age and palaeoenvironment remain poorly understood. One such fissure system was documented in detail during quarrying operations at Tytherington and has yielded in situ palynomorphs that add much information concerning its age and palaeoenvironment. Significantly, the Tytherington fauna is of the sauropsid type that has generally been dated as Norian or pre-Penarth Group transgression and was also regarded as representing a distinct upland fauna. The palynomorphs, which include a significant marine component, demonstrate that the Tytherington Triassic fissures are infilled with Late Triassic (Rhaetian) sediments that match specific levels in the Westbury Formation. In addition, many of the Tytherington solutional fissures probably formed during the Rhaetian and are consistent with a fluctuating saline to freshwater environment. There is no prima facie evidence of solutional formation and infilling of the reptile-bearing deposits before the Rhaetian trangression. The fissure reptile fauna, which includes the early dinosaur Thecodontosaurus , inhabited a small fire-swept limestone island in the Rhaetian sea. The features of the herpetofauna are entirely consistent with this island model which has Quaternary analogues.

Refractive error is a highly heritable quantitative trait responsible for considerable morbidity. Following an initial genome-wide linkage study using microsatellite markers, we confirmed evidence for linkage to chromosome 3q26 and then conducted fine-scale association mapping using high-resolution linkage disequilibrium unit (LDU) maps. We used a preliminary discovery marker set across the 30-Mb region with an average SNP density of 1 SNP/15 kb (Map 1). Map 1 was divided into 51 LDU windows and additional SNPs were genotyped for six regions (Map 2) that showed preliminary evidence of multi-marker association using composite likelihood. A total of 575 cases and controls selected from the tails of the trait distribution were genotyped for the discovery sample. Malecot model estimates indicate three loci with putative common functional variants centred on MFN1 (180,566 kb; 95% confidence interval 180,505-180, 655 kb), approximately 156 kb upstream from alternate-splicing SOX2OT (182,595 kb; 95% CI 182,533-182,688 kb) and PSARL (184,386 kb; 95% CI 184,356-184,411 kb), with the loci showing modest to strong evidence of association for the Map 2 discovery samples (p<10(-7), p<10(-10), and p = 0.01, respectively). Using an unselected independent sample of 1,430 individuals, results replicated for the MFN1 (p = 0.006), SOX2OT (p = 0.0002), and PSARL (p = 0.0005) gene regions. MFN1 and PSARL both interact with OPA1 to regulate mitochondrial fusion and the inhibition of mitochondrial-led apoptosis, respectively. That two mitochondrial regulatory processes in the retina are implicated in the aetiology of myopia is surprising and is likely to provide novel insight into the molecular genetic basis of common myopia.

There is evidence that doctors fail to inform patients when they diagnose cancer [1][2][3] and that this is more likely in older people. Yet Meredith et al showed that 96% of 250 patients with malignancy wanted to know if their illness was cancer. 4 Although it is now appreciated that patients want more information about their illness, few studies have specifically targeted elderly people to assess their opinions about cancer and how much they would wish to know about their diagnosis.

The continuing demand for agrochemical insecticides that can meet increasing grower, environmental, consumer and regulatory requirements creates the need for the development of new solutions for managing crop pest insects. The development of resistance to the currently available insecticidal products adds another critical driver for new insecticidal active ingredients (AIs). One avenue to meeting these challenges is the creation of new classes of insecticidal molecules to act as starting points and prototypes stimulating further spectrum, efficacy and environmental impact refinements. A new class of insecticides is foreshadowed by the first molecule exemplifying that class (first-in-class, FIC) and offers one measure of innovation within the agrochemical industry. Most insecticides owe their discovery to competitor-inspired (i.e. competitor patents/products) or next-generation (follow-on to a company's pre-existing product) strategies. In contrast, FIC insecticides primarily emerge from a bioactive hypothesis approach, with the largest segment resulting from the exploration of new areas of chemistry/heterocycles and underexploited motifs. Natural products also play an important role in the discovery of FIC insecticides. Understanding the origins of these FIC compounds and the approaches used in their discovery can provide insights into successful strategies for future FIC insecticides. This review analyses information on historic and recently introduced FIC insecticides. Its main objective has been to identify the most successful discovery strategies for identifying new agrochemical solutions to meet the challenge of minimizing crop losses resulting from insects. © 2022 Society of Chemical Industry.